Positive Pus Culture Research Articles

Clinical characteristics of pyogenic liver abscess with and without biliary surgery history: a retrospective single-center experience

Background & aimsPyogenic liver abscess (PLA) is a common hepatobiliary infection that has been shown to have an increasing incidence, with biliary surgery being identified as a trigger. Our aim was to investigate the clinical characteristics and treatments of PLA patients with and without a history of biliary surgery (BS).MethodsThe study included a total of 353 patients with PLA who received treatment at our hospital between January 2014 and February 2023. These patients were categorized into two groups: the BS group (n = 91) and the non-BS group (n = 262). In the BS group, according to the anastomosis method, they were further divided into bilioenteric anastomoses group (BEA, n = 22) and non-bilioenteric anastomoses group (non-BEA, n = 69). Clinical characteristics were recorded and analyzed.ResultsThe percentage of PLA patients with BS history was 25.78%. The BS group exhibited elevated levels of TBIL and activated APTT abnormalities (P = 0.009 and P = 0.041, respectively). Within the BS group, the BEA subgroup had a higher prevalence of diabetes mellitus (P < 0.001) and solitary abscesses (P = 0.008) compared to the non-BEA subgroup. Escherichia coli was more frequently detected in the BS group, as evidenced by positive pus cultures (P = 0.021). The BS group exhibited reduced treatment efficacy compared to those non-BS history (P = 0.020). Intriguingly, the BS group received a higher proportion of conservative treatment (45.05% vs. 21.76%), along with reduced utilization of surgical drainage (6.59% vs. 16.41%).ConclusionsPatients with BS history, especially those who have undergone BEA, have an increased susceptibility to PLA formation without affecting prognosis.

Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species

BackgroundPyogenic liver abscess (PLA) is a potentially life-threatening intra-abdominal infection. We compared the clinical features, treatments, and prognoses of patients who had Klebsiella pneumonia pyogenic liver abscess (KPPLA) and non-Klebsiella pneumonia pyogenic liver abscess (non-KPPLA). MethodsA retrospective analysis was used to compare the medical records of KPPLA and non-KPPLA patients with positive pus cultures at a single hospital in China from January 2017 to December 2019. ResultsWe examined 279 patients with definitively established PLA, 207 (74.2 %) with KPPLA, and 72 with non-KPPLA. The non-KPPLA group had a higher Charlson comorbidity index, longer hospital stay, longer duration of fever, and greater hospital costs. Multivariate analysis showed that alcohol intake (OR: 2.44, P = 0.048), cancer (OR: 4.80, P = 0.001), ICU admission (OR: 10.61, P = 0.026), resolution of fever OR: 1.04, P = 0.020), and a positive blood culture (OR: 2.87, P = 0.029) were independent predictors of primary treatment failure. Percutaneous needle aspiration (PNA) and pigtail catheter drainage (PCD) provided satisfactory outcomes, but PNA led to shorter hospital stays and reduced costs, especially in KPPLA patients whose abscesses were smaller than 10 cm. ConclusionKPPLA and non-KPPLA patients had some differences in comorbidities and treatment strategies, and non-KPPLA patients had a significantly worse prognosis.

Pyogenic liver abscess in non-liver cancer patients and liver cancer patients treated with TACE: Etiological characteristics, treatment, and outcome analysis.

Clinical, laboratory, and microbiological features, clinical outcomes, and pyogenic liver abscess (PLA) prognosis evaluation in non-liver cancer (Non-LC) and liver cancer patients treated with transarterial chemoembolization (TACE, LC-TACE). Clinical data of 48 consecutive PLA patients from January 2016 to December 2020 were retrospectively analyzed. Mortality between two PLA patient groups were compared, and mortality risk factors were evaluated. A total of 48 PLA patients (31 males and 17 females) from January 2016 to December 2020 met the study's inclusion criteria. There were 32 and 16 patients in the Non-LC and LC-TACE groups, respectively. Positive pus culture rate in the Non-LC group was 87.5% and positive pus culture rate in LC-TACE group was 81.3%. In the Non-LC group, 28 patients improved after treatment, 1 patient did not improve, and 3 patients died during hospitalization, with a 9.4% mortality rate. In the LC-TACE group, nine patients improved after treatment, three patients did not improve, and four patients died during hospitalization, with a 25% mortality rate. The Non-LC group cure time was 37.4± 23.1 days, while the LC-TACE group was 91.5± 49.7 days. PLA of the Non-LC group and the LC-TACE group were different in terms of pathogenic bacteria and cure time, and so on. A more comprehensive treatment should be considered for PLA after TACE.

Clinical Analysis of Acute Suppurative Thyroiditis in 18 Children.

ObjectiveTo summarize our clinical experience with the diagnosis and treatment of children with acute suppurative thyroiditis (AST).MethodsWe retrospectively reviewed the clinical data of 18 children with AST treated at our hospital between January 2009 and May 2022.ResultsThere were 8 boys and 10 girls, aged 7.8 ± 3.8 years at admission. The main clinical manifestations were fever (88.9%), neck pain (100%), and neck mass (100%). Blood and pus cultures were performed in 9 and 15 patients, respectively. All blood cultures were negative, while positive pus cultures were noted in eight cases (six Streptococcus spp., one Staphylococcus spp., and one Streptococcus spp. and Staphylococcus spp. mixed infection). Additionally, all patients received antibiotic treatment: three received antibiotics alone, seven received antibiotics and ultrasound (US)-guided needle aspiration, seven received antibiotics as well as surgical incision and drainage, and one received antibiotics, US-guided needle aspiration in addition to surgical incision and drainage. Consequently, the average length of hospital stay in patients who received antibiotics and US-guided needle aspiration was 9.1±2.9 days compared to 14.0±2.0 days in patients in the antibiotics alone group and 13.0 ± 2.2 days in patients in the antibiotics and surgical incision and drainage group. Follow-up was conducted in 15 of the 18 patients. Three patients relapsed, and the prognosis of the other patients was good.ConclusionAST has atypical clinical symptoms at the early stage. Regular monitoring of the thyroid gland using ultrasonography is strongly advised in unsure cases. Antibiotics combined with US-guided aspiration is a safe, effective, and minimally invasive treatment for AST in children and can reduce hospital stay. However, surgery may be necessary, particularly in the presence of complications. It is strongly recommended that patients with recurrence be examined for anatomical abnormalities and undergo radical treatment.

Sex differences in hospitalized adult patients with cellulitis: A prospective, multicenter study

ObjectivesSex differences in adult cellulitis, a frequent cause of hospitalization, have not been analyzed. These differences were investigated in a large cellulitis series. MethodsThis was a prospective observational study of 606 Spanish hospitalized cellulitis patients. Different comorbidities, clinical, diagnostic, and treatment data were compared between the sexes. Multiple logistic regression modeling was performed to determine the variables independently associated with sex. ResultsOverall 606 adult cellulitis patients were enrolled; 314 (51.8%) were male and 292 (48.2%) were female. Females were older (mean age 68.8 vs 58.9 years, p < 0.0001), less likely to have prior wounds (p = 0.02), and more likely to have venous insufficiency (p = 0.0002) and edema/lymphedema (p = 0.0003) than males. The location of the infection differed between the sexes (p = 0.02). Males were more likely to have positive pus cultures (p = 0.0008), the causing agent identified (p = 0.04), and higher rates of Staphylococcus aureus infection (p = 0.04) and received longer antibiotic treatment (p = 0.03). Factors independently associated with female sex in the multivariate analysis were older age (p < 0.0001), prior cellulitis (p = 0.01), presence of edema/lymphedema as the predisposing factor (p = 0.004), negative versus positive pus culture (p = 0.0002), and location of cellulitis other than in the lower extremities (p = 0.035). ConclusionsDifferences between male and female patients with cellulitis were age, recurrence, presence of edema/lymphedema, positivity of pus culture, and topography of the infection.

455. Gender Differences in Clinical, Microbiological and Treatment Characteristics of Adult Hospitalized Patients with Cellulitis: A Large, Prospective Multicenter Study

BackgroundStudies comparing gender differences between cellulitis features are lacking and might be useful for the knowledge, prevention and management of this infection.MethodsProspective, observational, multicenter study of 606 adult patients (314, 51.8% men) with cellulitis. Comorbidities, microbiological, clinical, lab, diagnostic, and treatment data were analyzed. Multiple logistic regression modeling was performed to determine the variables independently associated with gender.ResultsWomen were older (P < 0.0001), less likely to have prior wounds (P = 0.02), and more likely to have venous insufficiency (P = 0.0002), edema/ lymphedema (P < 0.0003) and prior cellulitis episodes than men (P = 0.07). Cellulitis location also differed between genders (P = 0.02). Regarding microbiology, male patients were more likely to have positive pus cultures than women (P = 0.0008), mainly monomicrobial (P = 0.03).There were differences in microorganisms isolated from pus (P = 0.002), with higher S.aureus infection rates among men than women (P = 0.04).Drawing of blood for culture was also more common in men (P = 0.03). Overall, any microorganism (P = 0.006) and the causative microorganism (P = 0.04) were more commonly identified in male than in female patients, due exclusively to the pus culture results, because there were no differences in the positivity of blood cultures (P = 0.9).Of the 61 S.aureus isolates 15 (24.6%) were methicillin-resistant, without significant differences between genders (P = 0.5). Regarding therapy, men had longer treatments (P = 0.03) and higher rates of antibiotic treatment after discharge (P = 0.04). Factors independently associated with female gender in multivariate analysis were:older age (P < 0.0001), prior episodes of cellulitis (P = 0.01), presence of edema/lymphedema as predisposing factor (P = 0.004), negative pus culture (P = 0.0002) and location of cellulitis in thorax/abdomen (P = 0.035) and head/neck (P = 0.0003) as compared with lower extremitiesConclusionCellulitis in women as compared with men present at older ages, recur more frequently, are more commonly related to edema/lymphedema, affect more frequently other locations compared with lower extremities, and have less frequently positive pus cultures.Disclosures All authors: No reported disclosures.

Microbiology of paediatric deep neck space infection

ObjectivesTo study the organisms and resistance profiles in the pediatric population of patients with deep neck space infection in a developing nation so as to aid in determining relevant, appropriate and effective antimicrobial empiric treatment. To describe the socioeconomic demographics of pediatric patients affected and the predominant age-related subtypes of deep neck space infections in an African population compared to those affected worldwide. MethodsA retrospective review of patients aged younger than 16 years of age, with deep neck space infections over a 5,5-year period was conducted at a tertiary hospital in Johannesburg, South Africa. Diagnosis of deep neck space infection was determined by clinical, radiographic and laboratory findings. All patients received abscess drainage via either needle aspiration or surgical drainage using a sterile technique. Aerobic and anaerobic bacterial cultures and cultures for Mycobacterium tuberculosis were performed. Duration of hospitalization was used as an indicator of treatment response. Results were recorded, and statistical analysis was performed. ResultsA total of 107 children with deep neck space infection were included in the study, with 121 pus specimens retrieved. The male: female ratio was 1.14:1, with a total of 57 males and 50 females, demonstrating a slight male predominance. Mean age was 5.8 years (range 2months–15years). There was no significant difference in duration of hospitalization in children less than 2 years and children older than 2 years of age. The submandibular space was the most common affected site (73.9%). Analysis of the 121 pus specimens demonstrated an identifiable organism in 71% (n = 86) of cases, with no bacterial growth in 29% (n = 35) of specimens. Staphylococcus aureus was the most predominant organism cultured, with a prevalence of 65% of positive pus cultures. 100% of these organisms were sensitive to cloxacillin, and 100% were resistant to penicillin/ampicillin. With respect to positive pus cultures, there was an overall organism sensitivity to cloxacillin of 67% and overall resistance to penicillin/ampicillin of 76%. MRSA, TB and anaerobic bacterial infection have a much lower incidence than aerobic bacterial infection. Risk factors identified in our study include anemia and HIV. ConclusionChildren across all age groups are affected by deep neck space infection in a low socioeconomic environment. Risk factors identified include anaemia and HIV infection. The incidence of TB and anaerobic infection is lower than expected. There is a high level of antimicrobial resistance to penicillin seen in our study, predominantly due to Staphylococcus aureus infection. These organisms are however sensitive to Cloxacillin, which is a cost-effective beta-lactam antibiotic. We therefore recommend empiric treatment with cloxacillin and metronidazole to cover for anaerobic bacterial infection and de-escalation if necessary once culture results are available.

Paediatric Osteomyelitis in Fiji.

Osteomyelitis can lead to significant morbidity and long-term disability if early treatment is not initiated in a timely manner. For developing countries this can lead to a significant burden on the healthcare system. This study aims to describe the demographic variables, aetiology and outcomes of treatment and to calculate the incidence of paediatric osteomyelitis in Fiji. The micro-organism profile and the outcomes for treatment were analysed. This is a retrospective review of medical records of all paediatric patients presenting to hospitals in Fiji over a 5-year period (2006-2010) with a diagnosis of osteomyelitis. Data were collected from the three divisional hospitals in Fiji (Colonial War Memorial Hospital, Lautoka Hospital and Labasa Hospital). Two hundred and twenty patients were identified. An annual incidence of 18.1 cases/100,000 paediatric population was identified. The highest incidence was in the itaukei (ethnic Fijian) population (21 cases/100,000). Males were at a higher risk of developing osteomyelitis (20.8/105 vs. 10.7/105). Staphylococcus Aureus was identified in 86% of all positive blood and 81% of all positive pus cultures, and it was sensitive to cloxacillin in 100% of cases. The most common factor identified preceding the development of osteomyelitis was trauma (55%) followed by skin sepsis (32%). Fifty-four per cent of the cases had chronic osteomyelitis, and the most common mode of presentation was in the form of an abscess (48%) followed by sinus/sequestrum (24%). The age group most commonly affected was between 5 and 9years of age (19.6/105). Children with chronic osteomyelitis were more likely to require operative intervention in addition to antibiotics as compared to acute osteomyelitis (85 vs. 24%). The success rate of treating acute osteomyelitis was 92% compared to 61% for chronic osteomyelitis. Paediatric osteomyelitis poses a significant problem in Fiji, especially in the male, ethnic Fijian population between 5 and 9years of age. The chance of complete resolution after treatment of acute osteomyelitis is very good. Therefore, interventions aimed at early diagnosis and treatments are required.

Primary pyomyositis in North India: a clinical, microbiological, and outcome study.

Background/AimsPyomyositis is an infective condition with primary involvement of the skeletal muscles. There is sparse recent literature on patients with pyomyositis.MethodsThis study was carried out at emergency services of a tertiary care center located in subtropical area of Indian subcontinent.ResultsSixty-two patients of primary pyomyositis formed the study cohort. Mean age of occurrence was 29.9 ± 14.8 years. There were 54 men. Twelve patients had underlying medical diseases. Muscle pain was seen in all 62 patients. Forty-eight patients (77.4%) had the fever. Most common site of involvement was thigh muscles (n = 29, 46.8%). Forty-nine patients (79%) presented in the suppurative stage of illness. Patients with comorbidities were older (age: median 36 years [interquartile range (IQR), 25 to 47] vs. 24 years [IQR, 16 to 35], p = 0.024), had higher culture positivity with gram-negative organisms (8/9 [88.89%] vs. 6/29 [20.69%], p = 0.001). Importantly, higher number of these patients received inappropriate antibiotics initially. Patients with positive pus culture result had higher complication rate (32/38 [84.21%] vs. 10/18 [55.56%], p = 0.044). Six patients (9.7%) had in-hospital mortality. Lower first-day serum albumin, initial inappropriate antibiotic therapy, and advanced form of the disease at presentation were associated with increased in-hospital mortality.ConclusionsPrimary pyomyositis is not an uncommon disease entity. Patients with comorbidities were more likely to receive initial inappropriate antibiotic therapy. Patients with positive pus culture report had the higher rate of complications. Lower first-day serum albumin, initial inappropriate antibiotic therapy and advanced form of the disease at presentation were associated with increased in-hospital mortality.

Varicella-related musculoskeletal complications in children

Eight children with post-varicella musculoskeletal complications were treated between 2001 and 2009. The complications that were observed were cellulitis (three children), pyomyositis (three children), osteomyelitis (two children) and gangrene (one child). On average, 8.8 days elapsed between primary varicella infection and complication. The most common presentation was pain. Before we started treating them, all children received antibiotics during interhospital transfers (average: 2.4). Interventions included drainage (eight), fasciatomy (one), arthrotomy (one), bone drilling (one), and amputation (one). Blood cultures were negative in all children. Two children had positive pus cultures for Staphylococcus aureus, one of them had a methicillin-resistant S. aureus infection. One of the four children who developed coagulopathy ended with significant morbidity. Varicella-related methicillin-resistant S. aureus osteomyelitis suggests a widening spectrum of these infections.

1393 Evaluation of the Prevalence and Risk Factors for Colonization by Vancomycin-Resistant Enterococcus Among Pediatric Icu Patients on Admission

Background: Our institution experienced an increase in the frequency of vancomycin-resistant enterococci (VRE) clinical isolates. Surveillance cultures upon hospital admission for patients at high risk is recommended. We sought to measure the prevalence and risk factors of VRE carriage among medical new patients in a Pediatric Intensive Care Unit in a university Children's Hospital. Method: We recorded the positive VRE samples from new patients entering the PICU from 10/10/2008 - 15/04/2010. Cases had positive VRE clinical cultures (perianal/stool samples) within 48 hours of hospital admission. Results: VRE carriage was 9,33% on admission(39 of 418 of new patients). 53,84% of the carriages had a recent previous hospitalization (33,33% of them being oncologic patients). 51,28 % of the cases had previous recorded antibiotic treatment. 46,16 % of the patients had no previous admission (33,33% of them being trauma patients). 3/39 patients developed sepsis with positive blood culture of E. faecalis(one), E. faecium (two). 3/39 of the carriages had abdominal infection with positive pus cultures of E. faecium. Conclusions: Our study demonstrates that recent previous hospitalization is not a significant predictor for identifying carriers on admission but previous antibiotic treatment and neoplastic disease are. The wide use of antibiotics among paediatric patients may be the answer. Early identification and isolation of VRE carriers among critically ill patients should supplement application of infectious control measures in an attempt to reduce nosocomial spread and burden.

Burkholderia pseudomallei musculoskeletal infections (melioidosis) in India

Melioidosis, an infection due to gram negative Burkholderia pseudomallei, is an important cause of sepsis in east Asia especially Thailand and northern Australia. It usually causes abscesses in lung, liver, spleen, skeletal muscle and parotids especially in patients with diabetes, chronic renal failure and thalassemia. Musculoskeletal melioidosis is not common in India even though sporadic cases have been reported mostly involving soft tissues. During a two-year-period, we had five patients with musculoskeletal melioidosis. All patients presented with multifocal osteomyelitis, recurrent osteomyelitis or septic arthritis. One patient died early because of septicemia and multi-organ failure. All patients were diagnosed on the basis of positive pus culture. All patients were treated by surgical debridement followed by a combination of antibiotics; (ceftazidime, amoxy-clavulanic acid, co-trimoxazole and doxycycline) for six months except for one who died due to fulminant septicemia. All other patients recovered completely with no recurrences. With increasing awareness and better diagnostic facilities, probably musculoskeletal melioidosis will be increasingly diagnosed in future.

Predictors of surgical site infection in dirty urological surgery

Risk factors for surgical site infection (SSI) following urologic dirty operations have not been clearly identified. This study was conducted to describe incidence, potential risk factors and common causative pathogens of the SSI in such operations. Medical records of patients who had undergone simple nephrectomy or lumbotomy for suppurative renal infection at our institutions from 1999 to 2006 were retrospectively evaluated. The following data were retrieved: presence of SSI, demographic data, laboratory findings, comorbidities, microbiological data, type of renal suppuration, type of urological surgery and antibiotic regimen. Risk factors for SSI were evaluated using the multiple logistic regression model. Sixty-five patients (mean age 55.6 +/- 13.1 years) were eligible for data analysis. In 20 of them (30.8%) a SSI was identified. The most common isolated pathogens were gram-negative bacteria. At univariate logistic regression analysis risk factors significantly associated with SSI included: presence of emphysematous infection, hypoalbuminemia, number of predisposing conditions, emergency operations, isolation of Enterobacteriaceae, positive pus culture. The use of trimethoprim/sulfamethoxazole was associated with a decreased risk for SSI. Multiple logistic model identified only the emergency operations and isolated Enterobacteriaceae as independent predictors of SSI (odds ratio [OR] = 11.1) (95% confidence interval [CI] = 3.0-40.8) and OR = 3.9 (1.0-14.8), respectively. Patients with suppurative renal infections are submitted to life-saving emergency surgery. Urological surgeons should keep in mind that this carries a high risk for subsequent SSI. Effective preventive measures in these circumstance cannot be identified. Further research in this area is necessary to clarify this issue.

Gluteal Abscesses Caused by Brucella Species

Soft tissue involvement is an uncommon complication of brucellosis. We report a rare case of gluteal abscesses caused by brucellosis. The patient was a housewife living in a city. There was no history of systemic complaints or other organ involvement. Diagnosis was made by positive pus culture and serological tests. Histopathological examination of the abscess wall revealed granulomatous inflammatory reaction. The patient was treated successfully with abscess drainage and a 6-week course of oral doxycycline and rifampicin. Brucellosis should be kept in mind in the diagnosis of gluteal abscess, especially in endemic areas.