Culture Results Research Articles

An anthropogenic site for Riella Mont. (Riellaceae, Sphaerocarpales) in Djerba (Tunisia)

ABSTRACT Introduction Four species of Riella were discovered in a small anthropogenic temporary pond on Djerba island (southern Tunisia). Riella bialata Trab. is not only a very rare species worldwide, but also a new record for Tunisia, and R. cossoniana Trab., R. macrocarpa (P.Allorge) Puche, Segarra-Moragues, Sabovlj., M.Infante & Heras, and R. notarisii (Mont.) are confirmed from Tunisia. Methods Observations from fieldwork were combined with the results of spore culture to understand the presence of the species in this habitat. Key results Significant differences in development, life strategy and ecology were hypothesised to promote the existence of the four Riella species in a small pond. Conservation issues were raised due to the anthropic origin of the habitat, emphasising the site’s ecological significance and vulnerability.

Longer Preoperative Antibiotic Duration Prior to High-Risk Ureteroscopy Does Not Decrease Infectious Complications.

Introduction: Postoperative infections after ureteroscopy are common and potentially devastating complications. National and international guidelines recommend treatment of symptomatic positive urine cultures prior to operation, but how to manage patients with asymptomatic colonization remains unclear. In clinical practice, there is wide variation in the choice and duration of antibiotics for these patients. To examine how preoperative antibiotic duration impacts postoperative infection rate, we evaluated our institutional practices and outcomes. Materials and Methods: Our prospectively collected database was queried for patients undergoing ureteroscopy between 2015 and 2023. Preoperative urine culture results and antibiotic duration/choice were abstracted. Patients included for study were those with a high risk of urinary colonization defined as those with history of neurological insult, bowel diversion, indwelling suprapubic catheter or foley, or a stent/nephrostomy. Our primary outcome was postoperative infection, defined by urinary tract infection (UTI), pyelonephritis, systemic inflammatory response syndrome (SIRS), or fever within 30 days of operation. Results: A total of 405 patients met our inclusion criteria. Preoperative prophylactic antibiotics were not utilized in 68% of the study cohort, while 11% received less than 3 days or 3-10 days of prophylaxis and the remaining 10% received more than 10 days. The overall rate of UTI or pyelonephritis was 9%, and the SIRS or sepsis rate was 5%. Although receipt of preoperative prophylactic antibiotics of any duration was not predictive of postoperative infectious complications on multivariable analysis, women were associated with a 4.135 (OR: 1.768-9.669, p = 0.001) increased odds of UTI/pyelonephritis compared with men. Conclusions: In high-risk patients, the duration of preoperative antibiotics prior to ureteroscopy did not reduce postoperative infectious complication rates. Women were the only clinical feature associated with increased risk of UTI/pyelonephritis. Further research is needed to identify alternative interventions to prevent postoperative infectious complications.

Methicillin-Resistant Staphylococcus aureus Nasal Screening With Polymerase Chain Reaction for Early De-escalation of Empiric Vancomycin in the Treatment of Suspected/Confirmed Respiratory Infection in Critically Ill Patients.

Vancomycin empirically for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia coverage often is prolonged. With high negative predictive value for MRSA pneumonia, we evaluated the efficacy of MRSA nasal screening with polymerase chain reaction for early de-escalation of empiric vancomycin for treatment of respiratory infections in patients admitted to the intensive care units. The impact of MRSA nasal screening on early de-escalation of vancomycin for respiratory infections. A retrospective, single-center cohort study was conducted to evaluate the outcomes of vancomycin therapy in patients admitted to the intensive care units with diagnosis of pneumonia before (control group) and after (study group) implementation of MRSA nasal screening. The primary end point was the difference in duration of vancomycin drug therapy in patients with suspected/confirmed pneumonia between the control and study groups. Secondary end points included the number of vancomycin trough levels obtained, discordance between polymerase chain reaction and sputum culture results, and clinical outcomes. In total, 123 patients (control: n = 76; study: n = 47) were included. The median vancomycin duration in the control group and the study group was 73.3 hours (54.3-110.6) and 30.2 hours (20.3-39.7), respectively, P < 0.0001. The control group had 2.73 times (95% CI: 2.15-3.45, P < 0.0001) longer vancomycin duration than the study group. There was a significant difference in the number of trough levels obtained between the 2 groups. The median in the control and study groups were 1 (1-3) and 1 (0-1), respectively, P < 0.0001. There was no difference between groups for length of stay, 30-day readmission for MRSA infection, reinitiation of anti-MRSA therapy for infection, vancomycin-resistant enterococci infection within 30 days, acute kidney injury, and in-hospital all-cause mortality. The implementation of a MRSA nasal screening for critically ill patients treated with vancomycin for pneumonia resulted in a significantly shorter duration of vancomycin treatment without negatively affecting patient outcomes.

Comparison of the prophylactic effect of cefazolin injection versus oral levofloxacin as prophylactic antibiotic in TURP surgery: a randomized clinical trial

IntroductionUse of antibiotic prophylaxis before transurethral resection of the prostate (TURP) is highly recommended. However, there is no agreement on the use of a single antibiotic for this purpose. This study aimed to compare the prophylactic effect of cefazolin injection with oral levofloxacin on postoperative complications in TURP surgery.Trial designBody temperature and urine culture results were obtained two and five days after surgery. Drugs’ side effects as well as surgery and catheterization time were also recorded.MethodsIn an analytical-comparative trial, the participants were randomly divided into two groups to receive cefazolin or levofloxacin before the surgery.ResultsThe duration of surgery (min) and catheterization (days) were 41.5 ± 11.7 and 4.7 ± 1.8 for levofloxacin-treated group and 43.9 ± 11.9 and 4.7 ± 1.8 for cefazolin-treated group, respectively. The number of positive urine cultures, 2 and 5 days post-surgery were 12 and 14 for levofloxacin-treated group and 9 and 12 for cefazolin-treated group, respectively. Furthermore, both groups reported one fever two days after surgery and had no fever after 5 days. In total, no significant difference was observed between the two groups. Additionally, no correlation was observed between the demographic data (i.e. age, BMI and prostate volume) and the postoperative complications (i.e. fever and urinary culture tests), except between age and urinary culture 2 days after the surgery.ConclusionConsidering the lack of significant differences between the two groups, the use of oral levofloxacin is suggested as an easy to take and cost-effective alternative to injection of cefazolin before TURP surgery.Trial registrationIranian registry of clinical trials, IRCT registration number IRCT20160514027893N4, available through www.irct.ir, Registration date: 2024-03-13 (Retrospectively registered).

Sputum culture contamination and associated characteristics in a diagnostic clinical trial, Papua New Guinea.

Papua New Guinea is a high-burden multidrug-resistant TB (MDR/RR-TB) country that reports low rates of bacteriological confirmation. Sputum drug susceptibility testing for second-line drugs is important. Access to culture is limited. To evaluate the prevalence of mycobacterial sputum sample culture contamination and determine factors associated with contamination. A retrospective analysis of data from a TB diagnostic accuracy study that used culture as the diagnostic reference standard. Data included characteristics of people with presumptive pulmonary TB who provided sputum, sputum quality and culture results. Sputum (1-3 samples) was collected from 174 adults. The median age was 33 years (IQR 24-47). Of 337 samples sent for culture, 28% were contaminated. Contamination was strongly associated with samples self-collected by participants outside clinic hours (aOR 5.69; 95% CI 2.62-12.38). Contamination risk increased with delays in shipping to the reference laboratory (aOR 1.19 per day, 95% CI 1.10-1.29) beyond the minimum 3 days. Contamination was less frequent among people aged 35-44 years compared to 18-24 years (aOR 0.27, 95% CI 0.10-0.73). Sputum quality was not associated with culture contamination. Culture contamination could be reduced using spot sputum collection, expedited submission to laboratories and faster shipping when required.

Deep infections after low-velocity ballistic tibia fractures are frequently polymicrobial and recalcitrant.

To identify risk factors for developing a fracture-related infection in operatively treated ballistic tibia fractures and to report the microbiologic results of intraoperative cultures. Retrospective review. Level 1 trauma center. One hundred thirty-three adults with operatively treated low-velocity ballistic tibia fractures, from 2011 to 2021. One dose of prophylactic cefazolin or equivalent as well as perioperative prophylaxis. Deep infection rate. The deep infection rate was 12% (16/134) with no significant difference in injury characteristics, index surgical characteristics, or time to antibiotics between the groups (P > 0.05). Patients who were slightly older (35.5 vs. 27 median years, P = 0.005) and with higher median body mass indexes (BMIs) (30.09 vs. 24.51, P = 0.021) developed a deep infection. 56.3% of patients presented with signs of infection within the first 100 days after injury. Nine patients had polymicrobial infections. There were 29 isolated organisms, 69% were uncovered by first-generation cephalosporin prophylaxis (anaerobes, gram-negative rods, Enterococcus, methicillin resistant Staphylococcus Aureus [MRSA]), and 50% of patients developed recalcitrant infection and required a second reoperation where 6 organisms were isolated, half of which were not covered by first-generation prophylaxis (Enterococcus, Staphylococcus Aureus MRSA). We found a deep infection rate of 12% among ballistic tibia fractures receiving standard-of-care antibiotic prophylaxis. Increased age and body mass index were associated with deep infections. Half became recalcitrant requiring a second reoperation. 66.7% of isolated organisms were not covered by first-generation cephalosporin prophylaxis. Consideration should be given to treatment options such as broader prophylaxis or local antibiotic treatment. IV.

Case report: Relaps of Streptococcus suis infection in patient with Meningoencephalitis at Prof. Ngoerah Hospital, Bali

Background: S. suis is a facultative anaerobic Gram-positive bacterium that causes human infection. It is a primary health problem in the swine industry. Ceftriaxone is a therapeutic option for meningitis besides Ampicillin. Recently, the incidence of resistance to ceftriaxone was reported. The recurrence of S. suis in this patient is thought to be caused by ceftriaxone resistance due to inadequate initial therapy. Case Presentation: A 43-year-old male patient came to the ER with headaches in the head and neck. The patient had a history of meningitis due to S. suis twice before. While in the ER, the patient was given ceftriaxone while awaiting culture results. Blood cultures showed S. suis infection using VITEK 2 COMPACT (Biomeriuex®) and ceftriaxone resistance. The patient was successfully managed with Ampicillin following these culture results, leading to good outcomes. Discussion: S. suis is a gram-positive bacterial pathogen in pigs that can cause severe human infection, including meningitis, septicemia, endocarditis and deafness the most common complications. The patient experienced three relapses due to S. suis. On the third visit, blood culture results identified ceftriaxone-resistant S. suis. The patient's recurrent relapses could be attributed to several factors, including inadequate antibiotic administration, antibiotic resistance, weak immune system, contact with the source of infection and environmental variables, highlighting the complexity and challenges in treating S. suis infection. Conclusion: The use of antibiotics in relapse cases has the potential to cause antibiotic resistance, so it’s necessary to make guidelines for antibiotic therapy in S. suis infection to prevent recurrent infections.

Rapid diagnosis of tuberculosis by PCR IS6110 from blood in the central region of Tunisia.

Tuberculosis remains one of the leading causes of mortality worldwide. Microscopy and culture still the references of Tuberculosis diagnosis. Microscopy has a low sensitivity, specificity and culture is time consuming. For this reason, rapid and reliable diagnosis of the disease is required. We describe a retrospective comparison study of tuberculosis diagnosis by PCR IS6110 directly from blood samples of patients with suspected Tuberculosis with Acid-Fast-Bacilli and culture. From 80 patients enrolled, culture results were positive for 25, acid fast bacilli were positive for 15 and blood PCR were positive for 45. Comparing blood PCR result with acid fast bacilli, the sensitivity and specificity were respectively 35% and 87.5% (PPV =9%, PNV =21.1%) for PTB. The specificity of blood PCR was 100% (PNV =72.73%), for EPTB. In comparison with culture blood PCR have a high sensitivity and specificity better than with the acid fast, they were respectively 57.89%, 100% for PTB and 50%, 100% for EPTB. This study is the first established in Tunisia and in Africa aiming to diagnose TB from blood. B-PCR results has shown a high correlation with culture that illustrates the usefulness of B-PCR as a rapid and early diagnostic, combined with others serological results B-PCR can be a solid, rapid and efficient TB diagnostic tools.

Outcomes of Modulator Therapy Discontinued After Short-Term Use in Adult Cystic Fibrosis.

Cystic fibrosis transmembrane conductance regulator modulator therapies (CFTR-MT) have altered management, reducing exacerbations and slowing pulmonary function decline. Nevertheless, it is still uncertain if the benefits of CFTR-MTs last when they are stopped. This study aimed to assess pulmonary function changes, and exacerbation rates during and after CFTR-MT use in adult cystic fibrosis patients. Between 2018 and 2022, we conducted a study involving adult CF patients who initially used CFTR-MTs but later discontinued them due to reimbursement issues. The study was divided into three phases: predrug (T1), in-drug (T2), and postdrug (T3). We recorded pulmonary function tests, laboratory and culture results, and the number of exacerbations. The study involved 33 patients, with 28 (84.8%) receiving Elexacaftor/Tezacaftor/Ivacaftor and 5 (15.2%) receiving Ivacaftor. The median treatment and interruption durations were 3.1 (IQR = 2.9-5.7), and 2.5 (IQR = 1.5-4.0) months, respectively. The mean FEV1% was 54.3% (± 26.6), 70.4% (± 27.4), and 60.2% (± 26.5) during T1, T2, and T3, respectively (p < 0.001). The mean FVC% was 65.5% (± 23.9) in T1, increased to 81.5% (± 24.5) in T2, and decreased to 71.6% (± 25.9) in T3 (p < 0.001). The number of Psedomonas aeruginosa, and Aspergillus positive sputum cultures decreased significantly with drug use (T1: 72.7%, 39.4%; T2: 48.5%, 9.1%; T3: 45.5%, 18.2%; p = 0.014, p = 0.004, respectively). The median number of hospitalizations was 1.0 (0-5.0) in T1, 0 (0-0) in T2, and 0 (0-1.0) in T3. This study revealed that CFTR-MTs are effective even in the short term for adult CF patients, but their beneficial effects quickly diminish after discontinuation. Real-life data obtained as a result of discontinuation of drugs due to reimbursement problems has highlighted the significance of regular and uninterrupted use of modulators.

Prevalence and risk factors for bacteremia in community-acquired pneumonia: a systematic review and meta-analysis

BackgroundBacteremia represents a significant complication in patients with community-acquired pneumonia (CAP). Nonetheless, there is currently a dearth of systematic research that determines the precise prevalence and risk factors of bacteremia in CAP patients. MethodsPubMed, Cochrane Library, Embase, and Web of Science databases were searched for published studies on the prevalence or risk factors for CAP with bacteremia up to April 21, 2024. The NOS scale was utilized to appraise the study quality, and the META process was carried out in R language. Results58,342 CAP patients were enrolled in 22 studies. Of these patients, 29,610 underwent blood culture tests, and 2332 patients had positive blood culture results. Meta-analysis pooled results showed that the incidence of bacteremia was 5.1% (95%CI: 3.6-6.8%) in CAP patients. The prevalence of co-bacteremia was 3.1% (95% CI: 1.5-5.1%) in minors and 6.9% (95% CI: 5.2%-8.8%) in adults. The most common pathogens of CAP were Streptococcus pneumoniae, Staphylococcus aureus. In addition, a summary of the original studies found that the risk factors for bacteremia in CAP patients were diverse and varied. ConclusionsThe incidence of bacteremia in CAP patients warrants significant attention. There is a pressing need to establish more specific bacterial screening protocols.

Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses, including incision and drainage alone or combined concurrent fistulotomy, remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula. AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures. METHODS In this retrospective study, 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included. A new classification for anorectal abscesses based on their propensity to develop into fistulas, considering 18 other potential risk factors, was established. These factors, from electronic medical records, were screened for significance using the χ ² test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses. RESULTS One year post-follow-up, the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively. Univariate χ ² analysis showed significant differences in recurrence rates based on anatomical classifications and pus culture results (P &lt; 0.05). Fistula-prone abscess, ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence, while diabetes mellitus was protective (P &lt; 0.05). Moreover, fistula-prone abscess [odds ratio (OR) = 7.651, 95%CI: 4.049–14.458, P &lt; 0.001], ≥ 7 days from symptom onset to surgery (OR = 2.137, 95%CI: 1.090–4.190, P = 0.027), chronic diarrhea (OR = 2.508, 95%CI: 1.216–5.173, P = 0.013), and local anesthesia (OR = 2.308, 95%CI: 1.313–4.059, P = 0.004) were independent risk factors for postoperative anorectal abscess recurrence using multivariate logistic regression. Body mass index ≥ 28 (OR = 2.935, 95%CI: 1.203–7.165, P = 0.018) was an independent risk factor for postoperative recurrence of non-fistula-prone abscess. CONCLUSION The choice of surgical procedure for treating anorectal abscesses should follow this new classification. Prompt and thorough incision and drainage can significantly reduce postoperative recurrence.

Subperiosteal Abscess of the Orbit: Long-term Trends in Bacteriology and Clinical Outcomes and Current Management Recommendations.

To evaluate the impact over time of evolving upper respiratory pathogens, modified microbial terminology, and improved laboratory isolation on the bacteriology and management of sinusitis-related subperiosteal abscess of the orbit. Comparative case series of pediatric patients with bacterial sinusitis-related subperiosteal abscess from 2012 to 2022. Outcomes, culture results, age-specific findings, and antibiotic duration were compared with those in 1977 to 1992, 1988 to 1998, 1999 to 2008, and 2002 to 2012 cohorts at the same institution. Ninety-one patients met the inclusion criteria. Forty-nine patients (53.8 %) recovered with medical therapy alone; 42 (46.2 %) underwent surgical drainage. There was increased representation in surgical cases of Streptococcus anginosus group (52.4%) and anaerobes (26.2%). Anaerobes were isolated from 2 patients <9 years of age, the youngest age 5; recovery in prior series was limited to patients ≥9 years old. Among 61 of 91 patients <9 years old, 41 (67.2%) were managed medically and 20 (32.8%) underwent surgery. Comparable proportions were 67.5%/32.5%, 85%/15%, and 72%/28% in prior cohorts. Among nonsurgical patients <9 years old, the mean duration of intravenous antibiotics was 4.02 ± 1.2 days. Four patients had multiple admissions. In cases positive for aggressive pathogens, initial findings prompted timely drainage. All patients had favorable visual and systemic outcomes. This study extends to 45 years a unique analysis of the bacteriology and clinical course of subperiosteal abscess at a single center with comparatively stable patient demographics and environmental factors, using a relatively uniform treatment algorithm. Despite the increased representation of S. anginosus group and anaerobes, a multifactor protocol with minor modifications remains an effective strategy.

Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study

BackgroundPostoperative intracranial neurosurgical infections (PINI) complicate < 5% neurosurgeries. Scarce attention was dedicated to the extension and characteristics of its antimicrobial management considering their high morbidity, not negligible mortality, delayed hospital stay and increased healthcare costs.MethodsWe analyzed retrospectively (2014–2023) 162 PINI from eight Spanish third-level academic hospitals.ResultsElective clean craniotomies after tumor or vascular causes were the leading procedures. Epidural abscess (24.7%), scalp infections (19.8%), postsurgical meningitis (16.7%) and cranioplasty infections (16.7%) were the most frequent PINI. Gram negative bacteria (38.6%) and Staphylococcus spp (28.6%) were the predominant isolates. Overall 85.2% patients underwent pus drainage, mostly by craniotomy (40.3%). Interestingly 34% were already receiving antibiotics for extracranial infections before developing PINI while 16.8% did not receive pre-operative antibiotic prophylaxis. In total 77.2% patients started a combined intravenous (IV) antimicrobial therapy, of which 85.2% switched after 5 days to a second-line IV antibiotic regimen, in 41.3% cases combined, after pus culture results, for a median of 21 days. Overall 61.1% patients continued on oral antimicrobials after hospital discharge, 30.3% as a combined regimen, for a median of 42 days. Complete cure was obtained in 81.5% cases, while 11.1% relapsed, 7.4% failed to cure and 6.8% died after PINI complications. In the multivariate analysis oral antimicrobial therapy after hospital discharge (p = 0.001) was significantly associated with PINI cure with no effect on survival.ConclusionsWe conclude that an extended 6 weeks sequential IV and oral antimicrobial therapy in addition to neurosurgical correction increases PINI cure rate with no effect on survival.Clinical trial numberNot applicable.

Shedding light on negative cultures in osteoarticular infections: leveraging mNGS to unravel risk factors and microbial profiles

BackgroundThe objective of this study is to utilize metagenomic next-generation sequencing (mNGS) to analyze the risk factors causing negative microbial cultures, comprehensively delineate the microbial profiles neglected by traditional cultures, and optimize the pathogenetic diagnostic procedure accordingly.Research design and methodsWe enrolled 341 patients diagnosed with OI at our center between 2016 and 2022, and gathered data including age, gender, clinical diagnosis, duration of antibiotic use prior to sampling, microbial culture results, and mNGS results for these patients. According to microbial detection results, risk factors for negative microbial culture and mNGS results were investigated through univariate and multivariate analyses, and the microbial profile in cases with negative microbial cultures was summarized in conjunction with mNGS results. Building upon this, we suggest strategies to enhance the positivity rate of microbial cultures based on clinical experience.ResultsInvasive osteoarticular infection (IOI), multi-infections, rare pathogen infections, and prior antibiotic use are risk factors for negative microbial cultures. When the duration of prior antibiotic use is ≥3 days, mNGS demonstrates significantly higher pathogen detection efficiency than microbial culture. Moreover, the risk of negative microbial culture increases by 4.8 times with the exposure to each additional risk factor (OR=4.043, 95%CI [2.835, 5.765], P&amp;lt;0.001). Additionally, over one-third of culture-negative OI involve polymicrobial infections or rare pathogens.ConclusionsClinicians should tailor microbial culture strategies based on patient conditions. When needed, they can collaborate with mNGS or optimize microbial culture conditions based on mNGS results to enhance the efficiency of pathogen diagnosis.

Low Prevalence of Anaerobic Bacteria in Pediatric Septic Arthritis Makes Obtaining Anaerobic Cultures of Questionable Value.

Pediatric acute septic arthritis necessitates urgent identification and treatment to avoid irreversible joint damage if not recognized and treated in a timely manner. Many centers routinely obtain both aerobic and anaerobic cultures for the purpose of pathogen identification; however, the yield of anaerobic culture results has been called into question. The goal of this study was to determine the positivity rate of anaerobic cultures collected intraoperatively in pediatric patients with clinically diagnosed septic arthritis. Patients with a clinical diagnosis of septic arthritis were extracted from a search of musculoskeletal infections at a large tertiary care pediatric hospital from 2007 to 2021. Cultures obtained from the operating room or through arthrocentesis were examined. We identified 470 cases of pediatric septic arthritis of which only 3 cultures were positive (0.6%) for anaerobic organisms. All cases involved a single isolate. The anaerobic bacteria that were detected included 1 facultative anaerobe, 1 strict anaerobe, and 1 relatively aerotolerant anaerobe. Four aerobic organisms grew on the anaerobic cultures. Three of the false positives also grew on aerobic culture media, whereas 1 aerobic specimen grew explicitly on anaerobic media. Neither the facultative anaerobe nor the aerotolerant anaerobe grew on aerobic culture media. Over a 14-year period, only 0.6% (3 cases) of septic arthritis cases yielded positive anaerobic cultures that were not able to be cultured on aerobic media. As such, an anaerobic culture was more likely to culture a bacterium that would have also been cultured on aerobic media. In addition, a true positive anaerobic culture that would not have been diagnosed on aerobic cultures only occurs about once every 5 years at our institution. If one were to decide against obtaining anaerobic cultures, they would only miss 3 infections out of almost 500 (0.6%), and antibiotics would only have changed 0.6% of the time. These results suggest that routinely obtaining anaerobic cultures may be of limited value in pediatric septic arthritis. The false-positive rate of anaerobic labs exceeds that of true-positive cases. These results provide actionable opportunity to help guide clinician decision-making in a more cost-effective and efficient management of pediatric septic arthritis. IV.

ALTERAÇÕES NO PERFIL DOS MICRORGANISMOS CAUSADORES DE INFECÇÕES DO TRATO URINÁRIO DE IDOSOS, RESIDENTES NO MUNICÍPIO DE MARECHAL CÂNDIDO RONDON-PR, NO PERÍODO PRÉ E PÓS PANDEMIA DA COVID-19

Urinary tract infections (UTIs) are frequent anomalies that affect the lower and upper urinary tract, in both sexes and all ages. Such infections are normally caused by gram-negative enterobacteria, which interfere with individuals' quality of life. This work aims to analyze how the Covid-19 pandemic influenced the profile and antimicrobial sensitivity of pathogens that cause UTIs in the elderly in the city of Marechal Cândido Rondon-PR, by verifying the results of positive urine cultures of elderly outpatients and hospitalized patients in the periods of May-December 2019 and May-December 2023. It is expected to find, as a result of the research, a difference in antimicrobial resistance and the predominant pathogen profile, bringing relevant information to be studied for the society of Marechal Cândido Rondon.

Analysis of clinical characteristics and laboratory examination data of 112 cases of Mycoplasma pneumoniae pneumonia in children

The aim of this study was to analyze the clinical characteristics of Mycoplasma pneumoniae (MP) infection in children and provide a basis for the diagnosis and treatment of MP and refractory Mycoplasma pneumoniae pneumonia (MPP) in children. A total of 112 children with MPP admitted to Luoyang Maternal and Child Health Hospital between January 31, 2023 and December 31, 2023 were studied, and their clinical characteristics were retrospectively analyzed, including children’s general data, clinical symptoms, imaging changes, bronchoscopy, and laboratory data, including inflammatory factors such as C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), bacterial culture results of bronchoalveolar lavage or sputum, and results of MP culture and detection of MP drug resistance gene loci 23sRNA A2063G and A2064G. Among the 112 children with MPP included in the analysis, 48 were males (42.86%), 64 were females (57.14%), with an average age of 5.74 ± 2.62 years old, 55 cases were older than 6 years old (49.11%), 35 cases were 3 to 6 years old (31.25%), and 22 cases were &lt;3 years old (19.64%), with the older children being the most; 103 cases were fever (91.96%), 94 cases were cough (83.93%), and 46 cases were dyspnea (41.07%). Fiber bronchoscopy showed that 112 cases were mucosal congestion and edema (100.00%), 69 cases were sputum embolism (61.61%), and 19 cases were mucosal erosion (16.96%); the incidence of CRP, PCT, IL-6, and bacterial infection in the MPP group were lower than those in the RMPP group (P &lt; .05), and there was no significant difference in the mutation rate of 23sRNA A2063G and A2064G between the 2 groups (P &gt; .05); logistic regression analysis showed that CRP, PCT, IL-6, alanine aminotransferase, lactate dehydrogenase, immunoglobulin A, IgG, and immunoglobulin M were the main influencing factors of RMPP (P &lt; .05); the length of hospital stay, biochemical treatment of alanine aminotransferase, lactate dehydrogenase, cardiac troponin I, and inflammatory factors of CRP, PCT, and IL-6 in the bronchoalveolar lavage treatment group were lower than those in the general treatment group (P &lt; .05). Children with MPP have more fever, cough, and dyspnea as the starting point, and mucosal congestion, edema, sputum embolism are the most common in bronchoscopy. Children with RMPP may be accompanied by decreased immune function and increased inflammation.

Asymptomatic nasopharyngeal carriage of multidrug resistant bacteria among children at University of Gondar Hospital Northwest Ethiopia Revealing Hidden Health Risks

Gram-negative bacteria in the nasopharynx can eventually invade bacteria-limited sites and cause serious illnesses such as meningitis, otitis media, and pneumonia. However, data related to the carriage of these bacteria in children attending outpatient departments in the study area are limited. To assess nasopharyngeal carriage, antibiotic susceptibility patterns, and associated factors of gram-negative bacteria among children attending the outpatient department at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A hospital-based cross-sectional study was conducted from September 1, 2023, to December 30, 2023. A total of 385 children aged 3 to 14 years were enrolled using a systematic random sampling technique. Sociodemographic and clinical data were collected using a semistructured questionnaire. A total of 385 nasopharyngeal samples were collected using a sterile specimen collection nasopharyngeal swab, transported using Amie’s transport medium, and subsequently inoculated on chocolate agar, blood agar, modified thayer martin agar, and MacConkey agar plates. Bacterial species were identified by colony morphology, Gram staining, and biochemical tests such as oxidase tests, satellitism tests, and carbohydrate utilization tests. An antibiotic susceptibility test was performed using the Kirby–Bauer and modified Kirby–Bauer methods on Mueller–Hinton agar plates. The data were entered into Epi-Data version 4.6.0.6 and exported to SPSS version 25 for analysis. The adjusted odds ratio at a 95% confidence interval with a P value of < 0.05 in the binary logistic regression model was considered to indicate statistical significance. The overall nasopharyngeal carriage of gram-negative bacteria was 146 (37.9%) (95% CI: 33.2–42.9). Among these, nonfastidious gram-negative bacteria represented 45 (11.7%), followed by M. catarrhalis 41 (10.6%), N. meningitidis 34 (8.8%), and H. influenzae 26 (6.8%). The isolates exhibited high resistance to tetracycline (85; 75.9%), trimethoprim-sulfamethoxazole (105; 71.9%), ampicillin (76; 67.9%), and amoxicillin/clavulanic acid (60; 69.8%) but high susceptibility to meropenem (122; 83.6%), gentamicin (73; 84.9%), and minocycline (87; 72.5%). There were 99 total multidrug-resistant strains (67.8%, 95% CI: 59.7–75.0). Male sex (AOR = 1.785, 95% CI: 1.102–2.892, P = 0.019), smoking (AOR = 2.675, 95% CI: 1.149–6.230, P = 0.022), and large family size (≥ 5) (AOR = 1.857, 95% CI: 1.140–3.023, P = 0.013) were risk factors for nasopharyngeal colonization. Increased nasopharyngeal colonization of multidrug-resistant gram-negative isolates was observed in this study. Gentamicin, minocycline, and meropenem were the most effective antibiotics for the tested isolates. Bacterial colonization increased with increasing family size, smoking status, and male sex. Therefore, a definitive diagnosis in the outpatient pediatric department should be based on culture and susceptibility test results.

Pyogenic Abscess Liver Secondary to Perforated Appendicitis

BACKGROUND: Pyogenic liver abscess (PLA) secondary to perforated appendicitis can be potentially life-threatening. However, the mortality of PLA has decreased due to earlier and improved diagnosis, development of intensive care, and progression of minimally invasive treatment. Here we present a patient with a pyogenic liver abscess formed after appendectomy. CASE REPORT: A 40-year-old man complained of abdominal pain in the right upper quadrant for the last month. Examination of his abdomen showed enlarged liver, approximately 3 fingers below costae. Laboratory results showed an increased white blood count of 14.000 /mL and slight hypoalbuminemia of 2.9 g/dL. An ultrasound showed liver abscess. The abdominal CT revealed a 6,78 cm x 6,18 cm x 5,4 cm lobulated hypodense cystic mass. The patient was treated with 3rd generation Cephalosporin and underwent percutaneous drainage with Escherichia coli growth on the culture result. The patient was discharged on the 8th day after admission with significant improvement dan there are no other complications. CONCLUSION: Early diagnosis and prompt treatment can lead to a better prognosis. Antibiotic is recommended in early treatment to lower bacterial load and control the symptoms of systemic infections. However, effective drainage is recognized as the most effective treatment for large liver abscess, since it could lower bacterial load and increase antibiotic penetration into the abscess.

Accuracy of Screening Tests for the Diagnosis of Urinary Tract Infections in Young Children.

The objective of this study was to compare the accuracy of available tests for pyuria, including newer automated tests, and to examine the implications of requiring them for the diagnosis of urinary tract infections (UTIs). We included children between 1 and 36 months of age undergoing bladder catheterization for suspected UTIs who presented to 1 of 3 pediatric centers. Using a positive urine culture result as the reference standard, we compared the sensitivity of 5 modalities for assessing pyuria at the cutoffs most often used clinically for detecting children with a positive culture result: leukocyte esterase on a dipstick, white blood cell (WBC) count on manual microscopy with and without using a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition. A total of 4188 children were included. Among febrile children, the sensitivity of the 2 most widely available modalities, the leukocyte esterase test and WBC enumeration using digital imaging, had sensitivity values of 84% (95% confidence interval, 0.80-0.87) and 75% (95% confidence interval, 0.66-0.83), respectively. Our findings suggest that for febrile children <36 months of age undergoing bladder catheterization for suspected UTI, pyuria will be absent in ∼20% of children who are eventually shown to have pure growth of a pathogen on a culture. This raises questions about the appropriateness of requiring pyuria for the diagnosis of UTIs.