Significance Of Positive Cultures Research Articles

Proportion of Urinary Tract Infection in Children between 6 Months to 5 Years of Age Presenting with Fever

Purpose: Fever serves as the most frequent cause of visits to emergency/outpatient pediatric departments among children under the age of five. Very frequently, the youngster is given antibiotics on an arbitrary basis without receiving the proper examination for a urinary tract infection (UTI). This study’s goals were to assess the prevalence of UTIs in febrile children between 6 months and 5 years of age. To study the proportion of UTIs in children between 6 months and 5 years presenting with fever. To study the association of various risk factors with UTI. Methodology: This Cross-sectional Descriptive observational research was done in the Pediatric department of tertiary care hospital from August 2020 to December 2022, in febrile kids between 6 months and 5 years age group using different variables. Association between two qualitative variables was seen by using Chi-square/Fischer’s exact test. A P < 0.05 was considered statistically significant whereas a P < 0.001 was considered highly significant. Results: Among the total study population, it was found that 5.58% of the patients with fever without focus had a UTI, while the majority of patients, 94.42% did not have a UTI but had fever without a specific focus. In UTI cases, urine culture growth patterns showed the presence of different isolates, including Escherichia coli (30.43%), Klebsiella (56.52%), Pseudomonas aeruginosa (8.7%), and Candida (4.34%). Conclusion: In the present research, the overall occurrence of UTI in children <5 years with fever without focus was 5.58%. Patients with significant pyuria and positive urine culture (UTI) were 43.75% and with significant pyuria but the sterile culture was 56.25%. So, it is concluded that significant pyuria can be sterile pyuria and cannot be labeled as UTI without confirmation on the urine culture report.

Limited Clinical Utility of Routine Mycobacterial Cultures for the Management of Diabetic Foot Infections.

Mycobacterial infections of the foot and ankle are uncommon. In a cohort of 2340 patients with diabetic foot infection (DFI) in a region with increased prevalence of mycobacterial disease, we identified no clinically significant positive cultures over a 3-year period. Routine mycobacterial culture of DFIs is of limited clinical utility.

BLOODSTREAM INFECTIONS IN INTENSIVE CARE UNIT PATIENTS IN TERTIARY HOSPITALS IN SANA’A CITY, YEMEN

Background and Aims: One of the most common infection among critically ill patients is bloodstream infection (BSI). The present study was conducted to inspect the clinical manifestations, and septic organisms in the intensive care units of university hospitals in Sana'a city, Yemen. Also to compare clinical characteristics, mortality and risk factors for positive case versus negative case for bacterial growth among sepsis patients. Subjects and methods: From January 1 to April 30, 2022, a cross-sectional study was undertaken on sepsis patients hospitalized in intensive care units at four hospitals in Sana'a, Yemen. A well-structured questionnaire was used to collect specific medical data for each subject. Patients suspected of having sepsis underwent tests such as blood culture, complete blood count, and C-reactive protein. Gram staining was used to identify organisms, and the VITEK II Bacterial Bioprinting System was used to study them. This study included 145 intensive care unit (ICU) patients who displayed one or more indications of sepsis. Results: Of the 145 ICU patients with suspected sepsis, 87 (60%) had culture-confirmed sepsis. The bulk of the identified bacteria (57.5%) were Gram-negative. In the ICU, the most prevalent sepsis agents are E. coli (23%), Klebsiella species (12.6%), and Burkholderia cepacia (7%). The most common Gram-positive pathogens are Staphylococcus epidermidis (27.6%) and S. aureus (10.3%). Significant positive culture outcomes were found with rapid onset of sepsis (OR=3.3, p=0.002), decreased urination (OR=2.2, p=0.02), older patients (OR=4, p=0.001), and death (OR=7.8). The commonest symptoms among the cases were fever (66.9%), increased heart rate (67.6%), confusion (62.8%) and respiratory distress (52.4%); the mortality rate was 29%. Conclusion: Gram-negative bacteria were the most common cause of sepsis, and substantial positive culture results were associated with early onset, decreased urination, older patients, and death. Sepsis's incidence, mortality, and morbidity rates in Yemen are likely underestimated because it is infrequently reported as a primary diagnosis (typically as a consequence of cancer or another illness). More research into the frequency and risk factors of sepsis in ICUs is recommended. Peer Review History: Received: 22 June 2023; Revised: 17 July; Accepted: 28 August, Available online: 15 September 2023 Academic Editor: Dr. Rola Jadallah, Arab American University, Palestine, rola@aauj.edu Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Wadhah Hassan Ali Edrees, Hajja University, Yemen, edress2020@gmail.com Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com

Implementation of moral state civil apparatus core values: a study of the influence of work culture, work discipline, and organizational commitment to the implementation of moral core values in Banyumas Regency

The launching of the Core Values and Employer Branding of the State Civil Apparatus (ASN) by the Ministry of Administrative and Bureaucratic Reform during the COVID-19 pandemic has yet to be completed. The emergence of the ASN Core Values will be a milestone in strengthening the ASN work culture. This study aims to determine the effect of work culture, work discipline, and organizational commitment on implementing core values with AKHLAK in the Government of Banyumas Regency. This study used a quantitative method in the form of a survey with a sample of 100 civil servants in the Banyumas Regency government environment. The analysis technique used to analyze primary and secondary data in this study is a linear regression analysis technique. The results are study results significant positive work culture, work discipline, and organizational commitment to the readiness of ASN in implementing core values with AKHLAK in the Government of Banyumas Regency. The results of this study imply that civil servants in the Banyumas Regency Government Environment are ready to face change and implement core values with AKHLAK.

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR)

Introduction and objectivesAs well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. MethodsThis study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. ResultsA total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. ConclusionOur real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

Influencia del sexo en los resultados de la cirugía retrógrada intrarrenal (CRIR). Datos obtenidos del Flexible Ureteroscopy Outcomes Registry (FLEXOR)

Introduction and objectivesAs well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. MethodsThis study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. ResultsA total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characterictis was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. ConclusionOur real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

MP35-06 DOES GENDER HAVE ANY INFLUENCE ON RIRS OUTCOMES? DATA FROM THE FLEXIBLE URETEROSCOPY OUTCOMES REGISTRY (FLEXOR)

MP35-06 DOES GENDER HAVE ANY INFLUENCE ON RIRS OUTCOMES? DATA FROM THE FLEXIBLE URETEROSCOPY OUTCOMES REGISTRY (FLEXOR)

97. Pharmacist Driven Antimicrobial Stewardship Interventions on the Management of Urinary Tract Infections in the Emergency Department at a Tertiary Military Treatment Facility

BackgroundWith the Joint Commission standards targeting ambulatory settings serving as a catalyst, we designed a quality improvement (QI) project was designed to evaluate the existing management and prescribing patterns for urinary tract infections (UTI) in the Walter Reed National Military Medical Center (WRNMMC) Emergency Department (ED) in order to identify targets for ASP intervention. MethodsThis was a Pharmacist-driven, prospective, QI project conducted over a 3-month period. The clinical presentations and microbiological data of uncomplicated cystitis and pyelonephritis cases managed in the ED were reviewed. Within 24-72 hours of ED discharge, recommendations were relayed to both patients and ED staff. Diagnostic criteria and management concordant with established clinical guidelines were assessed. Inclusion criteria included age ≥ 18, admission status, urine culture and antibiotics for UTI or pyelonephritis.ResultsA daily urinalysis (UA) report identified 1781 ED encounters of which 117 cases met inclusion criteria. Nitrofurantoin was most prescribed empirically at 39.3% followed by a cephalosporin (23.1%) or a fluoroquinolone (19.7%), accounting for 32% of inappropriate empiric antibiotic selection. Cases were identified with inappropriate duration of therapy (22.2%), dosage (9.4%), and drug-bug mismatch (9.4%). Nearly 38% of cases required intervention to discontinue (32.5%) or initiate new antibiotics (3.4%). Diagnostic concordance was defined as having positive urinary symptoms, clinically significant UA and positive urine culture. This was only observed in 37.6% of all cases, of which only 43.2% were treated with a guideline concordant empiric regimen, dosage and duration of therapy. Although not included in the final analysis, it was noted 916 urine culture results were ordered where 70% were not associated with genitourinary complaints or sepsis.ConclusionDespite guidelines for UTI management, considerable practice discordance was found in the ED. Multiple Pharmacist targeted interventions were identified. Prioritized areas for ED provider education include first-line therapy, treatment duration, and diagnostic stewardship. This QI project has potential for optimizing prescribing practices in Military Health System ambulatory settings. Disclosures All Authors: No reported disclosures

Antimicrobial Resistance Patterns in Clinically Significant Isolates from Medical Wards of a Tertiary Care Hospital in North India.

Background The global burden of infections due to multidrug-resistant organism (MDRO) has a significant impact on patients’ morbidity and mortality along with increased healthcare expenditure. Aim This article estimates the prevalence of MDRO and the spectrum of clinical infectious syndromes caused by these organisms in medical wards of a tertiary care hospital in India. Design and Methods A cross-sectional observational study was performed among patients admitted in medicine wards diagnosed with the various infectious syndromes and one or more clinically significant positive culture at a tertiary care hospital in North India over a period of 18 months. Results Out of 323 clinically significant microbiological culture isolates from 229 patients included in the study, 86 (27%) isolates showed multidrug resistance (MDR) pattern, 197 (61%) isolates showed possible extremely drug-resistance pattern, and only 40 (12%) isolates showed nonmultidrug-resistance pattern of antibiogram. Conclusion The prevalence of MRDOs is high in clinically significant culture isolates from medicine wards in India. This emphasizes the importance of appropriate antibiotic usage and implementation of antibiotic stewardship programs in this part of the world.

Risk factors for development of vancomycin-resistant enterococcal bacteremia among VRE colonizers : Aretrospective case control study.

We aimed to determine the proportion of vancomycin-resistant enterococci (VRE) colonized patients among all inpatients who later developed VRE bacteremia during hospital stay and to identify the risk factors for VRE bacteremia at atertiary hospital. Patients with positive rectal screening or any clinically significant positive culture results for VRE were included in 1‑year follow-up. Colonization with VRE was defined as apositive culture (rectal, stool, urinary) for VRE without infection and VRE bacteremia was defined as positive blood culture if the signs and symptoms were compatible with infection. To determine the risk factors for VRE bacteremia among VRE colonized patients, aretrospective case control study was performed. The two groups were compared in terms of variables previously defined as risk factors in the literature. Of 947 positive samples, 17VRE bacteremia were included in the analysis. Cephalosporin use for more than 3days within 3months was asignificant risk factor for bacteremia (p = 0.008). Prior use of carbapenems was found to be statistically significant for bacteremia (p = 0.007). In multivariate analyses the use of carbapenems and cephalosporins was an independent risk factor for developing bacteremia among VRE colonizers (odds ratio, OR, 6.67; 95% confidence interval, CI, 1.30-34; p = 0.022 and OR 4.32, 95% CI 1.23-15; p = 0.022, respectively). AVRE colonization in patients receiving broad-spectrum beta-lactam antibiotics including carbapenems and cephalosporins may result in bacteremia. It is possible to keep mortality at very low levels in VRE bacteremia with effective infection control measures, rapid infectious diseases consultation and rational antimicrobial treatment based on current epidemiological data.

ANALISIS KINERJA: TRAINING, LINGKUNGAN KERJA, BUDAYA ORGANISASI DAN KEPUASAN KERJA

The purpose of this study is to test training, employee environment, and organizational culture on employee performance with satisfaction as an intervening variable. using a quantitative approach, the data of this study were collected from 100 employees Sekretariat Badan Pelatihan dan Pendidikan Keuangan Jakarta. The sampling technique used was random sampling. Partial Least Square (PLS) is used to test the hypothesis in this study by using SmartPLS 3.0. The results of this study found that there is a significant positive effect of training on employee performance, there is a significant positive effect of the work environment on employee performance, and there is a significant positive effect of organizational culture on employee performance. then, there is a significant positive effect on job satisfaction, there is a work environment that has a significant positive effect on job satisfaction, there is a significant positive organizational culture on job satisfaction, and there is a positive job satisfaction on employee performance. besides, it was found that the direct effect of training on employee performance was greater than the indirect effect of training on job satisfaction, there was a work environment that directly affected employee performance greater than the indirect influence of the work environment on job satisfaction, and there was an influential organizational culture directly on employee performance is greater than the indirect influence of organizational culture on job satisfaction.

ANALISIS KINERJA: TRAINING, LINGKUNGAN KERJA, BUDAYA ORGANISASI DAN KEPUASAN KERJA

The purpose of this study is to test training, employee environment, and organizational culture on employee performance with satisfaction as an intervening variable. using a quantitative approach, the data of this study were collected from 100 employees Sekretariat Badan Pelatihan dan Pendidikan Keuangan Jakarta. The sampling technique used was random sampling. Partial Least Square (PLS) is used to test the hypothesis in this study by using SmartPLS 3.0. The results of this study found that there is a significant positive effect of training on employee performance, there is a significant positive effect of the work environment on employee performance, and there is a significant positive effect of organizational culture on employee performance. then, there is a significant positive effect on job satisfaction, there is a work environment that has a significant positive effect on job satisfaction, there is a significant positive organizational culture on job satisfaction, and there is a positive job satisfaction on employee performance. besides, it was found that the direct effect of training on employee performance was greater than the indirect effect of training on job satisfaction, there was a work environment that directly affected employee performance greater than the indirect influence of the work environment on job satisfaction, and there was an influential organizational culture directly on employee performance is greater than the indirect influence of organizational culture on job satisfaction.

2328. Community-Onset Invasive Bacterial Infections in Infants Under 3 Months–10 Years of Experience in Auckland, New Zealand

BackgroundSerious infections remain the leading cause of death in the first year of life. Sepsis in neonatal intensive care units is well described but infants with bacterial infections presenting from the community has not previously been described in New Zealand. Recent studies suggest an increasing incidence of Staphylococcus aureus and Streptococcus pyogenes in New Zealand pediatric populations. It is, therefore, important to understand the unique pattern of infections seen in the infant population in New Zealand as this may impact on empiric management.MethodsA retrospective study (2007–2017) including infants aged 8 to 90 days presenting with clinically significant infection and positive culture from a sterile site. Cases were identified from laboratory database and ICD discharge codes, enabling data collection and analysis.Results192 cases were identified from two major hospitals in Auckland. This represented an incidence of invasive bacterial infections of 129/100,000 live births. Escherichia coli (40%) and Streptococcus agalactiae (22%) were the commonest pathogens. Streptococcus pyogenes and Staphylococcus aureus caused 14% and 12% of bacteremias respectively. Pacific island infants had the highest rates of infection (255/100,000) as did those from deprived backgrounds.Conclusion Escherichia coli and Streptococcus agalactiae are the commonest causative organisms in community-onset infant sepsis in Auckland.Rates of invasive bacterial infections in this age group are higher than reported in other industrialized countries (including published data from the USA), with Staphylococcus aureus and Streptococcus pyogenes being the most disproportionate. Our study demonstrates the increased risk of invasive Staphylococcus aureus and Streptococcus pyogenes in New Zealand, even at this early age, and this impacts on empiric antibiotic prescribing and management of infant sepsis in New Zealand. The risk of invasive infection is highest in Pacific and Māori infants and those from deprived backgrounds.A small number of multi-resistant organisms were present in this age group, prior to antibiotic exposure, illustrating that rising rates of community antimicrobial resistance will need to be considered even when prescribing for infants.Disclosures All authors: No reported disclosures.

Yield of Anaerobic Blood Cultures in Pediatric Emergency Department Patients.

Anaerobic bacteremia is rare in children and current recommendations advocate against the routine use of anaerobic cultures in children. However, the incidence of anaerobic bacteremia and the utility of anaerobic blood cultures in children have not been assessed in recent years. Our pediatric emergency department (PED) policy still supports the use of both aerobic and anaerobic blood cultures in all cases of suspected bacteremia. This allowed us to re-evaluate the yield of anaerobic cultures in PED settings. Retrospective data of all blood cultures taken in the PED in a single tertiary center from 2002 to 2016 were collected. The incidence and characteristics of children with positive anaerobic blood cultures were assessed. Risk factors for anaerobic bacteremia were defined. Of the 68,304 blood culture sets taken during the study period, 971 (1.42%) clinically significant positive cultures were found. Pathogenic obligatory anaerobic bacteria were isolated in 33 (0.05%) cultures. The leading risk factors for anaerobic bacteremia were head and neck abscess and intra-abdominal infection. Of all the true positive cultures, 187 (22%) were only detected in the anaerobic culture and would have otherwise been missed. True anaerobic bacteremia is extremely rare in children admitted to the PED. Nevertheless, using anaerobic cultures may increase the overall yield of blood cultures.

Paper #19 - Analysis of Synovial Fluid Cytokine Profiles in Determining Significance of Positive Culture Results in Patients Undergoing Primary Total Shoulder Arthroplasty for Glenohumeral Osteoarthritis

Introduction: Determining the significance of a positive culture result in revision shoulder arthroplasty can be challenging, due to the indolent nature of the commonly cultured organisms, most notably P. acnes. Recent studies have also shown a significant positive culture rate with P. acnes following primary shoulder arthroplasty in patients with no prior history of shoulder surgery. These findings suggest that some P. acnes culture growth following shoulder arthroplasty may represent culture contaminant or non-infectious colonization, rather than true infection. However, further data is needed to clarify such distinctions. We have previously demonstrated the benefit of synovial fluid cytokine analysis in the diagnosis of shoulder periprosthetic joint infection (PJI). The purpose of this study was to compare synovial fluid cytokine profiles and culture results in patients with primary glenohumeral osteoarthritis (OA) undergoing primary total shoulder arthroplasty (TSA) to non-arthritic patients undergoing primary arthroscopic rotator cuff repair (RCR), in order to determine if cytokine levels can distinguish the significance of a positive culture result.

Using anaerobic blood cultures for infants younger than 90 days rarely showed anaerobic infections but increased yields of bacterial growth.

The use of anaerobic blood cultures in infants suspected of bacteraemia is controversial. Our children's hospital uses both aerobic and anaerobic media, regardless of the risk of anaerobic infection, and the aim of this study was to re-evaluate the use of anaerobic cultures in infants. We collected retrospective data from 2002 to 2016 on all blood cultures taken from infants younger than 90 days in the Hadassah-Hebrew University Medical Centre, Jerusalem, Israel. The incidence and characteristics of infants with positive anaerobic blood cultures were assessed. During the study period, 51 035 blood cultures were drawn from 44 304 infants. Of these, 1496 (2.9%) were clinically significant positive cultures. Pathogenic obligatory anaerobic bacteraemia was extremely rare, with only 37 positive cultures (0.07%) from all of the cultures drawn. No specific risk factors for obligatory anaerobic bacteraemia could be defined, but as many as 174 (11.6%) clinically significant isolates were only detected in the anaerobic culture bottle. True anaerobic bacteraemia was extremely rare in neonates. Nevertheless, using anaerobic culture media may increase the overall yield of bacterial culture growth by isolating anaerobic-facultative bacteria. This should be weighed up against increasing the volume of blood used for the aerobic culture.

Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome

The purpose of this study was to determine the impact of bacteremia on intensive care unit (ICU) mortality and to develop a bacteremia prediction tool using systemic inflammatory response syndrome (SIRS) criteria. Patients included those aged >18 years who had blood cultures taken in the ICU from January 1, 2011-December 31, 2013. Eligible patients were identified from microbiology records of the Glasgow Royal Infirmary, Scotland. Clinical and outcome data were gathered from ICU records. Patients with clinically significant bacteremia were matched to controls using propensity scores. SIRS criteria were gathered and used to create decision rules to predict the absence of bacteremia. The main outcome was mortality at ICU discharge. The utility of the decision tools was measured using sensitivity and specificity. One hundred patients had a clinically significant positive blood culture and were matched to 100 controls. Patients with bacteremia had higher ICU mortality (odds ratio [OR], 2.35; P = .001) and longer ICU stay (OR, 17.0 vs 7.8 days; P ≤ .001). Of 1,548 blood culture episodes, 1,274 met ≥2 SIRS criteria (106 significant positive cultures and 1,168 negative cultures). There was no association between SIRS criteria and positive blood cultures (P = .11). A decision rule using 3 SIRS criteria had optimal predictive performance (sensitivity, 56%; specificity, 50%) but low accuracy. ICU patients with bacteremia have increased mortality and length of ICU stay. SIRS criteria cannot be used to identify patients at low risk of bacteremia.

Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality.

Unlike Elizabethkingia meningoseptica, the clinical importance of E. anophelis is poorly understood. We determined the clinical and molecular epidemiology of bacteremia caused by Elizabethkingia-like species from five regional hospitals in Hong Kong. Among 45 episodes of Elizabethkingia-like bacteremia, 21 were caused by Elizabethkingia, including 17 E. anophelis, three E. meningoseptica and one E. miricola; while 24 were caused by other diverse genera/species, as determined by 16S rRNA gene sequencing. Of the 17 cases of E. anophelis bacteremia, 15 (88%) were clinically significant. The most common diagnosis was pneumonia (n = 5), followed by catheter-related bacteremia (n = 4), neonatal meningitis (n = 3), nosocomial bacteremia (n = 2) and neutropenic fever (n = 1). E. anophelis bacteremia was commonly associated with complications and carried 23.5% mortality. In contrast, of the 24 episodes of bacteremia due to non-Elizabethkingia species, 16 (67%) were clinically insignificant. Compared to non-Elizabethkingia bacteremia, Elizabethkingia bacteremia was associated with more clinically significant infections (P < 0.01) and positive cultures from other sites (P < 0.01), less polymicrobial bacteremia (P < 0.01), and higher complication (P < 0.05) and mortality (P < 0.05) rates. Elizabethkingia bacteremia is predominantly caused by E. anophelis instead of E. meningoseptica. Elizabethkingia bacteremia, especially due to E. anophelis, carries significant morbidity and mortality, and should be considered clinically significant unless proven otherwise.

Sonication as a Diagnostic Approach Used to Investigate the Infectious Etiology of Prosthetic Hip Joint Loosening

The purpose of the study was to evaluate the usefulness of sonication for the diagnosis of prosthetic joint infections (PJIs) by its comparison with periprosthetic tissues (PTs) and synovial fluid (SV-F) cultures. The study groups included 54 patients undergoing exchange of total hip prostheses for so called "aseptic" loosening occurring without clinical manifestations of an accompanying PJI and 22 patients who developed a sinus tract communicating with the prosthesis which was indicative of an ongoing infectious process. Significant positive culture results were obtained among 10 (18.5%) patients with "aseptic" implant failure and in 18 (81.8%) patients who developed a sinus tract. Sonicate-fluid (S-F) yielded bacterial growth in all culture-positive patients with "aseptic" loosening vs. 15 patients with presumed PJIs. There was a concordance in terms of bacterial species isolated from S-F and conventional cultures from individual patients. Coagulase-negative staphylococci were isolated most frequently. Sensitivity of sonication (75%) exceeded that estimated for PTs (69%) and SV-F (45%) cultures. We conclude that identification of causative agents of PJIs which is critical to further therapeutic decisions is aided by the combination of sonication and conventional culture.

Inflammation or infection at the time of second trimester induced abortion

BackgroundInduced abortion via dilation and evacuation (D&E) typically involves cervical preparation. Some clinicians also induce fetal death in the second trimester. We designed this study to determine if the combination of intra-amniotic digoxin and osmotic dilators induced intrauterine inflammatory changes. Study DesignTwenty-two women requesting abortion at 19–23 weeks gestation had amniotic fluid sent for measurement of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), white blood cell (WBC) count and anaerobic and aerobic cultures on Day 1, before dilators and digoxin amnioinjection. Sampling was repeated on Day 2, prior to D&E. ResultsAll subjects had significantly elevated IL-6, IL-8 and TNF-α in the amniotic fluid on Day 2. The median difference for IL-6 was 19,893.4 pg/mL (p<.0001), 7040.7 pg/mL (p<.0001) for IL-8 and 181.0 pg/mL (p<.0001) for TNF-α.There was no significant difference in WBC count. There were no clinically significant positive cultures and no clinical infections. ConclusionThe administration of intra-amniotic digoxin and the placement of osmotic dilators prior to D&E create an intrauterine inflammatory response.