Microbiological Culture Results Research Articles

Determination of resistance pattern of bacteriostatic antimicrobial drugs by analysis of blood culture reports

Background: Determination of each isolated bacterium from blood culture and pattern of antimicrobial sensitivity has an important role epidemiologically in a region and can assist physicians in the determination of primary antimicrobial agents. In this study, schema of resistance of bacteriostatic antimicrobials in blood culture is evaluated. Determination of resistance pattern of bacteriostatic antimicrobial drugs by analysis of blood culture report.Methods: A retrospective analysis of microbiological blood culture and antibiotics sensitivity results have been done. A total of 120 laboratory culture results were selected randomly during the observational period. These all-blood culture reports were analyzed for bacteriostatic antimicrobial resistance pattern.Results: The 41 bacterial isolates were obtained from 120 blood culture reports, 24.39% (10) were gram positive and 75.60% (31) were gram-negative. The most frequently isolated gram-negative organisms were K. pneumoniae (34.14%) followed by Pseudomonas (12.19%), E. coli (12.19%). The most frequently isolated gram-positive organism was staphylococcus aureus. All isolates showed less resistance to bacteriostatic antibiotics like clindamycin, chloramphenicol, co-trimoxazole, doxycycline, linezolid, tetracycline, nitrofurantoin, erythromycin, tigecycline.Conclusions: S. aureus, E. coli and Klebsiella spp. pseudomonas aeruginosa were the leading causes of septicaemia or any type of infection in our study finding. These bacteria isolates were highly resistant to bactericidal antimicrobials. But bacteriostatic antimicrobial has shown less resistance compared to bactericidal.

Detection of mecA and 16S rRNA Genes Using Real-Time PCR Can Be Useful in Diagnosing Iliopsoas Abscess, Especially in Culture-Negative Cases: RT-PCR for Iliopsoas Abscess.

The rapid detection of etiological agents is important for the successful treatment of iliopsoas abscess (IPA). The purpose of this study was to investigate the clinical utility of a real-time polymerase chain reaction (PCR) that targets the mecA gene for methicillin-resistant staphylococci (MRS) and the 16S rRNA gene for pan-bacteria. Our retrospective diagnostic study included 22 patients exhibiting IPAs and four patients with noninfectious iliopsoas mass regions who underwent computerized tomography or ultrasonography-guided biopsy and/or surgical treatment. Clinical symptoms, serum data, imaging analysis, and tissue microbiological culture were utilized for the diagnosis of IPA. The diagnostic accuracy of real-time PCR was determined based on the diagnosis of IPA and microbiological culture results. The microbiological culture was positive for 12 IPA cases that included 2 MRSA infections. Among 12 culture-positive IPA cases, 16S rRNA-PCR was positive in 12 and MRS-PCR in two. Among 10 culture-negative IPA cases, including 3 TB cases, 16S rRNA-PCR was positive in 8 and MRS-PCR in 2. In noninfectious iliopsoas mass patients, neither 16S rRNA nor MRS-PCR detected bacterial DNA. The sensitivity, specificity, positive predictive, and negative predictive values of 16S rRNA-PCR for diagnosing IPA were 0.91, 1.00, 1.00, and 0.67, respectively, while those for the diagnosis of MRS infection with MRS-PCR were 1.00, 0.92, 1.00, and 0.50, respectively. Real-time PCR targeting bacterial DNA can detect bacterial DNA in culture-negative cases and offer improved detectability of MRS infection in IPA patients.

Short- and Mid-Term Survival of Geriatric Patients with Septic Arthritis of the Knee and the Impact of Risk Factors on Survival.

Septic arthritis is common in older adults and can be related to joint surgery or hematogenous distribution. To date, the risk factors affecting survival are unknown. This study aimed to evaluate the effects of existing implants, positive synovial microbiological culture results, and the American Society of Anesthesiology Physical Status (ASA) classification on the short- and mid-term survival of older patients with primary septic gonarthritis. This retrospective study included 133 older adults >60 years who underwent surgery for primary septic gonarthritis. Data were collected from medical records and public obituaries. Kaplan–Meier survival curves were used to estimate the probability of survival, as well as log-rank tests to measure and compare survival rates over one- and five-year periods. The mean age was 74.9 years (SD ± 9.2), and the 5-year follow-up rate was 74.3% (the mean follow-up was 3000.5 days; SD ± 1771.6). Mean survival was significantly different in patients with implants and without implants (p = 0.015), and between ASA II, ASA III, and ASA IV (p < 0.001). There was no significant difference in the survival of patients with or without a positive synovial microbiological culture (p = 0.08). Older adults with septic monoarthritis and pre-existing medical implants showed impaired survival. The ASA classification prior to surgery for primary septic monoarthritis can be helpful in identifying patients with poorer mid-term outcomes.

A rapid assay of granulocytic esterase in the discharge of conjunctival sac as a tool for the recognition of bacterial ocular surface inflammation

AbstractPurposeOcular surface inflammation (OSI) is one of the most common diseases in ophthalmic practice. Bacteria can be one of many reasons of OSI. Topical antibiotics are prescribed in many cases of OSI. There is an important reason of the increase the antibiotic resistance. An enzyme granulocystic esterase (GE) is a marker of neutral granulocytes activated during bacterial inflammation. The goal of our study was to check the usage of rapid assay of GE in the discharge coming from conjunctival sac in patients with OSI.MethodsDischarge was collected from the conjunctival sac by sterile swab for microbiological cultures and the rapid assay of GE. There is a color reaction of indoxyl with diazonium salt in the assay. The positive result gives the purple color of the test area and its intensity is dependent on the amount of GE.ResultsThe intensity of the of the rapid assay color was the highest in patients with purulent discharge. In most cases, the presence of Staphylococcus aureus and Staphylococcus epidermidis was confirmed. Very low GE activity was found in most patients without purulent discharge. There were few patients without purulent discharge but with positive results of rapid assays and microbiological cultures. There was lack of correlation between intensity of subjective and objective symptoms (except purulent discharge) and positive result of rapid assay and microbiological cultures.ConclusionsA rapid assay of GE seems to be easy tool for the recognition of bacterial etiology of ocular surface inflammation. It can help to limit topical antibiotics usage in the treatment of ocular surface inflammations and reduce the antibiotic resistance.

Surgical treatment in severely immunocompromised patient with invasive fungal infection

Purpose: We present a case report of successful surgical treatment of a 58-year- old severely immunocompromised male patient with invasive fungal infection.&#x0D; Case presentation: A 58-year-old male with a smoking history of 30 years was admitted to hospital because of sudden shortness of breath. Radiographic imaging showed an extensive pneumothorax. The patient had a history of T-cell lymphoma, B-cell MALT lymphoma, and chronic obstructive pulmonary disease. He had also previously undergone chemotherapy. During hospitalization, his health state started to deteriorate. On the basis of imaging and microbiological culture results, he was diagnosed to have a fungal infection with Aspergillus fumigatus. After careful preoperative care, preparations, and several consultations, we performed video-assisted thoracic surgery. Because of poor visibility, inaccessibility, and rupture of an intercostal artery, we performed thoracotomy with excision of the right lung apex. Histopathology and microbiology results confirmed the initial diagnosis. Postoperatively, a 1-year treatment regimen with voriconazole was introduced. The follow-up CT scan showed no signs of fungal infection progression. The patient was given further instructions and discharged from the hospital in a cardiorespiratory compensated state.&#x0D; Conclusion: Despite poor prognostic factors, the surgical procedure was successful and the patient’s health state considerably improved.

INHALE: the impact of using FilmArray Pneumonia Panel molecular diagnostics for hospital-acquired and ventilator-associated pneumonia on antimicrobial stewardship and patient outcomes in UK Critical Care\u2014study protocol for a multicentre randomised controlled trial

BackgroundHospital-acquired and ventilator-associated pneumonias (HAP and VAP) are common in critical care and can be life-threatening. Rapid microbiological diagnostics, linked to an algorithm to translate their results into antibiotic choices, could simultaneously improve patient outcomes and antimicrobial stewardship.MethodsThe INHALE Randomised Controlled Trial is a multi-centre, parallel study exploring the potential of the BioFire FilmArray molecular diagnostic to guide antibiotic treatment of HAP/VAP in intensive care units (ICU); it identifies pathogens and key antibiotic resistance in around 90 min. The comparator is standard care whereby the patient receives empirical antibiotics until microbiological culture results become available, typically after 48–72 h. Adult and paediatric ICU patients are eligible if they are about to receive antibiotics for a suspected lower respiratory infection (including HAP/VAP) for the first time or a change in antibiotic because of a deteriorating clinical condition. Breathing spontaneously or intubated, they must have been hospitalised for 48 h or more. Patients are randomised 1:1 to receive either antibiotics guided by the FilmArray molecular diagnostic and its trial-based prescribing algorithm or standard care, meaning empirical antibiotics based on local policy, adapted subsequently based upon local microbiology culture results. Co-primary outcomes are (i) non-inferiority in clinical cure of pneumonia at 14 days post-randomisation and (ii) superiority in antimicrobial stewardship at 24 h post-randomisation (defined as % of patients on active and proportionate antibiotics). Secondary outcomes include further stewardship reviews; length of ICU stay; co-morbidity indicators, including septic shock, change in sequential organ failure assessment scores, and secondary pneumonias; ventilator-free days; adverse events over 21 days; all-cause mortality; and total antibiotic usage. Both cost-effectiveness of the molecular diagnostic-guided therapy and behavioural aspects determining antibiotic prescribing are being explored. A sample size of 552 will be required to detect clinically significant results with 90% power and 5% significance for the co-primary outcomes.DiscussionThis trial will test whether the potential merits of rapid molecular diagnostics for pathogen and resistance detection in HAP/VAP are realised in patient outcomes and/or improved antibiotic stewardship.Trial registrationISRCTN Registry ISRCTN16483855. Retrospectively registered on 15 July 2019

Catheter-Related Bloodstream Infections and Catheter Colonization among Haemodialysis Patients: Prevalence, Risk Factors, and Outcomes.

Introduction Catheter-related bloodstream infection (CRBSI) and catheter colonization (CC) are two complications among haemodialysis (HD) patients that lead to increased morbidity and mortality. This study aims to evaluate the prevalence of CRBSI and CC among HD patients registered at Universiti Kebangsaan Malaysia Medical Centre and to identify the factors involved by focusing on the demographic profile of the patients as well as their clinical characteristics and outcomes. Method This is a retrospective study of end-stage renal disease patients with suspected CRBSI during the period from 1 January 2016 to 31 December 2018. Data on patients who fulfilled the blood culture criteria for CRBSI and CC diagnosis were further analysed for clinical manifestations, comorbidities, history of dialysis, catheter characteristics, and microbiological culture results. The outcomes of CRBSI and CC were also assessed. Findings. In the 3-year period under study, there were 496 suspected CRBSI cases with a total of 175 events in 119 patients who fulfilled the inclusion criteria. During that time, the percentage of patients who experienced CRBSI and CC was 4.2% and 4.8%, respectively. The majority of the cohort consisted of male (59.4%), Malay ethnicity (75%), and patients on a tunnelled dialysis catheter (83%). Patients who were fistula naïve and had an internal jugular catheter were more common in the CRBSI group than in the CC group. The predominant microorganisms that were isolated were Gram-positive organisms. In terms of clinical presentation and outcome, no differences were found between the CRBSI and CC groups. Patients with Gram-negative bacteraemia, high initial c-reactive protein, and catheter salvation were likely to have poor outcomes. Recurrence of CRBSI occurred in 31% of the cohort. Neither catheter salvation nor antibiotic-lock therapy were associated with the recurrence of CRBSI. On the other hand, the femoral vein catheter site was associated with risk of recurrence. The overall mortality rate was 1.1%. Discussion. From the analysis, it was concluded that clinical assessment and positive culture are crucial in diagnosing CRBSI with or without peripheral culture. This study provides essential information for the local setting which will enable healthcare providers to implement measures for the better management of CRBSI.

ANTIBIOTIC SUSCEPTIBILITY OF BACTERIA ISOLATED FROM OPEN FRACTURE GRADE III PRESENTING TO DR. SOETOMO GENERAL HOSPITAL SURABAYA

Background: Open fracture is a typical case in the orthopedics field. Infection in the open fracture can cause osteomyelitis. Antibiotic susceptibility test of patient specimen bacteria with open fracture aims to obtain the suitable antibiotic agents to treat infectious diseases caused by these bacteria.Methods: This research is a descriptive study to assess Antibiotic susceptibility in the case of open fracture grade III in Dr. Soetomo General Hospital Surabaya. A total sampling was performed from microbiological culture results of patients diagnosed with open fracture grade III after debridement from October 2018 to September 2019. The identification of the microbes was based on Gram-positive and Gram-negative categories and the classification based on susceptibility to antibiotics classified into sensitive, intermediate, and resistant.Results: Data from microbiological culture results of patients with a diagnosis of open fracture grade III after debridement in October 2018 to September 2019 in Dr. Soetomo General Hospital Surabaya showed 56 research subjects who met the criteria. Acinetobacter baumannii is the most common bacterial species found in the microbiological examination of patients with open fractures, 15.84%. Cefazoline and ceftriaxone showed low susceptibility. Meanwhile, levofloxacin showed a relatively good value of susceptibility in both Gram-positive and negative bacterial groups.Conclusion: The antibiotic susceptibility pattern of bacteria from specimens in open fracture grade III patients in Dr. Soetomo General Hospital Surabaya varies between each species of bacteria isolate.

Introducing image-guided synovial aspiration and biopsy in assessing peri-prosthetic joint infection: an early single-centre experience.

Synovial sampling can be used in the diagnosis of peri-prosthetic joint infection (PJI). The purpose of this study was to establish the role of simultaneous image-guided synovial aspiration and biopsy (SAB) during an initial 2-year experience at our institution. Retrospective review of consecutive SABs performed during 2014-2016 at a tertiary referral musculoskeletal centre. Radiological SAB microbiology culture results were compared with intra-operative surgical samples or multidisciplinary team (MDT) meeting outcome at 1-year follow-up if surgery was not undertaken. Sensitivity, specificity and accuracy of synovial aspiration (SA), synovial biopsy (SB) and simultaneous SAB were calculated. 103 patients (46 male, 57 female) totalling 111 procedures were analysed with mean age 65years (range 31-83). Image-guided synovial procedures were performed on 52 (46.9%) hip and 59 (53.1%) knee joint prostheses. The mean combined sensitivity, specificity and accuracy for the entire cohort was 72.6%, 96.9% and 90%, respectively. When only SB was obtained, diagnostic accuracy (92.5%) was similar to SA alone (94.1%). In total, there were 21 (18.9%) true-positive, 80 (72.1%) true-negative, 2 (1.8%) false-positive and 8 (7.2%) false-negative cases (PPV 91.3% and NPV 90.9%). No post-procedural complications were recorded at 1-year follow-up. Percutaneous image-guided SAB is a valuable technique in assessing suspected PJI, with most samples indicative of infective status and causative organisms when validated against intra-operative results and specialist MDT evaluation. Image-guided SB is a safe and useful additional procedure following failed SA with equivalent levels of diagnostic accuracy.

Burn infections characteristics: A review

Burn injuries are unique in comparison to other types of trauma because of their severity and major systemic impact produced by extensive lesions with disfunctions that can persist even several years after the injury. Multiple complications can occur during burn injury evolution, from which infections are the most severe and the most frequently encountered, requiring adequate diagnosis and treatment. In most burn centers, increased mortality rates associate with severe burn injuries aggravated by the development of sepsis. There are multiple sources of infections in burned patients: lungs, wounds, catheters, gastrointestinal and urinary tract. Pathogens are often multi-resistant bacteria but also fungi and viruses appear as opportunistic infections. The main goal is represented by prevention of organ dysfunction development through specific supportive measures that avoid its onset. Early excision of the burn eschar and wound grafting is essential for patient outcome, decreasing duration of hospitalization, infectious risk and mortality. As a principle, antibiotic treatment in burn infectious complications is started empirically, with broad spectrum agents if the results of microbiological cultures are not available and immediately after the antibiogram is available, targeted antibiotic is introduced. De-escalation strategy is promoted in order to prevent antimicrobial resistance: narrow spectrum drugs with proven efficacy on determined germs are administered, avoiding if possible, reserve antibiotics.

Prevalence and Predictors of Bacterial Contamination in Excisional Lymph Node Biopsies: Implications for Diagnosis and Management.

Routine tissue handling exposes lymph node specimens to microbial contamination that can confound microbiological culture results and interfere with diagnosis. The scope and impact of this problem remain poorly understood. We combined over 13 years of lymph node pathology, culture data, and patient records to define the prevalence, predisposing factors, microbiology, and clinical management of false-positive lymph node cultures at a large academic medical center. Nearly one third (31.9%) of 216 cultured lymph nodes yielded bacterial growth. Approximately 90% of positive bacterial cultures grew 1 of 2 common skin-resident taxa-coagulase-negative Staphylococcus and Cutibacterium acnes-with well-documented predispositions for contamination in other clinical settings. Lymph nodes excised from axillary, cervical, and inguinal regions yielded higher positive culture rates than nodes excised from the mediastinum, suggesting proximity to the skin surface may increase contamination risk. Accordingly, cultures from thoracoscopic pulmonary resections displayed contamination rates over 5-fold lower than those from percutaneously accessed lymph nodes. Lymph nodal tissue allocated for culture in the operating room yielded unexpectedly high contamination rates, significantly higher than cultures sent from the frozen section processing area. A significant minority of contamination events were noted in the clinical record and prompted antibiotic therapy on multiple occasions. Collectively, our results illuminate the risk factors contributing to bacterial contamination and argue that routine lymph node bacterial cultures provide minimal clinical benefit for adult patients. This widespread bacterial contamination also warrants cautious implementation of increasingly sensitive molecular microbiology tools for excised tissues.

Urgent Vitrectomy with Vancomycin Infusion, Silicone Oil Endotamponade, and General Antibiotic Treatment in Multiple Cases of Endophthalmitis from a Single Day of Intravitreal Injections-Case Series.

The aim of this study was to report on the anatomical and functional results of surgical management of seven cases of endophthalmitis related to a single day of intravitreal aflibercept injections. Patients with signs of endophthalmitis who underwent aflibercept injections (seven eyes) performed on the same day were retrospectively evaluated. The data of visual acuity and optical coherence tomography (OCT) within nine months of the follow-up and the treatment and results of microbiological cultures are reported. Four of the total seven cases had a positive bacterial culture outcome (Streptococcus mitis). All patients underwent vitrectomy combined with phacoemulsification when the eyes were not pseudophakic, vancomycin infusion, and silicone oil tamponade within 24 h; additionally, systemic antibiotics were administered intravenously. The final best-corrected visual acuity (BCVA) after the treatment was finger counting or light perception in all cases, and all eyes were saved with disruption of the inner retinal layers and stabilization of the retina in regard to changes related to the wet age-related macular degeneration (AMD). Although the retinal anatomy was mostly preserved, most of the patients affected by Streptococcus mitis-induced endophthalmitis did not regain baseline vision after the therapy.

The Unyvero Hospital-Acquired pneumonia panel for diagnosis of secondary bacterial pneumonia in COVID-19 patients

The study was undertaken to evaluate the performance of Unyvero Hospitalized Pneumonia (HPN) panel application, a multiplex PCR-based method for the detection of bacterial pathogens from lower respiratory tract (LRT) samples, obtained from COVID-19 patients with suspected secondary hospital-acquired pneumonia. Residual LRT samples obtained from critically ill COVID-19 patients with predetermined microbiological culture results were tested using the Unyvero HPN Application. Performance evaluation of the HPN Application was carried out using the standard-of-care (SoC) microbiological culture findings as the reference method. Eighty-three LRT samples were used in the evaluation. The HPN Application had a full concordance with SoC findings in 59/83 (71%) samples. The new method detected additional bacterial species in 21 (25%) and failed at detecting a bacterial species present in lower respiratory culture in 3 (3.6%) samples. Overall the sensitivity, specificity, positive, and negative predictive values of the HPN Application were 95.1% (95%CI 96.5–98.3%), 98.3% (95% CI 97.5–98.9%), 71.6% (95% CI 61.0–80.3%), and 99.8% (95% CI 99.3–99.9%), respectively. In conclusion, the HPN Application demonstrated higher diagnostic yield in comparison with the culture and generated results within 5 h.

A PROSPECTIVE STUDY OF THE IMPACT OF MICROBIOLOGICAL CULTURES ON ANTIBIOTIC PRESCRIBING PATTERN IN A TERTIARY CARE HOSPITAL

Objective: Antibiotics are frequently prescribed because of clinical suspicion of infection, while the results of the microbiological analysis are still awaited. This study was undertaken to assess the impact of microbiological culture results on the antibiotic prescribing pattern.&#x0D; Methods: This prospective observational study was conducted on 400 patients of either sex and any age with positive microbiological culture results. Empirical antibiotic therapy details were recorded and change in empirical antibiotic therapy after positive culture results was also recorded. Assessment of sensitivity resistance pattern of microorganisms was also performed.&#x0D; Results: In the study, male: female ratio was 1.01:1. The majority of patients i.e. 94 (24.50%) were in the 46 y to 60 y of age group. Definitive antibiotic therapy was initiated in 103 patients (25.75%) out of 400 patients. The highest number of changes in antibiotic therapy was done in urinary tract infections (63.95%) and septicemia (32.61%) cases. Klebsiella (34.25%), E. coli (32%) and Staphylococcus aureus (14.75%) were commonly isolated microorganisms. Cephalosporins (77.75%) and aminoglycosides (47%) were commonly used in empirical antibiotic therapy, while nitrofurantoin (47.57%) and penicillins (22.33%) were commonly used in definitive antibiotic therapy. Definitive antibiotic therapy was associated with a reduced duration of hospital stay as compared to empirical antibiotic therapy (p&lt;0.0001).&#x0D; Conclusion: Antibiotic prescribing is infrequently influenced by microbiological culture results. Adjustment of the antimicrobial therapy according to microbiological culture results can decrease the duration of hospital stay as well as can decrease the spread of antimicrobial resistance.

Predictive modeling of bacterial infections and antibiotic therapy needs in critically ill adults.

Unnecessary antibiotic regimens in the intensive care unit (ICU) are associated with adverse patient outcomes and antimicrobial resistance. Bacterial infections (BI) are both common and deadly in ICUs, and as a result, patients with a suspected BI are routinely started on broad-spectrum antibiotics prior to having confirmatory microbiologic culture results or when an occult BI is suspected, a practice known as empiric antibiotic therapy (EAT). However, EAT guidelines lack consensus and existing methods to quantify patient-level BI risk rely largely on clinical judgement and inaccurate biomarkers or expensive diagnostic tests. As a consequence, patients with low risk of BI often are continued on EAT, exposing them to unnecessary side effects. Augmenting current intuition-based practices with data-driven predictions of BI risk could help inform clinical decisions to shorten the duration of unnecessary EAT and improve patient outcomes. We propose a novel framework to identify ICU patients with low risk of BI as candidates for earlier EAT discontinuation. For this study, patients suspected of having a community-acquired BI were identified in the Medical Information Mart for Intensive Care III (MIMIC-III) dataset and categorized based on microbiologic culture results and EAT duration. Using structured longitudinal data collected up to 24-, 48-, and 72-hours after starting EAT, our best models identified patients at low risk of BI with AUROCs up to 0.8 and negative predictive values >93%. Overall, these results demonstrate the feasibility of forecasting BI risk in a critical care setting using patient features found in the electronic health record and call for more extensive research in this promising, yet relatively understudied, area.

Microbiological culture results and antibiotic sensitivity in renal preservation solution

Aim/Background: The aim of this study is to investigate the effects of the solutions used to preserve kidney during transplant surgeries on microbiological culture results and antimicrobial resistance and to evaluate this process from the perspectives of recipients and donors.

New opacities in lung allograft after transbronchial cryobiopsy

BackgroundThe occurrence of radiological opacities post-transbronchial cryobiopsy may pose serious difficulties in differential diagnosis and management of lung allografts. This prospective study evaluated the frequency, characteristics, and evolution of new lung opacities after performing transbronchial cryobiopsy. MethodsFrom February 2018 to June 2018, 22 of 51 consecutive patients with an indication for transbronchial cryobiopsy underwent computed tomography (CT) of the thorax before and at 1, 4, and 8 weeks post-cryobiopsy. New CT images, required by the transplant team, were also evaluated during the next 6 months. Histological findings of transbronchial cryobiopsy and microbiological studies on bronchoalveolar lavage were evaluated as risk factors for opacities. ResultsAfter obtaining 112 cryobiopsy samples, 46 opacities >10 mm, including ground-glass, solid, cavitated, or a combination of these lesions were observed in 20 (91%) patients on post-cryobiopsy CT. All ground-glasses opacities on CT disappeared at 4 weeks. A single cavitated opacity persisted at 6 months. The remaining opacities disappeared or were decreased to <10 mm by 8 weeks. No correlations of the number, type, or evolution of opacities with the number or volume of cryobiopsy samples obtained, or with the histological diagnosis, type of transplant, or microbiologic culture results were observed. ConclusionNew pulmonary opacities >10 mm occur frequently after transbronchial cryobiopsy; a few may persist beyond 6 months. CT studies are recommended before implementing transbronchial cryobiopsy, whenever possible.

Nosocomial Infection Following Severe Traumatic Injury in Children.

Nosocomial infection is a common source of morbidity in critically injured children including those with traumatic brain injury. Risk factors for nosocomial infection in this population, however, are poorly understood. We hypothesized that critically ill pediatric trauma patients with traumatic brain injury would demonstrate higher rates of nosocomial infection than those without traumatic brain injury. Retrospective case-control study. PICU, single institution. Patients under 18 years old who were admitted to the PICU for at least 48 hours following a traumatic injury were included. Patients were admitted between September 2008 and December 2015. Patients with the following injury types were excluded: thermal injury, drowning, hanging/strangulation, acute hypoxic ischemic encephalopathy, or nonaccidental trauma. Data collected included demographics, injury information, hospital and PICU length of stay, vital signs, laboratory data, insertion and removal dates for invasive devices, surgeries performed, transfusions of blood products, and microbiology culture results. Initial Pediatric Risk of Mortality III and Pediatric Logistic Organ Dysfunction-2 scores were determined. Patients were classified as having: 1) an isolated traumatic brain injury, 2) a traumatic injury without traumatic brain injury, or 3) polytrauma with traumatic brain injury. None. Two hundred three patients were included in the analyses, and 27 patients developed a nosocomial infection. Patients with polytrauma with traumatic brain injury demonstrated a significantly higher infection rate (30%) than patients with isolated traumatic brain injury (6%) or traumatic injury without traumatic brain injury (9%) (p < 0.001). This increased rate of nosocomial infection was noted on univariate analysis, on multivariable analysis, and after adjusting for other risk factors. In this single-center, retrospective analysis of critically ill pediatric trauma patients, nosocomial infections were more frequently observed in patients admitted following polytrauma with traumatic brain injury than in patients with isolated traumatic brain injury or trauma without traumatic brain injury.

Efficacy of Posaconazole Prophylaxis for Fungal Disease in Hematology Patients Treated With Chemotherapy and Transplantation: An Open-Label, Prospective, Observational Study.

BackgroundPosaconazole (PCZ) is used prophylactically to prevent invasive fungal infections (IFIs) in patients with hematological malignancies.ObjectiveTo evaluate the cut-off serum concentration of PCZ for successful IFI prophylaxis in Chinese subjects.Patients and MethodsA total of 74 patients treated with induction chemotherapy (n = 10) and allogeneic hematopoietic stem cell transplantation (HSCT) (n = 64), who received PCZ prophylactically as an oral suspension for >7 days, were included in the study. Clinical, radiological, microbiological culture results, and treatment responses were analyzed and drug concentration assays performed.ResultsThe overall incidence of possible, probable, and proven IFIs was 13.5% (10/74), with five patients in the chemotherapy group and five in the HSCT group. The PCZ serum concentration in most patients (54/63) was in the range of 0.25–1.0 μg/ml, and this concentration range was significantly associated with the success rate of PCZ prophylaxis. A cut-off value of 0.47 μg/ml can be considered as an evaluation index for PCZ prophylaxis. Taking a proton pump inhibitor (PPI) would reduce the PCZ blood concentration, but not affect the IFD breakthrough point. PCZ treatment for hematopoietic malignancy or HSCT patients with a serum concentration of PCZ < 0.47 μg/ml were risk factors for PCZ prophylaxis of IFIs, determined by univariable and multivariable regression analyses.ConclusionThe serum concentration of PCZ was related to the incidence of IFIs and a serum concentration of >0.47 μg/ml is highly recommended to avoid IFIs after chemotherapy or HSCT.Clinical Trial RegistrationChinese Clinical Trial Registry: ChiCTR1900026294.

A Nine-Year Analysis of Practice Patterns, Microbiologic Yield, and Clinical Outcomes in Cases of Presumed Infectious Endophthalmitis

To analyze practice patterns, microbiologic yield, and clinical outcomes in cases of presumed infectious endophthalmitis at a single tertiary academic referral center. Retrospective chart review. Eyes diagnosed with endophthalmitis at the Duke Eye Center between January 1, 2009, and January 1, 2018, that underwent aqueous tap, needle vitreous tap, or mechanical vitreous biopsy with pars plana vitrectomy (PPV) in conjunction with intravitreal antimicrobials. Charts of 133 eyes of 130 consecutive patients were identified and reviewed for etiology of endophthalmitis, ocular history, interventions, visual outcomes, complication rates, and microbiologic culture results. Microbiologic yield and corrected visual acuity (VA) at initial presentation and last follow-up (up to 1 year) were the primary outcome measures. Secondary outcome measures included need for subsequent intervention, retinal detachment (RD) rate, and antimicrobial sensitivities. Of the 133 cases of presumed infectious endophthalmitis, 74% were unrelated to cataract surgery. Initial management included intravitreal antimicrobials with aqueous tap in 46% of eyes, needle vitreous tap in 59% of eyes, and mechanical vitreous biopsy with PPV in 14% of eyes. Twenty-seven percent of cases that underwent initial aqueous or needle vitreous tap required subsequent intervention with PPV. Overall, 45% of endophthalmitis cases were culture proven. Needle vitreous tap and mechanical vitreous biopsy with PPV were more likely to yield culture growth compared with aqueous tap (P= 0.042, P= 0.004, respectively). All isolated bacteria were sensitive to the combination of intravitreal vancomycin and ceftazidime. Eyes that underwent initial mechanical vitreous biopsy with PPV had worse VA at presentation (P= 0.024) and at last follow up (P= 0.011) compared with eyes that underwent initial aqueous tap or needle vitreous tap. An RD occurred within 3-12 months in 13% (17/133) of cases, and of these, 41% had an endogenous etiology. Needle vitreous tap and mechanical vitreous biopsy were more effective in yielding positive cultures compared with aqueous tap; however, culture results may not influence initial intravitreal antimicrobial choice. Eyes with presenting VA between counting fingers and hand motion at 1 foot were more likely to undergo initial PPV.