Pus Culture Research Articles

Chronic non-healing perianal ulcer as presenting sign of acquired immunodeficiency syndrome

A male in his forties presented with painful, persistent, nonhealing ulcers in the buttocks for two months with history of inadvertent weight loss and loss of appetite. History of highrisk sexual behavior including anal intercourse was present. On examination, the patient appeared cachexic with a body mass index of 15kg/m2. A shallow, tender, non-indurated, perianal ulcer of size around 10 x 7cm, with irregular margins, unhealthy granulation tissue and slough was noted. Multiple, skin-colored, umbillicated papules were also noted in bilateral buttocks (Figure 1). Multiple, non-tender, non-matted, inguinal lymph nodes were present bilaterally. A provisional diagnosis of chronic non-healing ulcer secondary to Herpes Simplex Virus with Molluscum contagiosum was considered. During workup, ELISA revealed antibodies to HIV-1 and was confirmed by Western blot test. His CD4 counts were 6.4% with absolute CD4 count of 113/µL. Blood culture revealed methicillin resistant coagulase negative staphylococci and pus culture reported growth of Enterobacter. His routine baseline investigations were normal. Rapid plasma reagin (RPR) test for syphilis and serology for hepatitis B and C virus were negative. The patient was started on tablet acyclovir 400mg thrice daily for 7 days and tablet linezolid 600 mg twice daily for 14 days along with topical antibiotic cream. The patient was then referred to the antiretroviral therapy (ART) centre. At 2 weeks’ follow-up, the ulcer showed complete re-epithelialization

Chronic non-healing perianal ulcer as presenting sign of acquired immunodeficiency syndrome

A male in his forties presented with painful, persistent, nonhealing ulcers in the buttocks for two months with history of inadvertent weight loss and loss of appetite. History of highrisk sexual behavior including anal intercourse was present. On examination, the patient appeared cachexic with a body mass index of 15kg/m2. A shallow, tender, non-indurated, perianal ulcer of size around 10 x 7cm, with irregular margins, unhealthy granulation tissue and slough was noted. Multiple, skin-colored, umbillicated papules were also noted in bilateral buttocks (Figure 1). Multiple, non-tender, non-matted, inguinal lymph nodes were present bilaterally. A provisional diagnosis of chronic non-healing ulcer secondary to Herpes Simplex Virus with Molluscum contagiosum was considered. During workup, ELISA revealed antibodies to HIV-1 and was confirmed by Western blot test. His CD4 counts were 6.4% with absolute CD4 count of 113/µL. Blood culture revealed methicillin resistant coagulase negative staphylococci and pus culture reported growth of Enterobacter. His routine baseline investigations were normal. Rapid plasma reagin (RPR) test for syphilis and serology for hepatitis B and C virus were negative. The patient was started on tablet acyclovir 400mg thrice daily for 7 days and tablet linezolid 600 mg twice daily for 14 days along with topical antibiotic cream. The patient was then referred to the antiretroviral therapy (ART) centre. At 2 weeks’ follow-up, the ulcer showed complete re-epithelialization

Microbial Flora and Their Antibiotic Susceptibility in Oral and Maxillofacial Infections at BPKIHS: A Prospective Observational Study

Background: We aimed to find out the causative bacteria involved in oral and maxillofacial infections, and to evaluate the antibiotic susceptibility by pus culture and sensitivity test. Methods: This prospective observational study conducted over a one- year period enrolled all 41 consecutive patients with features of oral and maxillofacial infections visiting the oral and maxillofacial surgery clinic at the university hospital of B. P. Koirala Institute of Health Sciences. Pus was collected on a sterile syringe and sent to the microbiology laboratory. Pus samples were inoculated in 5% sheep blood agar and MacConkey agar and incubated at 37°C for 48 hours. Identification of the bacterial colony was done by gram staining and different biochemical tests. Antibiotic susceptibility tests were done by disc diffusion method on Mueller-Hinton agar as per CLSI guidelines. Results: Out of 41 patients, 22 were male and 19 were female patients. The average age of the patients was 41.63 years. Odontogenic infection (17, 41.46%) was found to be the most common. Submandibular space (15, 36.59%) was the most common fascial space involved. The most common organism cultured was Enterococcus faecalis (13, 31.71%). The antibiotic susceptibility pattern of the isolates showed that 50% of the cultured organisms (n = 8) were resistant to Penicillin; five of them were Enterococcus faecalis and three were Staphylococcus aureus. Conclusion: We found that Enterococcus faecalis as the common organism causing oral and maxillofacial infections with high resistance to Penicillin.

A case of Cervical Cold Abscess Refractory to Empirical Anti-Tubercular Therapy due to Mycobacterium Fortuitum: Awareness on Non-Tuberculous Mycobacteria (NTM) Infection!

A third-year medical student, 19 years, had multiple cold abscess at left posterior triangle with systemic symptoms- poor appetite and weight loss. Histopathology was consistent with tuberculous lymphadenopathy as it showed Langham’s giant cells and caseation necrosis. Both systemic symptoms and local lesions were refractory to empirical treatment for tuberculosis standard anti-tubercular therapy: isoniazid, rifampicin, ethambutol and pyrazinamide. Pus for Gene Xpart was negative. Pus culture showed non-tuberculous mycobacteria (NTM); Mycobacterium fortuitum.

Black‐brown hairy tongue: An unusual adverse effect of linezolid

AbstractLinezolid‐induced black hairy tongue (BHT) is an uncommon side effect. We present a case of linezolid induced BHT and evaluate relevant literature from the home and worldwide. Its goal is to offer a secure and appropriate foundation for clinical drug usage. A 23‐year‐old male with recurrent boil infection erroneously reported by gram‐positive methicillin‐resistant Staphylococcus aureus (MRSA) by pus culture, which was misdiagnosed by a small clinic (diagnostic center) in a rural region of Bangladesh where he had previously been treated for that reoccurring boil infection. The patient was actually suffering from a different pus‐forming bacteria (Klebsiella), a gram‐negative bacterium that was just found after careful C/S report. Linezolid was administered to the patient 600 mg q12h orally in tablet after discharge from that rural clinic. On the 14th day following oral treatment, the patient presented to the hospital with BHT but no other atypical taste complaints. However, all symptoms were tolerable, and he finished the linezolid treatment period. After withdrawing from the medicine, all tongue symptoms vanished. Following a thorough study, it was determined that this patient had BHT brought on by drug linezolid. Long‐term linezolid usage is associated with neuropathies and bone marrow suppression. There is, however, little information about an uncommon adverse effect, black hairy tongue. We present here a case of linezolid induced BHT in a patient who was misdiagnosed. Also covered are the etiology, pathophysiology, diagnosis, and management of black hairy tongue.

Clinico-epidemiological evaluation of chronic folliculitis of leg- A single study from southern India

This study was conducted to determine the clinico-epidemiological evaluation of chronic folliculitis of the leg in the southern Indian population. This was a prospective observational study, undertaken over a period of two years. All patients attending the outpatient department Southern Indian tertiary care hospital's Dermatology Department (M.K.C.G.Medical College & Hospital, Odisha) were recruited. A total of 100 patients were enrolled, aged between 12 to 70 years with a M: F ratio of 10.1: 1. Eighty per cent of the population in the study were rural, and 20% belonged to the urban area. Clinical characteristics and demographic data of the patients were collected in a pre-designed proforma. Those patients who had pustules on the leg underwent pus culture and sensitivity test. Majority of the patients presented with papules and pustules (96%cases) and bilateral symmetrical leg involvement (98% cases). Pruritus was the most common clinical presentation ( 90% cases). Staphylococcus was isolated in the majority of cases (80%) and was sensitive to Amikacin (73%), Linezolid (70%), vancomycin (68%), and Gentamycin (65%). Chronic folliculitis of the leg is mainly a disease of young adult males of low socioeconomic status. Avoiding aggravating factors and cautious use of sensitive antibiotics may achieve treatment goals and decrease recurrence.

P488 Successful treatment of breakthrough invasive aspergillosis in an immunocompetent individual based on therapeutic drug monitoring: A case report

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMBackground: Invasive aspergillosis (IA) is an opportunistic fungal infection in immunocompromised patients with high mortality. Aspergillus flavus is the second pathogen of IA. Breakthrough IA was defined as any IA occurring during exposure to an antifungal drug.Case presentation: A 22-year-old female college student was admitted severely unwell with dizziness and left limb weakness. She was healthy previously and did not take any medication. Magnetic resonance imaging showed a right intracranial space-occupying lesion. The postoperative pathological and morphological examinations suggested Aspergillus flavus. The anti-fungal medication, voriconazole, was administered immediately. Unfortunately, her condition deteriorated, and she experienced coma after about 1 month of antifungal treatment. The emergency craniotomy revealed a large amount of pus and the culture of pus confirmed Aspergillus flavus. Antifungal regimen was developed by infectious disease specialists, and drug concentration was monitored continuously. This patient received antifungal treatment for 2 years. No recurrence was observed after 6 months of antifungal drug withdrawal, and she can take care of herself.See Figures below.ConclusionBreakthrough IA occurs in patients who lack high risk factors, making diagnosis more difficult and leading to a higher risk of mortality. Therapeutic drug monitoring is crucial for therapeutic success. Meanwhile, multidisciplinary therapeutics can improve the survival rate.

P187 Paratracheal abscess by plant fungus Chondrostereum purpureum. First case report of human infection

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectiveTo identify the etiological agent of paratracheal abscess applying molecular techniques.MethodsA 61-year-old male, plant Mycologist, who specially works with mushrooms presented to the OPD with hoarseness of voice and difficulty in swallowing for the last 3 months. CT scan demonstrated the presence of a right paratracheal abscess. CT-guided aspiration of the abscess was performed. The pus was sent for microbiological evaluation.ResultsThe pus culture done on Sabouraud dextrose agar grew a creamy pasty colony with buff-colored pigmentation on reverse side (Fig. 1). On LCB mount preparation it was found to be a yeast-like structure with slender hyphae as shown in Fig. 2. The fungus could not be identified phenotypically, so it was sent to the ‘WHO Collaborating Centre for Reference and Research on Fungi of Medical importance’. It was identified as Chondrostereum purpureum by DNA sequencing. Patient was treated with oral voriconazole following drainage of the pus and the outcome was favorable. The patient denied having worked with such a plant pathogen but he confirmed d that he was working with decaying material and other plant fungi for a long time as part of his research activities.ConclusionSilver leaf is a fungal disease of trees caused by the fungus plant pathogen Chondrostereum purpureum. The disease is progressive and often fatal for the plants. It is spread by airborne spores landing on freshly exposed sapwood. No human infection was reported till date. The case report demonstrates the crossover of plant pathogens into humans when working in close contact with plant fungi.

Venous gas caused by emphysematous pyelonephritis: a case report and review of literature

BackgroundEmphysematous pyelonephritis (EPN) is a potentially life-threatening disease caused by a gas-producing necrotizing bacterial infection that involves the renal parenchyma, collecting system, and/or perinephric tissue. EPN is often complicated by a previous diagnosis of diabetes mellitus, and venous air bubbles are an uncommon complication of it. We describe a 52-year-old woman who was admitted in coma, with a history of vomiting, and was found to have EPN with air bubbles in the uterine veins. We discuss the presentation, diagnosis, and pathogenesis of this uncommon but clinically significant event, and briefly review other case reports of venous gas or thrombosis caused by EPN.Case presentationWe report the case of a 52-year-old woman with past history of type 2 diabetes mellitus, presenting with loss of consciousness after vomiting for half a day. Abdominal computed tomography scan revealed unilateral EPN with air bubbles in the uterine veins. The blood, pus, and urine cultures were positive for extended-spectrum beta-lactamase-producing Escherichia coli. The patient’s condition improved well after conservative management comprising supportive measures, broad-spectrum antibiotics, percutaneous drainage therapy, and an open operation.ConclusionsVenous air bubbles are rare but fatal complication of EPN. Early diagnosis and treatment are critical to ensure good results.

Multi Bacterial Infection in Immunocompromised Patient

Infection is a major cause of morbidity and mortality in immunocompromised cancer patients due to chemotherapy, radiotherapy, or anti-inflammatory therapy. Approximately 0.9%-39% of cancer patients with febrile non neutropenia has bacteremia and about 7.3% of cancer patients hospitalized have positive bacterial blood cultures. Multi-bacterial infection with Multi Drug Resistant (MDR) in immunocompromised cancer patients complicates therapy and is often fatal. A 6 years old boy diagnosed with left orbital tumor intracranial infiltration. Physical examination: lump in the left eye ± 8 x 10 cm, solid, reddish in color, there was a wound on the left eye ± 12 x 10 cm; Temperature 390C. Hematology examination Hb 10.3 g / dL; PLT 156 x103 / uL; WBC 28.92 x103 / uL. Blood culture results: Methicillin Resistant Staphylococcus aureus (MRSA) resistant to Gentamicin, Amoxicillin Clavulanic Acid, Ampicillin, Penicillin G, Oxacillin and Enterococcus faecium resistant to Gentamicin, Ampicillin, Cotrimoxazole, Trimetoprim, Erythromycin, and Clindamycin. Results of pus culture from the left eye wound was Staphylococcus intermedius resistant to Gentamicin, Amoxicillin Clavulanic Acid, Ampicillin, Penicillin G, Oxacillin, Chloramphenicol, Ciprofloxacin. Based on the results of blood and pus culture, all bacterial isolates included multidrug-resistant organisms (MDRO). Multidrug resistant organisms are microorganisms, especially bacteria that are resistant to at least 1 antibiotic of three or more categories. Cancer patients are susceptible to infection with multi-drug resistant bacteria because of their decreased immune system, especially after undergoing chemotherapy. Appropriate antibiotic treatment determines patient morbidity and mortality. Infection due to multi-bacteria accompanied by multi-drug resistance in immunocompromised patients is a condition that has to be treated immediately since the onset of the disease to reduce morbidity and mortality.

POS-133 CASE REPORT OF DISSEMINATED KLEBSIELLA INFECTION IN T2DM LEADING TO CKD

K. pneumoniae can present as two forms of community-acquired pneumonia, acute and chronic. Although acute pneumonia may turn into necrotizing pneumonia, which results in a prolonged clinical course, it often has a rapidly progressive clinical course. In contrast, chronic Klebsiella pneumonia runs a protracted indolent course that mimics other chronic pulmonary infections and malignancies. The Klebsiella pneumoniae bacteria usually affects the right upper lung lobe and results in the creation of a cavity, as well as pus-producing tissue death.K. pneumoniae is an aggressive microorganism, accounting for 0.5 to 5% of pneumonia cases. It can lead to cavitation (30-50% of cases) and necrotising pneumonia (NP) within a short period of time (days). Case : 40 year old male with a history of diabetes mellitus (DM) was admitted 20 days back patient was admitted and treated for DKA and LRTI discharged after treatment. Patient readmitted 20 days later with complaints of right sided loin pain, high grade fever of 8 days, cough with expectoration for one month, pyuria for 5 days and anuria for one day. Patient readmitted On admission – P-96/min, BP-140/90 mmhg, RR-26/min, Spo2-96% with O2. On evaluation patient was found to have raised creat (8mg/dl) initiated on hemodialysis. Patient ultrasound showed of left sided bulky kidney with acute pyelonephritis. CXR showed cavitatory lesion in middle lobe of right side lung. 5days Later patient complaint of increased left loin pain repeat USG showed left sided psoas abscess so CT showed no any evidence of communication of pyelonephritis with abscess. Pigtail drain was placed for psoas abscess, culture which was positive for klebsiella. Sputum culture was positive for klebsiella, A diagnosis of dissiminated klebsiella infection was made. In spite of all necessary investigations and treatment patient was dialysis dependent, patient deteriorated over time and could not be saved. Investigations :Tabled 1ParametersValuesHemoglobin9.8 gm/dlTotal leukocyte counts25,500/cummPlatelets2.4 lac/cummUrea104 mg/dlCreatenine4.2 mg/dlSerum Na136 mmol/lSerum K4.5 mmol/lBilirubin1.5 mg/dlSGOT/SGPT45/32Calcium7.6 mg/dlPhosphorus5.8 mg/dlUric acid6.2 mg/dlHbA1c10.5%Urine examinationAlb ++ Sug + Epi cells 1-2/min Pus cells - plenty RBC - 1-2/hpf24 hr urinary protein1.5 gm/day Open table in a new tab Sputum culture & Pus culture – klebsiella Sputum for MTB - negative Fundus – moderate NPDR CXR – Cavitatory lesion in right lung middle zone USG – RK – 12.5*5.9cm, LK – 13.6*6.2cm mod dilation of pelvicalyceal system bilateral bulky kidneys with left acute pyelonephritis. CT abd – left psoas bulky with evidence of 8*2.5 cm well defined hypodense collection within. CT chest – Thick walled cavitatory lesions with surrounding consolidation noted in medial segment of right middle lobe, postero-basal segment of right lower lobe, superior segment of left lower lobe We conclude that patients with immunocompromised state like Diabetes mellitus are more prone to disseminated infections which can lead to high morbidity and mortality. Good glycemic control, early diagnosis and effective management with could be key role in managing a diabetic patient.

Near-Complete Whole-Genome Sequencing of Two Burkholderia pseudomallei Strains Harbouring Novel Molecular Class D Beta-Lactamase Genes, Isolated from Malaysia

ABSTRACTHere, we present two 7.1- and 7.3-bp near-complete genome sequences of Burkholderia pseudomallei strains of HTAA077 and HRPB058, isolated from a pus culture from a confirmed melioidosis patient at Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, and from blood culture from a patient at Hospital Raja Permaisuri Bainun, Ipoh, Malaysia, using a Nanopore MinION instrument.

Managemnet of Fournier’s Gangrene at Department of Urology Chandka Medical College Hospital

Aims and object: To assess the aetiology and management of Fournier’s gangrene. Methodology: We examined 30 paients retrospectivdely, during the period from 2015 to 2020, the patients from the Urology department of CMC Hospital at SMBB Medical University Larkana. All the related data were taken as well as demographic details, history and risk factor from the patients regarding illness. Routine investigation carried out including Blood CP ESR, Urine Dr, Blood sugar, Renal profile and pus culture sensitivity. 20 patients under gone for surgical debridement, 5 patients require skin grafting and 4 patients requires testes burrial after recovery under aseptic measures. Result: 30 male patients with mean age 20±10.5 year. Majority (80%) of patient presenting with necrotising infection on scrotum,perineum and hypogatric area. Basic laboratory investigations including Blood CBC showed mean WBC 15000/cmm3, mean Hb was 8.5 gms, Urine analysis showed pyuria and haematuria, pus culture and sensitivity positive in 90% cases and most prevalent organism was E.Coli, Mean Blood urea was 35mg and serum creatinine was 1.9mg. Commonest causes of fourneir gangreen was trauma, UTI, urethral stricture, indewelling catheter and perianal abcess and D.M was commonest comorbidity). All patients treated by surgical debridement while 5 patients requires skin grafting and 4 patients requires testes burrial after recovery under aseptic measures with with triple regimen antibiotics. Conclusion: Surgical debridment of necrotic tissues and triple regimen antibiotic are the main stay for primary management of Fournier’s gangrene (FG) to decrease the morbidity and mortality keywords: Fournier’s Gangrene, surgical debriment, and triple regimen antibiotics.

The difference in pathogenic bacteria between chronic rhinosinusitis in patients with and without Sjogren’s syndrome: a retrospective case–control study

BackgroundChronic rhinosinusitis (CRS) affects the quality of life of many people worldwide and can cause comorbidities. Our previous research proved that Sjogren’s syndrome (SS) is a predisposing factor for CRS, with a 2.5-fold associated risk. Antibiotics are important in CRS treatment; however, there is a paucity of research on the pathogenic bacteria of SS-CRS in the past. We conducted this study to investigate the pathogenic difference of SS-CRS and non-SS-CRS and aimed to give clinicians references when selecting antibiotics to treat SS-CRS.Materials and methodsA total of 14,678 patients hospitalized for CRS operation from 2004 to 2018 were identified from the Chang Gung Research Database. These CRS cases were classified as either SS-CRS or non-SS-CRS. We analyzed their bacterial distribution by studying the results of the pus cultures performed alongside surgery.ResultsThe top three facultative anaerobic or aerobic isolated bacteria in the SS-CRS group were coagulase-negative Staphylococcus (CoNS: 34.3%), Pseudomonas aeruginosa (28.6%), methicillin-sensitive Staphylococcus aureus (MSSA: 20%), and Staphylococcus epidermidis (20%). In the non-SS-CRS group, S. epidermidis (29.3%), CoNS (25.7%), and MSSA (14.2%) were identified. The top three anaerobic bacterial genera were Cutibacterium (54.3%), Peptostreptococcus (11.4%), and Fusobacterium (11.4%) in the SS-CRS group and Cutibacterium (53.8%), Peptostreptococcus (25%), and Prevotella (12.9%) in the non-SS-CRS group.ConclusionsP.aeruginosa is a major pathogen in SS-CRS patients. In addition, physicians should be aware of potential Fusobacterium and antibiotic-resistant bacterial infection in patients with SS-CRS.

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.

Screening and Characterization of Biofilm Formation by Staphylococcus Spp and Pseudomonas Spp Isolates from Diabetic Foot Ulcer

Diabetes mellitus is a very serious systemic disease worldwide. Around 416 million cases were estimated in 2015 worldwide, and are expected to reach 549 million in 2030 which is 8.6% higher. Diabetes mellitus is the leading cause of mortality and morbidity and is responsible for 3.8 million deaths annually. 25% of the diabetic patients are affected with foot infections out of which, 15% people are forced for limb amputation which affects the quality of life of the patients. Diabetic foot ulcer is a poly microbial infection mostly occurs due to Staphylococcus spp and Pseudomonas spp and pose serious complications. Bacteria are the cause for much type of diseases and generate resistance to wide range of biofilm forming. Biofilms constitute reservoirs of pathogens and are associated with resistance to antimicrobial agents and chronic infection. The study included 156 patients (59% male and 41% female) suffering diabetic foot ulcer whose pus culture was isolated. The identification of isolates for both gram-negative and gram-positive organisms was done as per the procedures mentioned in Bergey’s manual of Determinative Bacteriology. Further, MALDI- TOF (Matrix-Assisted Laser Desorption/Ionization) was used to confirm the identification of the isolates using classical methods. Staphylococcus spp (65%) and Pseudomonas spp (35%) biofilm producing isolates were identified for Congo red method assay and Tissue culture plate method. Results of biofilm production in positive, intermediate, negative differentiation on the Congo red plate assay and Tissue culture plate method assays were analyzed.

Susceptibilities of pus cultures in diabetic foot patients: an observational study

Objectives: The aim of our study is to evaluate the organisms growing into the pus cultures of diabetic foot patients and to further document their sensitivity and resistance toward antibiotics. Methods: This study was conducted among admitted patients in the department of Medicine and Orthopedics, of a tertiary care hospital, including patients with known diabetes mellitus for the last 5 years, with a foot ulcer of any grade and a positive culture for bacterial growth. Cultures showing fungal growth were excluded. Results: There were 139 participants in our study with a mean age of 55.27 years, and mean HbA1c levels of 9.51%, 101 (72.66%) patients were males and 38 (27.33%) females. According to the Wagner classification; there were 48 (34.53%) patients in grade 2, 27 (19.42%) patients in grade 3, 54 (38.84%) patients in grade 4, and 10 (7.19%) patients in grade 5. The most frequently isolated bacteria were Staphylococcus aureus (43.16%), methicillin-resistant staphylococcal aureus (5.03%), Enterococcus species (5.75%), Streptococcus species (7.91%), Pseudomonas aeruginosa (20.14%), Escherichia coli (24.46%), Klebsiella pneumonia 7 (5.03%), Proteus vulgaris 6 (4.31%), Proteus mirabilis 3 (2.15%), Enterobacter species 7 (5.03%), Morganella morganii 2 (1.43%), and Acinetobacter 7 (5.03%). Amikacin was the most susceptible antibiotic to the majority of the microorganisms, followed by gentamicin, piperacillin/tazobactam, vancomycin chloramphenicol, and clindamycin. Among the resistant antibiotics, penicillins and cephalosporins were the notable ones. Conclusions: This study will decipher the bacteriological profiles among patients of diabetic foot ulcers according to their susceptibility and might be helpful to provide effective treatment.

Neonatal supporative parotitis - A case report

A 9-day old male neonate was admitted for fever. He was born at term with normal antenatal records and a smooth transition from in utero to ex utero. He was febrile and had a left-sided pre auricular hot, tender, erythematous swelling and oral purulent discharge from Stensen’s duct. The septic profile was suggestive of sepsis. Ultrasonography revealed parotid gland enlargement with pus collection. Empirical antibiotics started, and parotid swelling pus drained. Culture of Pus from parotid swelling and Stensen’s duct yielded growth of Staphylococcus Aureus. According to the sensitivity report, antibiotics continued for ten days, and the patient was discharged after complete resolution of signs and symptoms.

Drug sensitivity Profile of Pseudomonas spp. isolated from a tertiary care hospital against commonly used antibiotics

Background: Antimicrobials agents are being abundantly used to control bacterial growth, like Pseudomonas, leading to resistance. Objective: To find out the drug sensitivity patterns of the Pseudomonas spp. against various antibiotics in the tertiary care hospital (Ghurki Trust & Teaching Hospital). Methodology: This cross-sectional study was designed on the retrospective collection of the records of 1000 sample reports, of the patients admitted in Ghurki Trust Teaching Hospital from the period of January 2018 to December 2019, who presented with multiple infections or developed pseudomonas infections during their stay in the hospital. Tests were carried out in the clinical microbiology Laboratory of Lahore Medical & Dental College for bacterial culture. Specimen included were breast tissues, pus, urine and stool culture, blood culture, wound discharge, ear discharge, abscess from the wound, various infected implants, and dead necrotic tissues from bone. Data were analyzed using SPSS version 26. Results: Out of the 1000 samples, a total of 150 (15%) were positive for bacterial growth. Among these 150, 70 were positive for gram-negative. The bacterial profiles of these 150 samples have shown that frequently (42) isolated gram-negative bacteria was Pseudomonas. On further tests, these bacteria were more sensitive to Imipenem and Cilastatin (69%) followed by levofloxacin ( 31%). No sensitivity was found against vancomycin and amoxicillin. Conclusion: In this study, the Pseudomonas were isolated and showed sensitivity to Imipenem and Cilastatin followed by levofloxacin. These studies should be conducted frequently to keep a track of the sensitivity patterns of bacteria.

Disseminated Staphylococcal Disease Complicated with Intracranial Internal Carotid Artery Mycotic Pseudoaneurysm and Cerebral Infarcts—A Rare Presentation in a Malnourished Child

AbstractA 2.5-year-old girl child patient with moderate malnutrition presented with right forehead abscess followed by ipsilateral orbital cellulitis. She also developed a left hydropneumothorax within a week. Subsequently she had left focal onset seizures with secondary generalized status epilepticus followed by development of left hemiparesis. Neuroimaging showed infarcts of varying ages in the right cerebral hemisphere and basal ganglia. Angiography revealed right internal carotid artery pseudoaneurysm. Blood and pus cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Investigations for immunodeficiency were negative. The patient received vancomycin intravenously for 6 weeks and intercostal tube drainage for hydropneumothorax. She was discharged with an antiepileptic drug and aspirin. There was complete resolution of the orbital cellulitis and hydropneumothorax and also the pseudoaneurysm on follow-up angiography 3 months later.