Positive Culture Growth Research Articles

A-264 Validation of a Novel Real-Time PCR Assay for Identification of Mycobacterium species Isolates Recovered from Clinical Culture

Abstract Background Historically, clinical mycobacteriology laboratories used the nucleic acid hybridization-based AccuProbe assay manufactured by Hologic, Inc., to rapidly rule in or rule out Mycobacterium tuberculosis (MTB) and members of the M. avium-intracellulare complex (MAC). The clinical value of this test was in its ability to rapidly rule in/out MTB from positive broth cultures and allow the initiation of appropriate antimicrobial therapy and infection prevention practices. Recent discontinuation of this commercial assay left a gap in testing available for the rapid identification of these organisms, which allowed us to develop an in-house real-time PCR test. Methods A replacement assay was developed by Labcorp R & D based on real-time PCR amplification of extracted nucleic acids from positive culture growth. Aliquots from positive AFB VersaTREK broth cultures were heat inactivated, and nucleic acids were extracted using the MagNA Pure 24 (MP24) instrument (Roche). Real-time PCR using published primer probe sets (Rocchetti, et al 2016) was performed on the QuantStudio™ 7 (QS7) instrument (Applied Biosystems®). The assay was designed with three independent primer/probe sequence targets: one for MTB Complex (IS6110), one for MAC (ITS), and one pan-target for the Mycobacterium genus (16s rRNA). Results Procedural verification was performed using 100 residual clinical specimens previously identified using the Hologic AccuProbe® assay. Categorical concordance was 97% (97/100). The three discrepant results were identified as MAC positive by PCR; however, these were not identified as MAC on the predicate assay. Analytical sensitivity for the PCR assay was established to be 1,000 CFU/mL for each target. Analytical specificity was assessed in vitro for nine Mycobacterium species, with no cross-reactivity observed. In vitro analysis of target detection in the presence of yeast (Candida glabrata) was also performed, and we saw no inhibition. Analysis of the primer/probe sets for all targets was performed in silico using XploreDB database of microbial genomes, with confirmed 100% matches for both MAC and MTB genomes compared to hundreds of species. By comparison, the PAN-Myco primer set showed decreased performance, having three mismatches (two on forward primer and one on the probe). As this target sequence is used as an Internal Control (IC) this was not problematic for overall assay performance. The assay demonstrated excellent precision (%CV) for each target: MTB = 0.74%, MAC = 1.10%, PAN-Myco = 3.19%. Conclusions Utilizing the depth of molecular methodologies available in our laboratories, we developed a rapid method for identification of MAC and MTB from positive broth cultures, which had excellent performance compared to the predicate assay. The PCR ID LDT test is now available and allows testing to continue with no interruption in patient care.

Surveillance of antibiotics use in inpatients at Benjamin Mkapa Zonal Referral Hospital in Dodoma, Tanzania: a point prevalence survey

ObjectiveTo assess antibiotics prescribing and use patterns for inpatients at Benjamin Mkapa Zonal Referral Hospital (BMH) using the WHO-Point Prevalence Survey (WHO-PPS).DesignA cross-sectional survey.SettingThe Benjamin Mkapa Zonal Referral Hospital, Dodoma,...

The accuracy and diagnostic value of gram staining joint aspirates in suspected joint infections.

Septic arthritis is a debilitating condition with prolonged treatment and adverse outcomes. A gram stain is often performed from the joint aspirate sample, followed by a definitive culture. In our study, we assessed the accuracy of gram staining for suspected septic arthritis and explored factors associated with positive culture growth and false negatives in the gram stain. We retrospectively reviewed joint aspirates performed from 2015-2021 at a major trauma centre. Aspirates not cultured for septic arthritis were excluded. Data collected included aspirate site, gram stain and culture result delay, patient demographics, orthopaedic/rheumatological history, and comorbidities. Outcomes measured were gram stain sensitivity and specificity. Factors influencing positive cultures and false negative gram stain results were analysed using logistic regression. Of 408 joint aspirates meeting the criteria, 37 did not undergo initial gram staining. Gram stain sensitivity was 30.4%, specificity was 97.6%. The delay from aspirate to definitive gram stain and culture results was 1.1 and 5.4 days, respectively Logistic regression identified that prosthetic joint(p = 0.007), past joint infections(p = 0.006), arthritis(p < 0.001), hypertension(p = 0.007), diabetes(p = 0.019) were positively associated with positive cultures. Past joint infections(p = 0.004) were positively associated with false negative gram stain results. Patients on antibiotics during the aspirate had a higher risk of false negative gram stain results (OR = 5.538, 95%CI, 2.802-10.948; p < 0.001). In conclusion, the initial gram stain has limited sensitivity and caution should be exercised when interpreting negative results. Vigilance is crucial when the highlighted comorbidities or antibiotic use are present, to assess patients with potential joint infections.

Time to Positivity of Blood Culture as a Predictor of Causative Pathogens and Survival in Neonatal Sepsis: A Retrospective Cohort Study from Indonesia.

In the blood culture procedure for neonatal sepsis, time to positivity (TTP) reflects the pathogenic bacterial load and the time required for empirical antibiotic regimen administration prior to definitive treatment. This study aims to identify the differences in TTP among causative pathogens and its predictive value for the overall survival of neonates with sepsis at a tertiary healthcare center in Indonesia. A retrospective cohort study was conducted from January 2020 to August 2022 at Dr. Soetomo General Hospital, Surabaya, Indonesia. Neonates with blood culture-proven neonatal sepsis were included in the analysis. TTP was defined as the time between the acceptance of a blood culture specimen from the neonatal intensive care unit and reports of positive culture growth by the laboratory. Across 125 cases, the median TTP was 58.1 hours (IQR = 24.48). Blood cultures were positive within 48 hours for 41.6% of cases, 72 hours for 86.4%, and 96 hours for 98.4%. A significantly shorter TTP was exhibited by the three major gram-negative organisms (Klebsiella pneumoniae,Acinetobacter baumannii,Enterobacter cloacae) compared to coagulase-negative Staphylococci. The neonatal sepsis mortality rate was 49.6% during the study period. In the Cox multivariate regression model, a shorter TTP was an independently predicted mortality in the entire cohort (hazard ratio (HR) = 0.985, 95% CI: 0.973-0.998) and the gram-negative sepsis cohort group (HR = 0.983, 95% CI: 0.968-0.999). TTP predicts different causative pathogens and the overall survival of neonatal sepsis cases at a tertiary healthcare facility in Indonesia.

Antibiotic resistance profiles and associated factors of Pseudomonas Infections among patients admitted to large tertiary care hospital from a developing country

BackgroundPseudomonas infections are among the most common infections encountered in hospitalized patients, especially those with chronic illnesses or an immunocompromised state. Management of these infections has become challenging due to increased antibiotic resistance. Therefore, this study examines the antibiotic resistance profiles of Pseudomonas spp. and the associated factors among patients admitted to a large tertiary hospital in a developing country.MethodsThis retrospective observational chart review study assessed patients admitted to a large tertiary hospital in a developing country with a positive culture growth of Pseudomonas from anybody site. Antibiotic susceptibility of the isolated Pseudomonas and patient characteristics were studied from the start of 2021 to the end of 2022. The study ground consisted of 185 patients.ResultsThe study included 185 patients with positive Pseudomonas isolates. Males constituted 54.6% of the sample, while 45.4% were females. The median age of the patients was 53 years. Patient comorbidities and risk factors for Pseudomonas infection and multidrug resistance were assessed. Antibiotic resistance to the Pseudomonas regimens showed the highest resistance to meropenem and ciprofloxacin (23.4%, similarly) among isolates of Pseudomonas aeruginosa. Multidrug resistance (MDR) was found in 108 (58.4%) isolates. The most commonly used antibiotic for treatment was piperacillin-tazobactam, accounting for 33.3% of cases, followed by aminoglycosides at 26.6%.ConclusionsPseudomonas aeruginosa isolates were resistant to meropenem and ciprofloxacin. Over half of the isolates were multidrug-resistant, which was worrying. Piperacillin-tazobactam and aminoglycosides were the most often utilized antibiotics, highlighting the significance of susceptibility testing. Implementing antimicrobial stewardship programs and infection control measures can help reduce drug resistance and improve outcomes in Pseudomonas infections.

Evaluation of Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) Prescribing Habits in Patients with a Positive MRSA Nasal Swab in the Absence of Positive Cultures.

Methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal swabs are guideline-recommended de-escalation tools in certain patients with pneumonia. Prior studies have demonstrated reduced anti-MRSA therapy with negative results, but the impact on durations of therapy has been poorly elucidated in patients with positive PCRs. The objective of this review was to evaluate anti-MRSA treatment durations in patients with a positive MRSA PCR in the absence of MRSA growth on culture. This was a single-center, retrospective observational study evaluating 52 hospitalized, adult patients receiving anti-MRSA therapy with positive MRSA PCRs. The overall median duration of anti-MRSA therapy was five days, including a median of four days after PCR results. This was consistent among intensive care unit (ICU) and non-ICU patient populations and in patients with suspected community-acquired pneumonia (CAP). Among patients with hospital-acquired pneumonia (HAP), the median duration of anti-MRSA therapy was seven days, with a median of six days after PCR results. Overall, patients received a median duration of anti-MRSA therapy that would constitute a full treatment course for many respiratory infections, which indicates that providers may equate a positive MRSA nasal PCR with positive culture growth and highlights the need for education on the interpretation of positive tests.

Correlation among Sterilization, Antibiotic Resistance and Malnutrition with Surgical Site Infection in a Teritary Level Hospital

Background: Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative techniques, surgical site infection (SSI) continues to be a major problem in all branches of surgery in the hospitals. However, there is no infection control policy that runs effectively in our country. Aim:This study was designed to see the correlation among sterilization, antibiotic resistance and malnutrition with surgical site infection in a tertiary level hospital. Methods: This cross-sectional observational study was conducted in the Department of Surgery, Shaheed Suhrawardy Medical College and Hospital. Informed written consent, detailed history, physical examination and necessary investigations were performed. Total 160 admitted patients undergoing different surgical procedure were included in this study, irrespective of their age, sex, race and ethnic group. Data were collected by using a semi-structured questionnaire. Collected data were analyzed by the SPSS 25. Results: Average age of all patient was 36.10±12.15 years (range: 13-65 years), wherein maximum patients were aged &lt;40 years, male gender (56.3%), had normal BMI (61.3%) and non-smoker (62.07%). About 1/4th patients had diabetes mellitus. Maximum patients had undergone abdominal surgery (34.4%) followed by orthopaedic and traumatology (20.6%),General surgery other than abdominal surgery (18.8%), Neurosurgery (13.8%), Vascular surgery (12.5%). Pre-operative waiting period for surgery was &lt;3 days in most of the cases (48.8%), followed by 3-7 days (31.3%) and &gt;7 days (20%). Mean operation duration was 1.49±0.73 hours. Twenty-nine patients (18%) developed SSI, of which 7% had deep incisional SSI, 6% had superficial incisional SSI and 5% had organ/space SSI. SSI culture reports showed that majority (93.1%) had positive culture growth, wherein 66.7% had single microorganism and rest 33.3% had multiple growth. Staphylococcus aureus (34.48%) was the most frequently found microorganism. surgical team sterility was properly maintained in maximum surgical procedures (71.9%). Besides, OT room and surgical instruments were also properly sterilized in most of the cases (65.6% and 70%, respectively). Older age, abnormal BMI, smoking history, DM, longer pre-operative waiting period and operation duration was significantly associated with development of SSI. Besides, surgical team sterility, OT room sterility and Instrument sterility were not properly maintained in most of the surgical procedures among SSI patients (65.52%, 68.97% and 58.62%, respectively). Conclusion: Abnormal BMI (underweight and overweight or obese) and poor sterilization had significant association with development of SSI. However, further studies are needed to establish and use the findings. J Shaheed Suhrawardy Med Coll 2021; 13(2): 143-149

Concomitant Bandage Contact Lens, Oral Nicergoline, and Topical Autologous Serum for Severe Neurotrophic Keratitis.

To report the outcomes of using the combination of oral nicergoline, autologous serum, and contact lens to enhance corneal epithelization in neurotrophic keratitis and to discuss the clinical potential of this management. This was a prospective consecutive case series study of eight patients treated for neurotrophic keratitis at the "Conde de Valenciana" Institute of Ophthalmology. Oral nicergoline, autologous serum, and bandage contact lens were initiated at the same time, immediately after stage 3 diagnosis keratitis was confirmed clinically, and until corneal epithelialization was achieved or eminent corneal perforation was seen. In patients where diabetes was a cause, glycosylate hemoglobin was measured to asses metabolic control. Corneal esthesiometry and corrected distance visual acuity were assessed before and after treatment. This study included eight eyes of eight patients (5 men [62.5%], average age 57±17.9 years). All patients completed at least 1 month of follow-up after nicergoline and contact lens suspension. Of the eight eyes, no one had positive culture growth and complete epithelial healing was achieved in all cases. Half of patients had diabetes and had a poor metabolic control. Corneal sensitivity improved in all eyes almost 2 centimeters in Cochet-Bonnet esthesiometry ( P= 0.01). In addition, final visual acuity gains were obtained ( P= 0.100). The combination of oral nicergoline, autologous serum, and bandage contact lens simultaneously could be an alternative in the management of stage 3 neurotrophic keratitis when conventional medical treatment has no improvement of corneal epithelization.

Evaluation of the GeneXpert Mycobacterium tuberculosis/Rifampicin Assay for Early Detection of Extrapulmonary Tuberculosis and Rifampicin Resistance in Aligarh Region of Northern India

Purpose: Early diagnosis of extrapulmonary tuberculosis (TB) with simultaneous detection of rifampicin (RIF) resistance (RR) directly from the sample is a revolution brought by GeneXpert Mycobacterium TB (MTB/RIF) assay. Line probe assay (LPA) is not recommended for extrapulmonary/nonsputum specimens; GeneXpert MTB/RIF provides a diagnostic option for these. Hence, the following study aimed to evaluate the performance of GeneXpert MTB/RIF assay in nonsputum samples. Materials and Methods: A total number of 642 extrapulmonary and nonsputum respiratory samples were subjected to Ziehl–Neelsen (ZN) staining technique, fluorescent microscopy (FM), and GeneXpert MTB/RIF Assay. All samples were cultured on a solid Lowenstein–Jensen (LJ) medium and culture-positive samples were subjected to GenoType MTBDRplus LPA and drug susceptibility testing by 1% proportion method on a solid LJ medium. Results: GeneXpert MTB/RIF assay detected MTB in 25.9% (166/642) of the samples. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ZN staining technique and FM were 21.52%, 99.35%, 91.89%, and 78.77% and 27.22%, 99.78%, 97.73%, and 80.07%, respectively. Sensitivity, specificity, PPV, and NPV of GeneXpert MTB/RIF in the detection of MTB were 93.75%, 96.53%, 90.36%, and 97.80%, and RIF RR was 92.0%, 97.74%, 88.46%, and 98.48%, respectively. LPA performed on positive culture growth showed 100% sensitivity and specificity in the detection of RIF and isoniazid resistance. Conclusion: GeneXpert MTB/RIF showed high sensitivity and specificity in detecting MTB and simultaneous RIF RR among the nonsputum samples which had a good concordance to LPA. It provides a judicious option for early detection of multidrug-resistant TB in extrapulmonary and nonsputum respiratory samples.

Extended-spectrum beta-lactamase and Antibiotic susceptibility pattern in uropathogens.

Objective: To identify rapidly changing antibiotic susceptibility of ESBL &amp; Uropathogens. Study Design: Comparative Cross-sectional prospective study. Setting: Allied Hospitals of Peshawar Medical College. Period: 8th November 2021 to 5th March 2022. Material &amp; Methods: 10-15ml of midstream urine was collected in a sterile container from 158 patients Pus cells, red blood cells, and bacteria were examined using microscopy. The standard loop technique was used to inoculate urine specimen on MacConkey and Blood agar. Plates were incubated for 24 hours at 37oC. A colony count of 105 cfu/ml was thought to be significant. Gram staining of the colonies was performed. The biochemical tests were conducted on API 10S for the identification of organisms. Extended-spectrum beta-lactamase organisms were identified by the double-disc synergy method. The Kirby-Bauer disc diffusion method was used to test antibiotic susceptibility on Mueller-Hinton agar according to CLSI guidelines 2021. A statistical package for the social sciences (SPSS) version 20.0 was used for statistical analysis. Results: Out of 158 urine samples 135 (85.5%) had positive culture growth with 35 (25.9%) ESBL confirmed. Antibiotic susceptibility was Nitrofurantoin (70.1%), Trimethoprim-sulfamethoxazole (26.8%), Ciprofloxacin (51.5%), Levofloxacin (51.5%), Ceftriaxone (25.77%) Cefotaxime (23.7%) Ceftazidime (19.5%) Cefepime (27.8%) Aztreonam (2.1%) Meropenem (86.6%) Amoxicillin/clavulanic (37.1%) Gentamycin (73%) Penicillin (0%). Conclusion: Surprisingly, only nitrofurantoin was found to be advised orally as a suitable drug for the treatment of UTIs among the 13 commonly used antibiotics.

Burden of Antibiotic Resistance at Wolaita Sodo University Comprehensive Specialized Hospital.

Antibiotic resistance is a serious threat to the human population everywhere. However, less attention is given to its concern in sub-Saharan Africa including Ethiopia. There is an information gap concerning antibiotic resistance and its pattern in Wolaita Sodo University Teaching Referral Hospital. This study is aimed at investigating the prevalence of antimicrobial resistance in the study area. Five-year retrospective data of cultures and records of 581 patients were utilized to analyze the pattern of antibiotic resistance. The statistical software including SPSS version 25 and Microsoft excel 2013 were used. Laboratory records with incompletely registered age, sex, culture isolation, or drug susceptibility test data were excluded. Out of the total of 581 samples extracted from the microbiology laboratory, 237 (40.8%) samples were culture positive for bacteria. From positive culture growth, 165 (69.6%) were gram-positive bacteria whereas 72 (30.4%) were gram negative. Staphylococcus aureus was the most prevalent isolate among gram-positive isolates as Escherichia coli was for gram-negative isolates. Overall antibiotic resistance of gram-positive isolates was 57.2% whereas that of gram-negative bacteria was 58.8%. S. aureus and E. coli were found to be the most prevalent pathogenic isolates among gram-positive and gram-negative bacteria, respectively. Most of the isolated pathogens showed high resistance towards the commonly prescribed antibiotic agents. The overall antibiotic resistance in this study was 57.7%, and the overall MDR prevalence was 72.2%.

Study of the current pattern of bacterial isolates with nasolacrimal passage obstruction and their antibiotic sensitivity patterns in a teaching hospital

Introduction: An acquired nasolacrimal duct obstruction can occur at any age, and is classified as either primary or secondary. The nasolacrimal obstruction occurring primarily also known as PANDO (Primary acquired nasolacrimal duct obstruction) is observed mainly in conditions occurring due to inflammation or fibrosis. Material and methods: This was a prospective observational study with a sample size of 100 patients. All the patients coming to Ophthalmology OPD with the complaints of epiphora, discharge or both along with regurgitation on pressure over lacrimal sac and mucoid or mucopurulent or clear regurgitant material on sac syringing were taken. Before the beginning of the investigative procedure, informed consent was taken. The Clinical and Laboratory Standards Institute's standardised Kirby-Bauer disc diffusion test was used to determine antibiotic susceptibility. Results: In our study, the distribution of patients according to bacterial isolates was as follows, a maximum of 62% patients were found with no growth while 18% MSSA, 10% CONS, 6% S.pneumoniae, 4% Pseudomonas were observed respectively. In our study, CONS was observed as the predominant bacterial isolate in the diabetics with a Female preponderance followed by MSSA (39%), Pseudomonas (75%) and S.pneumoniae (34%). We found Ciprofloxacin as a broad-spectrum antibiotic that works against most bacterial isolates. Conclusion: A higher female preponderance was observed in our study with the left side being affected in most of the patients. We also observed that most of the patients hailed from rural areas and belonged to lower socio-economic class. This is attributed to a lack of hygiene and awareness among low socioeconomic groups. In all the patients showing positive culture growth, Gram-positive organisms were the dominant species. We conclude, Ciprofloxacin as broad-spectrum antibiotic works against most bacterial isolates.

Skull Base Osteomyelitis: A Single-Center Experience.

BackgroundSkull base osteomyelitis (SBO) is an uncommon entity and carries a high mortality rate. It can be be odontogenic, sinogenic, or otogenic in origin, in addition to being a complication of skull surgery/trauma. Pseudomonas is one of the most commonly identified pathogen. The goal of the study is to describe the clinical spectrum, microbiologic characteristics, treatment, and its response among different patients with SBO. In addition, we compared the outcomes of bacterial and fungal osteomyelitis.MethodologyThis is a single-center retrospective analysis of patients with SBO who presented to Shaukat Khanum Memorial Cancer Hospital & Research Centre Lahore, Pakistan between January 1998 and September 2019. A total of 15 patients with SBO were identified.ResultsSBO was common in males (79.9%) with a high body mass index. Diabetes mellitus was the most common co-morbid condition (46.62%). Bacterial etiology was seen in 46.62% and fungal isolate was detected in 6.66% of the patients; 26.64% were culture-negative and the remaining had a mixed culture. The mean duration of treatment was 17.58 ± 10.85 weeks. Overall, five (33.3%) patients were cured and did not have a recurrence of symptoms at six months, while three (19.98%) had a recurrence of symptoms at six months from the end of the treatment; six (39.96%) patients were lost to follow-up.ConclusionsPatients with SBO can present with various conditions, and early identification of the condition and a positive culture growth can guide optimal treatment.

Bacteria Patterns on Tonsillar Surface and Tonsillar Core Tissue among Patients Scheduled for Tonsillectomy at Bugando Medical Centre, Mwanza, Tanzania.

Background: Tonsillitis is an inflammation of the tonsils due to either viruses or bacteria. Here, we report the bacteria patterns on the tonsillar surface and tonsillar core tissue among patients scheduled for tonsillectomy at Bugando Medical Centre (BMC), Mwanza Tanzania. Methods: The study included 120 patients planned for tonsillectomy between April and July 2019. Swab samples from tonsillar surface pre-tonsillectomy and core post-tonsillectomy were collected. Culture was performed following the microbiology laboratory standard operating procedures. Data analysis was completed using STATA version 13, as per the study objectives. Results: The slight majority of participants were males (73; 60.83%) with median age of 6 years (interquartile range 4–11). The proportion of positive culture growth was higher on the surface than in core swab samples: 65 (54.2%) vs. 42 (35.0%), p = 0.003. The commonest bacterial pathogen detected from the surface and core were S. aureus in 29 (40.3%) and 22 (51.2%) participants, followed by S. pyogenes in 17 (23.6%) and 11 (25.6%), respectively. Methicillin-resistant Staphylococcus aureus (MRSA) was observed in 20/51 (39%) of isolates. Streptococcus pyogenes resistance to macrolides ranged from 8.3% for core isolates to 35.3% for surface isolates. Features suggestive of tonsillitis on histology were reported in 83 (73.5%) samples. Conclusion: More than two-thirds of patients undergoing tonsillectomy had a positive culture for possible bacterial pathogens. Staphylococcus aureus and Streptococcus pyogenes were the predominant bacteria detected with more than one third of Staphylococcus aureus being MRSA. More studies to investigate the treatment outcome of these patients are highly recommended.

Pattern of Bacterial Infections in Indian Bone Marrow Transplant Patients - Experience from Chennai India

Introduction:Bone marrow transplant, both Autograft and Allograft produces profound immune-suppression and breach of mucosal surfaces leading to many opportunistic infections. There is a difference between infection pattern in countries like India compared to western countries. The western literature is more bothered about reactivation of viral and fungal infections, whereas Indian bone marrow transplant physicians are worried about losing patient to refractory gram negative sepsis. In this study, we have tried to decode the pattern of bacterial infections in Indian transplant patients and tried to suggest an antibiotic stewardship for the same.Materials and methods:This retrospective study included all bone marrow transplants with Febrile neutropenia done at our hospital from September 2014 to July 2021. A total of 440 patients were included and their pattern of bacterial infections with culture sensitivity and response to antibiotics were noted.Results:36% of patients we included in the study were aged between 40 to 60 years and the age range was from 2 years to 72 years. 59% were autograft and among Allograft 36% were haplo-identical bone marrow transplant. Nearly half the patients presented with fever above 99.5 F and tachycardia as the presenting sign. The WBC count during first episode febrile neutropenia was less than 100cells/cumm in around 25% patients. Empirical antibiotics post culture samples were initiated within 10 min in 95% of patients. Cefoperazone Sulbactum and Amikacin were started empirically as first line in all.Culture positivity rate was 22.7% of which 60% were multi-drug resistant gram negative bacilli which were sensitive only to Colistin / Fosfomycin / Tigecycline. This 60% MDR GNB is very high which may be partially due to MDR bugs in normal intestinal flora of patients from this part of the world. The common Gram-negative bacteria are Pseudomonas, Escherichia coli and Klebsiella. This made us to change antibiotic stewardship policy to Colistin / Fosfomycin / Ceftazidime avibactum very early in course in case of second fever / Hypotension or tachycardia. Our transplant related mortality is around 3% in Allograft due to sepsis and 0% in autograft. The rate of gram positive bacteremia is only 2% and this makes us think of avoiding drugs like Teicoplanin / Glycopeptides in first line empirical therapy.Conclusion:This seven year study had shown 22.7% culture positivity rate in febrile neutropenia transplant patients of which 60% are multi-drug resistant bacteria which is highly contrary to western literature. The rate of gram positive culture growth is only 2% which is lower than western literature. This study implies the importance of region and center specific antibiotic policy for febrile neutropenia and a generalized policy may not work always.Reference:-1. Ghafur A, Devarajan V, Raj R, Easow J, Raja T. Spectrum of bacteremia in posthematopoietic stem cell transplant patients from an Indian center. Indian J Cancer 2016;53:590-12. Krüger W,et al. Early infections in patients undergoing bone marrow or blood stem cell transplantation–a 7 year single centre investigation of 409 cases. Bone Marrow Transplant. 1999 Mar;23(6):589-97. doi: 10.1038/sj.bmt.1701614. PMID: 10217190. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

2198. Weak Interobserver Reliability in the Clinical Diagnosis of Pneumonia Among Infectious Disease Trained Physicians

BackgroundPneumonia remains a common global cause of death. Varied definitions of pneumonia rely on clinical features, imaging, and microbiological data. The Center for Diseases Control/National Healthcare Surveillance Network (CDC/NHSN) definition is used to study population-level trends. Prior studies have revealed discordance in components of the definition, yet reliability of overall clinical diagnosis has not been evaluated, nor has it been compared with the surveillance definitions. This study was designed to determine the overall concordance in the diagnosis of pneumonia by Infectious Diseases (ID) clinicians and the agreement between this and the surveillance definition. We then set out to determine which clinical features were weighted most heavily in provider decision-making.MethodsUsing an iterative approach with input from ID and Pulmonary Medicine physicians, we designed and refined an adjudication tool for diagnosis of pneumonia that consolidates clinical features, laboratory data, and imaging. Cases were analyzed by strict CDC/NHSN surveillance criteria and adjudicated independently by ID-trained physicians based on overall clinical opinion. Kappa coefficient (κ) was used to determine diagnostic reliability, and a random forest model was used to identify clinical factors most heavily weighted by physicians.ResultsTwenty-eight cases were adjudicated by three ID-trained physicians. Overall, interrater agreement was low (κ = 0.438). In comparing providers’ clinical adjudication with CDC/NHSN criteria, agreement was even worse (κ range 0.125 to 0.378). Among specific clinical features, positive culture growth strongly informed clinician diagnosis of pneumonia, while chest imaging did not play a significant role.ConclusionOverall agreement in the clinical diagnosis of pneumonia is poor, even among ID-trained physicians. Culture results more strongly inform clinician decision-making than does chest imaging. The surveillance definition used by the CDC/NHSN has only weak agreement with in-practice clinical assessment. These results underscore the need for more precise diagnostic tools in cases of suspected pneumonia. Disclosures All authors: No reported disclosures.

106. Subclinical propionibacterium acnes infection estimation in the intervertebral disc (SPInE-ID)

BACKGROUND CONTEXT Low back pain and vertebral end plate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, with Propionibacterium acnes specifically implicated with in relation to sciatica. PURPOSE To identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain. STUDY DESIGN/SETTING Single-center prospective cohort. PATIENT SAMPLE Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. OUTCOME MEASURES Tissue culture and pathogen identificationNRSODIEQ-5DModic changesESR, CRP, Leucogram. METHODS Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification. A disc infection is considered if only disc tissue has a positive culture growth. Score questionnaires for pain, functionality and quality of life will be given preoperatively and at 1, 3, 6 and 12 months postoperatively. An MRI will be performed 12 months after surgery for analysis of Modic changes and baseline comparison. The primary endpoint is the rate of disc infection in patients with symptomatic degenerative disease. The secondary endpoints will be performance scores, Modic incidence and size. RESULTS Ninety-five patients were enrolled and completed one-year follow-up with full data collected. Eighteen patients (18.9%) presented at least one of the 3 collected tissues with a positive culture and 4 patients (4.21%) presented only intervertebral disc positive tissue culture, which was considered disc infection, while other patients were considered contaminated. P. acnes was cultured in 2 of the 4 infected discs. NRS for low back pain and sciatica, and ODI improved from mean baseline 7, 6 and 45 to final follow-up 1.2, 2.2, and 16, respectively. Performance score improvements were not statistically related to presence of disc infection. Modic changes and increasing of size over time were not related to disc positive culture. No patients developed clinical discitis over time. CONCLUSIONS Based on a strict methodology of tissue culturing and contamination controls, subclinical infection rate of the intervertebral lumbar disc is at 4.2% and is overestimated in the current literature. Subclinical disc infection is not related to worse outcomes after lumbar microdiscectomy in patients with lumbar disc herniation, and worsening of Modic changes over time is not related to the presence of pathogens in the disc. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Incidence and Risk Factors Associated with Multi-Drug-Resistant Pathogens in a Critically Ill Trauma Population: A Retrospective Cohort Study.

Background: Multi-drug resistance is considered a serious health threat particularly in the intensive care unit (ICU) setting. Studies evaluating multi-drug-resistant (MDR) pathogens in critically ill trauma patients are limited. The objectives were to describe the incidence of MDR, extensive-drug-resistant (XDR), and pan-drug-resistant (PDR) organism growth in ICU patients admitted with traumatic injuries and to identify any risk factors associated with MDR growth. Patients and Methods: This was a retrospective single-center cohort study of all ICU adult patients identified via the institution's trauma registry from January 1, 2016 to August 31, 2017. Patients were included if they had positive culture growth with susceptibility data taken during the index hospitalization. Patients were excluded if their cultures were drawn within 48 hours of emergency department triage. Study groups were defined based on the presence of at least one MDR pathogen during the index hospitalization. Results: A total of 2,578 charts were reviewed and 95 patients (mean age, 60 years; 66 males [69%]) with 201 total cultures were included. The majority of positive cultures were from respiratory (69%) and urinary (16%) sources. Of the 201 positive cultures, the majority of species identified was Enterobacteriaceae (47%), Staphylococcus (32%), Enterococcus (7%), Acinetobacter (5%), and Pseudomonas (3%). Of the 95 patients with positive cultures, the incidence of MDR, XDR, and PDR organisms was found to be 31%, 17%, and 0%, respectively. Augmented renal clearance (ARC) was the only risk factor associated with an increased risk for MDR organism growth (adjusted odds ratio 9.78, 95% confidence interval [CI] 2.56-37.41; p = 0.001). Conclusions: In this cohort of critically ill trauma patients, the incidence of an MDR pathogen occurred in 31% of patients. This is the first study to find an association of ARC and multi-drug resistance, which should be further validated as a potential cause for MDR organisms.

Radiographic Soft Tissue Thickness Differentiating Pyogenic Flexor Tenosynovitis From Other Finger Infections

Characteristic swelling has been described as a differentiating sign of pyogenic flexor tenosynovitis (PFT) but has not been validated. We conducted a retrospective study of adults with finger infections to compare radiographic parameters of soft tissue dimensions. Our hypothesis was that in patients with digit infections, radiographic soft tissue thickness measurement would differ between PFT and non-PFT infected digits. Patients with a finger infection and radiographic evaluation were identified retrospectively ata large academic medical center and divided into 2 groups: PFT (n= 31) and non-PFT infections (n= 31). We defined PFT as purulence in the tendon sheath or positive culture growth from the sheath at surgery. Non-PFT infections included all other finger infections such as abscesses and cellulitis. Atotal of 15 radiographic measurements were made on all included digits. Ratios and differences were calculated to characterize the pattern of swelling for each infected finger. Bivariate analysis wasperformed to identify potential predictor variables between the PFT and non-PFT groups. Logisticregression was performed to reduce confounding and model potential relationships. Neither presence of diffuse swelling nor the shape of finger swelling distinguished PFT from non-PFT infections. All finger infections resulted in diffuse swelling. Pyogenic flexor tenosynovitis was distinguished by differential volar soft tissue thickness minus dorsal soft tissue thickness on radiographs at the proximal phalanx level (9 ± 1 mm for PFT vs 5 ± 1 mm for non-PFT). This was an independent predictor of PFT. The area under the receiver operating curve was 0.83 (95% confidence interval, 0.73-0.94). A difference between volar and dorsal soft tissue swelling of 7 mm or greater had a positive predictive value of 82% with a sensitivity of 84% and specificity of 74%. A difference of 10 mm predicted PFT infection with 76% probability (95% confidence interval, 73% to 99%). Pyogenic flexor tenosynovitis may result in uniform finger swelling, but this does not appear to distinguish PFT from other finger infections. Acute PFT swelling is distinguished by differential volar versus dorsal radiographic soft tissue thickness at the level of the proximal phalanx. The term "fusiform swelling" is a misnomer for the appearance of acute PFT because the finger is not spindle-shaped. Diagnostic IV.

Hemolytic strains of Propionibacterium acnes do not demonstrate greater pathogenicity in periprosthetic shoulder infections

Hemolysis has been suggested as a feature conferring increased pathogenicity to certain Propionibacterium acnes strains in the setting of shoulder infection. The purpose of this study was to compare the virulence of hemolytic and nonhemolytic P acnes strains in patients undergoing revision shoulder arthroplasty. Thirty-nine patients with at least 1 positive culture growth for P acnes at the time of revision surgery were identified with P acnes isolates available for hemolysis testing. Patients were grouped into those with P acnes isolates positive (n = 20) and negative (n = 19) for hemolysis. The groups were retrospectively compared based on objective perioperative findings around the time of revision surgery and the postoperative clinical course, including the need for revision surgery. All cases were classified into categories of infection (definite infection, probable infection, and probable contaminant) based on objective perioperative criteria. The presence of hemolysis was not significantly associated with an increased likelihood of infection (P = .968). Hemolysis demonstrated a 75% sensitivity and 26% specificity for determining infection (definite infection and probable infection categories). The hemolytic and nonhemolytic groups showed no difference regarding preoperative serum erythrocyte sedimentation rate and/or C-reactive protein level (P = .70), number of positive cultures (P = .395), time to positive culture (P = .302), and presence of positive frozen section findings (P = .501). Postoperatively, clindamycin resistance, shoulder function, and the rate of reoperation were not significantly different between the hemolytic and nonhemolytic groups. The presence of hemolysis was not associated with increased pathogenicity in patients with P acnes-positive cultures following revision shoulder arthroplasty, when assessed by objective perioperative criteria and the postoperative clinical course.