Standard Blood Culture Research Articles

Affinity-based 3D-printed microfluidic chip for clinical sepsis detection with CD69, CD64, and CD25

Sepsis is a life-threatening immune response to infection in the body, eventually resulting in fatal organ failure. Current methods utilize blood cultures and quick-Sequential-Organ-Failure-Assessment (qSOFA), but there is a need for more accurate and time-sensitive diagnostic methods to improve survival rates. We present a 3D-printed microfluidic chip that bioconjugates antibodies CD69, CD64, and CD25 to channel surfaces to capture sepsis cells in blood samples and validate it with clinical samples (n = 125 septic, n = 10 healthy). Other variables were taken such as healthy volunteer blood samples and patient demographics to validate and confirm our device’s diagnostic ability. Statistical differences were found between healthy volunteer and sepsis patient antigen cell counts (CD69 p-value < 0.001, CD64 p-value < 0.004, CD25 p-value < 0.0009), and were confirmed using principal component analysis. Demographics such as length of stay, age, culture results, and need for surgery also factored into sepsis detection on a smaller scale than the antigen cell counts. The receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.989, 0.988, and 0.992 for CD69, CD64, and CD25, respectively, and a combined biomarker panel of 0.997. Overall, the device performed within a shorter time frame of 4 h compared to standard blood culture tests and was validated for use in detecting sepsis in patients.

Evaluation of T2 Magnetic Resonance (T2MR®) Technology for the Early Detection of ESKAPEc Pathogens in Septic Patients.

Bloodstream infections (BSIs) and sepsis are a major cause of morbidity and mortality. Appropriate early antibiotic therapy is crucial for improving the survival of patients with sepsis and septic shock. T2 magnetic resonance (T2MR®) technology may enable fast and sensitive detection of ESKAPEc pathogens directly from whole-blood samples. We aimed to evaluate concordance between the T2Bacteria® Panel and standard blood culture and its impact on antibiotic therapy decisions. We conducted a single-centre retrospective study on patients with sepsis-induced hypotension or septic shock admitted to general, post-operative/neurosurgical, and cardiothoracic Intensive Care Units who were tested with the T2Bacteria® Panel from January 2021 to December 2022. Eighty-five consecutively admitted patients were included, for a total of 85 paired tests. A total of 48 ESKAPEc pathogens were identified by the T2Bacteria® Panel. The concordance rate between the T2Bacteria® Panel and blood cultures was 81% (69/85), with 20 concordant-positive and 49 concordant-negative cases. For the 25 microorganisms grown from accompanying blood cultures, blood pathogen coverage by the T2Bacteria® Panel was 88%. In this cohort of severely ill septic patients, the T2Bacteria® Panel was highly concordant and was able to detect more ESKAPEc pathogens, with a significantly shorter turn-around time compared to conventional blood cultures. The T2Bacteria® Panel also significantly impacted decisions on antibiotic therapy.

Diagnosis and Management of Neonatal Bacterial Sepsis: Current Challenges and Future Perspectives.

Sepsis remains the second cause of death among neonates after the pathological consequences of extreme prematurity. In this review we summarized knowledge about pathogens causing early-onset sepsis (EOS) and late-onset sepsis (LOS), the role of perinatal risk factors in determining the EOS risk, and the tools used to reduce unnecessary antibiotics. New molecular assays could improve the accuracy of standard blood cultures, providing the opportunity for a quick and sensitive tool. Different sepsis criteria and biomarkers are available to date, but further research is needed to guide the use of antibiotics according to these tools. Beyond the historical antibiotic regimens in EOS and LOS episodes, antibiotics should be based on the local flora and promptly modulated if specific pathogens are identified. The possibility of an antibiotic lock therapy for central venous catheters should be further investigated. In the near future, artificial intelligence could help us to personalize treatments and reduce the increasing trend of multidrug-resistant bacteria.

Prospective multicentre accuracy evaluation of the FUJIFILM SILVAMP TB LAM test for the diagnosis of tuberculosis in people living with HIV demonstrates lot-to-lot variability.

There is an urgent need for rapid, non-sputum point-of-care diagnostics to detect tuberculosis. This prospective trial in seven high tuberculosis burden countries evaluated the diagnostic accuracy of the point-of-care urine-based lipoarabinomannan assay FUJIFILM SILVAMP TB LAM (FujiLAM) among inpatients and outpatients living with HIV. Diagnostic performance of FujiLAM was assessed against a mycobacterial reference standard (sputum culture, blood culture, and Xpert Ultra from urine and sputum at enrollment, and additional sputum culture ≤7 days from enrollment), an extended mycobacterial reference standard (eMRS), and a composite reference standard including clinical evaluation. Of 1637 participants considered for the analysis, 296 (18%) were tuberculosis positive by eMRS. Median age was 40 years, median CD4 cell count was 369 cells/ul, and 52% were female. Overall FujiLAM sensitivity was 54·4% (95% CI: 48·7-60·0), overall specificity was 85·2% (83·2-87·0) against eMRS. Sensitivity and specificity estimates varied between sites, ranging from 26·5% (95% CI: 17·4%-38·0%) to 73·2% (60·4%-83·0%), and 75·0 (65·0%-82·9%) to 96·5 (92·1%-98·5%), respectively. Post-hoc exploratory analysis identified significant variability in the performance of the six FujiLAM lots used in this study. Lot variability limited interpretation of FujiLAM test performance. Although results with the current version of FujiLAM are too variable for clinical decision-making, the lipoarabinomannan biomarker still holds promise for tuberculosis diagnostics. The trial is registered at clinicaltrials.gov (NCT04089423).

Insights from genomic analysis of a novel Coxiella burnetii strain isolated in Israel

The diagnosis of Q fever is challenging due to nonspecific symptoms and negative standard blood culture results. Serological testing through immunofluorescence assay (IFA) is the most commonly used method for diagnosing this disease. Polymerase chain reaction (PCR) tests can also be used to detect bacterial DNA if taken at an appropriate time. Once the presence of bacteria is confirmed in a sample, an enrichment step is required before characterizing it through sequencing. Cultivating C. burnetii is challenging as it can only be isolated by inoculation into cell culture, embryonated eggs, or animals. In this article, we describe the isolation of C. burnetii from a valve specimen in Vero cells. We conducted genome sequencing and taxonomy profiling of this isolate and were able to determine its taxonomic affiliation. Furthermore, Multispacer sequence typing (MST) analysis suggests that the infection originated from a local strain of C. burnetii found around northern Israel and Lebanon. This novel strain belongs to a previously described genotype MST6, harboring the QpRS plasmid, never reported in Israel.

CD64 and I/T Ratio as a Diagnostic Test on Neonatal Sepsis in Banjarmasin

Neonatal sepsis remains a major problem in the service and care of neonates. The clinical features of neonatal sepsis are non-specific, which makes it difficult to diagnose. The primary objective of this study was to assess the clinical use of cluster of differentiation 64 as a diagnostic marker of neonatal infection. This research used an analytical observational study. The research subjects consisted of 43 samples of neonates at Ulin Hospital, Banjarmasin who had met the inclusion criteria. The results of the study concluded that there was no significant difference between the I/T ratio and cluster of differentiation 64 values in patients with suspected neonatal sepsis with the gold standard procalcitonin and/or blood culture at Ulin Hospital with p=0.874 for the I/T ratio and p=0.285 for cluster of differentiation 64. The diagnostic test for the I/T ratio with a cut-off of 0.2 showed a sensitivity of 23.8%, specificity of 72.7%, positive predictive value of 45.5%, negative predictive value of 50%, mean of 0.16, and median of 0.11. The results of the cluster of differentiation 64 diagnostic test with a cut-off of 2025 showed a sensitivity of 42.9%, specificity of 72.7%, positive predictive value of 81.8%, negative predictive value of 50%, mean of 2487.93, and median of 1671. There was no significant difference between the I/T ratio and cluster of differentiation 64 values in patients with suspected neonatal sepsis with the gold standard procalcitonin and/or blood culture at Ulin Hospital, Banjarmasin.

171. Gram-Positive Blood Culture Contamination Rates: A Comparative Assessment Between Verigene® and Conventional Method

Abstract Background The estimated cost of treatment for septicemia among hospitalized patients is $15.4 billion. Approximately 20%-50% of all positive blood cultures were likely false positives. The rates of the reported contaminations in the literature range from 0.6%-12.5%. The false positive report of bacteremia has significantly impacted overall healthcare by increasing mortality rates, prolonging hospital stays, and expanding the cost of care. The use of Verigene® offers polymerase chain reaction (PCR) amplification in &amp;lt; 5 minutes. In our study, we examine the Verigene®, compared to the standard blood culture by the Vitek-2®, to assess for detecting Gram-positive blood contamination (GPBC). Methods Blood cultures were collected from patients with sepsis in four hospitals in El Paso, Texas (1/1/2018-5/30/2022). Samples were run through Verigene®. Simultaneously, all specimens were cultured using the conventional method and then incubated for five days. Gram stain used for positive samples. Speciation and antimicrobial susceptibility using Vitek-2®. GPBC in Vitek-2® was identified when one set of two grows microorganisms, universally known as skin flora, without clinical sepsis within 48hr. GPBC in Verigene® was identified when it recognized any skin flora without clinical sepsis within 24hr. The analysis was made using McNemar’s Chi-square test. An observation was statistically significant if the p-value was ≤0.05. Results A total of 816 Gram-positive results were obtained. The prevalence of GPBC based on the traditional technique was 98.65% and 64.25% based on the Verigene®. Staphylococcus epidermidis was the most detected at 52%, followed by Staphylococcus aureus at 26%. The sensitivity of the Verigene® for GPBC detection was 64.22%, and the specificity was 33.33%.Figure 1.Frequency of Gram-positive Microorganisms DetectionFigure 2.Sensitivity and Specificity of Verigene® in Identification of Contamination in Gram-positive Blood CultureTable 1.Sensitivity and Specificity of Verigene® in Identification of Contamination in Gram-positive Blood Culture Conclusion The use of Verigene® alone in identifying GPBC is insufficient. Despite the higher sensitivity in detecting microorganisms compared to Vitek-2®, this should be paired with clinical judgment and conventional methods. The ability to recognize GPBC by Verigene® was affected by the lack of clinical evidence to exclude sepsis in the first 24hr. This study is the first to evaluate Verigene® for identifying GPBC. Further interventions should be introduced, i.e., reporting titer by PCR on any detection. Disclosures All Authors: No reported disclosures

Detection of Inflammatory Biomarkers Among Patients with Sepsis of Gram-Negative Bacteria: A Cross-Sectional Study.

Sepsis is a highly mixed ailment that affects patients with numerous conditions of infectious sources and can lead to multi-organ failure with dysregulated host immune response. To determine inflammatory biomarkers in patients with sepsis caused by Gram-negative bacteria and compare their role in the early detection of sepsis. This cross-sectional study was conducted on patients with sepsis admitted to the intensive care unit at different hospitals in Sulaimaniyah, Iraq, from May to December 2021. Patients (n=147) were enrolled in this study according to the primary diagnosis of sepsis by Sequential Organ Failure Assessment scores. Blood samples were taken from patients to investigate white blood cells, inflammatory biomarkers (pentraxin-3, procalcitonin, adrenomedullin, lipopolysaccharide binding protein, interleukin-17A, lactate dehydrogenase, and C-creative protein), blood culture, antibiotic susceptibility test, and coagulation biomarkers (Prothrombin time, activated partial thromboplastin time, and international normalized ratio). Then, isolated Gram-negative bacteria were tested for extended-spectrum β-lactamase enzymes production by screening and combined disc tests. A total of 51.7% samples were blood culture positive for different Gram-negative bacteria, and P. aeruginosa (51.95%) was a more isolated bacterium. Both males and females were affected by sepsis in a ratio of 1.23:1 with different age groups. Extended-spectrum β-lactamase was estimated to be 77.2% by antibiotic profile, and the rate decreased using two double-disc synergy tests. This was confirmed by combined disc test at a rate of 41.35%. The most prevalent biomarkers were procalcitonin (88.16%), adrenomedullin (84.21%), pentraxin-3 (22.37%), and lipopolysaccharide binding protein (11.84%). Sepsis is a life-threatening condition that can be diagnosed early by several blood biomarkers such as procalcitonin, adrenomedullin, and pentraxin-3 combined with a standard blood culture technique to improve the patient outcome.

Snapshots of ID Week 2022

Snapshots of ID Week 2022

885. Integrated Blood Culture and Molecular Diagnostic Device Reduces Time-to-Result to a Quarter of Traditional Methods

Abstract Background Prolonged antibiotic exposure in infants with negative blood cultures is associated with adverse outcomes, disruption of the developing microbiome, and increased carriage of antibiotic resistance genes. However, early administration of antibiotics significantly reduces risk of infant morbidity and mortality caused by infections, and therefore faster culture-to-identification is highly desirable. We combined blood culture (BC) and PCR-based pathogen identification into a single digital microfluidic (DMF) device to speed up BC results. Methods Our DMF BC+PCR device has a custom-built BC bottle incubator, which is connected to a disposable cartridge that performs sample preparation and PCR. Standard BC bottles were inoculated with K. pneumoniae, then incubated in either the DMF BC device or a traditional BC device (BD BACTEC 9050). Samples were drawn from the DMF BC bottle at 3, 4 and 5 hours and loaded in the cartridge for automated sample processing and PCR. Time-to-positivity for the DMF BC+PCR device was determined using cycle threshold and compared with the traditional method, which uses fluorescence from BC bottle followed by PCR on a separate device. Results Bacterial presence could be detected as quickly as 3 hours post inoculation (Ct values of 34, 31 and 28 at 3, 4, and 5 hrs) with five replicates of K. pneumoniae samples on the DMF BC+PCR device (growing 10x every hr), compared to &amp;gt; 12 hrs for the traditional method (10.5 hr culture and 2 hr PCR identification). Additionally, for 5 common pathogens that cause neonatal sepsis (K. pneumoniae, E. coli, S. aureus, S. agalactiae, or S. epidermidis), we also demonstrated that the DMF BC bottle incubator and the traditional BC device show similar growth curves using optical methods to determine growth. Conclusion The DMF BC system yields bacterial growth rates equivalent to traditional methods, but can drastically reduce time to pathogen identification, from 12 hrs to 3 hrs by leveraging PCR sensitivity to determine growth rather than fluorescence in the BC bottles. To our knowledge, this is the first demonstration of using an integrated microfluidic PCR platform to speed up culture and identification. Further work is ongoing to include antibiotic susceptibility testing and expand the panel of pathogens detected on the same cartridge. Disclosures Laura Huning, PhD, Baebies, Inc.: Stocks/Bonds Devika Varma, PhD, Baebies, Inc.: Stocks/Bonds Abbey Jackson, PhD, Baebies, Inc.: Stocks/Bonds Peter Bohlen, n/a, Baebies, Inc.: Stocks/Bonds Rainer Ng, PhD, Baebies, Inc.: Stocks/Bonds Vamsee Pamula, PhD, Baebies, Inc.: Stocks/Bonds.

AML-332 Antibiotic Resistance Profile of Blood Culture Isolates in Neutropenics in Morocco

The emergence of bacterial resistance to antibiotics is an international health issue affecting all age groups and all clinical profiles. These multidrug-resistances lead to therapeutic impasses and pose a problem of therapeutic management, particularly in immunocompromised patients. The aim of our study is to highlight the different germs isolated in blood culture as well as their antibiotic resistance profiles in patients hospitalized on the protected side of our department. This is a prospective study lasting 6 months, from June 2021 to December 2021, carried out within the protected side of the hematology department, in 53 patients who presented an episode of febrile neutropenia and in whom a standard blood culture was performed. Of the blood cultures performed in our 53 patients, 31 (58%) blood cultures were positive, with demonstration of a bacterial infection in 20 patients, i.e., 65% of cases. The main bacterial species found are Klebsiella pneumonia in 3 cases (15%), Acinetobacter baumannii in 3 cases (15%), Escherichia coli in 4 cases (20%), and Pseudomonas aeruginosa in 2 cases (10%). Out of this total of 20 isolated germs, there were 13 infections by multidrug-resistant bacteria (MRB), i.e., 65% of the cases of bacterial infection in our sample. The incidence of MRB is 0.44 cases per 59 patients per year. The antibiogram of the main MRB isolated shows the emergence of increased resistance to the antibiotics used: Klebsiella pneumonia is resistant to penicillins A, fluoroquinolones, C2G, C3G, and gentamycin; ABRI is resistant to aminoglycosides, cephalosporins, fluroquinolones, piperacillin-tazobactam, and imipenem; PARI is resistant to piperacillin-tazobactam, ticarcillin ceftazidime, fluoroquinolones, aminoglycosides, and carbapenem; and Escherichia coli is resistant to ampicillin, amoxicillin, cefoxitin, ceftriaxone, ceftazidime, ciprofloxacin, gentamicin, and ertapenem. The acquisition of resistance to antibiotics complicates therapeutic management and exposes patients to a high risk of death from septic shock, hence the importance of prevention through strict hygiene measures, staff awareness of patient health, and the rationalization of the prescription of antibiotic therapy, as well as the implementation of a monitoring system for multidrug-resistant bacteria.

Comparative of clinical performance between next-generation sequencing and standard blood culture diagnostic method in patients suffering from sepsis

Next-generation sequencing (NGS) is a massively unbiased sequencing technology. The objective of this study was to evaluate the performance of NGS-based approach in the detection of microorganisms from septic patients and compare with results of blood culture (BC). The observational and non-interventional study was conducted from April 2019 to August 2019. A total of 96 sets of BC and 48 NGS results obtained from 48 septic patients were analyzed in this study. Thirty-two microorganisms (27 bacteria, 3 fungi and 2 viral) were detected by NGS in 23 (47.9%) patients; and 18 bacteria in 18 (37.5%) patients by BC. Exclusion of skin commensals, the positivity of NGS and BC was 62.5% and 14.5%, respectively (P<0.001). Microorganisms identified by NGS demonstrated positive agreement with BC in 12 (25%) patients, including concordant results in 11 (22.9%) cases, and discrepancy results in 1 (2%). Of 11 patients with concordant results, 4 had additional microorganisms detected by NGS. NGS-positive but BC-negative was found in 9 (18.7%) patients. Using NGS, difficult-to-culture micro-organisms such as Pneumocystic jirovecii was identified in 2 patients, and Leptospira interrogans in one. Six (12.5%) patients with BC-positive but NGS-negative, whereas skin commensals were isolated in 4 (66.6%) cases. The number of patients that were positive by BC only increase from 29% to 47.9% when combining NGS and BC analyses (P=0.033). Our study support the advantage of NGS for the diagnosis of infecting microorganisms in sepsis, especially for microorganisms that are currently difficult or impossible to culture.

Combining Complete Blood Count with Differential Count; C-Reactive Protein and Band Neutrophils in Diagnosis of Early onset Neonatal Sepsis

Aim: To assess the diagnostic accuracy of complete blood count with band versus total neutrophil ratio and C-reactive proteins as an efficient analytical procedure for determining early onset sepsis in neonates. Study design: Cross sectional analytical study Place and duration of study: Department of Paediatric Medicine, Abbas Institute of Medical Sciences Muzafarabad, AJ Kashmir from 01-02-2022 to 31-07-2022. Methodology: Fifty patients were enrolled. Coulter counter was used for analyzing leucocytes of the neonates. Thin film-smears were generated by the laboratory scientist for identifying band neutrophils separately from mature neutrophils. C-reactive proteins level &lt;5mg/dl was considered as negative. Thio-glycate-oxide in liquid form was used for 2ml neonatal blood culture analysis mixed in the 20ml medium at 36 degree celsius. Results: There were 28 (56%) males and 22 (44%) females. The mean age of the neonates was 1.6± 0.77 days. The mean weight of the neonates was 2.4±0.51kg with a range of 4-1.2kg. A variance of band versus total neutrophil ratio was significantly higher in cultures which were positive than negative such as 70% vs 25%. There was also significant percentage of C-reactive proteins positive in positive sepsis cultures in comparison to negative blood culture. Conclusion: A combination of complete blood count with differential count, white blood cell analysis with band versus total neutrophil ratio and c-reactive proteins is an efficient early analytical procedure for determining early onset sepsis in neonates as gold standard test blood culture is time taking. Key Words: Complete blood count, C-reactive protein, Total neutrophils ratio, Early onset neonatal sepsis.

#41 Manual Validation of an Automated Tool to Extract Blood Culture and Susceptibility Data from the Electronic Health Record for Children with Acute Myeloid Leukemia

Abstract Background Children with acute myeloid leukemia (AML) receive high-intensity chemotherapy to achieve durable remission. AML chemotherapy causes bone marrow suppression resulting in vulnerability to infection, most frequently bloodstream infections (BSI). While the most commonly described organisms include Gram-negative pathogens and streptococci, the epidemiology and resistant profile of these pathogens can change. It is important to monitor the epidemiology of these infections over time to inform clinical care. Previously capture of these microbiology data required laborious manual chart reviews that are often done intermittently and with variable accuracy, limiting the impact of the results. We sought to develop and validate an automated process for extracting blood culture results, including antimicrobial susceptibility profiles for positive results from the electronic health record (EHR). Method An automated tool to extract blood culture results from the EHR (Epic Systems, Verona WI) was developed using SQL (Structured Query Language). The tool was applied to the EHR of all children with newly diagnosed AML treated at the Children’s Hospital of Philadelphia from January 1, 2011 to December 31, 2020, regardless of subsequent relapse and treatment. Data from all blood cultures (including standard, fungal, mycobacterial, and subacute bacterial endocarditis blood cultures) were captured. Manual chart review was performed by an Infectious Diseases physician to abstract the same blood culture results to determine accuracy of the automated extraction tool. The manual abstraction was considered the gold standard. The BSI epidemiology of AML patients during this time period were described to illustrate the utility of this tool. Results There were 91 children with newly diagnosed AML who received chemotherapy during the study period. Of the collected 3,150 cultures obtained and resulted, 206 (6.5%) were positive. There were 37 distinct pathogens identified (Table 1). Of positive cultures, 114 (55.3%) were reflexed to antimicrobial susceptibility testing (AST) per institutional standards. In total, 1,427 AST results were captured in the automated tool. Manual validation confirmed that concordance between the automated abstraction and chart review was 100% for the organisms grown on culture and accurately identified all AST results. The majority of organisms were Gram-positive. The most frequently identified species was Streptococcus mitis/oralis, found in 40/206 (19.4%) of positive cultures (Table 1). Of S. mitis/oralis that underwent AST, only 8/21 (38.1%) were susceptible to penicillin. Escherichia coli was the most common Gram-negative pathogen. Candida spp. accounted for 9.3% of detected pathogens, with C. krusei identified most commonly. Conclusion We developed and automated tool to extract blood culture results from the EHR of children and adolescents with AML at a single center. This tool was manually validated and found to be 100% accurate. This tool has the ability to efficiently capture the BSI epidemiology of a specific patient population at high risk for BSI. Further work is needed to confirm the accuracy of this tool at more centers. Implementation at other sites will allow this tool to be employed for various purposes including large, multicenter epidemiology research studies or quality improvement projects.

Can Beta-D-Glucan testing as part of the diagnostic pathway for invasive fungal infection reduce anti-fungal treatment costs?

Invasive fungal infection increases the risk of death in very sick people. So, treatment is started before test results are known. Beta-D-Glucan (BDG) test is faster than standard blood culture tests. We estimate that using BDG tests in how patients are diagnosed could save about £1643 per patient.

Risk Factors and Outcome of Sepsis in Traumatic Patients and Pathogen Detection Using Metagenomic Next-Generation Sequencing.

Objective Sepsis, a life-threatening clinical syndrome, is a leading cause of mortality after experiencing multiple traumas. Once diagnosed with sepsis, patients should be given an appropriate empiric antimicrobial treatment followed by the specific antibiotic therapy based on blood culture due to its rapid progression to tissue damage and organ failure. In this study, we aimed to analyze the risk factors and outcome of sepsis in traumatic patients and to investigate the performance of metagenomic next-generation sequencing (mNGS) compared with standard microbiological diagnostics in post-traumatic sepsis. Methods The study included 528 patients with multiple traumas among which there were 142 cases with post-traumatic sepsis. Patients' demographic and clinical data were recorded. The outcome measures included mortality during the emergency intensive care unit (EICU), EICU length of stay (LOS), all-cause 28-day mortality, and total ventilator days in 28 days after admission. A total of 89 blood samples from 89 septic patients underwent standard microbiological blood cultures and 89 samples of peripheral blood (n = 21), wound secretion (n = 41), bronchoalveolar lavage fluid (BALF) (19), ascites (n = 5), and sputum (n = 3) underwent mNGS. Pathogen detection was compared between standard microbiological blood cultures and mNGS. Results The sepsis group and non-sepsis group exhibited significant differences regarding shock on admission, blood transfusion, mechanical ventilation, body temperature, heart rate, WBC count, neutrophil count, hematocrit, urea nitrogen, creatinine, CRP, D-D dimer, PCT, scores of APACHE II, sequential organ failure assessment (SOFA), and Injury Severity Score (ISS) on admission to the EICU, and Multiple Organ Dysfunction Syndromes (MODS) (P < 0.05). Multivariate logistic regression analysis showed that scores of APACHE II, SOFA, and ISS on admission, and MODS were independent risk factors for the occurrence of sepsis in patients with multiple traumas. The 28-day mortality was higher in the sepsis group than in the non-sepsis group (45.07% vs. 19.17%, P < 0.001). The mortality during the EICU was higher in the sepsis group than in the non-sepsis group (P=0.002). The LOS in the EICU in the sepsis group was increased compared with the non-sepsis group (P=0.004). The total ventilator days in 28 days after admission in the sepsis group was increased compared with the non-sepsis group (P < 0.001). Multivariate logistic regression analysis showed that septic shock, APACHE II score on admission, SOFA score, and MODS were independent risk factors of death for patients with post-traumatic sepsis. The positive detection rate of mNGS was 91.01% (81/89), which was significantly higher than that of standard microbiological blood cultures (39.33% (35/89)). Standard microbiological blood cultures and mNGS methods demonstrated double positive results in 33 (37.08%) specimens and double-negative results in 8 (8.99%) specimens, while 46 (51.69%) samples and 2 (2.25%) samples had positive results only with mNGS or culture alone, respectively. Conclusion Our study identifies risk factors for the incidence and death of sepsis in traumatic patients and shows that mNGS may serve as a better diagnostic tool for the identification of pathogens in post-traumatic sepsis than standard microbiological blood cultures.

Diagnosis of Bloodstream Infections: An Evolution of Technologies towards Accurate and Rapid Identification and Antibiotic Susceptibility Testing.

Bloodstream infections (BSI) are a leading cause of death worldwide. The lack of timely and reliable diagnostic practices is an ongoing issue for managing BSI. The current gold standard blood culture practice for pathogen identification and antibiotic susceptibility testing is time-consuming. Delayed diagnosis warrants the use of empirical antibiotics, which could lead to poor patient outcomes, and risks the development of antibiotic resistance. Hence, novel techniques that could offer accurate and timely diagnosis and susceptibility testing are urgently needed. This review focuses on BSI and highlights both the progress and shortcomings of its current diagnosis. We surveyed clinical workflows that employ recently approved technologies and showed that, while offering improved sensitivity and selectivity, these techniques are still unable to deliver a timely result. We then discuss a number of emerging technologies that have the potential to shorten the overall turnaround time of BSI diagnosis through direct testing from whole blood—while maintaining, if not improving—the current assay’s sensitivity and pathogen coverage. We concluded by providing our assessment of potential future directions for accelerating BSI pathogen identification and the antibiotic susceptibility test. While engineering solutions have enabled faster assay turnaround, further progress is still needed to supplant blood culture practice and guide appropriate antibiotic administration for BSI patients.

Platelet count and its indices-effectiveness in early diagnosis of neonatal sepsis

Context: Neonatal sepsis is the major cause of morbidity and mortality in developing countries requiring early diagnosis and treatment. The Gold standard Blood culture results are often delayed for 48 h with high false-negative values. Emerging evidence suggests that platelet indices such as plateletcrit, mean platelet volume (MPV), and platelet distribution width (PDW) are reliable biomarkers that are readily available while obtaining routine complete blood counts. Aim: The aim of the study was to evaluate the efficacy of platelet count (Platelets) and its indices in the early diagnosis of sepsis. Settings and Design: Blood samples were collected from all neonates admitted to the hospital with features of suspected sepsis. Materials and Methods: One hundred patients were recruited for this cross-sectional analytical prospective study. All neonates delivered in Himalayan Institute of Medical Sciences and those referred from outside with features of suspected septicemia meeting the inclusion criteria were taken for study purposes. Blood samples were collected at the time of admission. Patients were divided into three groups clinically suspected sepsis (probable sepsis), culture-positive sepsis, and culture-negative sepsis. Non-parametric tests like the Chi-square test were applied to see the association between the variables. The three groups were compared for Platelets and its indices with the Analysis of variance test. Results: MPV was 219.2, 174.8, and 205.7 (p&lt;0.031), PDW 8.3, 12.5, and 11.5 (p&lt;0.174) and MPV as 10.9, 9.94 and 11.9 (p&lt;0.556) in probable sepsis, culture-positive and culture-negative sepsis, respectively. Conclusions: Platelets and its indices can be considered as a diagnostic tool for neonatal sepsis as it is cheap, rapid, and easily available and does not require additional equipment.

Bacteriological Profile and Antibiotic Susceptibility Pattern of Neonatal Septicemia and Associated Factors of ICU Hospitalization Days.

PurposeTo evaluate the microorganisms involved in neonatal septicemia and its antibiotic susceptibility pattern and to further investigate the factors associated with the length of intensive care unit (ICU) stay in neonatal septicemia.Patients and MethodsA total of 297 infants with septicemia at neonatal ICU (NICU), Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology from 2016 to 2020 were enrolled. Identification of bacterial species was done using the standard positive blood culture. Data included demographics, signs at time of septicemia, laboratory values, patient sources, complications, microbiologic characteristics, and the duration of ICU stay. Univariate and multivariate gamma regression analyses were applied to determine the variables associated with ICU stay.ResultsThe result demonstrated that the main causative pathogens of neonatal septicemia in our hospital were Gram-positive bacteria, among which Staphylococcus epidermidis (100 isolates, 47.17%) was the main conditional pathogens; Escherichia coli (27 isolates, 49.09%) was most frequently isolated among Gram-negative pathogens. Gram-positive bacteria had higher susceptibility to vancomycin, tigecycline and linezolid. Escherichia coli was susceptive to piperacillin (27/27, 100.00%), cefotetan (27/27, 100.00%), meropenem and imipenem (27/27, 100.00%). Streptococcus agalactiae (95% CI: 0.140–0.539), for patients who were transferred from other hospital (95% CI: 0.016 to 0.354), septicemia during hospitalization (95% CI: 0.411 to 0.825), the use of antibacterial drug during pregnancy (95% CI: 0.362 to 2.136), feeding intolerance (95% CI: 0.127 to 0.437), bradycardia (95% CI: 0.196 to 0.838), septicemia newborns have complications (95% CI: 0.063 to 0.291), the onset age (95% CI: 0.006 to 0.023), TRIPS score (95% CI: 0.005 to 0.016), and CRP level (95% CI: 0.002 to 0.005) were related to prolonged ICU stay days.ConclusionThis study summarized common pathogens and associated drug sensitivity, and factors influencing ICU stay length. Prevention and control policy in the NICU should be strengthened.

Role of the T2Dx magnetic resonance assay in patients with suspected bloodstream infection: a single-centre real-world experience

BackgroundT2Dx was approved by the US Food and Drug Administration for the rapid detection of a modified panel of ESKAPE bacterial species or Candida spp. causing bloodstream infection (BSI).Patients and methodsWe performed a retrospective, observational study from January 1, 2018 to December 31, 2019 of all hospitalised patients with suspected BSI who underwent assessment using T2Dx in addition to standard blood culture (BC). T2-positive patients (cases) were compared to a matched group of patients with BSI documented only by BC (1:2 ratio) to investigate the possible impact of T2Dx on the appropriateness of empirical antimicrobial therapy and 21-day mortality.ResultsIn total, 78 T2Dx-analysed samples (49 patients) were analysed. The T2Dx assay result was positive for18 patients and negative for 31 patients. The concordance rates of the T2Bacteria Panel and T2Candida Panel results with those of standard BC were 74.4% and 91.4%, respectively. In the matched analysis, inappropriate empiric antimicrobial therapy administration was significantly less frequent in cases than in comparators (5.5% vs. 38.8%). The 21-day mortality rate was twofold lower in cases than in comparators (22.2% vs. 44.4%), although the difference was not significant. No other analysed variables were significantly different between the two groups.ConclusionsThis study illustrated that T2Dx might be associated with an increase in the appropriateness of empiric antimicrobial therapy in patients with BSI. Further studies are needed to evaluate whether the T2Dx assay can improve patient outcomes.