Prolonged Antibiotic Regimens Research Articles

P-123. Unlocking Synergy: Exploring Combination Therapies in Whipple's Disease for Enhanced Clinical Efficacy

Abstract Background Whipple's disease (WD) is a rare chronic multisystemic infection that primarily affects the gastrointestinal tract. There are no FDA-approved treatments for WD. Standard treatment involves prolonged antibiotic regimens that can be controversial, especially in cases of relapse or neurological involvement. This study uses CURE ID, an online case reporting platform, to investigate WD cases in the literature, analyze combination therapies currently being used, and identify strategies that improve patient outcomes.Figure 1:Geographic Distribution of Whipple’s Disease Cases Methods We identified WD cases on PubMed and Embase reported between 2019-2024 using relevant keywords, MeSH terms, and Emtree terms. Rayyan.ai was used to screen articles following a PRISMA protocol. Out of 271 identified cases, 84 met inclusion criteria. They were added to CURE ID via the case report form. The aggregated WD data was then analyzed.Figure 2:Age Distribution of Whipple’s Disease Patients Results 74/84 patients improved or recovered (Table1). Figure 1 displays that most cases originated in Europe and North America, followed by a minority in Asia and South America. WD predominantly occurred in males (61/84) and most cases occurred in middle-aged patients (Figure 2). Most cases were associated with favorable outcomes (Table 1). As shown in Figure 3, the most used antibiotic combination was ceftriaxone and TMP-SMX and was associated with the best outcome followed by doxycycline and hydroxychloroquine. Corticosteroids were added in 4 patients to prevent the formation of Immune Reconstitution Inflammatory Syndrome (IRIS), and all cases were associated with a positive result.Figure 3:Outcome of the most frequently used treatment regimens Conclusion There appears to be a geographic clustering of WD cases as well as higher incidence in males. This needs to be investigated further for explanations for this correlation. It was noted that the majority of the cases occurred in immunocompromised patients. We aim to investigate this further in a full manuscript. The standard treatment of WD is using combination therapy with ceftriaxone and TMP-SMX and this was associated with favorable outcomes. Interestingly, the combination of doxycycline and hydroxychloroquine also emerged as a successful alternative in cases where the preferred combination was not tolerated or failed. We aim to further explore the mechanism of this combination and establish it as a standard alternative regimen.Table 1:Composite table of patient outcomes and frequency of drugs used. Disclosures All Authors: No reported disclosures

Prolonged 120-h meropenem antibiotic prophylaxis in radical cystectomy compared to 24h standard antibiotic prophylaxis: Final analysis of the randomized clinical trial

ABSTRACT Background Standard 24-h antibiotic prophylaxis (AP) is widely employed to minimize the risk of infection complications (ICs) within 30 days following a radical cystectomy (RC). However, a considerable variety of prophylaxis protocols do not prevent a high ICs rate after surgery (37–67%). Therefore, antibiotic’s type and its duration are still controversial for AP.( Objective To compare standard 24-h AP with a prolonged 120-h regimen in a multicenter randomized clinical trial. Methods Patients were randomized in a 1:1 ratio to standard 24-h AP regimen (Group A) versus the prolonged meropenem AP 120-h (Group B). The primary endpoint was an event rate defined as the frequency of ICs within 30 days. The secondary endpoint were biomarker’s analysis and antibiotic re-administration rate (ArAR). Results A total of 92 patients were enrolled. The Clavien-Dindo complications rate did not differ between the groups (p = 0.065), however the overall complication rate was higher in Group A (63.0% vs. 34.8%, p = 0.007). The infection complication rate was 2.75 times higher in the standard antibiotic prophylaxis group: 47.8% compared to 17.4% cases in Group B (p = 0.002). The new prolonged antibiotic regimen decreased the risk of ICs (OR 0.23; 95% CI 0.08–.598; p = 0.003). The event-free survival for ICs of clinical interest in group A was 7.00 days and in group B was 9.00 days (HR = 0.447; 0.191–1.050, p = 0.065). The ArAR was higher in Group A -47.8%, while in Group B it was only in 17.4% of the cases. The incidence of bacteriuria before RC was the same between groups (p = 0.666), however, after stent removal the risk of a positive culture was lower in group B (RR = 0.64; 95% CI 0.37–1.08; p = 0.05). Conclusions The administration AP over 120-h appears to be safe and feasible, demonstrating a reduction in the total number of complications and ArAR. Trial registration in Clinical Trials: NCT05392634. Trial registration in Clinical Trials: NCT05392634.

An evaluation of antimicrobial prophylaxis for transrectal prostate biopsies: A potential stewardship target

Transrectal prostate biopsy (TRPB) is a common procedure used to obtain a prostate biopsy. Although generally safe, complications may occur including infection. Preprocedural antimicrobial prophylaxis is recommended to minimize risk of subsequent infection. This study is a retrospective chart review via the computerized patient record system from January 1, 2018 to February 28, 2022. The study included patients who underwent a TRPB at the Western New York, Syracuse, or Albany Stratton Veterans Affairs Healthcare Systems. This study included a total of 932 patients who underwent TRPB. Postoperative infection occurred in 3.2% (n=30) of patients within 14days of the TRPB. Of the 30 patients who developed an infection, 30% (n=9) resulted in bacteremia. For the 932 patients evaluated, 24 different antibiotic regimens were used, none of which followed guideline recommendations. None of the regimens were found to have an impact on rates of subsequent infection. The results of this study suggest a need for guideline adherence. There was no benefit to using the guideline-discordant regimens as they were not associated with a decreased risk of infection, and in many cases exposed patients to unnecessarily broad and prolonged antibiotic regimens.

Prolonged Antibiotic Use in Gulf War Chronic Multisymptom Illness Induces Renal Fibrosis-Like Pathology Associated with microRNA-21-Mediated PTEN Inhibition

Gulf War veterans afflicted with chronic multisymptom Illness (GWI) often experience unexplained, debilitating symptoms, including microbiome dysbiosis, gastrointestinal and neuroinflammation. Prolonged antibiotic treatments, especially of fluoroquinolone class are commonly employed in these veterans, raising concerns about their potential side effects. To date, no studies have investigated the effects of Gulf War (GW) chemicals- Pyridostigmine bromide (PB) and insecticide, permethrin exposures on renal dysfunction in the veterans. Therefore, this study aimed to investigate the impact of prolonged antibiotic exposure on renal pathology in GWI and to elucidate the underlying molecular mechanisms leading to renal dysfunction. In this study, we used a persistent Gulf War Illness (GWI) mouse model to study the combined effect of prolonged antibiotic regimen involving Neomycin and Enrofloxacin treatment for 5 months (20 weeks). Our results showed that prolonged antibiotic treatment exacerbated renal inflammation leading to elevated levels of pro- inflammatory cytokines and significant activation of NF-κB signaling over Gulf war chemicals treated (GWI) mice (GWI). Further, we hypothesized the involvement of HMGB1 mediated RAGE activation leading to the inflammatory phenotype in the kidneys of GWI+ AB mice. We observed that prolonged antibiotic exposure in GWI- induced mice led to significant increased HMGB1-mediated RAGE activation compared to GWI mice, which was associated with increased TGF-β production in GWI+ AB mice. Furthermore, miR-21, whose expression is reported to be regulated by TGF-β is widely linked to renal fibrosis, was also significantly upregulated in antibiotic-treated GWI-induced mice. This upregulation was associated with decreased PTEN expression, a direct target of miR-21 in GWI+ AB mice over GWI- mice, resulting in the activation of the AKT signaling pathway and increased extracellular matrix (ECM) deposition in GWI+ AB mice. Furthermore, we examined the involvement of AKT signaling activation in the induction of Epithelial-Mesenchymal Transition (EMT) by assessing the immunoreactivity of α-SMA. The renal tissue of GWI+AB mice exhibited an elevated immunoreactivity of α-SMA, suggesting that the cells were undergoing transition from an epithelial to a mesenchymal state. In contrast, GWI- mice displayed no significant expression of α-SMA or increased fibronectin deposition, indicating that exposure to Gulf War chemicals alone was insuffcient to induce renal fibrosis-like pathology. These findings highlight the complex interplay between GWI, antibiotics, and renal pathology, emphasizing that prolonged antibiotic treatment in Gulf War Chronic Multisymptom Illness leads to renal fibrosis like- pathology by activating TGF- β dependent miR-21/ PTEN/ AKT signaling. This study was supported by VA Merit Award I01CX001923-01 awarded to Dr. Saurabh Chatterjee. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The Silent Invader: A Case Report of Pulmonary and Cerebral Nocardiosis by Nocardia cyriacigeorgica in a Renal Transplant Recipient

Nocardia species primarily affect the lungs of immunocompromised individuals. The clinical presentation may mimic pulmonary tuberculosis. Accurate identification and high clinical suspicion are crucial for correct diagnosis and treatment, especially in tuberculosisendemic regions. A prolonged antibiotic regimen with two or more drugs is needed, and non adherence to the treatment protocol can lead to potentially fatal outcomes. A 37-year-old man with systemic hypertension and chronic kidney disease, who also underwent live-related renal transplantation, presented with fever, cough, and weight loss. No other significant complaints were noted. Physical examination revealed elevated body temperature and bilateral basal crepitations. Baseline investigations showed anaemia, leukopenia and elevated renal parameters. A chest X-ray indicated right lower zone opacity. A provisional diagnosis of pulmonary tuberculosis or mycosis was considered. Video bronchoscopy revealed thick mucoid secretions that were collected for staining, culture, and sensitivity testing. Gram stain and modified Acid-Fast Bacilli (AFB) stain showed microscopic features suggestive of Nocardia species, while the colonies that grew on culture were identified as N. cyriacigeorgica. Treatment was initiated with oral cotrimoxazole and intravenous imipenem. After 14 days, he was discharged with a continuation plan but did not adhere to the regimen. The patient eventually presented again 10 days later with seizures and altered sensorium, leading to a diagnosis of cerebral nocardiosis. Despite treatment, he progressed to septic shock and died. Effective treatment of nocardiosis requires a multidrug regimen, typically consisting of cotrimoxazole, amikacin, or imipenem, tailored to the severity of the infection. Early diagnosis, prompt treatment, and strict adherence to protocols are mandatory for successful treatment, as delays or non compliance can lead to fatal outcomes.

Prolonged Antibiotic Use in a Preclinical Model of Gulf War Chronic Multisymptom-Illness Causes Renal Fibrosis-like Pathology via Increased micro-RNA 21-Induced PTEN Inhibition That Is Correlated with Low Host Lachnospiraceae Abundance.

Gulf War (GW) veterans show gastrointestinal disturbances and gut dysbiosis. Prolonged antibiotic treatments commonly employed in veterans, especially the use of fluoroquinolones and aminoglycosides, have also been associated with dysbiosis. This study investigates the effect of prolonged antibiotic exposure on risks of adverse renal pathology and its association with gut bacterial species abundance in underlying GWI and aims to uncover the molecular mechanisms leading to possible renal dysfunction with aging. Using a GWI mouse model, administration of a prolonged antibiotic regimen involving neomycin and enrofloxacin treatment for 5 months showed an exacerbated renal inflammation with increased NF-κB activation and pro-inflammatory cytokines levels. Involvement of the high mobility group 1 (HMGB1)-mediated receptor for advanced glycation end products (RAGE) activation triggered an inflammatory phenotype and increased transforming growth factor-β (TGF-β) production. Mechanistically, TGF-β- induced microRNA-21 upregulation in the renal tissue leads to decreased phosphatase and tensin homolog (PTEN) expression. The above event led to the activation of protein kinase-B (AKT) signaling, resulting in increased fibronectin production and fibrosis-like pathology. Importantly, the increased miR-21 was associated with low levels of Lachnospiraceae in the host gut which is also a key to heightened HMGB1-mediated inflammation. Overall, though correlative, the study highlights the complex interplay between GWI, host gut dysbiosis, prolonged antibiotics usage, and renal pathology via miR-21/PTEN/AKT signaling.

Evaluating the efficacy of single-shot versus prolonged antibiotic prophylaxis in alveolar cleft osteoplasty – A retrospective cohort study

This retrospective cohort study aimed to compare the outcomes of alveolar cleft osteoplasty using single-shot antibiotic prophylaxis versus a prolonged antibiotic regimen. The primary endpoints assessed were the incidence of infection, failure of surgical correction, and antibiotic-related side effects. Patients with orofacial clefts affecting the alveolar ridge who underwent alveolar cleft osteoplasty at a tertiary care center between 2015 and 2021 were included. The prolonged antibiotic group received extended antibiotic treatment, while the single-shot group received preoperative antibiotics only. Among 83 patients (mean age 12.8 years), 51 interventions were performed under prolonged antibiotic prophylaxis (mean duration 5.82 days) whereas in 40 interventions only single-shot prophylaxis was administered. There were no significant differences in infection frequency, surgical correction failure, implant loss, or adverse events between the groups. However, after single-shot antibiotic regimen, patients had significantly shorter hospital stays, being discharged on average one day earlier. The study suggests that single-shot antibiotic prophylaxis does not have drawbacks compared to prolonged antibiotic treatment in alveolar cleft osteoplasty. Considering increasing antibiotic resistance and potential side effects, omitting prolonged antibiotic prophylaxis is recommended for patients undergoing alveolar cleft osteoplasty.

The Efficacy of Fosfomycin as Antibiotic Prophylaxis for Transrectal Prostate Biopsy and Impact on Lower Urinary Tract Symptom After Biopsy: A Prospective Study.

Due to fluoroquinolone resistances worldwide, valid alternatives for anti- biotic prophylaxis for transrectal ultrasound-guided prostate biopsy are needed, thus, we aimed to evaluate the efficacy, safety, and tolerability of prophylactic fosfomycin versus other oral prolonged antibiotic regimens, in preventing complications after transrectal ultrasound-guided prostate biopsy. In this prospective study, patients submitted to transrectal ultrasound- guided prostate biopsy were divided into 2 groups according to the prophylactic antibiotic scheme performed: "short" (2 fosfomycin doses) versus "long" (antibiotic ≥ 8 days). One week and 1 month after transrectal ultrasound-guided prostate biopsy, we assessed complications' occurrence (lower urinary tract symptoms, fever, sepsis, hemorrhage) and adverse drug reactions. We included 244 patients (fosfomycin n=178, "long" antibiotic n=66). The only significant difference between groups was higher lower urinary tract symptom incidence 1 month after transrectal ultrasound-guided prostate biopsy in fosfomy- cin patients (16.85% vs. 6.06%, P=.031). However, after 1 week, lower urinary tract symptoms were tendentially frequenter on "long" antibiotic group (31.81% vs. 25.84%, P = .059). Infectious and hemorrhagic complications rate, adverse drug reactions, and recurrence to health services were similar between groups, and significantly decreased between the first week and first month. Antibiotic prophylaxis seems to impact lower urinary tract symptoms after transrectal ultrasound-guided prostate biopsy. Fosfomycin may provide slightly better outcome on the immediate period, while "long" antibiotic courses lead to significantly less lower urinary tract symptoms 1 month post-transrectal ultrasound-guided pros- tate biopsy, perhaps by preventing incipient prostatitis phenomena. Future directed studies should clarify these findings. Still, it seems feasible to ally fosfomycin advan- tages with noninferior safety, efficacy, and tolerability, allowing to reserve "long" regimens to other contexts. This is especially relevant in centers where transperineal biopsies are still not possible.

Treatment of intractable cholangitis in children with biliary atresia: Impact on outcome.

To evaluate the response and outcome with prolonged intravenous antibiotics including home-based intravenous antibiotics in children with intractable cholangitis (IC) after Kasai portoenterostomy (KPE) for biliary atresia (BA). A retrospective review of treatment and outcome of children with IC post KPE (no resolution after fourweeks of antibiotics) was donebetween 2014 and 2020. A protocol-based antibiotic regimen was used based on sensitivity and hospital antibiogram. Children afebrile for more than threedays were discharged on home intravenous antibiotics (HIVA). Twenty children with IC were managed with prolonged antibiotic regimen, including HIVA. All patients were initially listed for liver transplantation (LT) with indication being IC (n = 20) with portal hypertension (n = 12). Seven patients had bile lakes of which four underwent percutaneous transhepatic biliary drainage. Bile culture grew Klebsiella in four and Escherichia coli and Pseudomonas one each. There were eight children with IC who had positive blood culture with most of these organisms being gram-negative (Escherichia coli: 5, Klebsiella pneumoniae: 2, Enterococcus: 1). Median duration of antibiotics was 58days (interquartile range [IQR] 56-84). Median follow-up period post cholangitis was threeyears (IQR 2-4). Following treatment, 14 patients were successfully delisted from LT waitlist and are presently jaundice-free. Two of the five patients undergoing LT died of sepsis. One patient died awaiting LT. Timely and aggressive step-up antibiotic regimen may successfully treat IC and prevent/delay LT. HIVA provides a cost-effective and comfortable environment for a child which might improve compliance with intravenous antibiotics.

Antibiotic Prophylaxis in Alloplastic Breast Reconstruction: Regimens and Outcomes.

Surgical site infections (SSI) in prosthesis-based breast reconstruction can have a significant impact on patient outcome. Despite current CDC (Centers for Disease Control and Prevention) guidelines recommending 24 hours of postoperative antibiotics, various perioperative antimicrobial regimens are reported in the literature. Consensus on the optimal duration of antibiotics remains unclear. In this study, the aim is to compare the incidence of surgical site infections following different antibiotic durations in alloplastic breast reconstruction. In this retrospective cohort study, all consecutive patients who underwent expander/implant-based breast reconstruction between January 2009 and December 2014 at a tertiary centre were included. Data on patient demographics, risk factors, operative time, choice and timing of antibiotic used before surgery, and the duration of postoperative antibiotic use were collected. The primary outcome, SSI, is defined according to CDC criteria. A total of 507 consecutive expander/implant-based cases were included. Minimum follow-up time was 1 year. The overall infection incidence was 14% (95% CI: 11%-17%), and the rate of subsequent explantation was 8%. Of the infected cases, 80% (45/56) received 1 week of postoperative antibiotic, while 20% (11/56) had a prolonged course of antibiotics (2-3 weeks; P = .003, odds ratio [OR] = 2.9; 95% CI: 1.4-5.8). Most infections were superficial (65%). Prior history of radiation treatment was identified as a risk factor for developing surgical site infection (P = .02). Overall infection rate and risk factors for infections are in keeping with current literature. Prescribing one week of postoperative antibiotic was found to be associated with a higher incidence of SSI compared to a more prolonged antibiotic regimen.

What Are the Effects of Irreversible Electroporation on a Staphylococcus aureus Rabbit Model of Osteomyelitis?

The treatment of osteomyelitis can be challenging because of poor antibiotic penetration into the infected bone and toxicities associated with prolonged antibiotic regimens to control infection. Irreversible electroporation (IRE), a percutaneous image-guided ablation technology in which the targeted delivery of high-voltage electrical pulses permanently damages the cell membrane, has been shown to effectively control bacterial growth in various settings. However, IRE for the management of bone infections has yet to be evaluated. We aimed to evaluate IRE for treating osteomyelitis by assessing (1) the efficacy of IRE to suppress the in vitro growth of a clinical isolate of S. aureus, alone or combined with cefazolin; and (2) the effects of IRE on the in vivo treatment of a rabbit model of osteomyelitis. S. aureus strain UAMS-1 expanded in vitro to the log phase was subjected to an electric field of 2700 V/cm, which was delivered in increasing numbers of pulses. Immediately after electroporation, bacteria were plated on agar plates with or without cefazolin. The number of colony-forming units (CFUs) was scored the following day. ANOVA tests were used to analyze in vitro data. In a rabbit osteomyelitis model, we inoculated the same bacterial strain into the radius of adult male New Zealand White rabbits. Three weeks after inoculation, all animals (n = 32) underwent irrigation and débridement, as well as wound culture of the infected forelimb. Then, they were randomly assigned to one of four treatment groups (n = eight per group): untreated control, cefazolin only, IRE only, or combined IRE + cefazolin. Serial radiography was performed to assess disease progression using a semiquantitative grading scale. Bone and soft-tissue specimens from the infected and contralateral forelimbs were collected at 4 weeks after treatment for bacterial isolation and histologic assessment using a semiquantitative scale. The in vitro growth of S. aureus UAMS-1 was impaired by IRE in a pulse-dependent fashion; the number of CFUs/mL was different among seven pulse levels, namely 0, 10, 30, 60, 90, 120, and 150 pulses. With the number of CFUs/mL observed in untreated controls set as 100%, 10 pulses rendered a median of 50.2% (range 47.1% to 58.2%), 30 pulses rendered a median of 2.7% (range 2.5% to 2.8%), 60 pulses rendered a median of 0.014% (range 0.012% to 0.015%), 90 pulses rendered a median of 0.004% (range 0.002% to 0.004%), 120 pulses rendered a median of 0.001% (range 0.001% to 0.001%), and 150 pulses rendered a median of 0.001% (range 0.000% to 0.001%) (Kruskal-Wallis test: p = 0.003). There was an interaction between the effect of the number of pulses and the concentration of cefazolin (two-way ANOVA: F [8, 30] = 17.24; p < 0.001), indicating that combining IRE with cefazolin is more effective than either treatment alone at suppressing the growth of S. aureus UAMS-1. Likewise, the clinical response in the rabbit model (the percentage of animals without detectable residual bacteria in the bone and surrounding soft tissue after treatment) was better in the combination group than in the other groups: control, 12.5% (one of eight animals); IRE only, 12.5% (one of eight animals); cefazolin only, 25% (two of eight animals); and IRE + cefazolin, 75% (six of eight animals) (two-sided Fisher's exact test: p = 0.030). IRE effectively suppressed the growth of S. aureus UAMS-1 and enhanced the antibacterial effect of cefazolin in in vitro studies. When translated to a rabbit osteomyelitis model, the addition of IRE to conventional parenteral antibiotic treatment produced the strongest response, which supports the in vitro findings. Our results show that IRE may improve the results of standard parenteral antibiotic treatment, thus setting the stage for models with larger animals and perhaps trials in humans for validation.

A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery.

Especially in oral and maxillofacial surgery, where procedures involving the aero-digestive tract considered clean contaminated, surgical site infections (SSI) represent a severe health care burden. To improve implementation and methodological standard, an upgrade of the existing S1 guideline to a consensus-guided S3 guideline was initiated by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF, register number 067/009) and 25 collaborating medical societies. A systematic literature search based on the Scottish Intercollegiate GL Network (SIGN)-search string for the guideline "Antibiotic prophylaxis in surgery" from 2014 was performed and equivalent exclusion/inclusion criteria were applied. An additional hand search provided latest evidence. In total, 80 clinical trials, retrospective studies, reviews, and meta-analysis were analyzed. For orthognathic surgery, prolonged antibiotic regimen may reduce risk for SSI but there is lack of evidence for the effects of short- vs. long-term therapy. For maxillofacial traumatology, antibiotic prophylaxis might reduce SSI but prolonged postoperative dosing shows no benefit. For clean-contaminated oncological interventions, anti-infectious therapy for 24h only can reduce SSI; patients may not benefit from prolonged regimen. In contrast, for dentoalveolar procedures such as implantology or third molar removal, literature reveals ambivalent results. In summary, consensus process of the planned S3 guideline is much in need to transfer the indecisive results for antibiotic prophylaxis in dentoalveolar surgery in clinical praxis and encourage adherence to guidelines.

Trends in misoprostol use and abortion complications: A cross-sectional study from nine referral hospitals in Nigeria.

ObjectiveThe study aimed to assess the use of misoprostol and complications associated with abortions in referral hospitals in Nigeria, a country with restrictive abortion laws.MethodsA cross-sectional study at nine referral hospitals in South-west Nigeria. Nine years’ data were retrieved from medical records, including 699 induced abortions. Independent variable was the method of abortion; dependent variables were complications, need for treatment and mortality. Statistical significance was tested with Chi-square, Fishers’ exact and chi-square for trend tests (p<0.05).ResultsThere were 699 induced abortions amongst 2,463 abortions found in records. Nearly 70% were surgical abortions, but misoprostol use significantly increased over the study period in a linear trend (Χ2 trend: 30.96, P <0.001). Patients who used misoprostol were significantly less likely to have infectious morbidity, genital tract injuries or medical complications. There was no difference in incomplete abortion in the groups. Patients were more likely to have in-patient care with surgical abortions (p<0.001), to need prolonged antibiotic regimens (p = 0.003), need further surgeries or additional specialist care (p = 0.009).ConclusionMisoprostol abortion has significantly increased over time, and was associated with less morbidity and need for further treatment, in this study. It appears to be the safer option.

Culturomics: bacterial species isolated in 3 healthy donors for faecal microbiota transplantation in Clostridium difficile infection

&lt;em&gt;Background&lt;/em&gt;. &lt;em&gt;Clostridium difficile&lt;/em&gt; infections are the main cause of nosocomial acquired diarrhea, because of prolonged antibiotic regimens. In the last years, mortality has increased due to recurrent infections caused by metronidazole and vancomicin resistant hypervirulent &lt;em&gt;C. difficile&lt;/em&gt; strain 027. Faecal Microbiota Transplantation (FMT) is an infusion of faecal material obtained from healthy donors. This procedure reduces mortality in recurrent&lt;em&gt; C. difficile&lt;/em&gt; infections (CDI). In this study we identified bacterial species obtained from donors’ stool samples using culturomics. &lt;br /&gt;&lt;em&gt;Materials and methods&lt;/em&gt;. Three donors were selected for FMT in three recipients affected by CDI. Faces obtained for FMT underwent culturomics, applying 17 different culture methods. &lt;br /&gt;&lt;em&gt;Results and conclusions.&lt;/em&gt; Several different bacteria were isolated from donors. In two donors 4 potentially pathogenic bacteria were isolated; this suggests the use of culturomics for donors’ screening or for selection of bacteria to infuse.

A Retrospective Review of the Clinical Experience of Linezolid with or Without Rifampicin in Prosthetic Joint Infections Treated with Debridement and Implant Retention.

IntroductionDebridement and prosthesis retention, combined with a prolonged antibiotic regimen including rifampicin, is an accepted therapeutic approach when the duration of symptoms is less than 4 weeks and there are no radiological signs of loosening. The outcome of patients managed with this strategy has been previously assessed in several articles with success rates of 60–90%. This study aims to review the clinical experience with linezolid in 3 different hospitals from Spain and France in patients with prosthetic joint infection (PJI) managed with debridement, retention of the implant and treated with linezolid with or without rifampicin.MethodsPatients with an acute PJI who underwent open debridement with implant retention treated with linezolid for more than 7 days in 3 hospitals from Barcelona, Tours and Lille between 2005 and 2011 were retrospectively reviewed. Relevant information about demographics, co-morbidity, type of implant, surgical treatment, microorganism isolated, antimicrobial therapy, adverse events (AEs) and outcomes were recorded from patients.ResultsA total of 39 patients were retrospectively reviewed. The mean age (SD) was 70.5 (8.8) years and 9 patients had diabetes mellitus (23%). There were 25 (64%) knee prostheses, 13 (33%) hips and 1 shoulder (3%). The median interquartile range (IQR) days from arthroplasty to infection diagnosis was 17 (19–48) and 33 (85%) cases were diagnosed within the first 60 days. The median (IQR) duration of antibiotic treatment was 70.5 (34–96) days and the median (IQR) number of days on linezolid treatment was 44.5 (30–81). AEs were observed in 15 patients (38%), with gastrointestinal complaints in 8 cases and anemia in 5 being the most frequent. After a median (IQR) follow-up of 2.5 (1.8–3.6) years, there were 11 failures (28%) (8 relapses and 3 new infections). The failure rate was higher in the rifampicin group (36% vs. 18%) mainly due to a higher relapse rate (27% vs. 12%) although differences were not statistically significant.ConclusionManagement of acute PJIs with debridement and retention of the implant linezolid, with or without rifampicin, is associated with a high remission rate and it is an alternative treatment for infections due to fluoroquinolone and/or rifampicin-resistant staphylococci.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-014-0032-z) contains supplementary material, which is available to authorized users.

G196(P) Residual Small Bowel Length Predicts Raised D-Lactate When Screening For Bacterial Overgrowth in Children with Intestinal Failure

AimsSmall bowel bacterial overgrowth (SBBO) may cause non specific symptoms in children with intestinal failure (parenteral nutrition (PN) >28days). Rapid detection of raised serum D-lactate (DL) may be a clinically...

One-step tunneling of DBS extensions—a technical note

Infection constitutes a serious adverse event in deep brain stimulation (DBS) surgery, being responsible for difficult therapeutic decisions that may ultimately involve the removal of implanted material. Some cases begin with skin erosion and wound dehiscence of the retroauricular incision, which is one of the most fragile points. Several techniques of rotation flaps and skin reconstruction, as well as prolonged antibiotic regimens, have been proposed as therapeutic options. To prevent the onset of this complication, the authors propose a one-step tunneling technique of DBS extensions, avoiding the opening of the retroauricular space. We describe a surgical technique of a one-step tunneling of DBS extensions in 20 patients submitted to subthalamic DBS for Parkinson's disease, avoiding the opening of the retroauricular space. After implantation of the extensions using this technique, we had no erosions of the retroauricular skin, with a consequent reduction in the number of infections. The authors describe an easy surgical technique that allows reduction of wound and erosion complications, with great benefits for DBS patients.

ELECTIVE CAESAREAN SECTION

Objective: To compare short antibiotic prophylaxis versus prolonged antibiotic regime in terms of morbidity control of infection in patients undergoing elective caesarean section. Study Design and Settings: It was a experimental study done in Gynae/Obs unit I Holy Family Hospital Rawalpindi over a period of one year. Patients and Methods: Total of 200 patients selected randomly were admitted in antenatal ward for elective caesarean section. All these booked patients with age less then 40 years, gestational age of &gt; 38 weeks, Hb &gt;10g/dl, with no signs of genitourinary or respiratory tract infection were included in the study. These patients were divided in two groups with 100 patients in each group. In group I, short antibiotic prophylaxis in form of three doses of injectable antibiotic was given. In group II prolonged antibiotic regime wasgiven as 5 days course. Augmentin was chosen as it has proven efficacy and good coverage for microorganisms of urogential tract and skin. Injection Augmentin was given in dose of 1.2g (1g Amoxycillin + 200mg clavulanic acid) I/V x BD. All operation were performed by transverse lower segment caesarean section by registrars and consultants. Anaesthesia used was mostly spinal and more than 80% of the patients were having body mass index of &lt;30. These patients were followed in postnatal ward for post operative infectious morbidity till discharge. Data collected through proformas was entered in computer and analyzed using SPSS. Result: Over all post operative infectious morbidity in group I was 29% and in group II 30% (p = 0.877). Post operative fever in group I was 09% and group II 08% (p = 0.800), while frequency of endometritiswas found to be same in both groups which was 03%. No case of chest infection was recorded in both groups. Only 5% patients in group I and 4% patients in group II were reported to have urinary tract infection (p = 0.733). The most common complication found during study was wound infection, the rate being 12% in group I and 15% in group II (p = 0.535). So the overall results showed no statistically significant differencebetween two groups. Conclusion: Short antibiotic prophylaxis is as effective as prolonged antibiotic regimen. As it is cost effective and most of our patients come from low socio economic class, so this short antibiotic prophylaxis should be recommended routinely for all elective caesarean sections.

PROPIONIBACTERIUM ACNES ENDOCARDITIS IN AN ADOLESCENT BOY SUFFERING FROM A CONGENITAL CARDIOPATHY

Propionibacterium acnes endocarditis is an uncommon infection in pediatrics. We describe a case of P. acnes endocarditis in a 16-year-old boy that occurred 6 months after recurrent surgery for a congenital cardiopathy. Molecular identification of P. acnes was obtained. He recovered from this infection after a surgical treatment and with a prolonged antibiotic regimen including ceftriaxone.

Photoinactivation of Mycobacteria In Vitro and in a New Murine Model of LocalizedMycobacterium bovisBCG-Induced Granulomatous Infection

Treatment of tuberculosis is currently hindered by prolonged antibiotic regimens and the emergence of significant drug resistance. Alternatives and adjuncts to standard antimycobacterial agents are needed. We propose that a direct attack utilizing photosensitizers and light-based treatments may be effective in curtailing Mycobacterium tuberculosis in discrete anatomical sites in the most infectious phase of pulmonary tuberculosis. To demonstrate experimental proof of principle, we have applied established photodynamic therapy (PDT) technology to in vitro cultures and an in vivo mouse model using Mycobacterium bovis BCG. We report here in vitro and in vivo PDT efficacy studies and the use of a three-dimensional collagen gel as a delivery vehicle for BCG, subcutaneously inserted, to induce specifically localized granuloma-like lesions in mice. When a benzoporphyrin derivative was utilized as the photosensitive agent, exposure to light killed extracellular and intracellular BCG in significant numbers. Collagen scaffolds containing BCG inserted in situ in BALB/c mice for 3 months mimicked granulomatous lesions and demonstrated a marked cellular infiltration upon histological examination, with evidence of caseating necrosis and fibrous capsule formation. When 10(5) BCG were present in the in vivo-induced granulomas, a significant reduction in viable mycobacterial cells was demonstrated in PDT-treated granulomas compared to those of controls. We conclude that PDT has potential in the treatment of localized mycobacterial infections, such as pulmonary granulomas and cavities.