Systemic Bacteremia Research Articles

Moving Beyond Systemic Inflammatory Response Syndrome and Bacteremia: Are Modern Critical Care Calculators Useful in Predicting Debridement, Antibiotics, and Implant Retention Treatment Outcomes in Periprosthetic Joint Infection?

BackgroundIn critically ill periprosthetic joint infection (PJI) patients, surgeons need to balance the need for aggressive, definitive treatment against the health state of a potentially unstable patient. A clear understanding of the association between treatment outcomes and assessment scores for sepsis would benefit clinical decision-making in these urgent cases. The current study evaluates the effect of critical illness on debridement, antibiotics, and implant retention (DAIR) outcomes, as defined by systemic inflammatory response syndrome (SIRS) and, for the first time, by contemporary markers quick Sequential Organ Failure Assessment (qSOFA) and Modified Early Warning Score (MEWS). MethodsWe retrospectively identified 253 patients who underwent DAIR for PJI at a single institution between 2017 and 2021. The SIRS, qSOFA, and MEWS scores were calculated based on variables on admission. A DAIR treatment failure, defined as reoperation or mortality, was measured at 90 days and two years. Univariate analysis was used to determine the association between elevated critical care scores and DAIR failure. ResultsThe DAIR treatment success was 59% at two years, with hip procedures and Charlson comorbidity index (CCI) ≥ 1 independently associated with higher odds of DAIR failure. There were 43 patients (16%) who presented with SIRS, however, only four (2%) had positive qSOFA scores. Neither SIRS nor qSOFA were predictive of DAIR failure. For knees only, elevated MEWS scores were predictive of 90-day DAIR failure (P = 0.019). ConclusionOver one in six patients undergoing DAIR for PJI presented with SIRS, while only one in 50 had a positive qSOFA. The SIRS and qSOFA scores were not predictive of DAIR failure. Elevated MEWS scores were associated with DAIR failure at 90 days postoperatively in knee PJIs only, and should be confirmed in a larger cohort. Our results suggest that SIRS is not predictive of DAIR outcomes, possibly because it overestimates the proportion of critically ill patients.

First Report of Myocastor coypus Infected with Staphylococcus cohnii

In December 2021, a wildlife conservation base in Hunan, China, reported illness and death among its captive Myocastor coypus population. A gram-positive pathogen was isolated from the affected animals. The 16S rDNA sequence of the isolated strain was approximately 1,500 bp long and exhibited 98.4% homogeneity with Staphylococcus cohnii found in sea cucumbers. Interestingly, the biochemical reactions of the isolated strain were consistent with the characteristics of S. cohnii. The LD100 for BALB/c mice was 1.2 × 107 CFU/g, while the MLD was 0.6 × 107 CFU/g. Inflammatory cell infiltration was observed in the liver, spleen, and kidneys of infected mice, accompanied by widespread systemic bacteremia and focal hepatic and splenic necrosis. Moreover, mycelium was detected in the liver and kidney. The isolated strain possessed both HLB and PVL virulence genes. To the best of our knowledge, this is the first study to report a highly pathogenic strain of S. cohnii isolated from M. coypus, possessing both HLB and PVL virulence genes. The findings contribute to yielding a better understanding of the pathogenic mechanisms of S. cohnii and have significant implications for disease control in M. coypus, as well as for public health safety and the prevention of zoonotic diseases.

Periodontitis : An underestimated risk of cardiovascular diseases

Epidemiological studies have identified periodontitis as a contributing factor to cardiovascular risk. Periodontitis is a chronic inflammatory disease that affects the tissues supporting the teeth. Although the nature of the association between periodontitis and cardiovascular disease (CVD) remains to be defined, the low-grade systemic inflammation and chronic bacteremia associated with periodontitis appear to be involved in the development of atherosclerosis and associated cardiovascular pathologies. Periodontal treatment has been shown to improve cardiovascular health parameters. A bidirectional preventive approach, involving the management of both periodontitis and cardiovascular risk factors, could lead to a reduction in morbidity and mortality related to cardiovascular disease.

Improving the longevity of intravenous cannulas in sick neonates admitted to NICU in a tertiary care centre: a quality improvement project

BackgroundNeonatal intravenous cannulation, especially in preterms, is more challenging than in children or adults. Placement of an intravenous cannula is painful and many cannulas need frequent changing due to complications....

Periodontal Inflammation and Its Relationship with the Risk of Cardiovascular Diseases: Literature Review

For dental practice today, it has become important to emphasize the relevance of periodontal inflammation and oral microorganisms in the development and progression of atherosclerosis and cardiovascular diseases. Generally, the focus on PI as a causal factor of CVD is due to the great complexity and interaction that present the Gram-negative bacteria characteristic of chronic periodontal disease with the vast vascularization of the stomatognathic system. In many recent studies, researchers examined the association at the cellular and molecular level between periodontal and cardiovascular diseases. Although the specific causal correlation as a determining risk factor has not been established, it seems that periodontal disease is associated with several systemic diseases. In this connection, atherosclerosis is important in recent years. There is a possibility of an association documented in several field investigations, and this one refers to a systemic bacteremia caused by poor oral hygiene, which in turn can cause bacterial growth on the atherosclerotic plaques located in the coronary arteries, which possibly.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Prospective Randomized Trial of Antibiotic Prophylaxis Duration for Percutaneous Nephrolithotomy in Low-Risk Patients.

Introduction and Objective: Postoperative infection and sepsis account for the most common complications following percutaneous nephrolithotomy (PCNL), as high as 14% in low-risk patients. Although the American Urological Association (AUA) recommends perioperative antibiotics for 24 hours or less for PCNL, practice patterns vary regarding duration of antibiotic therapy. We aimed to compare the efficacy of 24-hour antibiotic coverage vs short-course protocol of antibiotic prophylaxis for PCNL. Materials and Methods: Low-risk patients with a sterile preoperative urine culture undergoing PCNL were prospectively randomized to antibiotics for up to 24 hours after procedure (24Hr) or continued until external urinary catheters were removed (CR) study groups. Patients were given a first generation cephalosporin, or ciprofloxacin in patients with penicillin allergy. Exclusion criteria included age <18 years, receiving antibiotics immediately before the procedure, history of urosepsis, presence of indwelling catheter >1 week, multistage procedure, immunosuppression, pregnancy, multiple antibiotic allergies, and patients who are breastfeeding. Results: Ninety-eight patients were randomized to either 24Hr (n = 49) or CR (n = 49). Mean duration of antibiotic administration was 20.6 and 34.0 hours in the 24Hr and CR groups (p = 0.04), respectively. Age, comorbidities, stone size, operative time, number of punctures, dilations, and proportion of "tubeless" procedures were similar between groups. There were no differences in febrile episodes, rates of systemic inflammatory response syndrome, bacteremia, or culture-proven postoperative urinary tract infection between the 24Hr and CR groups. Overall complication rates were similar between groups. In a subgroup analysis which excluded "tubeless" patients (24 and 29 patients in 24Hr and CR groups, respectively), no differences were seen in postoperative outcomes. Conclusions: In a randomized, prospective study, we found that a 24-hour protocol for antibiotic prophylaxis is not associated with increased risk of infection-related events compared to giving antibiotics until external catheters are removed in patients with low infectious risk undergoing PCNL. Clinicaltrials.gov: NCT02579161.

Approach to Liver Abscesses: Integrative Review

Liver abscess (HA) remains a serious and often difficult to manage problem. Infectious abscesses include those secondary to the direct extension of local infection, systemic bacteremia, and intra-abdominal infections that seed the portal system. However, over the years, the etiologies and risk factors for HA have continued to evolve. This work aims to carry out a bibliographic review regarding the approach of liver abscesses. This is a literature review, using studies published between 2020 and 2023 and indexed in the PUBMED database. Thus, studies were selected for this review using the search strategy, using keywords (MeSH): 'classification' AND 'diagnosis' AND 'treatment' AND 'liver abscess'. Immediate recognition is important to institute effective management and obtain good results.

Intestinal colonization regulates systemic anti-commensal immune sensitivity and hyperreactivity.

Healthy host-microbial mutualism with our intestinal microbiota relies to a large degree on compartmentalization and careful regulation of adaptive mucosal and systemic anti-microbial immune responses. However, commensal intestinal bacteria are never exclusively or permanently restricted to the intestinal lumen and regularly reach the systemic circulation. This results in various degrees of commensal bacteremia that needs to be appropriately dealt with by the systemic immune system. While most intestinal commensal bacteria, except for pathobionts or opportunistic pathogen, have evolved to be non-pathogenic, this does not mean that they are non-immunogenic. Mucosal immune adaptation is carefully controlled and regulated to avoid an inflammatory response, but the systemic immune system usually responds differently and more vigorously to systemic bacteremia. Here we show that germ-free mice have increased systemic immune sensitivity and display anti-commensal hyperreactivity in response to the addition of a single defined T helper cell epitope to the outer membrane porin C (OmpC) of a commensal Escherichia coli strain demonstrated by increased E. coli-specific T cell-dependent IgG responses following systemic priming. This increased systemic immune sensitivity was not observed in mice colonized with a defined microbiota at birth indicating that intestinal commensal colonization also regulates systemic, and not only mucosal, anti-commensal responses. The observed increased immunogenicity of the E. coli strain with the modified OmpC protein was not due to a loss of function and associated metabolic changes as a control E. coli strain without OmpC did not display increased immunogenicity.

Systemic Manifestation of Periprosthetic Joint Infection Is Associated With Increased In-Hospital Mortality.

Introduction Periprosthetic joint infection (PJI) is one of the most devastating complications of total joint arthroplasty. Systemic symptoms of infection may indicate a patient who is at a higher risk of serious complications. The goal of this study was to determine if systemic symptoms of infection in the setting of PJI were associated with greater in-hospital mortality. Materials and methods We used our institutional database to identify all patients urgently treated for deep PJI from 2002-2012. Records were reviewed to collect demographics, surgical data, vital signs prior to surgical intervention, blood and intraoperative culture results, preoperative intensive care unit (ICU) admissions, and deaths that occurred during the hospital admission. Patients were classified as having systemic inflammatory response syndrome (SIRS) based on the criteria established by the American College of Chest Physicians and the Society of Critical Care Medicine. Results During the 10-year timeframe of our study, 484 patients were treated emergently for deep infection, with 130 (27%) meeting SIRS criteria preoperatively and 31 (6%) of the patients with SIRS having positive blood cultures. Patients with positive blood cultures and SIRS demonstrated a higher in-hospital mortality rate (p < 0.001). Neither SIRSnor SIRS with positive blood cultures were associated with ICU admission. Discussion Occasionally, PJI can spread beyond the affected joint, showing physical symptoms of systemic illness and bacteremia. This study demonstrates that patients with SIRS and positive blood cultures are at an increased risk of in-hospital mortality. These patients should be monitored closely before definitive treatment in order to minimize their mortality risk.

Broad protective vaccination against systemic Escherichia coli with autotransporter antigens.

Extraintestinal pathogenic Escherichia coli (ExPEC) is the leading cause of adult life-threatening sepsis and urinary tract infections (UTI). The emergence and spread of multidrug-resistant (MDR) ExPEC strains result in a considerable amount of treatment failure and hospitalization costs, and contribute to the spread of drug resistance amongst the human microbiome. Thus, an effective vaccine against ExPEC would reduce morbidity and mortality and possibly decrease carriage in healthy or diseased populations. A comparative genomic analysis demonstrated a gene encoding an invasin-like protein, termed sinH, annotated as an autotransporter protein, shows high prevalence in various invasive ExPEC phylogroups, especially those associated with systemic bacteremia and UTI. Here, we evaluated the protective efficacy and immunogenicity of a recombinant SinH-based vaccine consisting of either domain-3 or domains-1,2, and 3 of the putative extracellular region of surface-localized SinH. Immunization of a murine host with SinH-based antigens elicited significant protection against various strains of the pandemic ExPEC sequence type 131 (ST131) as well as multiple sequence types in two distinct models of infection (colonization and bacteremia). SinH immunization also provided significant protection against ExPEC colonization in the bladder in an acute UTI model. Immunized cohorts produced significantly higher levels of vaccine-specific serum IgG and urinary IgG and IgA, findings consistent with mucosal protection. Collectively, these results demonstrate that autotransporter antigens such as SinH may constitute promising ExPEC phylogroup-specific and sequence-type effective vaccine targets that reduce E. coli colonization and virulence.

Making Sense of Late Tissue Nodules Associated With Hyaluronic Acid Injections.

The pathogenesis of delayed-onset tissue nodules (DTNs) due to hyaluronic acid (HA) injections is uncertain. To formulate a rational theory for DTN development and their avoidance and treatment. A multidisciplinary and multicountry DTN consensus panel was established, with 20 questions posed and consensus sought. Consensus was set at 75% agreement. Consensus was reached in 16 of 20 questions regarding the pathogenesis of DTNs, forming the basis for a classification and treatment guide. The group believes that filler, pathogens, and inflammation are all involved in DTNs and that DTNs most likely are infection initiated with a variable immune response. Injected filler may incorporate surface bacteria, either a commensal or a true pathogen, if the skin barrier is altered. The initially high molecular weight HA filler is degraded to low molecular weight HA (LMWHA) at the edge of the filler. Commensals positioned within the filler bolus may be well tolerated until the filler is degraded and the commensal becomes visible to the immune system. LMWHA is particularly inflammatory in the presence of any local bacteria. Commensals may still be tolerated unless the immune system is generally heightened by viremia or vaccination. Systemic pathogenic bacteremia may also interact with the filler peripheral LMWHA, activating Toll-like receptors that induce DTN formation. Given this scenario, attention to practitioner and patient hygiene and early systemic infection treatment deserve attention. Classification and treatment systems were devised by considering each of the 3 factors-filler, inflammation, and infection-separately.

Acute graft-versus-host disease presenting as Stevens–Johnson syndrome and toxic epidermal necrolysis: A retrospective cohort study

Cutaneous manifestations resembling Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in patients with acute graft-versus-host disease (aGVHD); however, the clinicopathological characteristics of SJS/TEN-like aGVHD remain unexplored. To investigate the clinicopathology, complications, and outcomes of patients with SJS/TEN-like aGVHD. We analyzed a multicenter cohort of patients with aGVHD between 2000 and 2021. We analyzed 31 patients with aGVHD, including SJS/TEN-like (n=15) and non-SJS/TEN-like (n=16). Patients with SJS/TEN-like aGVHD had significantly more extensive erythema and skin detachment/mucositis. SJS/TEN-like aGVHD was significantly associated with higher aGVHD grading and systemic complications, including pancytopenia, leukopenia, anemia, severe thrombocytopenia, coagulation abnormality, hepatitis, diarrhea, renal dysfunction, and bacteremia. A significantly lower hemoglobin/red cell distribution width ratio was identified in SJS/TEN-like aGVHD. Histopathology showed significant severe dyskeratosis and interface change. Patients with SJS/TEN-like aGVHD had lower 2-month survival rates and 5.35-fold higher 5-year mortality rates than those with non-SJS/TEN-like aGVHD. Total mortality rates of patients with SJS/TEN-like aGVHD reached 80% during follow-up; sepsis predominated the causes of death. Retrospective, nonrandomized study with a small sample size. SJS/TEN-like aGVHD is associated with multiple systemic complications and high mortality. Early recognition, differential diagnosis from drug-induced-SJS/TEN, and appropriate treatment are critical.

Insilico structure based drug design approach to find potential hits in ventilator-associated pneumonia caused by Pseudomonas aeruginosa

Tetraacyldisaccharide 4′-kinase (LpxK) is the prime enzyme responsible for the biosynthesis of lipid A. LpxK is a key antibacterial drug target, but it is less exploitation in Pseudomonas aeruginosa and other bacterial species limits its therapeutic use. Pseudomonas aeruginosa is responsible for severe infections like pneumonia and urinary tract infections. The precautionary measures of Pseudomonas aeruginosa infections are decisive as it results in extensive drug resistance, systemic bacteremia, and ventilator-associated pneumonia. The current rational approach highlights exploiting the use of computer-aided drug design approaches to counter Pseudomonas aeruginosa specific LpxK. The various approaches used were exploring the metabolic pathway database (Metacyc), drug target validation using DEG, protein modeling, ligand docking, e-pharmacophore assisted virtual screening, physicochemical and Toxicity profile prediction studies, and molecular simulations in spotting out novel potential hits compounds. The virtual hits which have highly ranked in the study were STOCK4S-16119, STOCK1S −60869, STOCK6S −43621, STOCK6S −3328, and STOCKS-39892 which can act as a scaffold for the establishment of new hits against LpxK and can result in control of Pseudomonas aeruginosa infectivity.

P248 Tuberculosis is still a major contributor to serious infection in juvenile SLE

Abstract Background/Aims Infections are a major cause of morbidity and mortality in juvenile systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in juvenile SLE. Methods We carried out a retrospective review of 175 patients of juvenile SLE (ACR 1997 criteria) with age &amp;lt;18 years visiting the rheumatology clinic at a single centre between 2010 and 2020. Clinical details were retrieved from clinical case records and supplemented with data from the hospital's electronic health records. Major infections (defined as need for hospitalization, prolonged antibacterial therapy &amp;gt;1 week, resulting in disability or death) were recorded. Predictors of infection and their outcomes were determined using multivariate logistic regression and Kaplan Meier survival analysis. Results Among 175 patients (154 were girls) with a mean age of 14.79±3.1 years, there were a total of 52 major infections in 43 patients with an incidence rate of 8.83 per 100 person-years. The respiratory tract (19) was the most commonly involved site followed by skin and soft tissue (10), gastrointestinal tract (6), systemic bacteremia (5), ear nose and throat (4), disseminated infection (3), urinary tract (2), central nervous system (1), joint (1) and dengue shock syndrome (1). Organisms isolated were Mycobacterium tuberculosis (11) which was the most common and predominantly extrapulmonary, followed by enterobacteria (12), Staphylococcus aureus (5), cytomegalovirus (3), Herpes zoster (2), Herpes simplex (1), MRSA (1), and Candida (1). Gastrointestinal involvement (OR 4.21), major organ involvement (OR 2.5), use of cyclophosphamide (OR 7.63), higher baseline SLEDAI (16[11.5-21] vs 12[8.75-16.25]) and a higher daily dose of prednisolone (16.1±15.1mg vs 6.1±5.8mg) at the time of the infection were predictors of a major infection. On multivariate analysis, only higher daily doses of corticosteroids (OR1.09, 95% CI 1.05-1.14) and gastrointestinal involvement (OR 4.98, 1.05-23.65) were significant predictors. Major infection-free survival at 1 year and 5 years was 82.5% (95% CI 76.8-88.7) and 72.5% (95% CI 65-80.9) respectively. There were eight deaths with five directly attributable to infection. Overall survival was worse in those who had an episode of major infection. Conclusion The risk of major infections in juvenile SLE is significant and associated with higher daily corticosteroid use and gastrointestinal involvement at baseline. Disclosure R. Chatterjee: None. S. Pattanaik: None. L. Gupta: None. D.P. Misra: None. V. Agarwal: None. A. Lawrence: None. A. Aggarwal: None.

JCS/JHRS 2021 guideline focused update on non-pharmacotherapy of cardiac arrhythmias.

JCS/JHRS 2021 guideline focused update on non-pharmacotherapy of cardiac arrhythmias.

Abstract 11301: Comparing All-Cause to Procedure-Related Mortality in Cardiac Implantable Electronic Device (CIED) Lead Removals: A Systematic Review

Introduction: Infection is a serious complication in patients with cardiac implantable electronic devices (CIEDs). Infection of the generator pocket, systemic bacteremia and lead-related or suspected endocarditis are absolute indications for device removal. While previous studies have reported infection as a major risk factor for mortality, it is unclear what proportion is related to complications of infection or the CIED lead removal procedure itself. Objective: We have conducted a systematic review looking at all-cause in-hospital mortality, intraprocedural, and procedure-related mortality in CIED lead removals and have done a subanalysis specifically exploring removals for infectious indications. Methods: A search was performed of studies published between January 1, 2000-August 29, 2019 indexed on Medline, EMBASE and Cochrane. Inclusion criteria were: (a) transvenous removal of ICD, pacemaker or CRT device leads, (b) Age≥18, (c) n&gt;100 patients. Exclusion criteria were: (a) generator only procedures, (b) planned surgical extractions, (c) data prior to 2000. From these studies, we further selected papers containing mortality data in which all subjects had infectious indications for removal, or papers with infectious only cohorts of n&gt;100 with mortality data. Outcomes: All-cause mortality during index hospitalization, intraprocedural mortality, procedure related mortality. Results: 2307 abstracts were screened after de-duplication resulting in 164 papers for full text review. Of these 164, 8 papers were selected for analysis based on our inclusion criteria. 7 reported periprocedural/mortality during index hospitalization which ranged from 1.47-7.20%; median 4.98% (IQR 2.74-5.69%). 4 studies reported intraprocedural mortality which ranged from 0-0.69%; median 0.10% (IQR 0.00-0.32%). and 6 reported procedure related death which ranged from 0-0.72%; median 0.50% (IQR 0.10-0.67%). Conclusions: Mortality after CIED lead removal is high in patients presenting with infection, however intraprocedural mortality and death directly related to the removal procedure remains low.

Nano-metal–organic-frameworks for treating H2O2-Secreting bacteria alleviate pulmonary injury and prevent systemic sepsis

As a vital bacteria-secreted toxin, hydrogen peroxide (H2O2) can destroy infected tissues and increase vascular permeability, leading to life-threatening systemic bacteremia or sepsis. No strategy that can alleviate H2O2-induced injury and prevent systemic sepsis has been reported. Herein, as a proof of concept, we demonstrate the use of H2O2-reactive metal-organic framework nanosystems (MOFs) for treating H2O2-secreting bacteria. In mice infected with Streptococcus pneumoniae (S. pneumoniae) isolated from patients, MOFs efficiently accumulate in the lungs after systemic administration due to infection-induced alveolar-capillary barrier dysfunction. Moreover, MOFs sequester pneumococcal H2O2, reduce endothelial DNA damage, and prevent systemic dissemination of bacteria. In addition, this nanosystem exhibits excellent chemodynamic bactericidal effects against drug-resistant bacteria. Through synergistic therapy with the antibiotic ampicillin, MOFs eliminate over 98% of invading S. pneumoniae, resulting in a survival rate of greater than 90% in mice infected with a lethal dose of S. pneumoniae. This work opens up new paths for the clinical treatment of toxin-secreting bacteria.

Ureteric Stone-Related Escherichia coli Bacteraemia Associated with Spondylodiscitis

Escherichia coli (E. coli)-related urosepsis associated with a ureteric stone has been shown to cause a systemic bacteraemia that can spread to other parts of the body. Hematogenous spread of infection is the most common cause of pyogenic spondylodiscitis. A 74-year-old female presented with acute left-sided flank pain and was found to have an obstructing 9 mm distal ureteric stone. After initial management involving ureteric stent insertion, the patient deteriorated and developed an E. coli associated bacteraemia, which proved difficult to treat. Further investigations revealed a subsequent spondylodiscitis, which required a 6-week course of antibiotics and no additional intervention. This case presents the likely association of stone-related bacteraemia, complicated by urinary tract instrumentation leading to spondylodiscitis, and demonstrates the importance of clinicians’ awareness of other causes of unresolving sepsis in an elderly patient.

Resident Perspectives 56-5

Resident Perspectives 56-5