Sterile Fluid Research Articles

A novel strategy for resource reduction in the wake of yet another sterile fluid shortage.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

The Utilization of a Pregnancy-Associated Glycoprotein Profile and PAG/P4 Ratio Biomarker for the Diagnosis of Pseudopregnancy in Dairy Goats.

Pseudopregnancy (PPG) is a common reproductive disorder in dairy goats, characterized by the accumulation of sterile fluid in the uterus and persistence of a corpus luteum, leading to temporary infertility and reduced farm efficiency. This study aimed to determine the pregnancy-associated glycoprotein (PAG) profile in dairy goats and to evaluate the PAG/P4 ratio as a potential novel biomarker for PPG diagnosis. A total of 605 Saanen and crossbreed mated goats were evaluated via transabdominal ultrasonography between 31 and 52 days after the removal of bucks in four intensive dairy farms, presenting an overall PPG incidence of 7.8%. Blood samples from PPG (n = 47), nonpregnant (NPG; negative control; n = 11), and pregnant (PG; positive control; n = 10) does were collected for PAG and P4 analysis. The PAG plasma levels were 0.08 ± 0.02, 0.13 ± 0.04, and 1.45 ± 0.04 OD (optical density) in the PPG, NPG, and PG groups, respectively (p < 0.001). The PAG/P4 ratio was lower in the PPG group (0.01 ± 0.11; p < 0.001) than in the NPG (0.24 ± 0.23) and PG (0.18 ± 0.23) groups. This difference allows for the establishment of a new methodological diagnostic approach to PPG. The area under the curve (AUC) was 0.996 for a cut-off of 0.04 and 97.9% and 100% sensitivity and specificity, respectively. This study suggests that the PAG/P4 ratio can serve as a reliable biomarker for PPG diagnosis, helping to distinguish it from pregnancy and nonpregnancy and improving reproductive management in dairy goats.

A Comprehensive Study of Bacterial Etiological Agents in Sterile Body Fluids and Antimicrobial Susceptibility Patterns Among Hospitalized Patients at an Academic Medical Center in India.

Background Sterile body fluids are devoid of any microbial presence, including commensal bacteria. However, bacterial invasion of these fluids can result in life-threatening infections, often leading to significant morbidity and mortality. Timely detection and precise identification of pathogens, along with antimicrobial susceptibility testing, are critical for optimizing therapeuticinterventions and improving patient outcomes. Objective To study the prevalence of bacterial infections in various body fluids in hospitalized patients and to determine the antimicrobial susceptibility patternand the phenotypic detection of extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL) and AmpC beta-lactamase producers within bacterial isolates. Materials and methods Sterile body fluid samples, excluding blood and urine, were collected and cultured at the Department of Microbiology, Krishna Institute of Medical Sciences, Western Maharashtra, India, from November 2022 to 2023. The microorganisms isolated from these fluids were identified using standard biochemical tests. Antibiotic sensitivity was assessed through the disc diffusion assay (zone of inhibition) and phenotypic identification of beta-lactamaseenzymes was performed using the combined disc diffusion method. Results During the study period, 180 sterile fluid specimens were collectedrepresenting 48 cerebrospinal fluid (CSF), 53 pleural fluid, 23 peritoneal fluid, and other sterile body fluid samples. Out of these, (n=32, 17.77%) samples were culture-positive. Gram-negative bacteria were oftentimes isolated at 84% (27/32), while gram-positive were 16% (5/32). Escherichia coli was frequently isolated and (n=9, 28.12%) exhibited maximum sensitivity to gentamicin and fosfomycin (n=7, 77.78%) and maximum resistance to cefoperazone-sulbactam (n=8, 88.88%). Pseudomonas aeruginosawas isolated as the second most common organism and showed maximum susceptibility to fosfomycin (n=5, 83.34%) and maximum resistance to gentamicin, cefotaxime, cefoxitin, etc. (n=5, 83.34%). Among gram-positive isolates, coagulase-positive Staphylococcus was high in prevalence rate and (n=3, 9.37%) presented 100% sensitivity to vancomycin and maximum sensitivity to tetracycline(n=2, 66.67%) and 100% resistance to ciprofloxacin, cefoxitin, erythromycin, and other antibiotics. Among gram-negative isolates, MBLproducers were 48.15%, ESBLproducers were 40.74%, and 18.51% were AmpCbeta-lactamase producerswith a multidrug-resistant (MDR) occurrence rate of 93.75%. Conclusion Infections affecting sterile body fluids are critical due to their high mortality and morbidity rates. Timely identification of the causative organisms and their antibiotic susceptibility is essential. The prompt initiation of appropriate antibiotic therapy can decreasethe duration of hospitalization and mitigate the emergence of drug resistance. The presence of MDR organisms in sterile body fluids constitutes considerable challenges in the management of critically ill patients.

Managing Maggots in the Eye: A Case Series

Purpose: To describe the presentation and management of ocular maggots and to identify the factors contributing to their occurrence. Study Design: Retrospective case series. Place and Duration of Study: Department of Ophthalmology Mayo Hospital Lahore from 2015 to 2022. Methods: The study involved retrospective chart analysis of patients who presented with Ophthalmomyasis and managed in the eye department. Data regarding age, gender, occupation, clinical findings, co-morbidities, associations and environmental factors were analyzed.Larvae were removed one by one under microscope. Follow up was done after 1 week, 1 month and 3 months. In patients with orbital myasis having distorted, large ulcerated wounds/socket, turpentine oil was used and larvae were removed mechanically under microscope. Results: There were 15 fifteen patients included in the study. Underlying co-morbidities were present in 60% patients and the most common being basal cell carcinoma (46.6%). Seventy four percent patients had some systemic disease; Diabetes Mellitus, Hypertension, AIDS, Hepatitis C etc. One thirdpatients had external ophthalmo-myasis while two third had orbital myasis. Patients who did not complete follow-up were 33%. Use of suffocating agents like turpentine oil, periodic removal of larvae, topical and systemic antibiotics, topical lavage with copious irrigation with sterile fluids resulted in good outcome in all cases that completed the follow up. Conclusion: The majority of patients came from rural communities and had underlying co-morbidities. Timely management resulted in good outcomes for all patients who completed the follow-up, highlighting the importance of comprehensive and sustained treatment protocols.

Effect of the Sho1 gene on the pathogenicity of Candida albicans and immune function in vivo

ObjectivesSho1, a ubiquitous membrane protein in fungi, plays a pivotal role in various physiological processes, such as osmotic stress, oxidative stress, temperature response, and virulence regulation across different fungal species. This study aimed to investigate the effect of the Sho1 gene on the pathogenicity of Candida albicans and its immune function in vivo. Materials and methodsNinety-nine clinical strains from various infection sites were collected to investigate the expression levels of the Sho1 gene compared to its levels in the standard strain (SC5314). Sho1-knockout strains (Sho1Δ/Δ) were constructed to investigate the impact of the Sho1 gene deletion on the biofilm formation, adhesion, and flocculation abilities of C. albicans. A mouse model of systemic infection was established to evaluate the impact of Sho1 deletion on survival, organ pathology, and immune cell function, as assessed by flow cytometry. ResultsThe expression level of the Sho1 gene was found to be higher in clinical strains derived from sterile fluids, sputum, and secretions compared to that in the standard strains. Deletion of the Sho1 gene diminished the biofilm-formation capacity of C. albicans, leading to a sparse structure and reduced thickness, as well as diminished adhesion and flocculation abilities. Deletion of the Sho1 gene prolonged mouse survival; decreased the fungal load in the liver, kidney, and spleen; and reduced inflammatory cell infiltration into the kidney. In the spleens of mice injected with the Sho1Δ/Δ strain, a decrease was observed in the percentage of M1-type macrophages and an increase in M2-type macrophages, resulting in a decreased M1/M2 macrophage ratio. Additionally, an increase was observed in the number of Th1 cells and a decrease in the number of Th2 and Th17 cells, leading to an increased Th1/Th2 ratio. ConclusionThe Sho1 gene significantly contributes to the pathogenesis of C. albicans by influencing its biological behaviour and immune response in vivo.

Fungal Enzyme-Responsive Hydrogel Drug Delivery Platform for Triggered Antifungal Release.

Fungal infections can lead to debilitating consequences if they are not treated effectively. Antifungal drugs used to treat these infections can be toxic and overuse contributes to growing antifungal resistance. Candida spp., particularly C. albicans, are implicated in a majority of these infections. Virulent C. albicans produce secreted aspartic proteases (Saps) that aid in pathogen tissue invasion and proliferation at an infected site. Here, fungi-responsive hydrogels are developed that degrade in the presence of Saps to provide a triggered release of encapsulated liposomal antifungals. The hydrogel backbone incorporates a Sap-cleavable peptide sequence enabling Sap-responsive degradation. Hydrogels are found to effectively degrade in the presence of Saps extracted from C. albicans. Encapsulated liposomal antifungals show similar release kinetics as hydrogel degradation products in the presence of Saps, supporting a degradation-dependent release mechanism. Antifungal liposome-loaded responsive hydrogels exhibit successful eradication of C. albicans cultures and remain stable in sterile murine wound fluid. Finally, no significant cytotoxicity is observed for murine fibroblast cells and red blood cells exposed to hydrogel degradation products. These fungi-responsive hydrogels have the potential to be used for local, on-demand delivery of antifungal drugs, for effective treatment of fungal infections while helping to limit unnecessary exposure to thesetherapeutics.

Evaluation of Inoculating Sterile Pericardial Fluid into Blood Culture Bottles

Background: There is limited data regarding the benefits of direct inoculation of sterile pericardial fluid into blood culture bottles. We discovered widespread adoption of this practice at our institution during pericardiocenteses and became concerned about over-capturing of skin flora contaminants. We aimed to understand how organisms detected in pericardial fluid inoculated into blood culture bottles were interpreted clinically. Methods: We investigated a cluster of four patients with coagulase-negative Staphylococcus (CoNS) isolated in pericardial fluid inoculated blood culture bottles (PF-BCxBs) over a 2-week period; three of these patients had recent cardiac surgery and were initially flagged as potential SSIs. We further expanded to a retrospective review and identified 28 patients with ≥1 organism isolated from PF-BCxBs from 7/2021 to 6/2023. Clinical, microbiological, and pharmacy data were abstracted. The primary outcome was the proportion of patients with a clinically diagnosed infection. Results: Investigation into the initial cluster revealed a pseudo-outbreak - three of four patients had no clinical evidence of infection (CoNS was deemed a contaminant); one was treated for a potential infection. All patients had concomitant negative routine fluid cultures. Discussions with the cardiology teams revealed areas for improvement in the process for inoculating fluid into blood culture bottles. From the two-year review, 18% (5/28) of patients were clinically diagnosed with an infection (two Staphylococcus aureus; two CoNS; one Candida rugosa). Of the patients without Staphylococcus aureus, all three had a concomitant negative routine fluid culture, were receiving antibiotics prior to pericardiocentesis, and had white blood cell counts (WBC) &gt;12 K/uL. The remaining 82% (23/28) of patients were deemed not to have an infection. Of these 23 patient without infection, organisms isolated were 16 CoNS (70%) and seven Cutibacterium species (30%). None of these patients had a fever, one (4%) was receiving pre-pericardiocentesis antibiotics, and three (9%) had WBC &gt;12 K/uL. 70% (16/23) of these patients were started on antibiotics after gram-stain results; all were eventually discontinued (mean antibiotic days = 2, range 1-5 days). 83% (19/23) of these patients had a concomitant negative routine fluid culture. Conclusion: The majority of patients with an organism isolated from PF-BCxBs had either CoNS or Cutibacterium species and were deemed not to have a clinical infection. Within the small cohort limitations, clinical utility of blood culture bottle inoculation seems highest for patients with pre-procedural concern for infection. IPC teams should be aware of the non-pathogenic skin flora frequency and potential implication on SSI surveillance.

Dual benefits of scleral lenses in collateral cases of Stevens-Johnson syndrome and Keratoconus-A case series

Scleral lenses (SL) are larger diameter lenses that rest over the scleral, unlike the corneal lenses. These lenses are fitted to not touch the cornea by creating a space that will be filled with sterile isotonic fluid. Indications of SL include corneal ectatic conditions such as keratoconus (KC), pellucid marginal degeneration,and ocular surface disorders such as dry eye (DE), Stevens-Johnson syndrome (SJS), and graft-versus-host disease. Corneal ectasia in SJS has been rarely reported but still exists, which causes severe DE, photophobia, and blurred vision. In such a scenario, SL is an ideal treatment option as they provide constant lubrication to the ocular surface and better visual acuity. This report witnessed the effectiveness of SL in SJS associated with KC – a rare combination.

Radiologic Manifestations of Mycobacterium chimaera Infection After Open Heart Surgery.

The objective of this study is to identify and detail the radiologic manifestations of surgical site and disseminated Mycobacterium chimaera ( MC) infection. The aim is to facilitate early identification and diagnosis of MC, considering its indolent nature and the challenges involved in clinically and pathologically establishing the diagnosis. This was a retrospective cohort study reviewing computed tomography (CT), positron emission tomography (PET)/CT, and magnetic resonance imaging examinations in patients over the age of 18 years with a history of open heart surgery and a clinical or pathologic diagnosis of MC. Two radiology residents, a fellowship-trained nuclear medicine radiologist, and a fellowship-trained cardiothoracic radiologist performed consensus reads to determine the imaging findings seen in MC infection. Twenty-five patients were included. Localized, surgical site infection was more common than disseminated disease. Typical CT findings included peristernal soft tissue thickening, sinus tracts often extending to the cutaneous surface, slowly enlarging fluid collections, and sternal osteolysis. PET/CT findings demonstrated hypermetabolic activity in nearly all patients localized to sites of infection. Imaging findings for disseminated infection included hepatosplenomegaly, lymphadenopathy, involvement of the central nervous system, discitis/osteomyelitis, and distant abscesses. Imaging plays a vital role in suggesting possible surgical sites and disseminated MC infection acquired from open heart surgery. Radiologists must keep a high index of suspicion given the indolent nature and subtle imaging change over time. PET/CT is most useful in diagnosis and helps in differentiating between a sterile postoperative fluid collection or scarring and active MC infection and helps provide a target for debridement.

Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study.

Post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria (CRGNB) is a life-threatening complication. This study aimed to assess the current practices and clinical outcomes of intravenous (IV) combined with intraventricular (IVT)/intrathecal (ITH) polymyxin B in treating CRGNB intracranial infection. A retrospective study was conducted on patients with post-neurosurgical intracranial infection due to CRGNB from January 2013 to December 2020. Clinical characteristics and treatment outcomes were collected and described. Kaplan-Meier survival and multivariate logistic regression analyses were performed. The study included 114 patients, of which 72 received systemic antimicrobial therapy combined with IVT/ITH polymyxin B, and 42 received IV administration alone. Most infections were caused by carbapenem-resistant Acinetobacter baumannii (CRAB, 63.2%), followed by carbapenem-resistant Klebsiella pneumoniae (CRKP, 31.6%). Compared with the IV group, the IVT/ITH group had a higher cerebrospinal fluid (CSF) sterilization rate in 7 days (p < 0.001) and lower 30-day mortality (p = 0.032). In the IVT/ITH group, patients with CRKP infection had a higher initial fever (p = 0.014), higher incidence of bloodstream infection (p = 0.040), lower CSF sterilization in 7 days (p < 0.001), and higher 30-day mortality (p = 0.005) than those with CRAB infection. Multivariate logistic regression analysis revealed that the duration of IVT/ITH polymyxin B (p = 0.021) was independently associated with 30-day mortality. Intravenous combined with IVT/ITH polymyxin B increased CSF microbiological eradication and improved clinical outcomes. CRKP intracranial infections may lead to more difficult treatment and thus warrant attention and further optimized treatment.

Repeated inoculation with rumen fluid accelerates the rumen bacterial transition with no benefit on production performance in postpartum Holstein dairy cows

BackgroundThe dairy cow’s postpartum period is characterized by dramatic physiological changes, therefore imposing severe challenges on the animal for maintaining health and milk output. The dynamics of the ruminal microbiota are also tremendous and may play a crucial role in lactation launch. We aim to investigate the potential benefits of early microbial intervention by fresh rumen microbiota transplantation (RMT) and sterile RMT in postpartum dairy cows. Twelve fistulated peak-lactation dairy cows were selected to be the donors for rumen fluid collection. Thirty postpartum cows were divided into 3 groups as the transplantation receptors respectively receiving 10 L fresh rumen fluid (FR), 10 L sterile rumen fluid (SR), or 10 L saline (CON) during 3 d after calving.ResultsProduction performance, plasma indices, plasma lipidome, ruminal microbiome, and liver transcriptome were recorded. After fresh and sterile RMT, we found that the molar proportion of propionic acid was increased on d 7 in the FR and SR groups and the bacterial composition was also significantly changed when compared with the CON group. A similarity analysis showed that the similarities between the CON group and FR or SR group on d 7 were 48.40% or 47.85%, whereas the similarities between microbiota on d 7 and 21 in the FR and SR groups were 68.34% or 66.85%. Dry matter intake and feed efficiency were not affected by treatments. Plasma β-hydroxybutyrate concentration in the FR group was decreased and significantly different lipids mainly included phosphatidylcholine and lysophosphatidylcholine containing polyunsaturated fatty acids. Hepatic transcriptomics analysis indicated acute-phase response pathways were upregulated in the SR group.ConclusionsOur study suggests that RMT can shorten the transition process of the ruminal microbiota of postpartum dairy cows with no benefit on dry matter intake or feed efficiency. Inoculation with rumen fluid may not be a useful approach to promote the recovery of postpartum dairy cows.Graphical

Lymphoplasmacytic endometritis and ovarian adenoma in a pinscher bitch associated with hydrometra

Hydrometra is the accumulation of sterile fluid in the uterine lumen, asymptomatic and abnormally observed in bitches, often identified accidentally during ovariosalpingohysterectomy (OSH). The aim of this study is to report a case of hydrometra in a seven-year-old nulliparous female Pinscher dog, which was brought to the veterinarian due to a gradual increase in abdominal volume. Prior to the consultation, the dog had received a dose of medroxyprogesterone acetate (50 mg). Abdominal ultrasound revealed normal configurations of abdominal organs, except for the uterus, which displayed a lumen filled with anechoic, non-cellular content. During OSH, a considerable enlargement of uterine horns was observed, along with circulatory changes in the organ, such as congestion. The uterine horns were incised longitudinally, revealing clear, translucent, and non-viscous intrauterine fluid. Histopathological examination confirmed mild lymphoplasmacytic endometritis in the uterus and the presence of ovarian adenoma. Therefore, it is believed that ovarian adenoma and hydrometra may result from elevated circulating exogenous progestagen concentrations. Thus, the importance of veterinary medical monitoring is emphasized to prevent and identify possible alterations in the early stages of hydrometra.

The Point-of-Care Peritoneal Dialysis System Early Evaluation Study (POC-PDEE): A pilot proof-of-principal study of the Ellen Medical Devices Point-of-Care affordable peritoneal dialysis system.

The global unmet need for kidney replacement therapy means that millions of people die every year as they cannot afford treatment. Peritoneal dialysis (PD) offers comparable survival to haemodialysis and is often more affordable, but one barrier to increasing access is that conventional manufacturing and distribution of PD fluid is costly. Here we report the results from a pilot proof-of-principal study demonstrating for the first time that the Ellen Medical Devices Point-of-Care system can be used by patients to produce sterile PD fluid at the point-of-care. With further development, this low-cost system could offer a solution to the many millions of people around the world who currently cannot afford treatment for kidney failure.

Co-occurrence of otitis media with effusion and another environment-dependent disease (selected allergic conditions).

Otitis media eith effusion (OME) is an inflammatory condition of the middle ear that involves accumulation of sterile fluid or effusion in the tympanic cavity with the tympanic membrane intact. The pathophysiology of OME is undoubtedly multifactorial. To assess the co-occurrence of OME, allergic rhinitis, and asthma. The study involved a group of 18,617 subjects aged 6-7 years, 13-14 years, or 20-44 years. ECRHS and ISAAC questionnaires, validated and adopted for Polish conditions, were used in the study. OME increases the risk of developing allergic rhinitis by nearly two-fold (OR = 2.07, 95% CI: 1.738-2.479 in 6-7-year-olds; OR = 1.61, 95% CI: 1.299-1.995 in 13-14-year-olds, and OR = 1.55, 95% CI: 1.262-1.83 in 20-44-year-olds). Protective factors against otitis media with effusion include the number of siblings (the more children in the family, the higher the risk of chronic OM; OR = 2.00, 95% CI: 1.15-1.346) and consumption of dairy products rich in lactic acid bacteria. OME significantly more often co-exists with other conditions, particularly allergic rhinitis.

1799. Patients Who Inject Drugs (PWID) and Unstable Housing are Associated with Invasive Group A Strep Infection: A retrospective collaboration between two large, quaternary care hospital systems in Philadelphia

Abstract Background Invasive infections involving Group A Streptococcus (iGAS), defined as infections beyond simple skin and soft tissue infection or pharyngitis, are rising nationally. We report an increase in incidence of iGAS at two urban, quaternary care health systems that contain 6 hospitals in the city of Philadelphia. Methods All blood, sterile fluid, and tissue cultures that yielded Streptococcus pyogenes were identified using the laboratory information systems at the Temple University Health System and the University of Pennsylvania Health System. Two cohorts were compared: cases diagnosed between January 1, 2019 and December 31, 2019, and between January 1, 2021 to December 31, 2021. We excluded 2020 data to avoid analysis of disease incidence when hospital admission patterns may have been highly biased due to COVID-19 pandemic. Electronic health records were reviewed and data pertaining to demographics, month of infection, culture site, HIV status, HCV status, housing status, and injection drug use were abstracted. Descriptive statistics were used to summarize findings. Results In 2021, there were 301 unique cases of iGAS (148 involving bacteremia) compared to 169 in 2019 (with 70 cases of bacteremia). This represented an overall increase in iGAS of 178% and a 211% increase in cases involving bacteremia. Of the cases in 2021, 210 (69.8%) were PWID compared to only 54 (32%) in 2019, a 388% increase. In 2021, 7.5% of patients had a diagnosis of HIV compared to 8.9% in 2019, but a large percentage did not have an HIV test (37% in 2019 and 19% in 2021). HCV Antibody positivity was 52.3% in 2021 versus 26.6% in 2019. Housing instability was recorded in 151 cases (50.2%) in 2021 and 31 (18.3%) in 2019, a 487% increase. Table 1 Demographic and clinical characteristics of iGAS cases in 2019 and 2021 Table 2 Age and Sex data in PWID Conclusion From 2019 to 2021, there was an increase in iGAS infections among an adult population in a large metropolitan city. We noted a 178% total increase in iGAS during our study period, with a 388% increase among PWID and 487% increase among those unstably housed. As the overdose crisis continues, public health practitioners and medical providers should be aware of the increase in iGAS when providing empiric treatment for PWID with infections and utilize local and national resources to report and manage cases. Disclosures Sara K. Schultz, MD FACP FIDSA, AbbVie: Advisor/Consultant

2716. Epidemiology of invasive fungal infection in pediatric liver transplant recipients: A retrospective, single-center study, 2012-2022

Abstract Background Studies on liver transplant (LT) recipients have reported an incidence of invasive fungal infection (IFI) ranging from 2.5 to 5%; however, antifungal prophylaxis has not yet been approved by the Ministry of Food and Drug Safety in Korea. We investigated the incidence of early-onset IFI and its characteristics in pediatric LT recipients in Korea, and also explored the risk factors for IFIs. Methods This is a retrospective, single-center study on children (&amp;lt; 19 years of age) who have undergone LT from 2012 to 2022 at Severance Hospital, Korea. IFI was defined as the detection of fungus in sterile fluid, tissue, and/or blood with symptoms of a fungal infection. Superficial fungal infection and colonization on the skin or urine were excluded. The primary outcome is the occurrence of IFI within 90 days of LT. The logistic regression method was used to analyze the risk factors for IFI. Results A total of 104 LT children were included, among whom 6 received multiple transplantations, resulting in 111 LT cases. 42% (n = 44) were male, and the median age at LT was 4.0 years of age (IQR 1.0–11.0). Two thirds of the patients received LT due to biliary atresia (n = 69, 66%), and the remaining were diagnosed with acute liver failure (n = 17, 16%), miscellaneous causes (n = 11, 11%), and so on (n = 7, 7%). Antifungal prophylaxis, except nystatin gargle, was done in 12.8% of recipients. IFI was identified in 19 patients (18%), and due to five multiple IFI events per patient, a total of 23 IFI events were noted at a median time of 16.5 days after LT (IQR 10-38). 87% of the pathogens detected were Candida species (C. albicans 40%, C. parapsilosis 35%, C. auris 15%), and Aspergillus fumigatus (13%). Antifungal susceptibility patterns are described in Table 1. The risk of IFI was significantly increased in those who underwent acute re-transplantation, postoperative intervention, or surgery due to bleeding, vascular, and bile duct complications (OR = 4.6; 95% CI, 1.5–13.6; P = 0.006) 8) and renal replacement therapy (OR=3.2; 95% CI, 1.1-8.8; P=0.028).Table.Antifungal susceptibility patterns of identified pathogens according to Clinical and Laboratory Standards Institute (CLSI). a Number of cases identified with the fungal pathogen b Antifungal susceptibility testing has to be additionally requested, so it was not performed in all cases. c 1 case had a fluconazole-resistant C.parapsilosis strain with intermediate resistance to other antifungal agents (MIC: fluconazole 32, micafungin 2, caspofungin 2, voriconazole 0.12, amphotericin B 0.5). d CLSI does not provide a tentative MIC breakpoint for voriconazole and other second generation azoles, but that of fluconazole may be considered as a surrogate. Conclusion The incidence of early IFI after LT in Korean children is considerable; therefore, universal antifungal prophylaxis is necessary. High-risk IFI patients, such as those undergoing reoperation, intervention, or renal replacement therapy, require attention and close monitoring. Disclosures All Authors: No reported disclosures

Design, Simulation and Multi-Objective Optimization of a Micro-Scale Gearbox for a Novel Rotary Peristaltic Pump.

Peristaltic pumps are widely used in biomedical applications to ensure the safe flow of sterile or medical fluids. They are commonly employed for drug injections, IV fluids, and blood separation (apheresis). These pumps operate through a progressive contraction or expansion along a flexible tube, enabling fluid flow. They are also utilized in industrial applications for sanitary fluid transport, corrosive fluid handling, and novel pharmacological delivery systems. This research provides valuable insights into the selection and optimal design of the powertrain stages for peristaltic pumps implemented in drug delivery systems. The focus of this paper lies in the simulation and optimization of the performance of a power transmission gearbox by examining the energy consumption, sound levels, reliability, and volume as output metrics. The components of the powertrain consist of a helical gear pair for the first stage, a bevel gear pair for the second one, and finally a planetary transmission. Through extensive simulations, the model exhibits promising results, achieving an efficiency of up to 90%. Furthermore, alternative configurations were investigated to optimize the overall performance of the powertrain. This process has been simulated by employing the KISSsoft/KISSsys software package. The findings of this investigation contribute to advancements in the field of biomedical engineering and hold significant potential for improving the efficiency, reliability, and performance of drug delivery mechanisms.

Transventricular transforaminal endoscopic fenestration with cysto-ventriculoperitoneal shunt to manage a third ventricular arachnoid cyst: a case report

Regular ventriculoperitoneal (VP) shunt is commonly used as the first option to manage a third ventricular arachnoid cyst due to the lack of facilities, unfamiliarity with endoscopic techniques, or misdiagnosis as purely obstructive hydrocephalus. A 9-year-old girl with obstructive hydrocephalus due to a third ventricular arachnoid cyst was treated with a VP shunt. 2 months later, the previous shunt device was removed due to an infection. Following a sterile cerebrospinal fluid analysis culture, we conducted a navigation-assisted transventricular transforaminal endoscopic fenestration and cysto-VP programmable shunt placement. A decrease in ventricular dilatation was seen on follow-up. This approach was justified due to the possibility of establishing communication with normal cisterns, the high rate of cyst elimination, and the potential for achieving shunt independence. Performing an endoscopic fenestration followed by cysto-VP shunt placement could be an optimal option for managing this condition.

S3763 A Case of Sterile Cerebrospinal Fluid Ascites Decades After Ventriculoperitoneal Shunt Placement Successfully Treated With Acetazolamide Monotherapy

S3763 A Case of Sterile Cerebrospinal Fluid Ascites Decades After Ventriculoperitoneal Shunt Placement Successfully Treated With Acetazolamide Monotherapy

Inter-laboratory variability of caspofungin MICs for Nakaseomyces glabrata isolates – an Irish tertiary hospital experience

Background. Nakaseomyces glabrata, formerly Candida glabrata, is an opportunistic yeast and emerging cause of human infections. The use of broth microdilution (BMD) methodologies for caspofungin (CSP) antifungal susceptibility testing (AFST) against N. glabrata is reported to be prone to high inter-laboratory variation. We aimed to compare CSP MICs of N. glabrata isolates from our institution with those obtained by the Reference Laboratory for the same isolates. Methods. All clinically significant N. glabrata isolates from 2019 to 2021 inclusive were reviewed. AFST was performed locally using the VITEK2 system with the AST-YS08 card, while E-tests were performed at the Mycology Reference Laboratory (MRL), and agreement between these two methods was evaluated – categorical and essential. Results. Forty-one isolates were reviewed during the study period – 30 from blood cultures, seven from intra-operative theatre specimens and four from sterile site drain fluids. Despite an essential agreement of 100 % within ±2 log2 dilutions, marked discrepancies were noted in interpretative breakpoints between assays with 17 Minor and 16 Major category errors. Categorical agreement was 19.5 %, with the VITEK2 over-estimating resistance. A Mann–Whitney U-test assessed the relationship of MICs across the AFST modalities, and a statistically significant difference was noted, P&lt;0.01, with a higher mean rank for VITKEK2 outputs. Conclusion. While the VITEK2 system is highly applicable, its performance for CSP AFST is unreliable and potentially results in the mis-classification of susceptible isolates as highlighted in our study. The use of VITEK2 AST-YS08 micafungin as a sentinel echinocandin should be explored and/or the evaluation of CSP-specific E-tests as utilized by the MRL. These methods appear more consistent and less prone to the variation seen with BMD for CSP.