Positive Microbiological Results Research Articles

The diagnostic yield of the Meares & Stamey test can be significantly improved by symptom-based patient selection and the experience of the test performer.

Even if Meares-Stamey 4-glass (M&S) test is regarded a decisive tool for diagnosing prostatitis its use is only rarely performed in everyday clinical practice. Here, we analyze if the diagnostic yield of the M&S test could be improved by a pre-test categorization of patients due to undergo a M&S test. All clinical and microbiological data of patients who underwent M&S test in two urological centers from January 2004 to December 2021 were analyzed in this retrospective cohort study. One center has a dedicated staff member for the study of prostatitis (Cohort I), while the other center is a general urological unit (Cohort II). All patients were divided into 3 groups on the basis of the assembled data: patients with symptoms related to prostatitis only (Group I), patients with symptoms related to both prostatitis and BPH (Group II), patients with symptoms related to BPH only (Group III). The rates of positive microbiological results in each group were compared. In the whole period, 9347 patients were analyzed and categorized as follows: Group I, 1884; Group II, 5151; Group III, 2312. Three-thousand and eight-hundred twenty-three patients showed positive culture results (40.9%). The most common isolated species was Escherichia coli (49.7%), followed by Enteroccus spp. (31.8%). The rates of positive M&S tests in the different symptom groups were: Group I, 1532 (81.4%); Group II, 1494 (29.0%); Group III, 797 (34.4%). The overall rate of positive M&S tests in each urology center showed that the center with a staff member who is dedicated to prostatitis studies (Cohort I) had a significantly higher rate of positive M&S tests than the general urological department (Cohort II) (64.3% vs 31.4%; p < 0.001). Symptom-based patient selection and dedicated staff members will increase the diagnostic yield of the M&S test and reduce the number of unnecessary tests.

Cat bite injuries to the hand and forearm: the impact of antibiotic treatment on microbiological findings and clinical outcome

IntroductionPatients and physicians often underestimate cat bite injuries. The deep and narrow wound seals quickly and provides an environment for the inoculated saliva and bacteria. Interestingly, the literature reports no bacterial growth in the microbiological workup of wound swaps in up to 43%. The time between bite injury and the first clinical presentation, the start of antibiotic treatment and surgical debridement might affect these findings. Therefore, the current project examines if (1) these factors impact the outcome of microbiological results following cat bite injuries and (2) the detection of bacterial growth leads to higher complication rates, longer hospital stays, longer total treatment time, or higher total treatment costs.Materials and methodsThis single-center retrospective study analyzed data from 102 adult patients. All patients received antibiotic and surgical treatment following a cat bite injury. Microbiological samples were collected during surgery in all cases. The time from the bite incident to the first presentation, beginning of antibiotic administration, and surgical debridement was calculated. Demographic data, complication rate, length of hospital stay, total treatment time, and total treatment costs were recorded. (1) A generalized linear model was fitted using the microbiological outcome as the dependent variable. (2) Two groups (negative or positive microbiological results) were formed and statistically compared.ResultsThe median age was 50 (SD 16), and 72% were female. (1) The time from the bite incident to the first clinical presentation, antibiotic administration, or surgical treatment was not associated with the outcome of the microbiological result. (2) No significant differences were observed between the two groups.ConclusionsOur data do not suggest that early antibiotic administration or delayed surgical treatment affects the outcome of the microbiological workup following cat bite injuries to the hand and forearm. The microbiological outcome did not affect the complication rate, treatment time, and total treatment costs.

Impact of Pharmacist Involvement in Post-Discharge Emergency Department Culture Review

Background: Many infectious diseases are diagnosed in emergency departments (ED) and patients are prescribed antimicrobial therapy. Results from cultures typically take a few days to become finalized. Following up on these results is necessary when medication changes are indicated due to results that show bacteria are resistant to the prescribed antibiotics. Involving pharmacists in assessing the culture and sensitivity results, and making interventions when needed, is an innovative way to ensure that patients receive appropriate antimicrobial therapy based on the culture and sensitivity data. This study analyzed the impact of pharmacist involvement in the ED’s post-discharge positive culture review process on ED re-visits and hospitalizations. Methods: This single-center, pre- and post-implementation study examined the impact of pharmacist involvement in the post-ED visit culture review process on ED re-visits and hospitalizations. Positive microbiological results included documented growth from urine, skin and soft tissue, throat, blood, or stool cultures. Patients included in the study were of 18 years of age or older and had a positive culture result post ED-discharge. Patients were excluded from the study if they were admitted to the hospital or transferred to another facility. The primary outcomes included ED re-visits within 7 days and hospital readmissions within 30 days for the same condition. The secondary outcomes were percentage of pharmacist interventions accepted and types of pharmacist interventions implemented. Results: A total of 141 patients were included in the study, with 65 in the pre-implementation group and 76 in the post-implementation group. The primary outcome of ED re-visits within 7 days for the same condition occurred in 11 (17%) patients in the pre-implementation group and 5 (7%) patients in the post-implementation group ( P = .0454). The primary outcome of hospitalizations within 30 days for the same condition occurred in 5 (8%) patients in the pre-implementation group and 1 (1%) patient in the post-implementation group ( P = .0137). Seventeen (94%) out of the 18 pharmacist interventions were accepted and implemented. The intervention types implemented were to recommend to: change antibiotic (35%), not initiate antibiotic (24%), initiate antibiotic (24%), and continue antibiotic (18%). Conclusion: Pharmacist involvement in the ED post-discharge positive culture review process showed a decrease in ED re-visits and hospitalizations for the same condition.

Clinical Characteristics and Microorganisms Isolated in Community-Acquired Pneumonia in the COVID-19 Period.

Community-acquired pneumonia is a leading cause of mortality and hospital admissions. The aetiology remains unknown in 30-65% of the cases. Molecular tests are available for multiple pathogen detection and are under research to improve the causal diagnosis. We carried out a prospective study to describe the clinical characteristics and aetiology of community-acquired pneumonia during the COVID-19 pandemic and to assess the diagnostic effectivity of the microbiological tests, including a molecular test of respiratory pathogens (FilmArray™ bioMérieux). From the 1st of February 2021 until the 31st of March 2022, 225 patients were included. Failure in microorganism identification occurred in approximately 70% of patients. Streptococcus pneumoniae was the most common isolate. There were 5 cases of viral pneumonia. The tested FilmArray exhibited a low positivity rate of 7% and mainly aided in the diagnosis of viral coinfections. Despite our extensive diagnostic protocol, there is still a low rate of microorganism identification. We have observed a reduction in influenza and other viral pneumoniae during the COVID-19 pandemic. Having a high NEWS2 score on arrival at the emergency department, an active oncohematological disease or chronic neurological conditions and a positive microbiological test result were related to worse outcomes. Further research is needed to determine the role of molecular tests in the microbiological diagnosis of pneumonia.

Paediatric cancer patients with severe sepsis or septic shock at the PICU with positive microbiological results do worse than those with negative results: a retrospective cohort study

PurposeInfections are a leading cause of mortality and morbidity in paediatric cancer patients. The aim of this study was to determine whether positive or negative microbiological results impact the clinical outcomes of sepsis in paediatric cancer patients admitted to the paediatric intensive care unit (PICU).MethodsWe performed a retrospective observational single-centre cohort study between 1 January 2018 and 31 December 2020 in the Netherlands. All paediatric cancer patients aged 0 to 18 years admitted to PICU due to severe sepsis or septic shock were included.ResultsWe identified 73 PICU admissions in 58 unique patients. Forty-nine of the 73 PICU admissions (67.1%) had positive blood and/or bronchoalveolar lavage microbiological results. Patients with positive results had a higher Paediatric Logistic Organ Dysfunction-2 (PELOD-2) score at PICU admission compared to patients with negative results (median (IQR), 7 (6–9) vs 6 (4–8), p = 0.04). Mortality in PICU among patients with positive results was significantly higher when compared to patients with negative results, 18% versus 0% respectively (p = 0.03). In addition, patients with positive results had significantly less ventilator-free days at day 28 compared to patients with negative results, median (IQR) 26 (19–28) versus 28 (27–28) respectively (p = 0.01).ConclusionsMicrobiologically confirmed infections (bacterial, viral, or fungal) in paediatric cancer patients with sepsis are associated with higher mortality in PICU and a higher need for PICU resources. Large-scale (multicentre) studies in paediatric oncologic patients are required to confirm these results.

Immediate vs. culture-initiated antibiotic therapy in suspected non-severe ventilator-associated pneumonia: a before–after study (DELAVAP)

BackgroundVentilator-associated pneumonia (VAP) is the leading nosocomial infection in critical care and is associated with adverse outcomes. When VAP is suspected, starting antibiotic therapy (AT) immediately after pulmonary sampling may expose uninfected patients to unnecessary treatment, whereas waiting for bacteriological confirmation may delay AT in infected patients. As no robust data exist to choose between these strategies, the decision must balance the pre-test diagnostic probability, clinical severity, and risk of antimicrobial resistance. The objective of this study in patients with suspected non-severe VAP was to compare immediate AT started after sampling to conservative AT upon receipt of positive microbiological results. The outcomes were antibiotic sparing, AT suitability, and patient outcomes.MethodsThis single-center, before–after study included consecutive patients who underwent distal respiratory sampling for a first suspected non-severe VAP episode (no shock requiring vasopressor therapy or severe acute respiratory distress syndrome). AT was started immediately after sampling in 2019 and upon culture positivity in 2022 (conservative strategy). The primary outcome was the number of days alive without AT by day 28. The secondary outcomes were mechanical ventilation duration, day-28 mortality, and AT suitability (active necessary AT or spared AT).ResultsThe immediate and conservative strategies were applied in 44 and 43 patients, respectively. Conservative and immediate AT were associated with similar days alive without AT (median [interquartile range], 18.0 [0–21.0] vs. 16.0 [0–20.0], p = 0.50) and without broad-spectrum AT (p = 0.53) by day 28. AT was more often suitable in the conservative group (88.4% vs. 63.6%, p = 0.01), in which 27.9% of patients received no AT at all. No significant differences were found for mechanical ventilation duration (median [95%CI], 9.0 [6–19] vs. 9.0 [6–24] days, p = 0.65) or day-28 mortality (hazard ratio [95%CI], 0.85 [0.4–2.0], p = 0.71).ConclusionIn patients with suspected non-severe VAP, waiting for microbiological confirmation was not associated with antibiotic sparing, compared to immediate AT. This result may be ascribable to low statistical power. AT suitability was better with the conservative strategy. None of the safety outcomes differed between groups. These findings would seem to allow a large, randomized trial comparing immediate and conservative AT strategies.

The prevalence and clinical context of antimicrobial resistance amongst medical inpatients at a referral hospital in Rwanda: a cohort study

BackgroundAntimicrobial resistance (AMR) is a growing global concern. AMR surveillance is a crucial component of the international response; however, passive surveillance of laboratory data is limited without corresponding patient-level clinical data. This study sought to examine the burden of AMR amongst medical inpatients in Rwanda, in the context of their clinical presentations and prior antibiotic exposures.MethodsThis cohort study was conducted over a 9-month period at a tertiary referral hospital in Kigali, Rwanda. We enrolled 122 adult medical inpatients with a history of fever and a positive microbiological culture result. Data were collected regarding the clinical and microbiological aspects of their admission.ResultsThe most common diagnoses were urinary tract infection (n = 36, 30%), followed by pneumonia (n = 30, 25%) and bacteraemia (11 primary [9%] and 10 catheter-related [8%]). The most common pathogens were E. coli (n = 40, 33%) and Klebsiella pneumoniae (n = 36, 30%). The cohort were heavily antibiotic-exposed at the time of culture with 98% of patients (n = 119) having received an antibiotic prior to culture, with a median exposure of 3 days (IQR 2–4 days). Eighty patients (66%) were specifically prescribed ceftriaxone at the time of culture. Gram-negative organisms predominated (82% [100/122]) and exhibited high rates of resistance, with only 27% (21/77) being susceptible to ceftriaxone, 2.4% (2/82) susceptible to co-amoxiclav and 44% (8/18) susceptible to ciprofloxacin. Susceptibility amongst Gram-negatives was relatively preserved to amikacin (91%, 79/87) and imipenem (85%, 70/82). There were no cases of methicillin-resistant Staphylococcus aureus (0/12) or vancomycin-resistant enterococci (0/2). Discordant antibiotic therapy was significantly associated with in-hospital mortality (OR 6.87, 95%CI 1.80–45.1, p = 0.014).ConclusionsThis cohort highlights high rates of resistance amongst Gram-negative organisms in Rwanda, including the presence of carbapenem resistance. Nonetheless, the detailed prescribing data also highlight the challenges of using routine laboratory data to infer broader AMR prevalence. The significant exposure to empiric broad-spectrum antibiotic therapy prior to culturing introduces a selection bias and risks over-estimating the burden of resistant organisms. Broadening access to microbiological services and active surveillance outside of teaching hospitals are essential to support national and international efforts to curb the growth of AMR in low-resource settings.

Variability of bile bacterial profiles and drug resistance in patients with choledocholithiasis combined with biliary tract infection: a retrospective study.

Biliary tract infection is a common complication of choledocholithiasis. This study aimed to analyse the distribution of pathogenic bacteria in bile cultures from patients with choledocholithiasis combined with biliary tract infection to guide clinical application of antimicrobials and reduce the emergence of drug resistance. A total of 880 patients were enrolled in this retrospective study from 30 March 2017 to 31 August 2022 at the Affiliated Hospital of Qingdao University in China. Bile specimens were extracted for microbiological culture under aseptic conditions using endoscopic retrograde cholangiopancreatography. Bacterial culture, strain identification, and antimicrobial susceptibility testing were conducted according to the standard protocol. Baseline data were retrieved from patient files. Overall, 90.34% (795/880) of bile samples showed positive microbiological results and 37.50% (330/880) demonstrated polymicrobial infections. Among the 795 bile specimens with positive culture results, 1,216 pathogenic bacteria were detected, with gram-negative bacilli accounting for 56.33%, gram-positive cocci for 41.86%, and fungi for 1.81%. The predominant gram-negative bacilli in the bile cultures were Escherichia coli (30.43%) and Klebsiella pneumoniae (13.98%), whereas the main gram-positive cocci were Enterococcus faecium (14.04%) and E. casseliflavus (4.28%). The annual trend analysis revealed a gradual decrease in the proportion of gram-negative bacilli and a gradual increase in the proportion of gram-positive cocci, with a concomitant decrease in the dominance of E. coli. Both E. faecium and E. coli showed high resistance to conventional antibiotics but high sensitivity to piperacillin/tazobactam, carbapenems, amikacin, and vancomycin. A significant change has occurred in the bile bacterial spectrum in patients with choledocholithiasis and biliary tract infection. The incidence of gram-positive cocci infections has increased annually, while that of gram-negative bacilli and E. coli infections has decreased. Antibiotic administration should be tailored based on the local bacterial profile.

Increase in antibiotic resistance in diabetic foot infections among peruvian patients: a single-center cross-sectional study.

Diabetic foot is one of the most significant complications in individuals with diabetes and is closely associated with lower limb amputation. The antibiotic susceptibility patterns of these bacterial isolates play a critical role in guiding effective treatment strategies We aimed to determine the most common bacterial agents causing diabetic foot infections in a tertiary-care hospital in Peru. Clinical and microbiological data were collected from 181 patients diagnosed with diabetic foot infections and positive microbiological culture results. All the samples were analyzed with the Vitek 2 compact system and the cut-off points were defined with the CLSI M100 guide. The data were segregated based on mono-microbial or poly-microbial cultures, bacterial types, and antibiotic susceptibility profiles. A total of 32 bacterial species were identified, predominantly Gram-negative (63%). The most frequent bacterial agents isolated were Staphylococcus aureus (19.9%), Escherichia coli (12.2%), Pseudomonas aeruginosa (8.3%), and Proteus vulgaris (6.6%). These bacteria commonly exhibited resistance to Ampicillin, Ciprofloxacin, Levofloxacin, Trimethoprim-sulfamethoxazole, and Cefuroxime. E. coli showed the highest antibiotic resistance (19 antibiotics), while Gentamicin, Tobramycin, and Levofloxacin demonstrated the highest sensitivity against the most prevalent bacteria. Gram-negative bacteria also exhibited notable antibiotic-susceptibility to Meropenem, Piperacillin/tazobactam, and Amikacin. Regarding the presence of Extended-Spectrum Beta-Lactamase, 54 isolates tested positive, with 35 (64.8%) and 14 (42.4%) of these being S. aureus and E. coli. Bacterial agents causing diabetic foot infections pose a constant concern, particularly due to the increasing antibiotic resistance observed. This difficulty in treating the condition contributes to a higher risk of amputation and mortality. Further research on bacterial susceptibility is necessary to determine appropriate dosages for pharmacological treatment and to prevent the overuse of antibiotics.

Point prevalence survey on healthcare-associated infections in Apulian region, Italy, 2022-2023

Abstract Background Since 2011-2012, the ECDC coordinates the measurement of Healthcare-associated infections (HAIs) and antimicrobial use (AMU) in European acute-care hospitals through repeated point prevalence surveys (PPS) every five years. Here we present the main results of the 3rd ECDC-PPS conducted in Apulia region, Italy, during November 2022, in comparison as a benchmark with data from Italian PPS 2016-2017. Methods The ECDC protocols were applied. Prevalence of HAIs and AMU was expressed as percentages. Proportion of isolates resistant to selected AMR markers were also calculated. Results Twenty-four/39 Apulian hospitals provided data on 3,710 patients. The prevalence of patients with ≥1 HAI was 9.9% (PPS-2016-17:8.03%). The highest prevalence was recorded in rehabilitation wards (31.6%; PPS-2016-17:16.4%), in large hospitals (10.5%; PPS-2016-17:9.3%), among elderly (11.2%; PPS-2016-17:9.1%), males (11.1%; PPS-2016-17:7.9%), and patients with a rapidly fatal McCabe score (28%; PPS-2016-17:18.8%). The most reported types of HAI were pneumonia (19.8%; PPS-2016-17:22.8%) and urinary tract infections (18.3%; PPS-2016-17:18%). Prevalence of patients with ≥1 antimicrobial was 49.3% (PPS-2016-17:44.5%). At least a positive microbiological result was reported for 66.1% of the HAIs (N = 244/369; PPS-2016-17:53.8%). Klebsiella pneumoniae (14.9%; PPS-2016-17:10.4%) and Escherichia coli (9.8%; PPS-2016-17: 13%) were the most frequently isolated microorganisms. The susceptibility tests were available for 56% of microorganisms (N = 177/316) and a resistant result was reported for 50.3% (PPS-2016-17:42.3%) of tests. Conclusions HAI, AMU, and AMR prevalence estimated in Apulia region was higher, when compared with previous national PPS. Efforts in implementing antimicrobial stewardship and reducing HAIs should be established. Key messages • HAI and AMR remain a major public health threat in Apulia region, particularly for K. pneumoniae and E. coli. • Frail patients bear a greater burden of illness.

Etiology of Fever and Associated Outcomes Among Adults Receiving Chemotherapy for the Treatment of Solid Tumors in Uganda.

Little is known about the microbiology and outcomes of chemotherapy-associated febrile illness among patients in sub-Saharan Africa. Understanding the microbiology of febrile illness could improve antibiotic selection and infection-related outcomes. From September 2019 through June 2022, we prospectively enrolled adult inpatients at the Uganda Cancer Institute who had solid tumors and developed fever within 30 days of receiving chemotherapy. Evaluation included blood cultures, malaria rapid diagnostic tests, and urinary lipoarabinomannan testing for tuberculosis. Serum cryptococcal antigen was evaluated in participants with human immunodeficiency virus (HIV). The primary outcome was the mortality rate 40 days after fever onset, which we estimated using Cox proportional hazards models. A total of 104 febrile episodes occurred among 99 participants. Thirty febrile episodes (29%) had ≥1 positive microbiologic result. The most frequently identified causes of infection were tuberculosis (19%) and bacteremia (12%). The prevalence of tuberculosis did not differ by HIV status. The 40-day case fatality ratio was 25%. There was no difference in all-cause mortality based on HIV serostatus, presence of neutropenia, or positive microbiologic results. A universal vital assessment score of >4 was associated with all-cause mortality (hazard ratio, 14.5 [95% confidence interval, 5-42.7]). The 40-day mortality rate among Ugandan patients with solid tumors who developed chemotherapy-associated febrile illness was high, and few had an identified source of infection. Tuberculosis and bacterial bloodstream infections were the leading diagnoses associated with fever. Tuberculosis should be included in the differential diagnosis for patients who develop fever after receiving chemotherapy in tuberculosis-endemic settings, regardless of HIV serostatus.

Secondary pulmonary infection and co-infection in elderly COVID-19 patients during the pandemics in a tertiary general hospital in Beijing, China.

Most people are infected with COVID-19 during pandemics at the end of 2022. Older patients were more vulnerable. However, the incidence of secondary bacterial, fungal or viral pulmonary infection and co-infection is not well described in elderly hospitalized COVID-19 patients. We retrospectively reviewed the medical records of all elderly (≥65 years) hospitalized patients with laboratory-confirmed COVID-19 from December 1, 2022 to January 31, 2023. Demographics, underlying diseases, treatments, and laboratory data were collected. Univariate and multivariate logistic regression models were used to explore the risk factors associated with secondary bacterial, fungal or viral pulmonary infection and co-infection. A total of 322 older patients with COVID-19 were enrolled. The incidence of secondary bacterial, fungal or viral pulmonary infection and co-infection was 27.3% (88/322) and 7.5% (24/322), respectively. The overall in-hospital mortality of all patients was 32.9% (106/322), and the in-hospital mortality among patients who acquired with secondary pulmonary infection and co-infection was 57.0% (57/100). A total of 23.9% (77/322) of patients were admitted to ICU within 48 h of hospitalization. The incidence of secondary pulmonary infection and co-infection among patients admitted to the ICU was 50.6% (39/77) and 13.0% (10/77), respectively. The overall in-hospital mortality of ICU patients was 48.1% (37/77), and the in-hospital mortality of ICU patients acquired with secondary pulmonary infection and co-infection was 61.4% (27/44). A total of 83.5% (269/322) of the included patients received empirical antibiotic therapy before positive Clinical Microbiology results. Influenza A virus (the vast majority were the H3N2 subtype) was the most common community acquired pathogen for co-infection. While A. baumannii, K. pneumoniae, and P. aeruginosa were the common hospital acquired pathogens for co-infection and secondary pulmonary infection. The incidence of Carbapenem-resistant Gram-negative bacilli (CR-GNB) infections was high, and the mortality reached 76.9%. Predictors of secondary pulmonary infection and co-infection were ICU admission within 48 h of hospitalization, cerebrovascular diseases, critical COVID-19, and PCT > 0.5 ng/mL. The prognosis for elderly hospitalized COVID-19 patients with secondary pulmonary infection or co-infection is poor. The inflammatory biomarker PCT > 0.5 ng/mL played an important role in the early prediction of secondary pulmonary infection and co-infection in COVID-19 patients.

Association of Positive Bacterial Cultures Obtained from the Throat, Anus, Ear, Bronchi and Blood in Very-Low-Birth-Weight Premature Infants with Severe Retinopathy of Prematurity-Own Observations.

The causative factors responsible for the development of Retinopathy of Prematurity (ROP) are still unexplored. Therefore, one of the most important factors can be perinatal inflammation. This retrospective study included 114 premature infants (228 eyes) meeting a birth criteria of ≤ 32 weeks gestational age (GA) and a birth weight (BW) ≤ 1710. Examined Group (EG) n = 51 of BW 852.7 ± 255.7; GA 26.3 ± 2.0 with severe ROP treated by diode laser or anti-VEGF intravitreal injection. Control Group (CG) n = 63 of BW 1313.9 ± 284.5; GA 28.8 ± 1.6 without ROP. Microbiological bacterial and fungal cultures of the ear, anus, bronchial throat and blood were taken. Medical data and laboratory tests in correlation to 3 ROP and A-ROP were analysed. Positive bacterial tests dominated in EG, 47% vs. CG, 23%. Significant correlations between positive cultures obtained from natural cavities: anus (p < 0.001), throat (p = 0.002), as well as from blood (p = 0.001) and severe ROP which requires diode laser and anti-VEGF treatment were noted. Significant inflammation markers which correlate with the development of severe ROP are Klebsiella pneumoniae (KP) (p = 0.002) and Coagulase-negative Staphylococci (CoNS) (p < 0.001). CoNS, p < 0.001; KP, p = 0.002; the remaining Maltophilia stenotrophomonas (MS); Staphylococcus aureus (SA), p = 0.005; and Enterobacter cloacae (EC), p = 0.02 were the most frequent bacteria in severe ROP. High levels of white blood cells (WBC), C-reactive protein (CRP), lymphocytes (LYM) and low thrombocytes (PLT) correlated sequentially with (Odds Ratio, OR) CoNS (2.3); MS (5.9); KP (3.1); and all positive cultures (APC) (9.5). An important correlation between the BPD-EC (4.3); intrauterine inflammation-KP (3.4); PDA-EC (3.9); and asphyxia-CoNS (3.0) was identified. It cannot be ruled out that positive microbiological results of blood, anal and pharyngeal cultures may become prognostic markers for the early development of ROP, which would enable early initiation of ophthalmological treatment in premature infants from the VLBW group.

Minimally invasive autopsies for the investigation of pulmonary pathology of COVID-19—experiences of a longitudinal series of 92 patients

Minimally invasive autopsies (MIAs) allow the collection of tissue samples for diagnostic and research purposes in special situations, e.g., when there is a high risk of infection which is the case in the context of COVID-19 or restrictions due to legal or personal reasons. We performed MIA to analyze lung tissue from 92 COVID-19 patients (mean age 78 years; range 48–98; 35 women, 57 men), representing 44% of all patients who died from the disease between October 2020 and April 2021. An intercostal approach was used with removal of a 5-cm rib section followed by manual collection of four lung tissue samples (5–8 cm in size). Diffuse alveolar damage (DAD) was found in 89 (97%) patients at various stages. Exudative DAD (eDAD) predominated in 18 (20%) patients, proliferative DAD (pDAD) in 43 (47%) patients, and mixed DAD (mDAD) in 31 (34%) patients. There were no significant differences in the predominant DAD pattern between tissue samples from the same patient. Additional purulent components were present in 46 (50%) cases. Fungi were detected in 11 (12%) patients. The pDAD pattern was associated with longer hospital stay including intensive care unit (p=0.026 and p<0.001) and younger age (p=0.019). Positive bronchoalveolar lavage and blood cultures were observed more frequently in pDAD patterns (p<0.001; p=0.018). In contrast, there was no significant association between intravital positive microbiological results and superimposed bronchopneumonia or fungal infection at autopsy. Having demonstrated the characteristic lung changes in a large longitudinal autopsy series, we conclude that the presented MIA approach can be considered a reliable and safe method for performing post mortem lung diagnostics in COVID-19 and other high-risk situations. The lack of correlation between histological changes indicative of bacterial or fungal superinfection and microbiology could have clinical implications for disease and treatment surveillance.

INVESTIGATION OF BACTERIAL AND VIRAL SLOW INTERVERTEBRAL DISC INFECTIONS

Objective. Currently, few publications have been available regarding an effect of level, type of intrusion, and viral infections on spinal disc degeneration. The study was aimed to evaluate an incidence of indolent bacterial and viral intervertebral disc infections in unstratified group of patients operated on for spinal degenerative pathologies.&#x0D; Material and methods. For the study, intraoperative disc samples were collected from patients who underwent discectomy and total spinal fusion surgery for degenerative pathologies between the years December, 2018 to January, 2020. 447 samples were examined obtained from 392 patients (189 women and 203 men) with a mean age of 58.1 years.&#x0D; The following epidemiological and clinical data were collected: gender, age, spinal segments affected, type of surgical approach, preoperative C-reactive protein (CRP; reference range 0.00.5 mg/dL), and preoperative as well as 6-month postoperative ODI and NDI, both expressed as a percentage. The incidence of postoperative infections within six months after surgery as well as MI for each operated segment was assessed. Only patients with ventral cervical or dorsal thoracic access were enrolled in the study. In the lumbar region, the ventral assess was chosen for anterior lumbar interbody fusion, the lateral approach for oblique or extreme lateral interbody fusion, and the dorsal approach in case of standard microdiscectomy of posterior transforaminal interbody fusion or transforaminal interbody fusion.&#x0D; A logistic regression analysis was performed to model a risk of positive microbiological culture and a risk of emerging modal changes by using a set of independent variables selected in a stepwise manner by using the Akaike information criterion as a measure of quality of select procedure.&#x0D; Results. MRI for modal analysis was available for all 447 segments. MRI revealed 45 type 1 SCs (10.07% of all segments), 118 type 2 SCs (26.4%), and 5 type 3 SCs (1.12%). Microbiological culture was available in 410 segments. In these 410 segments, 39 type 1 MCs, 113 type 2 MCs, and 5 type 3 MCs were found. A statistically significant relationship was found between SC type 2 and a positive microbiological result (p = 0.0127). In contrast, there were no statistically significant associations for type 1 and type 3 SCs (p=0.3052 and p=0.0767, respectively).&#x0D; Conclusion. A relation between disc degeneration and infections seems unlikely. Histopathological evidence of inflammation in degenerated discs is rare and unrelated to microbiological findings.

IgG Replacement Therapy Use in Patients with Hypogammaglobulinemia after Lung Transplant

BackgroundSecondary hypogammaglobulinemia (HG) occurs in up to 73% of patients in the first year post-lung transplant (LT). Severe HG (sHG) with immunoglobulin (Ig)G levels <400 mg/dL is associated with increased infections and mortality. Although IgG replacement therapy (IGRT) may mitigate adverse outcomes associated with HG, further investigation is needed to understand the optimal role for IGRT in HG management. MethodsData were reviewed for 191 patients who underwent first LT before 11/30/2021 with HG (at least one IgG < 600 mg/dL) post-transplant. Bacterial and fungal microbiology results (bronchoalveolar lavage, induced sputum culture, bronchial lavage), IGRT prescriptions, and IgG levels were chart-reviewed. Antimicrobial prescriptions were extracted from electronic medical records. Active infection (AI) was defined as prescription of a non-prophylactic antimicrobial; severe AI (SAI) as inpatient or intravenous prescription of a non-prophylactic antimicrobial. Positive microbiology results, AI, and SAI were reported in patient-years for the one year after first IgG < 600 mg/dL in 141 patients who never received IGRT (No-IGRT), and for the time between LT and IGRT initiation (Pre-IGRT) as well as the one year after IGRT initiation (Post-IGRT) in 50 patients who received IGRT. ResultsIGRT was initiated for secondary HG 82% (41/50), donor specific antibodies 12% (6/50), cytomegalovirus 2% (1/50), and both secondary HG and donor specific antibodies 4% (2/50). Thirty-seven patients started intravenous-IGRT (IVIG), of whom 5 switched to subcutaneous-IGRT (SCIG) during the course of treatment. Thirteen started SCIG, of whom 2 switched to IVIG. IVIG was administered for 18 ± 18 (mean ± standard deviation) doses of 41 ± 22 grams/month over 71 ± 74 weeks. SCIG was administered for 74 ± 53 doses of 27 ± 20 grams/month over 86 ± 64 weeks.There were more AI and SAI per patient-year Pre-IGRT (15.8 and 11.7, respectively) than No-IGRT (4.9 and 2.6) and Post-IGRT (8.3 and 5.8). Positive microbiology results per patient-year were 3.8 Pre-IGRT, 3.3 Post-IGRT, and 2.3 No-IGRT. Among 29 patients with sHG, positive microbiology results per patient-year were 4.8 Pre-IGRT, 4.3 Post-IGRT, and 3.1 No-IGRT.Table 1Infectious Agents Detected on Pulmonary MicrobiologyOrganism (n, %)No-IGRT (n = 318)Pre-IGRT (n = 251)Post-IGRT (n = 166)Penicillium spp.52 (16)36 (14)13 (8)Aspergillus spp.59 (18)34 (13)28 (17)Staphylococcus epidermidis8 (3)21 (9)7 (4)Pseudomonas aeruginosa20 (7)17 (7)18 (11)Staphylococcus aureus2 (1)15 (6)12 (7)Enterococcus spp.0 (0)10 (4)3 (2)Mycobacterium spp.7 (2)12 (5)4 (2)Sterile mycelium8 (3)9 (3)3 (2)Stenotrophomonas maltophilia3 (1)9 (3)8 (5)Enterobacter cloacae complex1 (<1)8 (3)3 (2)Escherichia coli4 (1)7 (3)7 (4)Haemophilus parainfluenzae44 (13)4 (2)9 (5)Klebsiella pneumoniae11 (3)2 (1)8 (5)Other99 (31)67 (27)43(26)Legend: The 735 specific microorganisms detected on bronchoalveolar lavage, sputum culture and bronchial lavage are shown. Abbreviation: Species (spp.) ConclusionThese findings suggest that IGRT was utilized for patients who presented with infections in addition to HG, with a possible decrease in antimicrobial use after initiation.

SG-APSIC1058: Microbiological surveillance of endoscopes in a Singapore tertiary-care academic hospital: A retrospective study from 2018 to 2021

Objectives: Improper reprocessing of endoscopes may result in healthcare-associated infections. Regular microbiological surveillance is an important means of evaluating the quality of endoscope reprocessing. We evaluated the effectiveness of reprocessing endoscopes (including the protocols on steps to be taken in the event of any positive microbiological results) in a sterile supply unit (SSU) and an endoscopy unit in a Singapore tertiary-care academic hospital. Methods: Singapore General Hospital (SGH) is a 1,750-bed, tertiary-care, academic medical center in Singapore with 2 main SSUs: 1 inpatient endoscopy unit and 1 outpatient endoscopy unit. We reviewed microbiological surveillance results from endoscopes following reprocessing from January 2018 to December 2021. In total, 160 endoscopes (27 bronchoscopes, 58 gastroscopes, 52 colonoscopes, 6 duodenoscopes, 5 echoscopes, 5 cystoscopes, 5 rhinolaryngoscopes, and 5 enteroscopes) and 15 automated endoscope reprocessors (AERs) were evaluated for the presence of microorganisms. Samples were obtained by swabbing the tip of the scope and the biopsy channel. Fluid was flushed from the biopsy channel after reprocessing, and this water from the AERs was sampled after waterline disinfection. Results: Of the 15,783 samples collected, 15,667 (99.3%) yielded no growth; 36 (0.2%) were positive for gut and environmental flora; and 80 (0.5%) were positive for low-concern organisms such as skin flora. Conclusions: Microbiological surveillance yielded a high percentage of negative results confirming the effectiveness of endoscope reprocessing. This quality-assurance process is necessary and beneficial in achieving patient safety.

Antibiotics Used for COVID-19 In-Patients from an Infectious Disease Ward.

although the prevalence of bacterial co-infections for COVID-19 patients is very low, most patients receive empirical antimicrobial therapy. Furthermore, broad spectrum antibiotics are preferred to narrow spectrum antibiotics. in order to estimate the excess of antibiotic prescriptions for patients with COVID-19, and to identify the factors that were correlated with the unjustified antibiotic usage, we conducted an observational (cohort) prospective study in patients hospitalized with COVID-19 at the National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, on an infectious disease ward, from November 2021 to January 2022. To evaluate the prevalence of bacterial co-infection in these patients, all positive microbiology results and concomitant suspected or confirmed bacterial co-infections, as documented by the treating doctor, were recorded. The patients were grouped in two categories: patients who received antibiotics and those who did not receive antibiotics, justified or not. from the 205 patients enrolled in the study, 83 (40.4%) received antibiotics prior to being admitted to the hospital. 84 patients (41.0%) received antibiotics during their hospitalization; however, only 32 patients (15.6%) had signs and symptoms suggestive of an infection, 19 (9.3%) presented pulmonary consolidation on the computed tomography (CT) scan, 20 (9.7%) patients had leukocytosis, 29 (14.1%) had an increased procalcitonin level and only 22 (10.7%) patients had positive microbiological tests. It was observed that patients treated with antibiotics were older [70 (54-76) vs. 65 (52.5-71.5), p = 0.023, r = 0.159], had a higher Charlson index [4 (2-5) vs. 2 (1-4), p = 0.007, r = 0.189], had a severe/critical COVID-19 disease more frequently [61 (72.6%) vs. 38 (31.4%), p &lt; 0.001, df = 3, X2 = 39.563] and required more oxygen [3 (0-6) vs. 0 (0-2), p &lt; 0.001, r = 0.328]. empirical antibiotic treatment recommendation should be reserved for COVID-19 patients that also had other clinical or paraclinical changes, which suggest a bacterial infection. Further research is needed to better identify patients with bacterial co-infection that should receive antibiotic treatment.

Diagnostic Utility of Bronchoalveolar Lavage in Immunocompromised Patients with Lung Infiltrates.

Lung infections are associated with a high mortality rate in immunocompromised patients. Achieving an accurate and rapid diagnosis is vital to help guide management, and thus improve survival. To establish the diagnostic yield, clinical value, and safety of bronchoscopy with bronchoalveolar lavage (BAL) in immunocompromised adult patients with pulmonary infiltrates. This retrospective study included all immunocompromised adult patients who underwent bronchoscopy with BAL for investigation of radiologically confirmed pulmonary infiltrates at a tertiary care hospital between January 01, 2014, and June 30, 2021. Clinically significant findings of BAL were defined as a positive microbiological result of a potential pathogen determined using routine culture, acid-fast bacilli smear, mycobacterial culture, tuberculosis PCR, fungal culture, Aspergillus antigen, and multiplex PCR panel and/or positive cytology. A total of 103 unique patients were included (mean ± SD age: 44.5 ± 14.1 years), of which the majority were male (60.2%). The BAL diagnostic yield was 52.4% (95% CI: 42.6-62.2%). In the multiple logistic regression model, positive BAL was predicted by symptom of sputum (aOR 4.01, 95% CI: 1.27-12.70, P = 0.018). Almost half of the procedures (43.7%, 95% CI: 33.9-53.4%) resulted in a change in the management plan, with positive BAL findings more than twice as likely to result in a change (OR 2.39, 95% CI: 1.07-5.33, P = 0.033). Only three (2.9%) procedures resulted in complications and required ventilator support and/or oxygen escalation. BAL is a safe clinical tool that can be useful in impacting clinical management in a significant proportion of immunocompromised patients with pulmonary infiltrates.

Investigations on the shelf life of rainbow trout fillets covered by quinoa biofilms enriched with different essential oils (Nigella sativa and Mentha piperita).

Having no adverse effects on the consumer's health, causing zero or minimal damage to the environment, and maintaining the nutritional quality of the product are too important criteria for food packaging materials. Edible biofilm packaging techniques are successful to meet many of these features. To strengthen this claim, rainbow trout (Oncorhynchus mykiss) fillets were coated with an edible film solution (obtained from quinoa starch), which attracted a lot of attention in terms of nutritional value. The prepared biofilm solutions were applied in four different groups (control, quinoa, quinoa + black seed oil, and quinoa + mint oil) and stored in refrigerator conditions (4 ± 1 °C) for 15 days. Microbiological (total aerobic mesophilic bacteria, psychrophilic bacteria, Pseudomonas, lactic acid bacteria, and Enterobacteriaceae) and chemical analyses (TBARS, TVB-N, pH) were performed on certain days of storage. At the end of the study, it was stated that coating fish fillets with edible quinoa, which was enriched by black cumin and mint essential oils, had positive chemical and microbiological results. The highest value for pH was 7.03 ± 0.09 obtained in the control group. It was found that black seed oil has antimicrobial specifications via slowing the microorganism development and prolongs the storage time. The TVB-N value was below the consumable limit value (25 mg/100 g) in the treatment groups and the TBARS value was lowest (1.62 ± 0.21 μmolMA/kg) in the black seed oil group. Consequently, it is suggested that black seed oil may be used on trout fillets to prolong storage time.