Positive Microbial Cultures Research Articles

A single-center study on the distribution and shifting trend of infectious keratitis pathogens from 2018 to 2022

Objective: To investigate the pathogen species, composition, and distribution characteristics of infectious keratitis pathogens in Shandong Province and its surrounding areas. Methods: In this cross-sectional study, patients with keratitis who underwent corneal sampling and microbiological culture at the Shandong Eye Hospital from January 1, 2018 to December 31, 2022 were included. Under topical anesthesia, the edge of the lesion was scraped by an experienced physician. The samples were inoculated on blood agar and Sabouraud dextrose agar plates, separately for bacterial and fungal culture and identification. If necessary, the samples were inoculated on a non-nutrient agar medium with Escherichia coli for Acanthamoeba culture. Bacterial isolates were identified using Vitek 2 compact or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Fungal isolates were identified based on morphological characteristics or sent to a company for sequencing in cases of difficult identification. The epidemiological data of the patients, pathogen species and number (counting as 1 strain if the same strain was isolated from multiple corneal specimens of the same patient), culture positivity rate, and seasonal distribution were recorded. Differences in pathogen positivity rates among different seasons were analyzed using the chi-square test. Results: Among the 4, 024 patients with infectious keratitis during the study period, there were 2 510 males (62.3%) and 1 514 females (37.6%), aged from 46 days to 94 years. Positive microbial culture results were achieved in 2, 363 patients (58.7%), including 906 cases (38.3%) with bacterial positivity, 1 231 cases (52.1%) with fungal positivity, 28 cases (1.2%) with Acanthamoeba positivity, and 198 cases (8.4%) with mixed fungal and bacterial infections. A total of 2 561 strains were isolated, including 1 104 bacterial strains. The most common bacteria were coagulase-negative Staphylococcus spp. (623/1 104, 56.4%), followed by Streptococcus spp. (131/1 104, 11.9%) and Pseudomonas aeruginosa (68/1 104, 6.2%). The most common fungi were Fusarium spp. (634/1 429, 44.4%), followed by Aspergillus spp. (279/1 429, 19.5%) and Alternaria spp. (229/1 429, 16.0%). Bacterial keratitis was more common in summer and autumn, while fungal keratitis was more common in autumn and winter. Conclusions: Among infectious keratitis cases in Shandong Eye Hospital, Fusarium species were predominant fungal pathogens, while coagulase-negative Staphylococcus predominated in bacterial pathogens. Both fungal and bacterial corneal infections showed seasonal variations.

Bone and periosteum protein analysis via tandem mass tag quantitative proteomics in pediatric patients with osteomyelitis.

Bone healing is crucial in managing osteomyelitis after fracture fixation. Understanding the mechanism of extensive callus formation in pediatric osteomyelitis is highly important. This study aims to analyze bone and periosteum samples from pediatric patients to elucidate the essential processes involved in callus formation during osteomyelitis. The study included eight patients from our hospital: four with positive microbial culture who underwent osteomyelitis debridement and four who had osteotomy surgery as contral. We used tandem mass tag quantitative proteomics to investigate proteomic changes in bone and periosteum tissues obtained from these patients. Differential expression proteins were analyzed for their pathways through Gene Ontology (GO) annotation, GO enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, and protein-protein interaction networks. A total of 4737 proteins were successfully identified. About 2224 differentially expressed proteins were detected in the bone tissues group and periosteum tissues group. Among the differentially expressed proteins, 10 protein genes in the bone group were associated with inflammation and osteogenesis, while in the periosteum group were nine. Cytochrome b-245, beta polypeptide (CYBB), nicotinamide phosphoribosyltransferase (NAMPT), tissue inhibitor of metalloproteinases 1 (TIMP-1), Raf-1 proto-oncogene, serine/threonine kinase (RAF-1), RELA proto-oncogene, NF-KB subunit (RELA), and sphingomyelin synthase 2 (SGMS2) may play an important role in callus formation in patients with osteomyelitis. This study provides novel clues for understanding callus formation in pediatric patients with osteomyelitis.

PSI-18 Intra-articular triamcinolone acetonide administration does not affect microbial culture or synovial fluid volume in young, exercising Quarter Horses

Abstract Intra-articular corticosteroids (IAC) are administered to horses experiencing joint inflammation, at times with a concurrent articular antibiotic for prophylaxis. However, information regarding the biologic effects of IAC and potential for microbial contamination in IAC-administered joints is limited in young, exercising horses. The objective of this study was to evaluate the impact of IAC on traditional microbial culture, synovial fluid (SF) volume, and the presence of IAC; hypothesizing negative microbial culture, no change of SF volume, and detection of IAC in SF post-administration. To test this, 2-yr-old Quarter Horses {n = 24; body weight (BW) = 409 ± 6 kg; 825 ± 21 d of age; 12 fillies, 12 geldings) were stratified by BW, age, and sex, and randomly assigned to 1 of 3 treatment groups for a 56-d trial. Horses were housed individually in stalls with runs and fed concentrate offered at 0.75% BW/d split evenly every 12 h with ad libitum Coastal bermudagrass hay and water. Every 21 d, BW and body condition score (BCS) were recorded, and concentrate was adjusted accordingly. Horses were exercised 5 d/wk, up to 45 min/d in a progressive workload using a free-stall exerciser. Blood was collected post-exercise during wk 1, 4, and 7 via jugular venipuncture and lactate (BL) was measured to monitor increasing workload. Intra-articular treatments consisted of 0 mg (CON; n = 8), 6 mg (CORT6; n = 8), or 12 mg (CORT12; n = 8) of triamcinolone acetonide (TA). On d 0, treatments were administered in one randomly selected radiocarpal joint per horse. Following aseptic preparation, SF from both radiocarpal joints was collected before administration (pre), and on d 7, 14, 28, and 56. Volume of SF was recorded, and standard microbial culture and detection of TA were performed by a commercial laboratory. Data were analyzed using PROC MIXED (BW, BCS, BL, SF volume) and PROC GLM (TA) of SAS. For SF volume, data from the contralateral radiocarpal joint were used as a covariate. Horses increased BW and BCS over time (P ≤ 0.01) across treatments. Post-exercise BL increased from wk 1 to 4 and remained increased through wk 7 (P < 0.01). Microbial culture for all horses and time points were negative. Concentration of TA was not evaluated on d 7 due to limited SF volume, but TA was detected on d 14 and concentration did not differ between CORT6 and CORT12 (P = 0.13). Recorded SF volume did not change from d 0 (pre) to 7 but increased to d 56, regardless of treatment (P < 0.01). These results indicate that, based on standard culture, TA administration did not result in positive microbial culture, or decrease SF volume in young horses undergoing regular exercise, however, TA was detectable to d 14.

Diagnostic and prognostic implications of bacteremia in patients with complicated pleural infection.

The clinical significance of bacteremia in patients with complicated pleural infection is still uncertain. We aimed to examine the incidence and clinical significance of bacteremia in patients with complicated pleural infection. This retrospective study comprised of consecutive patients who received pleural drainage due to complicated parapneumonic effusion or empyema. The clinical, laboratory, and radiologic data and clinical outcome were compared between patients with and without bacteremia. Additionally, the factors associated with overall mortality were evaluated in these patients. Of 341 patients included in the analysis, 25 (7 %) had a positive blood culture. Blood culture testing added 2 % identification of causative pathogen compared to pleural fluid culture alone. By multivariable analysis, radiologic features ofcavitary lesion, a RAPID score≥5, and a positive microbial culture in pleural fluid were independently associated with bacteremia. Despite these clinical distinctions, there was ultimately no significant difference in in-hospital mortality between patients with and without bacteremia (3 vs. 4 %, p=1.0). The only factor significantly associated with overall mortality among patients with complicated pleural infections was a higher RAPID score [HR=1.96 (95 % CI=1.35-2.84)]. The rate of bacteremia in patients with complicated pleural infection was 7 %. Blood culture testing demonstrated limited diagnostic yield and had minimal impact on clinical outcomes compared to pleural fluid culture. Therefore, it seems that blood culture testing is more advantageous for specific patients with suspected pleural infection who have cavitary lesions or a RAPID score≥5.

Rerouting bei Infektionen des vaskulären Zugangs unter Verwendung eines biosynthetischen Gefäßtransplantats (Omniflow® II)

Abstract Background Surgical treatment of infected arteriovenous grafts (AVG) while preserving the hemodialysis access remains a challenge. Partial graft excision (PGE) directly followed by interposition grafting (IG) is an established method but is associated with a high rate of local reinfection. This retrospective study investigated the technique of rerouting using a biosynthetic vascular graft (Omniflow® II). Methods This was a retrospective analysis of all patients at a tertiary referral center undergoing surgical treatment for AVG infections using PGE and IG with the rerouting technique using Omniflow® II between January 2009 and December 2018. Follow-up data were collected until May 2021. Results Fifteen patients (53% male, median age 62 years [range 49-81]) were identified for further analysis, thereof twelve received an Omniflow® II vascular graft. Eleven patients had positive local microbial cultures, with Staphylococcus aureus being the most frequently identified pathogen (9 cases). Mortality and reoperation rates within 30 days were both 0%. Median follow-up was 32 months (range 2–101 months) with a median follow-up index of 0.92 (range 0.18–1). During follow-up a surgical intervention for reinfection was necessary in 3 patients with Omniflow® II at a median of 304 days (range 298–485 days). Conclusion Partial graft excision and direct interposition grafting using a biosynthetic Omniflow® II vascular graft is a valid treatment option in selected patients with AVG infections when total graft excision can be avoided. Using a careful rerouting technique, while preserving clinically noninfected graft sections the risk of early reinfection can be minimized and the dialysis access maintained.

The relationship between microbial contaminations of embryo transfer catheters with pregnancy outcome after embryo transfer.

Different stages of assisted reproductive technologies are susceptible to contamination by various microorganisms. The aim of the study was to investigate the relationship between microbial contamination of embryo transfer catheters and the pregnancy outcome after embryo transfer. This cohort study was conducted on 60 patients candied for in vitro fertilization and embryo transfer cycles from 2021 to 2022. All embryos were transferred using a sterile syringe. The catheter contamination was checked by the microbial culture method, and in the case of microbial culture that were negative, polymerase chain reaction was done to confirm the result. The data analyzed using STATA 17 to determine the impact of catheter contamination on the clinical pregnancy rate. The average age of peoples whose microbial culture was positive was lower than that of people whose microbial culture was negative (P<0.05). Also the results showed that people who live in villages have more positive microbial cultures than people who live in cities (P<0.05). Also there is no difference between the number of successful implantations and the pregnancy outcome between people whose microbial culture results were positive or negative. The results of the current study showed that the contamination of the embryo transfer catheter with microorganisms under our investigation did not affect the pregnancy outcome.

In vivo Comparison of Positive Microbial Culture by Wound Irrigation Methods: Biportal Endoscopic versus Open Microscopic Transforaminal Lumbar Interbody Fusion.

This study aimed to evaluate the risk factors and prevalence of intraoperative contamination (IoC) through the microbial culture of superficial and deep samples obtained during surgery. Surgical site infection (SSI) in spinal surgery is a serious complication. The prevalence of IoC may differ based on surgical approach and technique, even in the setting of the same procedure. In this in-vivo study, microbial cultivation was performed with superficial (ligamentum flavum, LF) and deep (nucleus pulposus, NP) surgical specimens to evaluate IoC in 132 patients undergoing single-level transforaminal lumbar interbody fusion (TLIF). Biportal endoscopic (BE) TLIF was performed under continuous wound irrigation (group A, n=66), whereas open microscopic (OM) TLIF was performed under intermittent wound irrigation (group B, n=66). LF and NP specimens were homogenized, gram-stained, and cultured in aerobic and anaerobic media for 14 days. Microbial culture results and occurrence of SSI in the two groups were assessed. The Chi-square test and Fisher's exact test were used to determine significant differences among categorical variables. Logistic regression analysis was used to assess the influence of patient characteristics on the prevalence of positive microbial cultures. Of the 132 patients, 34 (25.8%) had positive microbial cultures, and positive culture required an incubation period of 72 h to 2 weeks in all these patients except for three. Overall positive culture was significantly higher in group B than in group A (P=0.029). The subgroups of LF- and NP-positive cultures were 18.18% (n=24) and 12.88% (n=17), respectively; the SSI was 0.76% (n=1). Group A had a significantly lower subgroup of NP-positive culture than group B (P=0.035). OM technique was an independent risk factor associatd with overall positive culture (P<0.05). The most common microorganism was Cutibacterium acnes (C. acnes). BE-TLIF with continuous wound irrigation showed significantly lower overall, and NP-positive cultures, than OM-TLIF with intermittent irrigation. The most common strain of positive culture was C. acnes. II.

Surgical debridement in long bone chronic osteomyelitis: is wide tumour-like resection necessary?

The standard of wide tumour-like resection for chronic osteomyelitis (COM) has been challenged recently by adequate debridement. This paper reviews the evolution of surgical debridement for long bone COM, and presents the outcome of adequate debridement in a tertiary bone infection unit. We analyzed the retrospective record review from 2014 to 2020 of patients with long bone COM. All were managed by multidisciplinary infection team (MDT) protocol. Adequate debridement was employed for all cases, and no case of wide resection was included. A total of 53 patients (54 bones) with median age of 45.5 years (interquartile range 31 to 55) and mean follow-up of 29 months (12 to 59) were included. In all, ten bones were Cierny-Mader type I, 39 were type III, and five were type IV. All patients were treated with single-staged management, except for one (planned two-stage stabilization). Positive microbial cultures grew in 75%. Overall, 46 cases (85%) had resolution of COM after index procedure, and 49 (90.7%) had resolution on last follow-up. Four patients (7%) underwent second surgical procedure and six patients (11%) had complications. We challenge the need for wide tumour-like resection in all cases of COM. Through detailed preoperative evaluation and planning with MDT approach, adequate debridement and local delivery of high concentration of antibiotic appears to provide comparable outcomes versus radical debridement.

Investigation of microbial coinfection in 453 septic COVID-19 patients admitted to hospital; a retrospective study.

We evaluated the rate of COVID-19 microbial coinfection in an Iranian population. In this single-center, retrospective observational study, we evaluated 453 septic COVID-19 patients for possible coinfection in an Iranian hospital. Overall, 211 (46.57%) cases died due to COVID-19 complications. Positive respiratory secretion and blood cultures were reported in 99 (21.9%) and 19 (4.2%) cases. Klebsiella species were the most commonly isolated microorganisms in respiratory (n=50, 50.5%) and blood (n=10, 52.6%) specimens. After adjustment for underlying disorders, positive respiratory microbial cultures significantly increase the odds of developing death, intubation, and ICU admission and negatively impact healthy discharge (P<0.05). Coinfections with bacteria and fungi independently contribute to poor outcomes in septic COVID-19 patients.

Association between early blood urea nitrogen-to-albumin ratio and one-year post-hospital mortality in critically ill surgical patients: a propensity score-matched study

BackgroundBlood urea nitrogen to albumin ratio (BAR) is increasingly recognized as an early predictor for short-term outcomes in critically ill patients, but the association of BAR with long-term outcomes in critically ill surgical patients remains underexplored.MethodsWe enrolled consecutive patients who were admitted to surgical intensive care units (ICUs) at Taichung Veterans General Hospital between 2015 and 2020, and the dates of death were retrieved from Taiwan’s National Health Insurance Research Database. In addition to Cox regression, we also used propensity score matching to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for one-year post-hospital mortality of the variables.ResultsA total of 8,073 eligible subjects were included for analyses. We found that age, male gender, high Charlson Comorbidity Index, high Acute Physiology and Chronic Health Evaluation II score, positive microbial culture, and leukocytosis were predictors for mortality, whereas high body mass index, scheduled surgery, and high platelet counts were protective factors against long-term mortality. The high BAR was independently associated with increased post-hospital mortality after adjustment for the aforementioned covariates (adjHR 1.258, 95% CI, 1.127–1.405). Notably, the association tended to be stronger in females and patients with fewer comorbidities and lower disease severity of critical illness. The propensity score matching, dividing subjects by BAR higher or lower than 6, showed a consistent association between week-one BAR and post-hospital mortality (adjHR 1.503, 95% CI 1.247–1.811).ConclusionsBAR is a newly identified predictor of short-term outcome, and we identified long-term outcome-relevant factors, including BAR, and the identified factors may be useful for risk stratification of long-term outcomes in patients discharged from surgical ICUs.

Epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns

Objective: To explore the epidemiological characteristics and risk factors of sepsis development and death in patients with extremely severe burns. Methods: A retrospective case series study was conducted. From January 2017 to December 2021, 135 patients with extremely severe burns who met the inclusion criteria were admitted to the Department of Burn and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine, including 100 males and 35 females, aged 18-84 years. The incidence and diagnosis time of sepsis, the rate of positive microbial culture of blood samples (hereinafter referred to as positive blood culture), and the mortality rate of all patients, as well as the incidence of sepsis and the pathogen of infection in patients with positive blood culture were recorded (statistically analyzed with chi-square test or Fisher's exact probability test). According to the occurrence of sepsis, all patients were divided into sepsis group (58 cases) and non-sepsis group (77 cases), and the gender, age, body mass index, history of hypertension, history of diabetes, combination of inhalation injury, burn site, burn type, total burn area, and combined injury of patients were compared between the two groups. According to the outcome, all patients were divided into death group (37 cases) and survival group (98 cases), and the aforementioned data grouped according to sepsis as well as the stability of shock period and the combination of sepsis of patients were compared between the two groups. The aforementioned data between two groups were statistically analyzed with univariate analysis of independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, or Fisher's exact probability test. Factors with P<0.1 were selected for multivariate logistic regression analysis to screen independent risk factors of sepsis and death in patients with extremely severe burns. Results: Among all patients, the incidence of sepsis was 42.96% (58/135), the diagnosis time of sepsis was 14 (7, 24) d after injury, the positive blood culture rate was 62.22% (84/135), and the mortality rate was 27.41% (37/135). The incidence of sepsis of patients with positive blood culture was 69.05% (58/84). The top 5 pathogenic bacteria in the detection rate of septic patients with positive blood culture were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterobacter cloacae, ranking from high to low, and the proportion of Acinetobacter baumannii infected was significantly higher than that of non-septic patients with positive blood culture (χ2=7.49, P<0.05). Compared with those in non-sepsis group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the total burn area of patients in sepsis group increased significantly (with χ2 values of 11.08 and 17.47, respectively, Z=5.68, P<0.05), while the other indicators did not change significantly (P>0.05). Multivariate logistic regression analysis showed that combination of inhalation injury, total burn area ≥80% total body surface area (TBSA), and perineal burns were independent risk factors for patients with extremely severe burns developing sepsis (with odds ratios of 3.15, 7.24, and 3.24, respectively, with 95% confidence intervals of 1.07 to 9.29, 1.79 to 29.34, and 1.21 to 8.68, respectively, P<0.05). Compared with those in survival group, the proportion of combination of inhalation injury, the proportion of perineal burns, and the proportion of combination of sepsis (with χ2 values of 6.55, 11.64, and 22.26, respectively, P values all <0.05), total burn area (Z=4.25, P<0.05), and proportion of instability of shock period (P<0.05) of patients in death group all increased significantly, while the other indicators did not change significantly (P>0.05). Multivariate logistic regression analysis showed that the instability of shock period and combination of sepsis were independent risk factors for death of patients with extremely severe burns (with odds ratios of 4.87 and 3.45, respectively, with 95% confidence intervals of 1.21 to 19.57 and 1.28 to 9.33, respectively, P<0.05). Conclusions: Patients with extremely severe burns have a high incidence of sepsis and a high mortality rate. The peak period of sepsis onset is 2 weeks after injury, with Acinetobacter baumannii as the most prominent infectious pathogen. Combination of inhalation injury, total burn area ≥80% TBSA, and perineal burns are independent risk factors for extremely severe burn patients complicated with sepsis, and combination of sepsis and instability of shock period are independent risk factors for death of patients with extremely severe burns.

Evaluation of Microbiological Culture and Antibiogram of the Patient with Corneal Ulcer due to Exposure Keratitis in the Intensive Care Unit in Sina Farshchian Hospital (2019-2020)

Background: Since patients admitted to the intensive care unit have a compromised immune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective: Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Methods: This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetracaine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thioglycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Results: Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion: The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.

SURGICAL DEBRIDEMENT IN LONG BONE CHRONIC OSTEOMYELITIS: IS RADICAL DEBRIDEMENT NECESSARY? EVOLVING CONCEPTS AND REVIEW OF CASES IN A TERTIARY BONE INFECTION UNIT

IntroductionWide, tumor-like resection for chronic osteomyelitis (COM), a standard practice previously, has been challenged recently with adequate, local debridement. This paper reviews the evolution of surgical debridement for long bone osteomyelitis, and presents the outcome of adequate debridement in a tertiary bone infection unit.Materials &amp; MethodsRetrospective review of records from 2014 to 2020 of patients with long bone osteomyelitis. All records were searched electronically and imaging reviewed. All patients were managed by Multidisciplinary Infection Team protocol.Results53 patients (54 bones) with median age of 45.5 years (IQR 31 to 55) and mean follow-up of 29 months (12 – 59) were identified. According to Cierny-Mader classification, ten bones were type I, 39 were type III, and five were type IV; via the BACH classification of long bone osteomyelitis 21 were uncomplicated, 32 were complex, and one had limited options. All patients were treated with single-staged management with one planned second stage stabilization. Seventy-five percent grew positive microbial cultures. Forty-six (85%) cases had resolution of COM after index procedure and 51 (94%) had resolution at last follow up. Four (7%) patients underwent second surgical procedure and six (11%) patients had complications.ConclusionsWe report high COM resolution rate through detailed pre operative evaluation and planning with multidisciplinary team approach. We challenge the need for wide tumor-like resection and the need for regenerative procedures in all cases of COM. Adequate debridement and local delivery of high concentration of antibiotic appears to provide comparable outcomes.

Assessment of risk factors associated with multidrug-resistant organism infections among patients admitted in a tertiary hospital - a retrospective study

BackgroundBacterial resistance has become a global health concern. To treat suspected multidrug resistant organisms (MDROs), physicians first use broad-spectrum antibiotics; however, this increases the chance of developing antimicrobial resistance. Thus, defining the risk factors for MDROs could aid in the selection of the ideal initial antimicrobial therapy and improve clinical outcomes. ObjectiveThis study aimed to identify the common risk factors for MDRO infection among patients admitted to King Fahad Hospital (KFH) and to analyze the comorbidity factors associated with MDRO infections. MethodsThis retrospective, observational, case-control study included adult patients ≥ 18 years old admitted to KFH between 1st of January to 31st of March 2021, with positive microbial culture. Pediatric patients, outpatients, or patients with only positive fungal cultures were excluded. Data were obtained from the KFH laboratory MDRO documenting database. ResultsTwo hundred and seventy patients were included in this study: 136 in the study group and 134 in the control group. Among patients, 167 (61.9 %) were males and 184 (68.1%) were 18 to 65 years old. The use of drugs such as cotrimoxazole, amikacin, and imipenem (OR = 4.331, C. I. of OR:1.728, 10.855, p = 0.002) were significantly associated with MDRO infections, whereas cefazolin was associated with a lower risk of MDRO infections (OR = 0.080, C.I. of OR:0.018, 0.347, p < 0.001). The intensive care unit showed higher odds of significant association with MDRO infections than those of the surgical unit (odds ratio [OR] = 8.717, 95% C.I. of OR: 3.040, 24.998, p < 0.001). Patients who previously consumed acid-suppressive medications showed higher odds of developing MDRO infections (OR = 5.333, C.I. of OR: 2.395, 11.877, p < 0.001). ConclusionThe most significant comorbidities were diabetes, hypertension, antibiotic use prior to hospitalization and the use of cotrimoxazole, amikacin and imipenem among other antibtiotics was mostly associated with MRDO infections. This study revealed an increasing trend of MDRO infections and a positive correlation with the incidence of strokes and mortality, which highlights the importance of understanding the risk factors for MDRO infections.

Study on the Changes in Common Laboratory Parameters in Dengue Patients with Secondary Bacterial Infection

Secondary bacterial infection can adversely affect the clinical course of primary viral infection indengue fever. Time consuming microbiological culture confirmations and false negative culture resultsdelay the timely initiation of antibiotics. The objective of this study was to describe the variation in thecommon laboratory parameters during the illness, identify criteria that may predict secondary bacterialinfection before microbial culture confirmation, identify the common organisms causing secondarybacterial infections and their antibiotic sensitivity patterns. A retrospective case-control study was carriedout at the Dengue Management Unit of the National Institute of Infectious Diseases, Sri Lanka. Patientstreated with antibiotics upon suspicion or culture confirmation of secondary bacterial infections andpatients not treated with antibiotics were selected for the study. Total WBC count, absolute neutrophilcount, platelet count, HCT (Hematocrit), CRP (C Reactive Protein) and average body temperature wererecorded. Independent sample t-test was used to analyze the data. Study results showed that most positivemicrobial cultures were detected on the 6th and 7th days of illness. Staphylococcus, Streptococcus, andnon-speciated Gram-positive cocci were the commonly isolated organisms. Patients with confirmedsecondary bacterial infection had significantly higher neutrophil count (3.32±0.35x103/μL, p&lt;0.05) andlower platelet counts (49.33±7.66x103/μL, p&lt;0.05) on the 6th and 5th day of illness respectively. Theaverage body temperature was significantly higher in the study group than the control from the fever day3 onwards (p&lt;0.05). The study subjects were more likely to have significantly lower HCT values(38.62±1.12%, p&lt;0.05) than their controls on the third and fourth days of fever. Overall, the present studysuggests that bacterial co-infection increases the mortality rate in dengue patients. The variation inabsolute neutrophil count, platelet count, and body temperature pattern compared to the illness day can beused along for early prediction of secondary bacterial infection.&#x0D; Keywords: dengue, bacterial infection, antibiotics, platelet count, HCT

Factors Affecting Incidence of Ventilator-Associated Pneumonia With Multidrug-Resistant Microbes in Intensive Care Unit

Ventilator-associated pneumonia (VAP) with multidrug-resistant (MDR) microbes is one of the leading causes of hospital mortality. In this study, the risk factors of pneumonia with MDR microbes are investigated. This work was a retrospective study conducted at 2 academic centers and 3 intensive care units (ICUs). All patients who were clinically suspected VAP and had a positive microbial culture have been included in this study from late March 2018 to mid-June 2019. Patients were divided into 2 groups: MDR and non-MDR. Clinical and paraclinical (CBC, microbial culture, CXR) findings of these patients were recorded and reviewed. Then, using the multivariate analysis, the factors affecting the incidence of VAP with MDR microbes were investigated. Out of the 1854 patients admitted to the ICU, 110 of them have been diagnosed with VAP using X-ray and microbiological findings, and MDR microbes were separated in the culture of 85 patients. The mean age range of the patients was 60 ± 20 years and 75% of them were male. In univariate analysis, the factors affecting the incidence of MDR VAP were as follows: length of stay in the ICU, length of stay in other wards, history of admission in ward before ICU, duration of mechanical ventilation, and diabetes. In multivariate analysis, diabetes (odds ratio, 2.66; 95% confidence interval, 0.9–7.8; P = 0.002), history of admission in ward before ICU (odds ratio, 10.25; 95% confidence interval, 3.17–33.1), and a combination of the 3 factors related to the length of exposuring health care environment which named FAC, were independent risk factors of infection with MDR microbes. Hence, the FAC variable includes the length of stay in ICU, duration of mechanical ventilation, and length of stay in other wards.

Borescope examination and microbial culture results of endoscopes in a tertiary care hospital led to changes in storage protocols to improve patient safety

Flexible endoscopes are highly versatile and useful medical instruments, and their proper reprocessing is critical to patient health and safety. The value of routine visual inspections and surveillance of endoscopes in a tertiary care hospital was assessed by performing borescope examinations and microbial sampling on respiratory, gastro-intestinal (GI), and urological endoscopes. A total of 42 endoscopes were cultured, and 36 endoscopes were examined with a borescope. The flush-brush-flush method was used to culture the endoscopes. Microbiologic sampling water was vortexed prior to being suctioned through a membrane filter device. The membrane was plated on a blood agar plate and incubated at 37°C for 48 hours. A 1.9-meter borescope with a 1.6mm diameter was used to perform borescope examinations in an antegrade and retrograde approach. Positive microbial cultures were seen in 28% of bronchoscopes, 22% of GI endoscopes, and 30% of urological endoscopes. Only Gram-positive colonies were identified in endoscopes that had microbial growth. Borescope examinations revealed multiple abnormalities and damage including channel shredding, filamentous debris, water retention, discoloration, dents, and red particles. Borescope examination and microbial sampling should be used routinely to assure endoscopic safety. Borescope examination enabled us to visualize structural damage, foreign material, and moisture within endoscopes. The structural damages and the particles found in endoscopes resulted in timely repair and discontinuation of this type of distal end protectors in our facility.

Clinical outcomes of long-term corneas preserved frozen in Eusol-C used in emergency tectonic grafts.

To report the clinical results on the use of corneas frozen in Eusol-C as tectonic corneal grafts.Retrospective review of medical records of patients who received frozen corneas as emergency tectonic grafts from 2013 to 2020. Corneas had been stored in Eusol-C preservation media at − 78 °C for a mean time of 6.9 months. Diagnosis, transplant characteristics, microbial culture results, anatomic integrity, epithelial healing, neovascularization, transparency, infection and need for additional surgeries were registered. Fifty corneas were used in 40 patients (mean age 60.5 years, 20 males) with a median follow-up of 27.3 months after surgery. Need for tectonic graft was due to: perforation secondary to immune diseases (6, 12%), neurotrophic ulcer (11, 22%), trauma (3, 6%), corneal infection (11, 22%), chronic disorders of the ocular surface (9, 18%) and previous corneal graft failure (10, 22%). Mean size of grafts was 5.6 mm and 36 cases (72%) also received an amniotic membrane graft. Thirty-eight corneas achieved epithelization (76%), 25 (50%) were clear and 19 (38%) developed neovascularization. None of the corneas were rejected. Seventeen corneas (34%) failed: 7 (14%) due to reactivation of baseline disease and 10 (20%) due to primary graft failure. Four corneas (8%) had positive microbial cultures suggestive of contamination and 2 (4%) developed a cornea abscess non-related to a positive microbial culture. Long-term preservation of donor corneas in Eusol-C at − 78 °C is a viable technique to meet the needs of emergency grafts with minimal equipment.

Application value of metagenomic next-generation sequencing for pathogen detection in childhood agranulocytosis with fever

To study the application value of metagenomic next-generation sequencing (mNGS) for pathogen detection in childhood agranulocytosis with fever. A retrospective analysis was performed on the mNGS results of pathogen detection of 116 children with agranulocytosis with fever who were treated from January 2020 to December 2021. Among these children, 38 children with negative mNGS results were enrolled as the negative group, and 78 children with positive results were divided into a bacteria group (n=22), a fungal group (n=23), and a viral group (n=31). Clinical data were compared between groups. For the 116 children with agranulocytosis and fever, the median age was 8 years at diagnosis, the median turnaround time of mNGS results was 2 days, and the positive rate of mNGS testing was 67.2% (78/116). Compared with the negative group, the bacterial group had a higher procalcitonin level (P<0.05), the fungal group had higher level of C-reactive protein and positive rate of (1,3)-β-D glucan test/galactomannan test (P<0.05), and the fungal group had a longer duration of fever (P<0.05). Among the 22 positive microbial culture specimens, 9 (41%) were consistent with the mNGS results. Among the 17 positive blood culture specimens, 8 (47%) were consistent with the mNGS results. Treatment was adjusted for 28 children (36%) with the mNGS results, among whom 26 were cured and discharged. The mNGS technique has a shorter turnaround time and a higher sensitivity for pathogen detection and can provide evidence for the pathogenic diagnosis of children with agranulocytosis and fever.

Analysis of clinical features and treatment of pyoderma gangrenosum

Objective: To explore the clinical features and treatment of pyoderma gangrenosum (PG). Methods: A retrospective observational study was conducted. From January 2012 to July 2021, 25 patients with PG who met the inclusion criteria were admitted to Beijing Fucheng Hospital, including 16 males and 9 females, with the age of onset of disease being 14 to 75 years. Among them, the classification of PG identified 17 cases of ulcerative type, 6 cases of pustular type, 1 case of proliferative type, and 1 case of bullous type. Six patients were accompanied with systemic diseases, while 19 patients were not accompanied with systemic diseases. At the same time of systemic treatment with glucocorticoids, dressing changes or surgical skin grafting was performed on the wounds. The results of laboratory and histopathological examinations, the overall curative effects and follow-up of patients, the wound healing time of patients with negative and positive microbial culture results of wound secretion specimens, and the curative effects of patients with and without systemic diseases were analyzed. Results: The results of blood routine examination of 19 patients were abnormal, and all the immunological indexes were normal in all the patients; the microbial culture results of wound secretion specimens were positive in 14 patients; and the histopathological examination results of ulcer boundary tissue in 15 patients with rapid wound progress were mainly local tissue inflammatory changes. The wounds were cured in 17 patients, mostly healed in 7 patients, and not healed in 1 patient. After one-year's follow-up, the PG in 3 patients relapsed due to self-discontinuation of medication after discharge, and the wounds were healed gradually after adjustment of medication, while the remaining patients had no relapse. The days of wound healing in 14 patients with positive microbial culture results of wound secretion specimens were 21-55 days, and the days of wound healing in 11 patients with negative microbial culture results in wound secretion specimens were 20-54 days. In the 6 patients with systemic diseases, the wounds of 3 patients were cured, and the wounds of the other 3 patients were mostly healed. In the 19 patients without systemic diseases, the wounds of 14 patients were cured, the wounds of 4 patients were mostly healed, and the wound of 1 patient was not healed. Conclusions: The laboratory examination and pathological manifestations of patients with PG lacks characteristics, and their clinical manifestations are rich and diverse, thus PG can be easily misdiagnosed. The glucocorticoids combined with immunosuppressive therapy have good effects on PG. Surgical intervention can be performed on the wounds. Specifically, excessive debridement is not recommended in the acute phase, but skin grafting can be performed in the contraction phase.