Positive Blood Cultures Research Articles

Outcomes of HeartMate 3 in pediatric patients with end-stage heart failure: a single-center preliminary experience from Turkey.

We aim to evaluate our initial experience with the HeartMate 3 (HM3) device (Abbott, USA) for palliating pediatric patients with end-stage heart failure (ESHF). We conducted a retrospective review of clinical data from pediatric patients (aged 7-18 years) who underwent HM3 implantation for ESHF at our institution between 2022 and 2024. Patient demographics and follow-up data were comprehensively analyzed. We identified 11 patients (45% males) with a median age of 14 years (IQR 11-17), a median weight of 47 kg (IQR 28-50), a median height of 159 cm (IQR 135-165), and a median body surface area of 1.36 m2 (IQR 1.07-1.53) at the time of the intervention. All patients were diagnosed with dilated cardiomyopathy and categorized with PEDIMACS profiles ranging from one to three. The median ICU stay was 14 days (IQR 6-32), with 11 patients receiving inotropic support for a median of four postoperative days (IQR 3-8). The median follow-up period was 150 days (IQR 90-210). Early complications included two cases of pleural effusion, 1 case of cardiac tamponade, 3 cases of polyuria, and one instance of positive blood cultures. One patient, who was non-compliant with warfarin therapy, developed a thrombus in the right atrium that was resolved with a revision of anticoagulant therapy, and did not experience pump thrombosis. During follow-up, one patient died after 28 days from sepsis, one underwent heart transplantation after 10 days, and nine patients remained alive on the device. Notably, there were no reported cases of pump thrombosis, ischemia, or stroke post- implantation. The HM3 device appears to be a safe and effective palliative option for pediatric patients with ESHF.

Evaluation of an intervention to decrease length of stay in children with low-risk febrile neutropenia

Abstract Background Febrile neutropenia is one of the most common serious complications of myelosuppressive chemotherapy. For this reason, pediatric oncology patients with FN have traditionally been admitted to the hospital and started on empiric intravenous antibiotics. However, not all FN patients are at high risk of developing subsequent complications, and a low-risk group exists that could safely be discharged early. Methods A retrospective study of 194 FN episodes presenting in pediatric oncology patients at St. Jude Children’s Research Hospital. Outcomes of FN episodes were studied and compared before and after early discharge guidelines for low-risk febrile neutropenic (LRFN) were implemented at St. Jude on May 6, 2020. Results Total length of hospital stay was similar in the pre- and post-intervention groups (median 4 [IQR 3,6] vs. 4 [IQR 3,7] days, P = 0.443). Differences in adverse outcomes were insignificant between the pre- and post-intervention cohorts, with only two ICU admissions after the first 24 hours inpatient in the post-intervention group, one new positive blood culture (> 24 hours – 14 days of admission) in each group, and 36.2% versus 21% new fever after resolution of initial fever in pre- and post-intervention cohorts respectively. Cumulative antibiotic use between the pre- and post-intervention groups was statistically insignificant (median 13.5 [IQR 22.8,8] vs. 14 [IQR 22,9] days, P = 0.537), whereas Levofloxacin use was significantly longer in the post-intervention cohort versus the pre-intervention cohort (median 0 [IQR 0,4] vs. 0 [IQR 0,0] days, P = <0.001). Conclusion The implementation of guidelines for early discharge of LRFN patients showed no reduction in hospital stay. Understanding the optimal strategy for effectiveness of guideline implementation is crucial to improve quality and efficiency of care.

Surveillance of fever and neutropenia episodes at Yeolyan Hematology and Oncology Center in Armenia

Abstract Background Fever and neutropenia frequently occur as complications in pediatric patients with malignancies, significantly escalating morbidity and mortality if not appropriately addressed. We implemented a fever registry to identify patient factors and outcomes associated with fever in patients undergoing treatment at our facility. Methods We conducted a single-center prospective observational study at the Pediatric Cancer and Blood Disorders Center of Armenia. All patients aged 0-21 years with a malignancy diagnosis and developing fever and neutropenia between June 25 and November 20, 2023, were included. Variables collected included age, gender, date and time of fever onset, patient symptoms, time to antibiotic administration, identified microbiologic and clinical infections, and subsequent outcomes, including mortality and requirement for critical care level interventions. Data were entered in Microsoft Excel 2016 and analyzed using descriptive statistical methods. Results Sixty-one patient episodes in 36 patients met the inclusion criteria. Of these, 22% of episodes had fever at home. The most common malignancy was acute leukemia, specifically B-ALL (21/61), followed by T-ALL (9/61), AML (7/61), and mixed T- and B-type (1/61). Eight out of 61 fever episodes occurred in patients with relapsed disease. The median time-to-antibiotics was 100 minutes (max: 24 hours 40 minutes) in patients developing fever outside the hospital; for inpatient cases, the median time-to-antibiotics was 30 minutes (max: 6 hours 45 minutes). The time-to-antibiotics was longer for patients experiencing fever at home compared to those in inpatient settings (p=0.043). 21% of patient episodes were pretreated, however 11 out of 61 patient episodes (18%) had a positive blood culture. Of 13 total positive cultures, ten were obtained at the time of the patient’s presentation. The most common pathogens identified were Staphylococcus spp. (8/13) including coagulase-negative (3/8), and Klebsiella spp. (3/13). Polymicrobial-positive cultures were observed during two fever and neutropenia episodes. During 35 episodes, patients presented with no complaints except for general weakness. Among the identified sources of infection (20/61), central-line-related bloodstream infections (n=6), bacteremia (n=5), and Clostridiodes difficile colitis (n=5) were the most common. One febrile neutropenia episode resulted in death (1.6%). Conclusion In summary, over 75% of episodes were observed among patients with hematologic malignancies, and localizing symptoms were absent in half of episodes at presentation. We have identified opportunities for quality improvement in time to administration of antibiotics in outpatient fever episodes. The adaptation of an electronic-based medical record system will simplify the tracking process for a febrile episode.

The epidemiology of gram-negative bacteremia in Lebanon: a study in four hospitals

IntroductionGram-negative bacteremia is a life-threatening infection with high morbidity and mortality. Its incidence is rising worldwide, and treatment has become more challenging due to emerging bacterial resistance. Little data is available on the burden and outcome of such infections in Lebanon.MethodsWe conducted this retrospective study in four Lebanese hospitals. Data on medical conditions and demographics of 2400 patients diagnosed with a bloodstream infection based on a positive blood culture were collected between January 2014 and December 2020.ResultsMost bacteremias were caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, with the more resistant organisms being hospital-acquired. Third-generation cephalosporin and quinolone resistance was steady throughout the study, but carbapenem resistance increased. Mortality with such infections is high, but carbapenem resistance or infection with Pseudomonas or Acinetobacter species were significant risk factors for poor outcomes.ConclusionThis is the first multi-center study from Lebanon on gram-negative bacteremia, resistance patterns, and factors associated with a poor outcome. More surveillance is needed to provide data to guide empirical treatment for bacteremia in Lebanon.

A-165 Value Of Monocyte Distribution Width In Bacteremia Assessment In Emergency Department Patients

Abstract Background Monocyte distribution width (MDW) is an immune response biomarker and part of a CBC differential. MDW is derived from the distribution of monocyte volumes and elevated MDW values correlate with severe infections and sepsis in Emergency Department (ED) adult patients. Neutrophil to lymphocyte ratio (NLR) is predictive of infections and inflammatory stress. Evaluating these biomarkers could be valuable in bacteremia risk assessment. Bacteremia is the presence of viable bacteria in the bloodstream and is present in up to 20% of septic patients. Blood cultures establish pathogen identity but require culture time, potentially delaying appropriate treatment. Our goal was to characterize MDW and NLR clinical performance in ED patients with suspected bacteremia. Methods This was an observational cohort study of ED patients 18 years and older with CBC differential and blood cultures obtained. MDW values ≥20 is the published cut-off for increased infection risk. Clinical literature suggests that NLR ≥3 is abnormal. We assessed the diagnostic performance of MDW and NLR for positive blood cultures using SPSS Version 25. Results From 07/2021-09/2023, 9,400 blood cultures were ordered and 5174 patients had differential CBCs. The overall blood culture positivity rate was 14.4%. MDW and NLR performance for positive blood cultures is shown in Table 1. Conclusions Our analysis provides evidence that MDW and NLR may be useful for early recognition of bacteremia in ED patients. CBC differential results are reported sooner than culture results. MDW is directly reported, NLR can be readily calculated from the differential. Therefore both could contribute to earlier risk stratification and our findings suggest potentially distinct information from MDW and NLR. Combining MDW with other CBC parameters may provide additional diagnostic advantage. Further analysis will incorporate added clinical data for enhanced decision support in interpreting MDW values in the context of pending blood culture results.

A-290 Prevalence and Antimicrobial Resistance Pattern of Microorganisms Recovered From Bloodstream Infections From Public Hospitals of São Paulo City, Brazil

Abstract Background Nosocomial Bloodstream Infections (nBSI) are an important cause of morbidity and mortality. Brazilian studies concerning bloodstream infections are important tools that can bring specific issues related to antimicrobial resistance. The objective of this study was to describe the frequency and antimicrobial susceptibility profile of bacterial isolates from BSI in patients admitted to public hospitals in 2022 and 2023. Methods This study was a retrospective analysis from 12 hospitals (January 2022 to December 2023) based on BSI isolates laboratory data detected by the clinical microbiology department of a medical diagnostic laboratory. The identification and susceptibility tests were performed using MALDI-TOF mass spectrometry (Vitek MS) and Vitek®2 systems, according to the manufacture’s recommendations. Coagulase Negative Staphylococci (CoNS) BSI was only considered in the presence of at least two sets of positive blood cultures with the same organism. Results During the period (January 2022 to December 2023) a total of 19,588 microorganisms isolated from BSI were obtained from 12 hospitals. The frequency of organism group was Gram-positive (10,707; 54.7%), Gram-negative (7,874; 40.2%), yeasts (961; 4.9%) and filamentous (46; 0.2%). The order of prevalence (top ten) organisms was CoNS (5,149; 26.3%); Staphylococcus aureus (2,769; 14.1%); Klebsiella spp. (2,355; 12.0%); Escherichia coli (1,301; 6.6%); Acinetobacter spp. (1,293; 6.6%); Streptococcus spp. (1,125; 5.7%); Enterococcus spp. (1,112; 5.7%); Candida spp. (937; 4.8%); Pseudomonas spp. (749; 3.8%) and Proteus spp. (553; 2.8%). Extended spectrum beta-lactamase rates for E. coli and Klebsiella pneumoniae were 31.6% (268/848) and 74.9% (1027/1371), respectively. The resistance to carbapenems was detected mainly in 74.1% (661/892) of Acinetobacter spp. isolates, 60.7% (832/1371) of Klebsiella pneumoniae; 24.5% (114/465) of P. aeruginosa; 9.7% (34/349) of Proteus spp. and 1.4% (12/828) of Escherichia coli. Antimicrobial resistance was observed mainly in 87.2% of CoNS (2831/3247) and 44.5% of S. aureus (743/1669) to methicillin; 22.9% (146/637) of Enterococccus spp. to vancomycin. Conclusions The frequency of Klebsiella spp. isolates from nBSI has progressively increased and effective infection control measures should be taken to prevent them from spreading. The rates of antimicrobials resistance reported for Klebsiella pneumoniae, Acinetobacter spp., CoNS, S. aureus and Enterococcus spp. reinforce the high resistance rates to antimicrobials in São Paulo city.

Mean platelet volume in preterm infants as a predictor of late-onset neonatal sepsis: a retrospective comparative study

BackgroundNeonatal sepsis remains a primary cause of morbidity and mortality among newborns. Rapid and accurate diagnosis poses a significant challenge—the non-specific clinical presentation of neonatal sepsis relies heavily on various...

Clinical Presentation and Prognosis of Infective Endocarditis Prosthesis: A Retrospective Study in a Tertiary Cardiology Center

Introduction: Prosthetic valve endocarditis (PVE) is a serious infection involving the prosthetic heart valve and the endocardium. It carries high morbidity and mortality, especially in patients with mechanical valves. Aim of the Study: To investigate the clinical, biological, bacteriological, and echocardiographic characteristics of patients with prosthetic valve endocarditis and identify the predictive factors of in-hospital mortality. Patients and Methods: This retrospective, descriptive study was conducted over a period of 5 years, from June 2020 to July 2024, and included 82 cases of PVE diagnosed at a tertiary cardiology center. Results: A total of 82 patients were included, with an average age of 39.12 ± 5.6 years. All patients had mechanical valves, with the infection localized to the mitral valve in 53 cases and the aortic valve in 29 cases. Positive blood cultures were obtained in 36 patients, and Staphylococcus aureus was the most common pathogen, isolated in 26 cases (31.7%), followed by coagulase-negative Staphylococcus in 18 cases (21.95%). Transthoracic and transesophageal echocardiography revealed vegetations in 75 patients (91%), with prosthesis disinsertion in 27 cases and periprosthetic abscesses in 15 cases. The most common complications included heart failure in 17 patients, embolic events in 46 patients, and renal failure in 15 patients. Antibiotic therapy was administered to all patients, with a total average duration of 39.26 days. Surgery was indicated in 62 patients, with an average surgery delay of 42 ± 2 days. The main surgical indications were uncontrolled heart failure (32 cases), embolic complications (17 cases), and failure to control infection with antibiotics (13 cases). The overall mortality rate was 26%. Predictive factors of mortality included heart failure, delayed surgery, and early-onset PVE. Conclusion: Prosthetic valve endocarditis remains a challenging and life-threatening condition. Prompt diagnosis, appropriate antibiotic therapy, and timely surgical intervention are essential for improving patient outcomes. Mortality is influenced by multiple factors, including the timing of the infection and the presence of comorbid conditions.

Etiology of septic arthritis in children of Qatar.

Septic arthritis is an orthopedic emergency and if not evaluated and treated appropriately, it can lead to poor clinical outcomes. Previously several studies have been performed to identify the etiology of septic arthritis in the pediatric population in developed countries. The main objective of our study was to identify the etiology of septic arthritis in children in Qatar in previously healthy and fully vaccinated children. We performed retrospective chart analysis of children presenting to our emergency department between July 2018 and June 2024, who were diagnosed and treated with septic arthritis. The study was conducted at a level 1 pediatric trauma center and the only children's hospital in the country. We used ICD 9 and ICD 10 codes to identify such cases. After using predefined exclusion criteria, children with positive blood cultures, blood titers for Brucella and/or synovial cultures were included in the analysis. Clinical symptoms and signs, ultrasound findings, and culture results were tabulated using descriptive statistics. A total of 45 patients were included. The median age of children was 5 years (interquartile range [IQR] 2-10 years). Majority (60%) were male. The most common clinical findings were limping/limitation of joint movement (100%), fever (80%), and swelling of joints (58%). The median C-reactive protein and erythrocyte sedimentation rate were 94mg/L and 47mm/h. The knee and hip were the most common joints affected. The most common causative organisms were Staphylococcus aureus (56%), Streptococcus pyogenes (13%), and Brucella (11%). Pre-intervention imaging, such as ultrasound and/or magnetic resonance imaging, was performed in 95% of patients. All patients recovered without any complications. One of the limitations of our study is that cases of Kingella kingae septic arthritis may be underreported as polymerase chain reaction (PCR) analysis of synovial fluid was not performed on all patients. Gram-positive cocci, especially S. aureus, remains the most common cause of septic arthritis in vaccinated children. We also identified Gram-negative bacilli as causative organisms in our study. We suggest including empiric coverage for both Gram- and Gram-negative bacilli when treating children with suspected septic arthritis till culture results are available.

The Association Between Hypoalbuminemia and Catheter-Related Infections in Hemodialysis Patients

Background: Catheter-related infections cause significant complications in patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD). Objectives: This study aimed to evaluate the association between serum albumin level and catheter-related infection in HD patients. Methods: This study included 210 HD patients with positive blood and catheter cultures and 210 without catheter infection. Mean albumin level, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were also checked as surrogate disease markers and compared between the two groups. Results: Staphylococcus aureus (38.6% of cases) and Staphylococcus epidermidis (27.6% of cases) were the most frequently detected bacteria. Erythrocyte sedimentation rate and CRP were significantly higher in the target group (P = 0.002 and P = 0.001, respectively). Conclusions: In this investigation, hypoalbuminemia did not emerge as an independent risk factor for access-related infections. S. aureus and S. epidermidis were the predominant bacteria responsible for catheter-related infections in HD patients.

A Chart Review for Epidemiology and Outcome of Fungal Bloodstream Infections Among Neonates in a Tertiary Care Hospital at North India

Background and Aims The risk of fungal bloodstream infection (BSI) and accompanying mortality in neonates varies widely in between centres depending on the region, the population characteristics and the risk factors. Methods This chart review of neonatal cases with fungal BSI admitted in a tertiary care teaching hospital in North India aimed to comprehensively investigate the epidemiology, profile of fungal species (and their susceptibility to various antifungal agents), risk factors, clinical profile and outcomes in these neonates. The study spanned over a one-year period, from September 2022 to August 2023, included all symptomatic neonates with positive blood cultures for fungal pathogen. Results Over one year, 24 out of 1,174 neonates at risk were diagnosed with fungal BSI, with a cumulative risk of 2.0 per 100 neonates. A peak in cases occurred in February. Candida pelliculosa was the predominant species (75% of isolates), while Candida albicans constituted 4.2%. Most isolates were sensitive to fluconazole, except for some fluconazole-resistant Candida pelliculosa (5.5%) and Candida tropicalis (25.0%), which remained susceptible to amphotericin-B and voriconazole. Around 60% of neonates were preterm, 40% had very low birth weight and 37% were small for gestational age. Nearly all had received prior broad-spectrum antibiotics, with 92% receiving prolonged courses over five days. Respiratory support, including intubation and mechanical ventilation, was used in 83% before onset of fungal sepsis. Intriguingly, all neonates had some invasive device in place for more than seven days. Mortality rate of 25% was observed, with preterm birth and gastrointestinal anomalies contributing to adverse outcomes. Conclusions This study confirms the ongoing shift in trend from albicans to non-albicans Candida infections in our region as well. A seasonal peak of fungal sepsis noted in the month of February hinted at potential seasonal variation or lapses in infection control practices during colder months. The analysis of trends in fungal BSI might hold a significance within neonatal intensive care units (NICUs) for the prompt detection of outbreaks. Simultaneously, understanding and analysing risk factors associated with fungal BSI are essential for targeted prevention.

An investigation of scattered light integrating collector technology for rapid blood culture sensitivity testing.

Introduction. Sepsis rates are increasing, with Gram-negative organisms representing a large proportion of bloodstream infections. Rapid antibiotic administration, alongside diagnostic investigations, is required for the effective management of these patients.Gap statement. Current diagnostics take ~48 h for a final report; therefore, rapid diagnostics are required.Aim. This study investigated a novel antibiotic sensitivity method, the scattered light integrating collector (SLIC), combined with a rapid identification method using matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) technology to determine if an accurate identification and susceptibility result can be provided within 4 h of a positive blood culture report.Methodology. A total of 47 blood cultures containing Gram-negative bacteria from 46 patients were processed using the MALDI-TOF Biotyper Sepsityper for identification directly from the blood and the SLIC instrument for susceptibility testing. All organisms were also tested using the current standard workflow used in the host laboratory. Categorical agreement (CA), major errors (MaEs) and very major errors (VMEs) were determined.Results. SLIC produced susceptibility results with a 71.9% CA, 30.6% MaE and 17.5% VME. The median difference in time to the final result was 44.14 (43 : 05-45 : 15) h earlier compared to the current method.Conclusion. We conclude that SLIC was unable to consistently provide sufficiently accurate antibiotic susceptibility results compared to the current standard method.

Prevalence of bacteremia and antimicrobial resistance pattern among patients in South Lebanon

Bacteremia is a leading cause of morbidity and mortality worldwide. Rising prevalence and antimicrobial resistance (AMR) are critical public health issues. This study aims to determine the prevalence of bacteremia and the AMR pattern among patients in South Lebanon. A cross-sectional study analyzed 76 positive blood cultures from Hammoud and Labib Hospitals in South Lebanon between September 2023 and March 2024. The phenotype and antimicrobial susceptibility of gram-positive and gram-negative were determined by using disk diffusion. Genotypically, polymerase chain reaction was used to detect the carbapenemase-resistant Enterobacterales (CRE), extended-spectrum β-lactamases (ESBL), and methicillin-resistant Staphylococcus aureus genes. Out of 76 isolates, 38 (50%) were gram-positive and 38 (50%) were gram-negative. Escherichia coli was the most common among gram-negative (18. 42%), with 10.52% ESBL and 3.94% CRE. Staphylococcus coagulase negative was the most common among gram-positive (40.78%), followed by Staphylococcus aureus (6.57%), with 3.94% methicillin-resistant S. aureus. The prevalent ESBL gene was CTX-M (100%), and for the CRE, NDM (66.66%) was the most common gene. Regarding S. aureus, 66.66% were mecA. The diverse bacteremia isolates and resistance genes in South Lebanon reflect global variability in incidence and resistance profiles. High rates of bacteremia and AMR in South Lebanon underscore the need for effective antibiotic stewardship programs.

Evaluation of a nucleic acid amplification system, GENECUBE, for rapid detection of staphylococcal nuc and mecA in blood culture samples

ObjectiveThis study determined whether the GENECUBE rapid nucleic acid amplification test could directly detect nuc and mecA genes in clinical blood culture samples of Staphylococcus and various other pathogens. MethodsBetween September 2020 and December 2021, 537 blood culture samples from 192 patients with suspected bacteremia were tested using conventional assays (MicroScan WalkAway96 or VITEK 2 systems) and GENECUBE nuc and mecA assays. Isolates from samples with discrepant results between the conventional and GENECUBE assays were further evaluated using MALDI-TOF mass spectrometry, disk diffusion testing using cefoxitin, broth microdilution testing using oxacillin, and sequencing for mecA. Bacterial solutions containing a mixture of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus epidermidis (MRSE) were prepared to evaluate the limit of detection (LOD) of mecA. ResultsUsing conventional assays as the reference, the sensitivity, specificity, and positive and negative predictive values (95 % confidence interval) of GENECUBE were 100 % (96.8–100 %), 100 % (99.1–100 %), 100 % (96.8–100 %), and 100 % (99.1–100 %), respectively, for nuc detection and 100 % (96.1–100 %), 98.9 % (97.4–99.6 %), 94.9 % (88.5–98.3 %), and 100 % (99.2–100 %), respectively, for mecA detection. Sequencing analysis of five samples identified as methicillin-sensitive staphylococci using conventional assays and methicillin-resistant staphylococci using GENECUBE revealed the presence of methicillin-resistant isolates in all samples. The estimated LOD of mecA was 104 colony-forming units (CFU)/mL of MRSE with GENECUBE, compared with 105 CFU/mL with conventional assays. ConclusionThe GENECUBE assay accurately detected mecA in positive blood culture samples and had higher sensitivity than conventional assays.

Clinical Characteristics of the Extensively Prolonged Hospitalization: A Retrospective Analysis at a Large Tertiary Medical Center

Background: Prolonged hospitalizations have contributed to the concentration of American healthcare spending in a small subset of patients. Research related to such events is scarce. Methods: The authors performed a retrospective analysis of hospitalizations at a tertiary care center between 2012 and 2022. Extensively prolonged hospitalization (EPH) was defined as an uninterrupted hospital stay of at least 183 days. Patient data, including past medical history, hospital complications, barriers to discharge, and long-term outcomes were collected. Results: Among 393,474 unique adult hospitalizations, mean length of stay was 5.49 days. There were 42 EPH, making up 0.01% of all admissions and 0.69% of hospital days. Patients with EPH were 62% male and had a median age of 58.5 years old. EPH featured a mean of 8.88 CTs and 2.12 MRIs. MRSA blood culture positivity was documented in 48% of cases. Mechanical ventilation and gastrostomy tube placement were performed in 88% and 71% of EPH, respectively. In 64% of cases, patients were medically stable for discharge and awaiting post-acute facility bed availability for at least three months. In-hospital death occurred in 31% of cases. Among patients who survived hospitalization, none were able to live independently, and median post-discharge survival was 94 days. At five-year follow-up, 1 patient (2%) was still alive. Conclusions: These findings emphasize the importance of non-medical barriers to discharge in EPH. While larger studies are needed, this study suggests that long-term outcomes in EPH are grim.

Helicobacter cholecystus Bacteremia in an Adult with Acute Cholecystitis.

We report the isolation of Helicobacter cholecystus from a positive blood culture of a 58-year-old male with bacteremia and acute cholecystitis, in China. The patient's condition improved after symptomatic support treatment and subtotal cholecystectomy. This suggests that H. cholecystus should be considered a potential human pathogen.

Enteric fever in a young man with bowel wall thickening and hepatosplenomegaly

Typhoid fever (enteric fever), caused by Salmonella enterica subsp. enterica serovar Typhi (S. Typhi), is a public health problem especially in South Asia and sub-Saharan African countries, while incidence remains low in most other parts of the world, where the disease is primary related to recent travel to endemic countries or contact with chronic carriers. The diagnosis of typhoid fever is challenging in endemic countries, often also low- and middle- income countries (LMIC), due to the poor sensitivity/specificity of available serologic tests and lack of adequate infrastructure for blood cultures. We report the case of an 18-year-old male patient with a 21-day history of right-sided abdominal pain, malaise, headache, intermittent fever and watery diarrhea. Contrast-enhanced abdominal computed tomography (CT) exhibits thickening of the terminal ileum, cecum and ascending colon with mesenteric lymphadenopathy. Laboratory findings indicate elevated transaminases, positive blood culture to S. Typhi and a positive Widal test to S. Paratyphi A, B and S. Typhi H (flagellar) antigens. A diagnosis of complicated typhoid fever was made. Following a 13-day regimen of ceftriaxone, all symptoms resolved. Few reports have been made about CT manifestations in patients with typhoid fever. While CT can aid in diagnosis, it is particularly important for identifying complications of typhoid fever such as perforation, bleeding and abscess formation.

Infective endocarditis in children with heart diseases at Jakaya Kikwete Cardiac Institute, Tanzania: a cross-sectional study

BackgroundInfective endocarditis (IE) in children with pre-existing heart conditions is a life-threatening disease entity associated with significant morbidity and mortality. In our cardiac setting, the management outcomes of children with IE are not well documented. We therefore aimed to document the clinical profile and treatment outcomes of children with IE attended at the Jakaya Kikwete Cardiac Institute (JKCI).MethodsThis was a hospital-based cross-sectional study with longitudinal follow-up conducted among children with IE diagnosed by Modified Duke’s Criteria at the JKCI from November 2021 to November 2023. A structured questionnaire was used to collect patients’ socio-demographic and clinical data.ResultsDuring the study period, 1,546 children were admitted to the JKCI. A total of 30 children with IE were enrolled, of these half (n = 16, 53%) were aged 10 to 18 years, with a median of 10 yrs (Inter quartile range, IQR: 6.5–12.2 yrs). Twelve children (40%) and nearly half (n = 14, 47%) had fever and used antibiotic therapy respectively. Majority of participants had anaemia (n = 26, 87%) and heart failure (n = 21, 70%). Nine children (30%) had positive blood cultures and S. aureus was the most frequently isolated organism (n = 7). Ten patients (33%) developed acute kidney injury (AKI), and eleven (37%) children died during the hospital stay.ConclusionIn our setting, in-hospital mortality due to IE among children with heart diseases is high. Heart failure and anaemia were the common presentations of IE. Furthermore, AKI was observed to be the leading in-hospital non-cardiac complication.

The PARK2_e01(-697) Polymorphism does not Associate with Susceptibil-ity to Typhoid in Punjabi Population, Pakistan: A Case Control Study.

SNP based association studies have revolutionized the field of biomed-icines. Enteric fever is a systemic disease with etiologic agents Salmonella enterica serovar typhi and paratyphi. It is a serious health issue worldwide and presents wide variations in incidence, rates, and severity. Previous investigations have revealed that genetic variations may lead to sus-ceptibility to typhoid fever. A current study was performed to investigate the potential association of PARK2_e01(-697) polymorphism with the susceptibility to typhoid in the Punjabi population. For this case-control study, blood samples obtained from typhoid patients with positive Typhidot or blood culture test (n=72) and healthy controls (n=73) were processed for DNA ex-traction. The polymorphism PARK2_e01(-697) analysis was carried out by using PCR and RFLP. No allelic association was found between PARK2_e01(-697) and susceptibility to ty-phoid fever in the understudy population. This case control study is the demonstration of the non-association of PARK2_e01(-697) with typhoid in the Pakistani population. Future research, using a larger population size, will help to elucidate the role of PARK2_e01(-697) polymorphism in typhoid pathogenesis.

Pseudo-outbreak of Bacillaceae species associated with poor compliance with blood culture collection recommendations.

This study describes a pseudo-outbreak of Bacillaceae spp. bloodstream infections that spanned five months starting in May 2023 and the infection prevention measures implemented to control it. This retrospective study was conducted at a tertiary infectious disease hospital in Bucharest, Romania. An observational audit of the blood culture collection practice in our hospital was performed, and the materials used during blood culture collection were sampled. Bacterial colonies were identified using MALDI Biotyper. The Bacillaceae blood culture positivity rates in the previous four years were compared using the Kruskal‒Wallis rank test. Bacillaceae spp.-positive blood cultures were recovered from 60 patients over a five-month period. In the case of 58 patients, Bacillaceae spp.-positive blood cultures were considered contaminated. Two patients were treated for Bacillus spp. bacteraemia. The audit revealed significant variation during the preparation of the venipuncture site step and the use of nonsterile medical cotton wool. Medical cotton wool contaminated with species of Bacillaceae was found in 10 out of 12 wards. The control measures included repeated training on the blood culture collection procedure and the removal of Bacillaceae spp.-contaminated cotton wool. The pseudo-outbreak was caused by the unjustified use of medical cotton wool for disinfection of the skin and blood culture bottle septums. The investigation of this pseudo-outbreak highlighted a gap in blood culture collection practices at our facility and thus allowed for its improvement.