Positive Blood Culture Results Research Articles

Generalized Mycobacteriosis in HIV Patients

The objective: to evaluate clinical, laboratory and instrumental signs of generalized mycobacteriosis (MB) in HIV patients.Subjects and Methods. Generalized MB was diagnosed in 83 patients with HIV, patients. 57.8% (48 people) were men, while 42.2% (35 people) were women. The average age of patients was 39.2 years (from 19 to 63 years).Results. The M. avium complex was the main etiological agent of generalized MB in HIV patients (97.6%). The most frequent clinical manifestations included fever (80/83 (96.1%)); abdominal discomfort and pain, diarrhea (53/83 (63.8%)), and decreased body weight (56/83 (67%)). The median CD4+ count in the group was 50 cells/μL. In 52% (43/83) of cases, generalized MB developed concurrently with other opportunistic or secondary infections (CMVI, pneumocystis pneumonia, and candidiasis). In 70% of cases (55/78), NTMs were isolated from two or more biological specimens. The positive result of blood culture for NTM had the greatest clinical significance (in 32/60 (53%) of the examined patients).

Evaluation of a host-protein signature score for differentiating between bacterial and viral infections: real-life evidence from a German tertiary hospital.

A host-protein signature score, consisting of serum-concentrations of C-reactive protein, tumour necrosis factor-related apoptosis-inducing ligand, and interferon gamma-induced protein 10, was validated for distinguishing between bacterial and viral infections as an antimicrobial stewardship measure for routine clinical practice among adult patients in a German tertiary hospital. This single-centre, explorative study prospectively assessed the host-protein signature score, comparing it with serum procalcitonin (PCT) in patients with blood stream infections (BSI) and evaluating its efficacy in patients with viral infections against the standard of care (SOC) to assess the need for antibiotics due to suspected bacterial super/coinfection. Manufacturer-specified threshold scores were used to differentiate viral (< 35) and bacterial (> 65) infections. Ninety-seven patients (BSI [n = 56]; viral infections [n = 41]) were included. The score (cut-off score > 65) tended to detect BSI with higher sensitivity than did PCT (cut-off > 0.5 ng/mL) (87.5% vs. 76.6%). Three patients (5.4%) with BSI had a score < 35. One patient with BSI did not receive antibiotic treatment following SOC prior to positive blood culture results. Among patients with viral infections, 29 (70.7%) had scores > 65, indicating bacterial superinfections. Additionally, 11 patients (26.8%) had scores < 35, indicating no bacterial superinfections. In total, the antibiotic treatment discrepancy in the viral group between the SOC and a host-protein signature score guided approach was 2/41 patients (4.9%). The score tended towards a higher sensitivity in detecting BSI than that with PCT. However, its impact on reducing antibiotic use in viral infections was minor compared with that of SOC.

Bacteraemia and fungemia in patients with cardiac implantable electronic devices: A retrospective cohort study

ObjectivesThe risk of cardiac implantable electronic device (CIED) infection in the setting of any bloodstream infection (BSI) is unclear. Previous studies have mainly focused on Staphylococcus aureus. The aim of this study is to evaluate the risk of CIED infection and the outcome during BSIs caused by any pathogen. MethodsAll positive blood culture results of patients with a CIED implantation or modification procedure between January 2013 and September 2021 in Tampere Heart Hospital occurring after the recorded procedure date until September 30th 2022 were identified. The primary outcome was the occurrence of a CIED infection within 90 days from the onset of BSI, defined according to the 2019 International CIED Infection Criteria. Secondary outcomes were all-cause death and recurrence of BSI. ResultsThe study included 630 BSIs with 16 CIED infections (incidence 2.5 %) during the follow-up period. The bacteraemias were most commonly caused by Escherichia coli (161 cases, 26 %) and Staphylococcus aureus (132 cases, 21 %). The risk of CIED infection was highest with staphylococcal bacteraemia (8.2 %) and lowest with gram-negative bacteria (0.4 %). CIED removal did not influence the overall mortality (P = 0.14) or the recurrence of bacteraemia: recurrence occurred in 14 % of the cases (2/14) if the CIED was removed and in 4 % (25/616) if it was not. ConclusionsThe risk of CIED infection associated with BSI was generally low, but dependent on the causing pathogen. The occurrence of BSI in a patient with CIED does not automatically warrant removal of the CIED.

Comparison of clinical characteristics and outcomes of patients with sepsis identified by the Sepsis-3 criteria by blood and urine culture results: A multicentre retrospective cohort study.

Blood and urine are the most common culture testing for sepsis patients. This study aimed to compare clinical characteristics and outcomes of sepsis patients by blood and urine culture positivity and to identify factors associated with positive cultures. This retrospective study included patients aged ≥16 years with sepsis identified by the Sepsis-3 criteria presenting to the emergency department at four hospitals between 2017 and 2019 in Australia. Patient clinical outcomes were in-hospital mortality, intensive care unit (ICU) admission, hospital length of stay, and representation following discharge. Four culture groups were defined based on the positivity of blood cultures (BC) and urine cultures (UC) ordered within 24 h of triage. Of 4109 patient encounters with sepsis, 2730 (66%) were nonbacteremic, urine culture-negative (BC-UC-); 767 (19%) nonbacteremic, urine culture-positive (BC-UC+); 359 (9%) bacteremic, urine culture-negative (BC+UC-); and 253 (6%) bacteremic, urine culture-positive (BC+UC+). Compared with BC-UC- patients, BC+UC- patients had the highest risk of ICU admission (adjusted odds ratio [AOR] 95% CI: 1.60 [1.18-2.18]) while BC-UC+ patients had lowest risk (adjusted odds ratio [AOR]: 0.56 [0.41-0.76]). BC+UC- patients had the highest risk of 3-day representation (AOR: 1.51 [1.02-2.25]) and second longest hospital stay (adjusted relative risk 1.17 [1.03-1.34]). Antibiotic administration before sample collection for culture was associated with lower odds of positive blood or urine culture results (AOR: 0.38, p < 0.0001). Enhanced clinical care should be beneficial for nongenitourinary sepsis patients (BC+UC-) who had the highest comparative risk of adverse clinical outcomes. Every effort needs to be made to collect relevant culture samples before antibiotic administration, to follow up on culture results, and tailor treatment accordingly.

Assessing the clinical utility of abdominal computed tomography in sepsis patients with unknown origin: A retrospective cohort study.

Early identification of the sources of infection in emergency department (ED) patients of sepsis remains challenging. Computed tomography (CT) has the potential to identify sources of infection. This retrospective study aimed to investigate the role of CT in identifying sources of infection in patients with sepsis without obvious infection foci in the ED. A retrospective chart review was conducted on patients with fever and sepsis visiting the ED of Linkou Chang Gung Memorial Hospital between July 1, 2020 and June 30, 2021. Data on patient demographics, vital signs, clinical symptoms, underlying medical conditions, laboratory results, administered interventions, length of hospital stay, and mortality outcomes were collected and analyzed. Of 218 patients included in the study, 139 (63.8%) had positive CT findings. The most common sources of infection detected by CT included liver abscesses, acute pyelonephritis, and cholangitis. Laboratory results showed that patients with positive CT findings had higher white blood cell and absolute neutrophil counts and lower hemoglobin levels. Positive blood culture results were more common in patients with positive CT findings. Additionally, the length of hospital stay was longer in the group with positive CT findings. Multivariate logistic regression analysis revealed that hemoglobin levels and positive blood culture results independently predicted positive CT findings in patients with fever or sepsis without an obvious source of infection. In patients with sepsis with an undetermined infection focus, those presenting with leukocytosis, anemia, and elevated absolute neutrophil counts tended to have positive findings on abdominal CT scans. These patients had high rates of bacteremia and longer lengths of stay. Abdominal CT remains a valuable diagnostic tool for identifying infection sources in carefully selected patients with sepsis of undetermined infection origins.

Neutrophil volume, conductivity, and scatter (VCS) as a screening tool in neonatal sepsis

Background The aim of the study is to establish changes in Neutrophil volume, conductivity, and scatter (VCS) in neonatal sepsis and to determine appropriate cutoff levels to be used as a screening tool for neonatal sepsis. Methods This prospective observational study was conducted at the Neonatal Intensive care Units at Ain Shams University. It included 25 septic neonates diagnosed based on the presence of risk factors of sepsis, clinical or laboratory evidence suggestive of sepsis, and positive blood culture results. A control group of 25 age-matched neonates was also included. Blood counts were processed in the automated hematology analyzer, Beckman coulter LH 750. Neutrophil VCS Parameters were analyzed and correlated with different clinical and laboratory data of the study sample. Results In this study, the value of mean neutrophil volume (MNV) was significantly increased, and the value of mean neutrophil scatter (MNS) was significantly decreased in the septic group compared with the control group, with P value = 0.026 and 0.025, respectively. The MNV showed a sensitivity of 96%, a specificity of 48%, a PPV of 64.9%, an NPV of 92.3%, and a cutoff point of &gt;140.2 with AUC of 0.713. The MNS showed a sensitivity of 68%, a specificity of 92%, a PPV of 89.5%, a NPV of 74.2%, and a cutoff point of ≤129.4 with an AUC of 0.718. Conclusion Although neutrophil VCS parameters cannot be used alone to diagnose or rule out neonatal sepsis, they aid as additional markers for early diagnosis of neonatal sepsis. They can also be used in combination with other hematological screening tests to improve the diagnostic accuracy of the neonatal sepsis screen.

Kidney damage relates to agonal bacteremia: a single-center retrospective study.

Agonal bacteremia, diagnosed with postmortem positive blood culture results, is considered a possible contributing factor to death. We hypothesized that some premortem organ damage, such as kidney damage, can enhance agonal bacteremia. We performed a postmortem blood and alveolar fluid culture study in 30 cadavers and evaluated the relationship between blood culture results and clinical parameters, including organ damage (brain, heart, lung, kidney, liver and gastrointestinal tract). A total of 23 cases (76.7%) were positive for blood culture; the number of cultured species was one in 12 cases, two in 7 cases, and three in 4 cases. The ratio of agonal bacteremia was significantly higher in patients with heart damage (100%, n=13) and those with kidney damage (end-stage kidney damage, acute kidney injury, obstructive kidney failure, or metastatic kidney tumours) (100%, n=13). The mean number of cultured species was 0.67±0.98 in heart or kidney damage, 1.40±0.55 in heart damage only, 1.40±0.55 in kidney damage only, and 2.00±0.93 in heart and kidney damage. As the number of damaged organs increased (0 organs, no heart/kidney damage; 1 organ, heart or kidney damage; and 2 organs, heart and kidney damage), the mean number of cultured species increased significantly (p for trend=0.001964). Premortem kidney damage relates to agonal bacteremia.

Performance evaluation of 4-day versus 5-day blood cultures using the BD BACTEC FX system

Background: Blood culture (BC) systems have evolved to increase sensitivity and reduce turnaround times. This study compared the performance of a 4-day versus a 5-day BC incubation period using the BD BACTEC™ FX (Becton, Dickinson and Company, USA). Methods: A total of 37,379 consecutive sets of BC were evaluated over a 3-month period in a 2,700-bed tertiary care hospital. Positive BC results were reviewed to assess time-to-positivity (TTP) and species identification of the isolates. The BCs were performed in pairs of vials, utilizing either BD BACTEC Plus Aerobic/F or Peds Plus/F with BD BACTEC Lytic Anaerobic media. Results: A total of 14,899 episodes, averaging 2.51 sets per episode, were analyzed. Of these, 1,398 (9.38%) were positive, yielding 1,465 isolates. TTP (hours) were &lt; 12 in 48.87%, 12-24 in 31.40%, 24-48 in 13.38%, 48-72 in 3.28%, 72-96 in 1.43%, and &gt;96 in 1.64%. The two most prevalent organisms, Escherichia coli and Klebsiella spp. were detected within 12 hours in 88.75% and 78.90%, respectively. The respective median TTP (T50) values for E. coli, Klebsiella spp., Enterococcus faecalis/E. faecium, and Staphylococcus aureus were 9.24, 9.60, 13.75, and 14.20. T50 values for these species were significantly shorter in anaerobic bottles than in aerobic bottles. Of 24 BCs with TTP &gt; 96, only 4 containing anaerobic bacteria or molds were f irst detected after 96 hours. Conclusion: A 4-day incubation has demonstrated excellent sensitivity. However, a 5-day incubation may be beneficial for hospitals caring for patients at high risk for infections with slow-growing fungi or fastidious bacteria.

Metagenomic identification of pathogens and antimicrobial-resistant genes in bacterial positive blood cultures by nanopore sequencing.

Nanopore sequencing workflows have attracted increasing attention owing to their fast, real-time, and convenient portability. Positive blood culture samples were collected from patients with bacterial bloodstream infection and tested by nanopore sequencing. This study compared the sequencing results for pathogen taxonomic profiling and antimicrobial resistance genes to those of species identification and phenotypic drug susceptibility using traditional microbiology testing. A total of 37 bacterial positive blood culture results of strain genotyping by nanopore sequencing were consistent with those of mass spectrometry. Among them, one mixed infection of bacteria and fungi was identified using nanopore sequencing and confirmatory quantitative polymerase chain reaction. The amount of sequencing data was 21.89 ± 8.46 MB for species identification, and 1.0 MB microbial strain data enabled accurate determination. Data volumes greater than or equal to 94.6 MB nearly covered all the antimicrobial resistance genes of the bacteria in our study. In addition, the results of the antimicrobial resistance genes were compared with those of phenotypic drug susceptibility testing for Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Therefore, the nanopore sequencing platform for rapid identification of causing pathogens and relevant antimicrobial resistance genes complementary to conventional blood culture outcomes may optimize antimicrobial stewardship management for patients with bacterial bloodstream infection.

Multi-institutional retrospective study investigating blood culture protocols and test positivity in 701 dogs.

(i) To determine the influence of specimen collection protocol (timing and specimen quantity), primary disease process, and pre-existing antimicrobial or immunosuppressive therapy on blood culture (BC) positivity and (ii) To determine agreement between urine culture and BC results. 701 client-owned dogs. Multi-institutional retrospective study (2019-2022). Mixed-effect logistic regression was used to determine whether primary disease process, the number of BCs, or the timing of specimen collection was associated with BC positivity. Prediction plots were generated. Associations between urine culture and BC results were performed using logistic regression. Dogs with a positive urine culture were more likely to have a positive BC (OR: 4.36, 95% CI: 2.12-8.97, p = 0.003). Dogs that had three BC specimens had the greatest odds of obtaining a positive BC result (adjusted predictive value: 0.44, 95% CI: 0.21-0.70), although this was not significant. Isolates from 38.5% of dogs with a positive BC had resistance to ≥3 antimicrobial classes. The timing between specimen collection had no significant association with BC positivity. Pre-existing antibiotic or immunosuppressive therapy had no significant association with BC positivity. Dogs with a positive urine culture were more likely to have a positive BC result.

Relationship between blood culture time to positivity, mortality rate, and severity of bacteremia

ObjectivesWe investigated the association between patient severity or mortality and time to positivity in bacteremia caused by various pathogens. Patients and methodsThis single-center retrospective study included patients with positive blood culture results. ResultsLonger time to positivity was associated with 30-day mortality for Staphylococcus aureus (221 cases, time to positivity: 17.4 h in the 30-day mortality group vs. 14.1 h in the survival group). Age, chronic kidney disease, cerebrovascular disease, hypertensive drug use, consciousness disorder, and minimal systolic blood pressure were significant predictors of 30-day mortality. For S. aureus, mortality within 30 days was significantly higher when time to positivity was > 24 h (p = 0.04). The time to positivity of Streptococcus pneumoniae, α, β-hemolytic Streptococcus, Enterococcus sp., Enterobacteriaceae, glucose-nonfermenting Gram-negative rods, Candida sp., and anaerobe was not significantly associated with 30-day mortality. ConclusionsAmong various pathogens, time to positivity > 24 h was associated with 30-day mortality for S. aureus.

State-of-the-Art Review: Persistent Enterococcal Bacteremia.

Persistent enterococcal bacteremia is a commonly encountered and morbid syndrome without a strong evidence base for optimal management practices. Here we highlight reports on the epidemiology of enterococcal bacteremia to better describe and define persistent enterococcal bacteremia, discuss factors specific to Enterococcus species that may contribute to persistent infections, and describe a measured approach to diagnostic and therapeutic strategies for patients with these frequently complicated infections. The diagnosis of persistent enterococcal bacteremia is typically clinically evident in the setting of repeatedly positive blood culture results; instead, the challenge is to determine in an accurate, cost-effective, and minimally invasive manner whether any underlying nidus of infection (eg, endocarditis or undrained abscess) is present and contributing to the persistent bacteremia. Clinical outcomes for patients with persistent enterococcal bacteremia remain suboptimal. Beyond addressing host immune status if relevant and pursuing source control for all patients, management decisions primarily involve the selection of the proper antimicrobial agent(s). Options for antimicrobial therapy are often limited in the setting of intrinsic and acquired antimicrobial resistance among enterococcal clinical isolates. The synergistic benefit of combination antimicrobial therapy has been demonstrated for enterococcal endocarditis, but it is not clear at present whether a similar approach will provide any clinical benefit to some or all patients with persistent enterococcal bacteremia.

Bacterial profile and antimicrobial sensitivity pattern of blood specimen isolates in patients with bacteremia in the intensive care unit at Dr. Soetomo Hospital

Link of Video Abstract: https://youtu.be/2wcFE-82J2s Background: Critically ill patients in intensive care have a higher predisposition to acquire bacterial infections in the bloodstream. Research on bacterial profiles and blood culture sensitivity patterns in bacteremia patients can provide information for the basis of diagnosis, approaches, and treatment strategies in patients. To better understand the microbial profile and pattern of antimicrobial sensitivity of blood specimen isolate among non-COVID patients in the intensive care unit, we evaluated data from medical records that included blood cultures for all participants in the intensive care unit from January 2019 to April 2022. Method: A retrospective observational study with a cross-sectional approach was conducted in the Clinical Microbiology Department and Medical Record Unit at Dr. Soetomo Hospital. Data on surgical and non-surgical noncovid patients with bacteremia in intensive care unit patients was collected from January 2019 to April 2022. The Sample was taken with a consecutive sampling technique. Results: There were 140 isolates with positive blood culture results. The most common bacteria are coagulase-negative Staphylococcus 22 (15.7%), Acinetobacter baumanii 25 (17.9%), and Pseudomonas aeruginosa 13 (4.9%) in surgical and non-surgical patients. Sensitivity to Gram-positive bacteria in surgical and non-surgical patients before the pandemic linezolid 75% and vancomycin 58,3%. During pandemic linezolid at 76.9% and vancomycin at 69.2%. Sensitivity of Gram-negative bacteria in surgical patients before the pandemic was imipenem 57.1%, meropenem 57.1%, and amikacin 47.6%. During the pandemic, amikacin 73.5%, meropenem 55.1%, and imipenem 53.1%. Non-surgical patients before the pandemic gram negative sensitivity to meropenem was 100%, ceftazidime 66.7%. During the pandemic, amikacin 59.1%, and cotrimoxazole 45.5%. Conclusion: There was no difference in the surgical and non-surgical bacterial profiles before the pandemic and during the pandemic.

Machine learning-derived blood culture classification with both predictive and prognostic values in the intensive care unit: A retrospective cohort study

ObjectivesDiagnosis and management of intensive care unit (ICU)-acquired bloodstream infections are often based on positive blood culture results. This retrospective cohort study aimed to develop a classification model using data-driven characterisation to optimise the management of intensive care patients with blood cultures. Setting, methodology/designAn unsupervised clustering model was developed based on the clinical characteristics of patients with blood cultures in the Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 2451). It was tested using the data from the MIMIC-III database (n = 2047). Main outcome measuresThe prognosis, blood culture outcomes, antimicrobial interventions, and trajectories of infection indicators were compared between clusters. ResultsFour clusters were identified using machine learning-based k-means clustering based on data obtained 48 h before the first blood culture sampling. Cluster γ was associated with the highest 28-day mortality rate, followed by clusters α, δ, and β. Cluster γ had a higher fungal isolation rate than cluster β (P < 0.05). Cluster δ was associated with a higher isolation rate of Gram-negative organisms and fungi (P < 0.05). Patients in clusters γ and δ underwent more femoral site vein catheter placements than those in cluster β (P < 0.001, all). Patients with a duration of antibiotics treatment of 4, 6, and 7 days in clusters α, δ, and γ, respectively, had the lowest 28-day mortality rate. ConclusionsMachine learning identified four clusters of intensive care patients with blood cultures, which yielded different prognoses, blood culture outcomes, and optimal duration of antibiotic treatment. Such data-driven blood culture classifications suggest further investigation should be undertaken to optimise treatment and improve care. Implications for clinical practiceIntensive care unit-acquired bloodstream infections are heterogeneous. Meaningful classifications associated with outcomes should be described. Using machine learning and cluster analysis could help in understanding heterogeneity. Data-driven blood culture classification could identify distinct physiological states and prognoses before deciding on blood culture sampling, optimise treatment, and improve care.

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.

Early Onset Sepsis in Neonates

Background Neonatal sepsis is one of the most important causes of neonatal morbidity and mortality. The most common risk factors associated with early onset sepsis (EOS) are preterm delivery, low birth weight, premature rupture of membranes, maternal urinary tract infection, Clinical manifestations of neonatal sepsis are nonspecific. These include temperature instability, respiratory distress, apnea, poor feeding, lethargy, irritability, convulsions, hypotonia, poor perfusion and abdominal distension Aim and objectives To describe epidemiology, demographic and incidence of early onset sepsis in neonate with risk factors at NICUS of Ain Shams University Hospitals. Subjects and methods This study is prospective cohort study, was carried out on 80 neonates with one or more maternal risk factors associated with EOS. Neonates will be completely evaluated and subsequently discriminated over the period of 1st 72hours of life in Neonates with risk factors for early-onset sepsis. diagnosis of EOS will be established based on the presence of any clinical evidence suggestive of sepsis, quantitatie C-reactive protein (CRP) levels ≥6 mg/dL, Rodwell’s hematological scores ≥3 and/or Tollner’s scores ≥ 10 with or without positive blood culture results, within the 1st 72 hours postnatal age. Result Among the studied maternal risk factors of neonatal sepsis in our study, 73.8% had PROM being the most common maternal risk factor for early neonatal sepsis followed by ceserian mode (C.S) of delivery 66.3%, and 26.2% had Chorioamintis. The gestational age was distributed as 36.76±3.01 with minimum 30 and maximum 42 weeks, of Ballard score 37.05±2.88 and weight was 2.87±0.82. 58.8% were females and 41.3% were males. Also, 42.5% of the studied group was preterm. 42.5% of studied group was diagnosed with sepsis. Conclusion Early diagnosis is important for early intervention and treatment. This diagnosis in neonates is usually based on clinical and laboratory findings.

Lymphocyte to C-Reactive Protein Ratio as an Early Biomarker to Distinguish Sepsis from Pneumonia in Neonates.

Neonatal sepsis is an acute and severe disease that seriously threatens the life and health of newborns. Neonates with pneumonia may also have unrecognized neonatal sepsis. Early diagnosis of neonatal sepsis is beneficial for early treatment. This study aimed to evaluate the clinical significance of the lymphocyte-to-C-reactive protein ratio (LCR) as an early biomarker to distinguish sepsis from pneumonia. This retrospective study enrolled 1635 neonates with pneumonia from February 2016 to March 2022. Among them, 182 cases were diagnosed with sepsis based on the positive blood culture results. Clinical and laboratory data were extracted from the electronic medical records. LCR was calculated as the ratio of the total lymphocyte count (×109 cells/L) to the C-reactive protein level (mg/L). Binary logistic regression analysis was conducted to evaluate the clinical significance of LCR as an early biomarker in distinguishing sepsis from pneumonia. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic value of LPCR in sepsis cases. All statistical analyses were conducted using Statistical Product and Service Solutions, version 24.0. The neonates with pneumonia combined with sepsis had a lower LCR than that of the neonates with pneumonia. Further analysis showed that the prevalence of neonatal pneumonia combined with sepsis was significantly higher in the low-LCR group than in the high-LCR group (20.7% vs 5.5%, P < 001). Binary logistic regression revealed that LCR was an independent risk factor for identifying pneumonia combined with sepsis. The ROC curve analysis revealed that LCR had better power than the lymphocyte count and CRP level individually in diagnosing neonatal pneumonia combined with sepsis (0.72 vs 0.65 vs 0.66, P < 0.001), with 62% sensitivity and 72% specificity. LCR can be a potential early biomarker in distinguishing neonates with sepsis from those with pneumonia.

Clinical Characteristics and Outcomes of Patients With Cutibacterium acnes Endocarditis

It is suggested that patients with Cutibacterium acnes endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed this statement. To assess the clinical characteristics and outcomes of patients with C acnes endocarditis. A case series of 105 patients presenting to 7 hospitals in the Netherlands and France (4 university hospitals and 3 teaching hospitals) with definite endocarditis according to the modified Duke criteria between January 1, 2010, and December 31, 2020, was performed. Clinical characteristics and outcomes were retrieved from medical records. Cases were identified by blood or valve and prosthesis cultures positive for C acnes, retrieved from the medical microbiology databases. Infected pacemaker or internal cardioverter defibrillator lead cases were excluded. Statistical analysis was performed in November 2022. Main outcomes included symptoms at presentation, presence of prosthetic valve endocarditis, laboratory test results at presentation, time to positive results of blood cultures, 30-day and 1-year mortality rates, type of treatment (conservative or surgical), and endocarditis relapse rates. A total of 105 patients (mean [SD] age, 61.1 [13.9] years; 96 men [91.4%]; 93 patients [88.6%] with prosthetic valve endocarditis) were identified and included. Seventy patients (66.7%) did not experience fever prior to hospital admission, nor was it present at hospitalization. The median C-reactive protein level was 3.6 mg/dL (IQR, 1.2-7.5 mg/dL), and the median leukocyte count was 10.0 × 103/µL (IQR, 8.2-12.2 × 103/µL). The median time to positive blood culture results was 7 days (IQR, 6-9 days). Surgery or reoperation was indicated for 88 patients and performed for 80 patients. Not performing the indicated surgical procedure was associated with high mortality rates. Seventeen patients were treated conservatively, in accordance with the European Society of Cardiology guideline; these patients showed relatively high rates of endocarditis recurrence (5 of 17 [29.4%]). This case series suggests that C acnes endocarditis was seen predominantly among male patients with prosthetic heart valves. Diagnosing C acnes endocarditis is difficult due to its atypical presentation, with frequent absence of fever and inflammatory markers. The prolonged time to positivity of blood culture results further delays the diagnostic process. Not performing a surgical procedure when indicated seems to be associated with higher mortality rates. For prosthetic valve endocarditis with small vegetations, there should be a low threshold for surgery because this group seems prone to endocarditis recurrence.

Platelet-to-lymphocyte ratio in early onset neonatal

Objectives Neonatal sepsis is a major contributor to morbidity and mortality worldwide. Although blood culture is the gold standard of sepsis diagnosis, it often lacks sensitivity and diagnostic speed. Platelet-to-lymphocyte ratio (PLR) is a widely available, effective, simple, and affordable marker that can predict early onset neonatal sepsis (EONS).&#x0D; Objective To assess the correlation between PLR and EONS as well as the diagnostic value of PLR for predicting EONS.&#x0D; Methods This study included all inpatient neonates with suspected early-onset neonatal sepsis at Dr. R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia. Neonates were categorized into sepsis (confirmed by positive blood culture results) and non-sepsis (negative blood culture results) groups. Bivariate analysis, including the chi-square test for categorical data and independent t-test for numerical data, was performed to identify any significant associations between the platelet-to-lymphocyte ratio (PLR) and EONS. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve were calculated to determine the optimal PLR cut-off point to predict EONS.&#x0D; Results In this study, we investigated the relationship between PLR and early-onset neonatal sepsis (EONS) in 176 neonates with suspected EONS. Blood cultures confirmed sepsis in 84 neonates (47.7%), with Klebsiella pneumoniae being the most common causative organism. We found a significant positive correlation between PLR and EONS (p&lt;0.001), and a PLR cut-off point of 61.806 was identified to predict EONS with high sensitivity (90.2%) and specificity (85.7%)&#x0D; Conclusion Our study demonstrates a strong positive correlation between PLR and EONS, and a PLR cut-off point of 61.806 can be used as a valuable marker for predicting EONS in neonates with suspected sepsis. These findings could aid in the early identification and treatment of neonates with sepsis, ultimately improving patient outcomes.

Clinical characteristics and laboratory test in full-term neonates with sepsis in Vietnam National Children’s Hospital (Northern Vietnam)

Background. Sepsis is a life-threatening condition in response to an infectious agent, causing damage to organs. Sepsis causes serious consequences in neonates due to high rates of mortality, sequelae, and disability. The Southeast Asian country of Vietnam features on of the highest infectious disease rates in the world (high rates of infection, disability and mortality), as well as being a middle-income country with a stratified health care system. The aim of this study was to evaluate the clinical and laboratory characteristics of patients at the Vietnam National Childrens Hospital. Materials and methods. This descriptive study was conducted with 85 full-term infants with sepsis admitted to Vietnam National Childrens Hospital in the period from December 2019 to April 2021. Patients had at least 2 clinical symptoms and 2 laboratory signs according to the criteria for assessment of neonatal sepsis (European Medicines Agency in 2010) along with positive blood culture results. Results. Common clinical symptoms in neonates with sepsis included poor feeding (89.4%), respiratory failure (69.4%), fever (51.8%), tachycardia (52.8%), and shock (25%). Anemic patients accounted for many (72.9%). Patients with increased white blood counts accounted for 41.2%. Newborns with a low white blood count accounted for 15.4%. Patients with thrombocytopenia were 49.6%. Most patients had elevated CRP (88.3%). The mean value of nCD64 was 10167.16136.9 molecules bound/cell. mHLA-DR was 9898.414173.9 molecules bound/cell. The Sepsis Index was 274.6287.5. Conclusions. We recorded differences in clinical characteristics and laboratory tests in full-term neonates with sepsis at National Childrens Hospital, of which, nCD64, mHLA-DR, and Sepsis Index should be further investigated and referred to as prospective routine biomarkers in diagnosis of neonatal sepsis.