The Bacterial Profile of Aortic Infectious Endocards: Experience of the Cardiology Department, Mohammed VI University Hospital of Marrakech, Morocco

Introduction: Infective endocarditis is defined as infection of a native or prosthetic heart valve, endocardial surface, or cardiac device. The causes and epidemiology, as well as the microbiology of the disease have evolved over the last few decades with the doubling of the average age of patients and an increased prevalence in patients with indwelling cardiac devices. Patients and Methods: This is a retrospective study, including all subjects over 20 years of age who presented with infective endocarditis of the aortic valve, hospitalized between January 2019 and December 2022, in the Department of Cardiology and Vascular Diseases at ERRAZI Hospital-Mohammed VI University Hospital in Marrakech. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form. Results: Over the study period, 46 patients had presented with aortic positional AR, with a sex ratio that was equal to 1.8. The mean age of the patients was 43±12.5 years. Endocarditis on aortic prosthesis was found in 15%. The valves were rheumatic in 85%. The presumed portal of entry was cutaneous in 45%, oral and ENT in 33%, urinary in 15%, and digestive in 7%. In our series, 21 out of 26 patients presented a biological inflammatory syndrome. At least one or more blood cultures were positive in 38% of cases. Coagulase-negative Staphylococcus was the most common germ in aortic infective endocarditis, found in 40% of positive blood cultures. All the patients in our series had received a combination of broad-spectrum intravenous antibiotic therapy, initially probabilistic, taking into consideration the portal of entry. Adapted after antibiogram results. The evolution during the hospitalization, was marked by an improvement of the clinical state in only 12%, a perioperative death in 38%, and a worsening of the clinical state in 50%, with an average duration of hospitalization of 14 days. In our series, 60% of the patients with positive blood cultures died, whereas there was 75% survival in the group with negative blood cultures. Conclusion: Infective endocarditis is a serious disease because of its high morbidity and mortality. Despite improvements in diagnostic testing, antimicrobial therapy, and surgical intervention, changes in the epidemiology of IE, including the increase in healthcare-associated infections and the virulence of staphylococcus aureus as the causative organism, increase the risk of complications and death in the acute phase of IE. Action must be taken to prevent infective endocarditis, especially in this rheumatically endemic area.

Healthcare-associated blood stream infections: An evaluation of blood culture as indicator

Background: A nosocomial infection or healthcare-associated illness that develops in patients after they are admitted to the hospital but was not present or incubating at the time of admission is referred to as a hospital acquired infection. In patients with severe viral and fungal infections today, it is one of the most prevalent and life-threatening consequences. Blood culture is one of the most important diagnostic tools for the diagnosis of hospital acquired infections. It can also help in providing a clinical as well as an etiological diagnosis. Aims and Objectives: The aim of the study is early detection of blood stream infections along with its antibiotic susceptibility pattern. Materials and Methods: All samples were obtained and processed using conventional microbiological techniques, and an antibiotic sensitivity test was carried out in accordance with CLSI recommendations. Results: Total 160 samples were processed, out of which 54 (34%) samples were positive. Out of 54 positive blood sample, maximum samples were from NICU (28) 52%, followed by causality (10) 18%, PICU (4) 7%, HDU (2) 3%, intensive careunit (4) 7%, surgery (6) 11%, and overall males contributed to higher positivity rate. Total nine different organisms were isolated, out of which Gram negative bacilli were comprised 40 (74%), Gram positive cocci 8 (14%) and Candida were 6 (11%). Among Gram-negative bacilli of most common species were Klebsiella pneumonia (30%), Acinetobacter baumanii (18%), Pseudomonas aeruginosa (11%), Burkhoderia cepacia (11%), and Serratia fonticola (3%). The most prevalent isolated species of gram-positive cocci were Staphylococcus aureus (11%), Coagulase negative S. aureus (3%), and Enterococcus faecalis (3%). Conclusion: This study on blood culture gives insight to magnitude of hospital acquired infections in our set up. Again result of antibiotic susceptibility tests gives overview of drug resistance problem at our set up. This may help in antibiotic stewardship program.

Infective Endocarditis: Experience of the Cardiology Department of the Mohammed VI University Hospital

Introduction: Infective endocarditis (IE) is a rare but potentially serious disease. It causes a high mortality and a high level of morbidity and complications. Its epidemiological, clinical and microbiological characteristics have changed in recent years. The Aim of our Work: Is to study the epidemiological, clinical, bacteriological, ultrasonographic, therapeutic and evolutionary data of IE between January 2017 and October 2022 in the Mohammed VI University Hospital and to compare them to the global profile. Materials and Methods: Retrospective study including 110 patients hospitalized for a definite IE, according to the modified DUKE criteria, in the cardiology department of the Mohammed VI University Hospital over a period of 5 years and 10 months from January 2017 to October 2022. Results: The average age of our patients was 43 years with a male predominance. The bacterial graft was on native valve in 80% with predominance of rheumatic origin (69%), on cardiac prosthesis in 10% of patients, on healthy heart (4%) and congenital heart disease (6%). The most frequent portal of entry was dental (30%). Blood cultures were positive only in 33% of patients, isolating a staphylococcus (16%), a streptococcus (14%) and a GNB (3%). Transthoracic echocardiography (TTE) showed vegetation in 108 cases, valve perforation in 7 cases, cord rupture in 1 patient and perivalvular abscess in 10 cases. Seventy-seven percent of patients had surgical treatment with a mean delay of 29 days. The overall mortality was 24% with heart failure (p<0.001), renal failure (p=0.004) and neurological complications (p=0.002) as predictive factors of mortality. Conclusion: Infective endocarditis remains a real health problem with a consequent mortality and morbidity. The population is often young, revealing the IE by complications; its prevention is the best way to improve its prognosis.

The value of immediate bedside blood cultures in the adjustment of antibiotics for children with bloodstream infections in PICU / 中国小儿急救医学

Objective:To explore the value of immediate bedside blood culture in the adjustment of antibiotics for children with bloodstream infections in pediatric intensive care units(PICU).Methods:Retrospective analysis of children in PICU at Henan Children′s Hospital from May 2017 to March 2021 was conducted.The cases were divided into laboratory blood culture(LBC) group and satellite blood culture(SBC) group according to different blood culture methods.The difference in the time to blood culture incubation, time to blood culture positivity, microbial results time and antibiotic adjustment time were compared between two groups.Results:A total of 3 720 blood cultures were completed in 2 718 children, including 1 888 in LBC group and 1 832 in SBC group, with a positive rate of 3.5% in LBC group and 4.9% in SBC group, and a significantly higher positive rate in SBC group compared to LBC group( χ2=3.954, P=0.046). The differences in age, sex, site of infection, survival rate at 28 d after discharge, pediatric critical illness score, and pediatric risk of mortality Ⅲ score between LBC group and SBC group with positive blood cultures were not statistically significant ( P>0.05). Children in SBC group had significantly shorter specimen receipt time, time to obtain microbiological results, and antibiotic adjustment time than those in LBC group[0.33(0.03, 1.78) h vs. 3.38(1.38, 7.29) h, (57.40±21.92) h vs. (68.14±21.26) h, and (52.53±27.23) h vs. (66.41±28.57) h, all P<0.05]. Conclusion:Immediate bedside blood culture shortens the time from culture to final result reporting, increases the positive rate of blood culture, and saves time on accurate antibiotic treatment for critically ill children.

Bloodstream infections and antibiotic resistance at a regional hospital, Colombia, 2019-2021 / Infecciones del torrente sanguíneo y resistencia a los antibióticos en un hospital regional en Colombia, 2019-2021 / Infecções de corrente sanguínea e resistência a antibióticos em um hospital regional, Colômbia, 2019-2021

ABSTRACT Objectives. To assess antibiotic susceptibility of World Health Organization (WHO) priority bacteria (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus, and Streptococcus pneumoniae) in blood cultures at the Orinoquía regional hospital in Colombia. Methods. This was cross-sectional study using routine laboratory data for the period 2019-2021. Data on blood samples from patients suspected of a bloodstream infection were examined. We determined: the total number of blood cultures done and the proportion with culture yield; the characteristics of patients with priority bacteria; and the type of bacteria isolated and antibiotic resistance patterns. Results. Of 25 469 blood cultures done, 1628 (6%) yielded bacteria; 774 (48%) of these bacteria were WHO priority pathogens. Most of the priority bacteria isolated (558; 72%) were gram-negative and 216 (28%) were gram-positive organisms. Most patients with priority bacteria (666; 86%) were hospitalized in wards other than the intensive care unit, 427 (55%) were male, and 321 (42%) were ≥ 60 years of age. Of the 216 gram-positive bacteria isolated, 205 (95%) were Staphylococcus aureus. Of the 558 gram-negative priority bacteria isolated, the three most common were Escherichia coli (34%), Klebsiella pneumoniae (28%), and Acinetobacter baumannii (20%). The highest resistance of Staphylococcus aureus was to oxacillin (41%). For gram-negative bacteria, resistance to antibiotics ranged from 4% (amikacin) to 72% (ampicillin). Conclusions. Bacterial yield from blood cultures was low and could be improved. WHO priority bacteria were found in all hospital wards. This calls for rigorous infection prevention and control standards and continued surveillance of antibiotic resistance.

RESUMEN Objetivos. Evaluar la sensibilidad a los antibióticos de las bacterias incluidas en la lista prioritaria de la Organización Mundial de la Salud (OMS) (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus y Streptococcus pneumoniae) en hemocultivos en el Hospital Regional de la Orinoquía en Colombia. Métodos. Se trata de un estudio transversal que empleó datos rutinarios de laboratorio del período comprendido entre los años 2019 y 2021. Se examinaron datos de muestras de sangre de pacientes con presunción clínica de infección del torrente sanguíneo. Se determinó el número total de hemocultivos realizados y la proporción cultivos con resultados, las características de los pacientes con bacterias prioritarias, así como el tipo de bacterias aisladas y los patrones de resistencia a los antibióticos. Resultados. De 25 469 hemocultivos realizados, se aislaron bacterias en 1628 (6%); 774 (48%) con agentes patógenos prioritarios de la OMS. La mayoría de las cepas bacterianas prioritarias aisladas (558; 72%) eran gramnegativas y 216 (28%), organismos grampositivos. La mayoría de los pacientes con bacterias prioritarias (666; 86%) fueron hospitalizados en salas distintas de la unidad de cuidados intensivos, 427 (55%) eran varones y 321 (42%) tenían 60 años o más. De las 216 bacterias grampositivas aisladas, 205 (95%) eran Staphylococcus aureus. De las 558 bacterias prioritarias gramnegativas aisladas, las tres más comunes fueron Escherichia coli (34%), Klebsiella pneumoniae (28%) y Acinetobacter baumannii (20%). La mayor resistencia de Staphylococcus aureus fue a la oxacilina (41%). Entre las bacterias gramnegativas, la resistencia a los antibióticos varió del 4% (amikacina) al 72% (ampicilina). Conclusiones. El aislamiento de bacterias en los hemocultivos fue bajo y podría mejorarse. Se encontraron bacterias de la lista prioritaria de la OMS en todas las salas del hospital, por lo que es necesario aplicar rigurosas normas de prevención y control de infecciones y realizar una vigilancia continua de la resistencia a los antibióticos.

RESUMO Objetivos. Avaliar a suscetibilidade a antibióticos das bactérias consideradas prioritárias pela Organização Mundial da Saúde (OMS) (Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Staphylococcus aureus e Streptococcus pneumoniae) em hemoculturas coletadas no hospital regional de Orinoquía na Colômbia. Métodos. Estudo transversal utilizando dados laboratoriais de rotina do período 2019-2021. Foram examinados os dados de amostras de sangue de pacientes com suspeita de infecção de corrente sanguínea. Determinamos o número total de hemoculturas realizadas e a proporção de culturas com rendimento, as características dos pacientes com bactérias prioritárias, e o tipo de bactéria isolada e padrões de resistência a antibióticos. Resultados. Das 25.469 hemoculturas realizadas, 1.628 (6%) foram positivas para bactérias, sendo que 774 (48%) dessas bactérias eram da lista de agentes patogênicos prioritários da OMS. A maioria das bactérias prioritárias isoladas (558; 72%) eram gram-negativas e 216 (28%) eram gram-positivas. A maioria dos pacientes com bactérias prioritárias (666; 86%) estava internada em enfermaria, e não em unidade de terapia intensiva. 427 (55%) eram homens e 321 (42%) tinham ≥ 60 anos de idade. Das 216 bactérias gram-positivas isoladas, 205 (95%) eram Staphylococcus aureus. Das 558 bactérias gram-negativas prioritárias isoladas, as três mais frequentes foram Escherichia coli (34%), Klebsiella pneumoniae (28%) e Acinetobacter baumannii (20%). O Staphylococcus aureus apresentou maior resistência à oxacilina (41%). Entre as bactérias gram-negativas, a resistência aos antibióticos variou entre 4% (amicacina) e 72% (ampicilina). Conclusões. O rendimento bacteriano das hemoculturas foi baixo e pode ser melhorado. As bactérias consideradas prioritárias pela OMS foram encontradas em todas as enfermarias do hospital. Os achados exigem normas rigorosas de prevenção e controle de infecção, e vigilância contínua da resistência bacteriana a antibióticos.

Rapid bacterial identification and antimicrobial susceptibility testing assay in positive blood cultures / 预防医学

Objective@#To establish a rapid bacterial identification and antimicrobial susceptibility testing assay in positive blood cultures, so as to provide insights into timely diagnosis and treatment of bloodstream infections.@*Methods@#A total of 1 154 blood culture samples were collected from inpatients in Zhejiang Hospital from February to May, 2022. The bacterial isolates were enriched and purified using improved separation gel method, and bacterial identification and antimicrobial susceptibility tests were performed using VITEK2 mass spectrometry system and VITEK2 Compact automated microbiology system. The accuracy of the new assay for bacterial identification and antimicrobial susceptibility tests was evaluated with the conventional VITEK 2 compact system as the standard. @*Results@#Of 1 154 blood culture specimens, the conventional VITEK 2 compact system detected 174 positives and 980 negatives. The new assay and the conventional VITEK 2 compact system identified consistent bacterial isolates in 165 out of 174 positive blood culture samples, and the accuracy of bacterial identification was 94.83% for the new assay, with a 99.21% accuracy for identifying Gram-negative bacteria and 82.22% for Gram-positive bacteria. Antimicrobial susceptibility tests were performed in 158 bacterial isolates, and the new assay presented a 90.17% accuracy, with a 90.27% accuracy for Gram-negative bacteria and 89.74% for Gram-positive bacteria. The conventional VITEK 2 compact system required 30 hours and longer to complete bacterial identification and antimicrobial susceptibility tests, and the new assay required 9 to 18 hours.@*Conclusions@#The new rapid bacterial identification and antimicrobial susceptibility testing assay shortens the time of bacterial culture, achieves rapid bacterial identification and antimicrobial susceptibility testing in blood culture specimens and has a high accuracy that meets clinical needs, which facilitates rapid diagnosis and treatment of bloodstream infections.

Distribution and drug resistance analysis of pathogenic bacteria in a hospital blood culture, 2018-2022 / 中国热带医学

@#Abstract: Objective　To analyze the distribution and drug resistance of pathogenic bacteria in blood culture specimens of patients with bloodstream infections before and after COVID-19 (2018-2019 and 2020-2021), and to provide scientific basis and reference for rational treatment and effective control of bloodstream infections in the post-epidemic period. Methods Blood culture specimens were collected from patients in Zhongnan Hospital of Wuhan University in the two years before and after the COVID-19 outbreak (2018-2021). The Automated Blood Culture Systems were used to perform blood culture on blood specimens sent for clinical inspection, and the Vitek MS automatic bacterial identification mass spectrometer was used for strain identification and the Vitek 2 automatic bacterial drug susceptibility analyzer was used for drug susceptibility testing and drug resistance analysis. Results　Blood culture specimens were performed on 28 736 patients with suspected bloodstream infection submitted for inspection from January 2018 to December 2019, and a total of 2 181 strains of pathogenic bacteria were detected after removing duplicate strains, with a positive rate of 7.69%, including 1 046 strains of Gram-negative bacteria, accounting for 47.96%. From January 2020 to December 2021, blood culture specimens from 26 083 patients with suspected bloodstream infection were submitted for inspection, and a total of 2 111 strains of pathogenic bacteria were detected after excluding duplicate strains, with a positive rate of 8.09%, including 1 000 strains of Gram-negative bacteria accounted for 47.37%. The drug resistance of Klebsiella pneumoniae was relatively serious, and the sensitivity rate to ertapenem, polymyxin B and tigecycline was more than 90%. The main non-fermentative bacteria Acinetobacter baumannii was more than 50% sensitive to piperacillin/tazobactam, amikacin and polymyxin B. The sensitivity rates of Pseudomonas aeruginosa to piperacillin/tazobactam, ceftazidime, cefepime, amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, piperacillin and meropenem were more than 50%. Conclusions　In the two years before and after COVID-19, there are many types of pathogenic bacteria in bloodstream infection, but the distribution do not differ significantly. The pathogens of bloodstream infection are mainly distributed in ICU, hepatobiliary research institute, and nephrology department. Among them, Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii are the main ones, and different pathogens showed great differences in drug resistance.

Species distribution and antifungal susceptibility of fungi originating from positive blood cultures in Guangdong, 2019-2021 / 中国热带医学

@#Abstract: Objective　To investigate the species distribution and the antifungal susceptibility of fungi originating from positive blood cultures in Guangdong, so as to provide a basis for the rational use of antifungal drugs in clinical fungal bloodstream infections. Methods All data were collected for retrospective study from monitoring units of the Guangdong Fungal Disease Surveillance Network between 2019-2021, including clinical characteristics, species distribution and antifungal susceptibility. Results A total of 3 589 fungi strains were isolated, most of which were Candida spp. (86.5%, 3 105/3 589). The most common species was Candida albicans (36.6%, 1 315/3 589), followed by Candida tropicalis (17.4%, 1 626/3 589) and Candida parapsilosis (14.5%, 520/3 589). There were 42.1%(1 512/3 589) of strains isolated from ICU. The proportions of Candida albicans strains were 40.0%-50.0% among ICU, general surgery, organ transplantation and emergency department. Candida tropicalis (60.0%, 144/240) was the most common species in hematology department. Both Cryptococcus neoformans (35.4%, 69/195) and Talaromyces marneffei (35.9%,70/195) were common in infection department. All of the Candida isolates were of wild-type (WT) phenotype to amphotericin B. Resistance rates of caspofungin and micafungin for Candida spp. ranged from 0.0% to 4.2%. The resistance rates of Candida tropicalis to fluconazole and voriconazole were 42.3% and 38.9%, which were significantly higher than other common Candida spp. The cryptococcus neoformans strains were totally of WT phenotype to fluconazole and voriconazole. Conclusions Candida albicans is the most common species originating from positive blood cultures in Guangdong Province. Common Candida strains are highly sensitive to echinocandins and amphotericin B. Candida tropicalis has a high resistance rate to triazole drugs.

Comparison of yield of microorganisms in cord blood between two automated blood culture systems / 中国输血杂志

【Objective】 To compare the difference in the detection rate of microorganisms in cord blood between BACTEC FX and BacT/ALERT 3D automated blood culture systems, and to compare the influence of incubation time and different types of culture sample on the detection rate of microorganisms in cord blood. 【Methods】 Cord blood samples prepared from April to August 2020 in Sichuan Cord Blood Bank(n=4 358) were selected, and 20 mL of plasma was used as culture samples for microbial detection. In addition, cord blood samples prepared in the same months of 2021(n=4 057) were selected, and 19 mL of plasma plus 1 mL of final product was used as culture samples for microbial detection. The total sample size was 8 415, of which 4 849 samples(2 458 in plasma group and 2 391 in plasma plus final product group) were assigned to the BACTEC FX system, and 3 566 samples(1 900 in the plasma group and 1 666 in the plasma plus final product group) to the BacT/ALERT 3D system. All samples were cultured for 7 days, and culture data were recorded on day 5 and day 7. Positive results were confirmed by Gram staining. 【Results】 The positive rate detected by the BACTEC FX system was higher than that of the BacT/ALERT 3D system(4.08% vs 2.69%), with statistically significant difference(P0.05) detected by the BacT/ALERT 3D system. With quality control strains, there were significant differences in TTP between these two systems for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Clostridium sporogenes, and Bacillus subtilis(P0.05). 【Conclusion】 This study suggests that the selection of BACTEC FX blood culture system with incubation time of not less than 7 days and plasma plus final product as culture samples may improve the detection rate of microorganisms in cord blood.

Clinical and Bacteriological Profile of Neonatal Sepsis- A Retrospective Study

Background: Neonatal sepsis is a major cause of mortality and morbidity in newborn in developing countries. The spectrum of bacteria which causes neonatal sepsis varies in different parts of the world. Surveillance of causative organisms and their antibiotic sensitivity pattern promotes rational use of antibiotics and antibiotic stewardship. Objective: To assess the clinical and bacteriological profile of neonatal sepsis.Material & Methods:A retrospective study was conducted at Department of Pediatrics, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January to June 2019. Of the 207 neonates with clinical suspicion of sepsis, 55 neonates included. Culture positive sepsis was defined as isolation of bacterial pathogen from blood in neonates with clinical suspicion of sepsis.Results:Of the 207 neonates with clinical suspicion of sepsis, 55 neonates had blood culture positive sepsis. Sepsis was predominant in males (64.5%). Low birth weight (47.2%) and prematurity (40.9%) were important neonatal risk factors for sepsis. Early onset sepsis occurred in 58.1% of the cases and late onset sepsis in 41.9% of the neonates. Gram-positive cocci constituted 67.52% of all isolates and gram negative 30.76%. The most frequently isolated organism in blood was methicillin resistant coagulase negative staphylococcus (MRCONS) (32.47%). Gram positive organisms included MRCONS, methicillin resistant Staphylococci aureus (MRSA), group B Streptococci (GBS), Staphylococcus aureus and Enterococci. Among Gram-negative organisms, Acinetobacter was most frequently isolated followed by Klebsiella, Escherichia coli, Pseudomonas, Citrobacter and Burkholderia species. The mortality in the study group was 13.5%. Gram negative organisms were most resistant to ampicillin and cephalosporins. Gram positive isolates were least resistant to vancomycin and linezolid.Conclusion:In conclusion, gram positive sepsis was found to be common in present study, although mortality was high in gram negative sepsis. Careful measures have to be taken to overcome the change in trend of organisms causing sepsis, and selection of antibiotics should be prudent.

The role of the serum tube agglutination test in the monitoring of human brucellosis: evaluation of post-treatment SAT titers

SUMMARY OBJECTIVE: Positive results of the serum tube agglutination test that persist after treatment may be interpreted by clinicians as treatment failures. Therefore, our study examined the value of serum tube agglutination test in demonstrating treatment success. METHODS: In this retrospective study conducted at a single center, the pre- and post-treatment serum tube agglutination test titers of patients diagnosed with brucellosis were compared. RESULTS: The end-of-treatment serum tube agglutination test titer was negative in 24 (18%) of 139 patients diagnosed with brucellosis. The most common complaints of the patients were fever (78.4%), chills (88.5%), sweating (84.9%), anorexia (79.1%), and arthralgia (63.3%). The rate of positive blood culture before the treatment was 68.3%. The absence of fever (p=0.005) and arthralgia (p=0.024) and the pretreatment serum tube agglutination test titer of <1/160 (p=0.014) were significant markers of serological cure. CONCLUSION: Although serum tube agglutination test is an effective and very successful test in the diagnosis of brucellosis, our study shows that serum tube agglutination test is not useful in demonstrating the treatment success of human brucellosis in the early post-treatment period.

Sensitivity profile of blood culture isolates in a clinical analysis laboratory, Fortaleza, CE / Perfil de sensibilidade de isolados de hemocultura em um laboratório de análises clínicas, Fortaleza, CE / Perfil de sensibilidad de hemocultivos aislados en un laboratorio de análisis clínicos, Fortaleza, CE

Background and objectives: bacteremia is defined from the presence of bacteria in the bloodstream. Its clinical importance is associated with the high morbidity and mortality rate in the world. In severe cases, it can culminate in sepsis, with a constant increase in cases in Brazil. Therefore, this study aims to assess the main bacterial isolates in blood cultures and a possible change in their sensitivity profiles in a clinical analysis laboratory in Fortaleza, Ceará. Methods: an epidemiological, descriptive, retrospective study was carried out, with a quantitative approach of positive blood cultures, seeking to assess the main isolated microorganisms and their sensitivity profiles. The data used were obtained from the laboratory system through the EpiCenter→ software, from January 2019 to December 2020. Statistical analysis was performed using the Graphpad 7.0 software. Results: 840 microorganisms were identified from blood cultures, and the main ones were E. coli, K. pneumoniae, P. aeruginosa, S. epidermidis, S. aureus and S. haemolyticus. Some isolates show a change in the sensitivity profile, such as K. pneumoniae and P. aeruginosa, showing an increase in sensitivity to carbapenems and cephalosporins, while S. epidermidis showed a decrease in sensitivity to minocycline in the comparison between years 2019 and 2020.Conclusion: clinical isolates from blood cultures showed a change in the sensitivity profile between 2019 and 2020, taking into account that, for K. pneumoniae, P. aeruginosa, this change resulted in an increase in sensitivity, with an increase in resistance in S. epidermidis isolates.(AU)

Justificativa e objetivos: bacteremia é definida a partir da presença de bactérias na corrente sanguínea. Sua importância clínica está associada à alta taxa de morbidade e mortalidade no mundo. Nos casos graves, pode culminar em sepse, com constante aumento dos casos no Brasil. Portanto, o presente estudo tem como objetivo avaliar os principais isolados bacterianos em hemoculturas e uma possível alteração nos seus perfis de sensibilidade em um laboratório de análises clínicas de Fortaleza, Ceará. Métodos: foi realizado um estudo epidemiológico, descritivo, retrospectivo, com abordagem quantitativa de hemoculturas positivas, buscando avaliar os principais microrganismos isolados e seus perfis de sensibilidades. Os dados utilizados foram obtidos a partir do sistema laboratorial através do software EpiCenter→, referente ao período de janeiro de 2019 a dezembro de 2020. A análise estatística foi realizada pelo software Graphpad 7.0. Resultados: foram identificados 840 microrganismos a partir das hemoculturas, sendo os principais E. coli, K. pneumoniae, P. aeruginosa, S. epidermidis, S. aureus e S. haemolyticus. Alguns isolados apresentam uma alteração no perfil de sensibilidade, como K. pneumoniae e P. aeruginosa, apresentando um aumento na sensibilidade frente aos carbapenêmicos e as cefalosporinas, enquanto o S. epidermidis apresentou uma diminuição na sensibilidade frente à minociclina na comparação entre os anos de 2019 e 2020. Conclusão: os isolados clínicos de hemocultura apresentaram uma alteração no perfil de sensibilidade entre 2019 e 2020, levando em consideração que, para K. pneumoniae e P. aeruginosa, essa alteração resultou no aumento na sensibilidade, com aumento na resistência nos isolados de S. epidermidis.(AU)

Justificación y objetivos: la bacteriemia se define por la presencia de bacterias en el torrente sanguíneo. Su importancia clínica está asociada con la alta tasa de morbimortalidad en el mundo. En casos severos, puede culminar en sepsis, con un aumento constante de casos en Brasil. Por tanto, este estudio tiene como objetivo evaluar los principales aislados bacterianos en hemocultivos y un posible cambio en sus perfiles de sensibilidad en un laboratorio de análisis clínicos en Fortaleza, Ceará. Métodos: se realizó un estudio epidemiológico, descriptivo, retrospectivo, con abordaje cuantitativo de hemocultivos positivos, buscando evaluar los principales microorganismos aislados y sus perfiles de sensibilidad. Los datos utilizados se obtuvieron del sistema de laboratorio a través del software EpiCenter→, para el período de enero de 2019 a diciembre de 2020. El análisis estadístico se realizó mediante el software Graphpad 7.0. Resultados: se identificaron 840 microorganismos a partir de hemocultivos, siendo los principales E. coli, K. pneumoniae, P. aeruginosa, S. epidermidis, S. aureus y S. haemolyticus. Algunos aislados muestran un cambio en el perfil de sensibilidad, como K.pneumoniae y P. aeruginosa, mostrando un aumento en la sensibilidad a los carbapenémicos y cefalosporinas, mientras que S. epidermidis mostró una disminución en la sensibilidad a la minociclina, en la comparación entre los años de 2019 y 2020. Conclusiones: los aislados clínicos de hemocultivos mostraron un cambio en el perfil de sensibilidad entre 2019 y 2020, teniendo en cuenta que para K. pneumoniae, P. aeruginosa, este cambio resultó en un aumento de la sensibilidad, con un aumento de la resistencia en los aislados de S. epidermidis

Microbial Profile of Neonatal Septicemia and its Antibiogram Prevalent in a Tertiary Care Hospital of Western Odisha

Introduction : A disseminated disease with positive Blood Culture during the first month of life and encompasses various systemic infections of the newborn such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis and Urinary Tract Infection is defined as Neonatal Sepsis. It is one of the leading causes of morbidity and mortality amongst neonates of developing countries. Aim : To determine the microbial profile of Blood Culture-positive Septicemia cases and study their antimicrobial susceptibility pattern. Materials and Methods : Blood Culture and C-reactive Protein (CRP) estimation were done for all 220 clinically suspected neonates. All the pure Bacterial and Candida isolates were identified using standard biochemical tests. Antimicrobial susceptibility testing was done for all bacterial isolates using the Kirby-Bauer disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results : Out of 220 cases, 68.2% were culture positive. Early-onset Neonatal Septicemia (EONS) cases were 74% and Late-onset Neonatal Septicemia (LONS) 26%. The male to female ratio was 1.9:1. Bacterial cases were 66% and 34% were due to Candida. Gram-negative isolates predominated, with Klebsiella pneumonia being the most common one. In the case of Gram-positive isolates, Staphylococcus aureus was most common. The best overall sensitivity of Gram-negative isolates was to Amikacin (100%), Colistin (100%), and Imipenem (96%). Grampositive isolates reported 100% sensitivity to Vancomycin, Teicoplanin and 97.4% to Linezolid. Conclusion : Gram-negative isolates were the leading cause of Sepsis in our study. Strict antimicrobial stewardship should be implemented to prevent the emergence of multi-drug resistant strains.

Neonatal Facial Subcutaneous Abscess: A Case Report

Skin and soft-tissue infections (SSTIs) are common diagnosis in both the pediatric and adult populations and include abscesses and cellulitis. An abscess is a focal, contained, purulent infection with a clearly defined “cavity” and surrounding inflammation involving the deep subcutaneous tissues. There has been overall increase in SSTIs, with a concomitant rise in the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). We here report a case of facial subcutaneous abscess in neonate, a 20-days-old male full term baby born to a G2P1D1 mother via LSCS in view of non-progression of labor with birth weight of 2.8 kgs presented in our hospital with subcutaneous abscess diffusely present on the left side of the scalp & face. Informant was father with good reliability. All relevant investigations sent & IVantibiotics like meropenem & vancomycin started. Incision & drainage done by pediatric surgeon & 100 ml pus removed. IVantibiotics given for 14 days. In summary, though upper & lower limb skin abscesses are more common, but one should not miss the facial subcutaneous abscess for their prompt and effective management.

Mapa Microbiológico - 2020 del Instituto de Hematología e Inmunología de Cuba / Microbiological Map

Introducción: Los mapas microbiológicos se consideran un marcador epidemiológico pues resumen estadísticamente las bacterias circulantes y su comportamiento frente a los antibióticos en uso. Permiten establecer una política de antibióticos que garantiza el uso más racional de los antimicrobianos y disminuye el riesgo de resistencia bacteriana. Objetivos: Identificar las bacterias aisladas con mayor frecuencia a partir de cultivos microbiológicos de pacientes hospitalizados en el Instituto de Hematología e Inmunología durante el año 2020 y determinar la resistencia de las bacterias más frecuentes a los antimicrobianos ensayados, con vista a establecer el primer mapa microbiológico de la institución. Métodos: Se realizó un estudio de corte transversal que incluyó los cultivos de pacientes hospitalizados durante el año 2020. La identificación bacteriana se realizó según métodos convencionales y para determinar los perfiles de resistencia se empleó el método de Bauer-Kirby. Resultados: El hemocultivo fue el estudio microbiológico más indicado con una positividad de 32,80 por ciento. Predominaron las bacterias Gram negativas (81,71 por ciento), siendo las más identificadas Pseudomonas spp., Enterobacter spp., Klebsiella spp. y Escherichia coli. Entre las bacterias Gram positivas predominó Staphylococcus spp. coagulasa negativa. Se obtuvieron elevados porcentajes de resistencia frente a casi todos los antimicrobianos evaluados. Conclusiones: La realización del mapa microbiológico de la institución permite actualizar la política de uso de los antimicrobianos al identificar a los bacilos Gram negativos, con elevados porcentajes de resistencia, como los principales agentes etiológicos de las infecciones registradas en este centro de salud durante el año 2020(AU)

Introduction: Microbiological maps are considered an epidemiological marker as statistically summarize circulating bacteria and their behavior against antibiotics in use. They allow establishing an antibiotic policy that guarantees the most rational use of antimicrobials and decreases the risk of bacterial resistance. Objectives: Identify the isolated bacteria with more frequency from microbiological crops of hospitalized patients in the Institute of Hematology and Immunology during the year 2020 and determine the resistance of the most frequent bacteria to the antimicrobials tested, with a view to establishing the first microbiological map of the institution. Methods: An observational, descriptive, cross-sectional study was performed that included cultures of patients hospitalized during the year 2020. Bacterial identification was carried out according to conventional methods and to determine the resistance profiles was used by the Bauer-Kirby method. Results: The blood culture was the most indicated microbiological study with 32.80 percent positivity. The Gram negative bacteria predominated (81.71percent), being the most identified Pseudomona spp., Enterobacter spp., Klebsiella spp. and Escherichia coli. Among the Gram positive bacteria predominate Staphylococcus spp. coagulase negative. High percentages of resistance were obtained in front of almost all antimicrobials evaluated. Conclusions: The completion of the institutional microbiological map allows updating the antimicrobial use policy by identifying the Gram negative bacilli, with high percentages of resistance, as the main etiological agents of the infections registered in this health center during 2020(AU)

Nivel de conocimiento sobre la extracción de hemocultivos en enfermeras de la Unidad de Cuidados Intensivos / Level of Knowledge about Blood Culture Extractions in Intensive Care Unit Nurses

Introducción: El hemocultivo es una prueba sencilla, pero existe el riesgo de contaminación por un inadecuado procedimiento, en muchas ocasiones puede estar relacionado con la mala praxis del personal de enfermería. Objetivo: Valorar el nivel de conocimientos sobre la técnica de extracción de hemocultivo en enfermeras de una Unidad de Cuidados Intensivos. Métodos: Se realizó estudio descriptivo, transversal, en la Unidad de Cuidados Intensivos del Centro Nacional de Cirugía de Mínimo Acceso, La Habana, en enero 2021. La población estuvo conformada por 12 licenciadas en enfermería, se aplicó un cuestionario de conocimiento con la escala de puntuación: 0-30 puntos (no conocimiento); 31-60 puntos (poco conocimiento); 61-90 puntos (adecuado conocimiento), 91-100 puntos (excelente conocimiento). Se calcularon las frecuencias absolutas, porcentaje, prueba T para una muestra y chi cuadrado. Se utilizó el programa IBM SPSS versión 20 para Windows. Resultados: De la muestra estudiada, 41,70 por ciento consideró que el hemocultivo se realiza a pacientes febriles y el uso de guantes estériles como único medio de protección; 33,30 por ciento hizo referencia al alcohol como antiséptico cutáneo de elección; 58,30 % planteó que se inoculan con diez ml de sangre y 66,70 por ciento afirmó que se debe comenzar por el aeróbico. El promedio de puntuación general fue de 64,25. Conclusiones: Los profesionales de enfermería mostraron un adecuado conocimiento, los guantes estériles fueron el medio de protección más utilizado, destaca el uso de alcohol 76 por ciento para la desinfección de la piel, diez mililitros es el volumen de sangre considerado a inocular en los frascos, existe adherencia a los protocolos de transporte y conservación de la muestra(AU)

Introduction: Blood culture is a simple test, but there is a risk of contamination due to an inadequate procedure, which many times can be related to malpractice of the nursing personnel. Objective: To assess the level of knowledge about the blood culture extraction technique in nurses of an intensive care unit. Methods: A descriptive and cross-sectional study was carried out in the intensive care unit of the National Center for Minimal Access Surgery, Havana, in January 2021. The population consisted of twelve registered nurses. A knowledge questionnaire was applied, which included the following scoring scale: 0-30 points (no knowledge), 31-60 points (little knowledge), 61-90 points (adequate knowledge), 91-100 points (excellent knowledge). Absolute frequencies, percentage, T-test for one sample and chi-square were calculated. The program IBM SPSS (version 20) for Windows was used. Results: Of the sample studied, 41.70 percent considered that blood culture is performed on febrile patients and the use of sterile gloves as the only means of protection. 33.30 percent referred alcohol as the skin antiseptic of choice. 58.30 percent stated that test tube or flask inoculation is completed with 10 mL of blood. 66.70 percent stated that the technique should start with the aerobic. The average overall score was 64.25. Conclusions: Nursing professionals showed adequate knowledge. Sterile gloves were the most used means of protection. The use of 76 percent-alcohol for skin disinfection is relevant. The volume of blood to empty into the flask or sample tube is 10 mL. The protocols for sample preservation and transport are followed(AU)

Identificación directa de microorganismos a partir de hemocultivos positivos utilizando espectrometría de masas (MALDI-TOF MS) / Direct identification of microorganisms in positive blood culture bottles by mass spectrometry (MALDI-TOF MS)

Resumen La espectrometría de masas (MALDI-TOF MS) permite la identificación de microorganismos directamente de las colonias en pocos minutos. En este estudio se ha desarrollado y evaluado un protocolo reducido para identificar microorganismos directamente de las botellas de hemocultivos positivos en 30 minutos con una alta sensibilidad y especificidad, utilizando MALDITOF. Un total de 2535 hemocultivos positivos fueron estudiados por el método directo de MALDI-TOF MS, a partir de una alícuota de sangre de las botellas y el método de colonia, utilizando los cultivos desarrollados en medios sólidos. Del total de hemocultivos positivos incluidos en este estudio, 2381 (93,9%) fueron monomicrobianos y 146 (5,8%) polimicrobianos. Mil trescientos treinta (55,9%) de los aislamientos correspondieron a cocos gram positivos, 922 (38,7%) a bacilos gram negativos, 60 (2,5%) a anaerobios, 36 (1,5%) a bacilos gram positivos y 13 a levaduras. La concordancia global entre ambos métodos fue del 81,7% a nivel de especie (90,0% para bacilos gram negativos, 76,7% para cocos gram positivos y 33,3% para bacilos gram positivos). Se identificó al menos un germen en el 88% de las botellas positivas con desarrollo polimicrobiano. Los resultados del presente estudio demostraron que el protocolo basado en MALDI-TOF MS permite la identificación microbiana directamente de hemocultivos positivos en un tiempo corto, con una alta precisión, con excepción de los bacilos gram positivos.

Abstract Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) enables the identification of microorganisms directly from colonies within minutes. In this study this technology was adapted and tested for use with blood culture bottles, thus allowing identification in 30 minutes once the blood culture is detected as positive by the automate. A total of 2535 blood culture bottles reported as positive were tested by MALDI-TOF MS directly from positive blood culture bottles and colonies. A total of 2381 (93.9%) and 146 (5.8%) of the positive blood cultures were monomicrobial and polymicrobial, respectively. And 1330 (55.9%), 922 (38.7%), 60 (2.5%), 36 (1.5%) and 13 of the isolates were gram-positive cocci (GPC), gram-negative bacilli (GNB), anaerobic bacteria, gram-positive bacilli (GPB) and yeast respectively. Concordance between both methods was 81.7% (76.7% of GPC, 90% of GNB, 74.2% of anaerobic bacteria and 33.3% of GPB) in monomicrobial cultures. Eighty eight per cent of the polymicrobial cultures were identified correctly in at least one of the two bacteria. The results of the present study show that this fast, MALDI-TOF MS based method allows microbial identification directly from positive blood culture in a short time, with a high accuracy, with the exception of gram-positive bacilli.

Resumo A espectrometria de massa (MALDI-TOF MS) permite a identificação de microorganismos diretamente das colônias em minutos. Nesse estudo, foi desenvolvido um protocolo reduzido para identificar microrganismos diretamente das garrafas de hemoculturas positivas em 30 minutos com alta sensibilidade e especificidade, utilizando MALDI-TOF. Um total de 2535 hemoculturas positivas foram relatadas -o método direto de MALDI-TOF MS, a partir de uma alíquota de sangue dos vidros e o método de colônia, a partir das culturas desenvolvidas em meios sólidos. Do total de hemoculturas positivas incluídas neste estudo, 2.381 (93,9%) eram monomicrobianas e 146 (5,8%) eram polimicrobianas. Mil trezentos e trinta (55,9%) dos isolados corresponderam a cocos gram-positivos, 922 (38,7%) bacilos gram-negativos, 60 (2,5%) anaeróbios, 36 (1,5%) bacilos gram-positivos e 13 leveduras. A concordância geral entre os dois métodos foi de 81,7% em nivel de especie (90,0% para bacilos gram-negativos, 76,7% para cocos gram-positivos e 33,3% para bacilos gram-positivos). Pelo menos um germe foi identificado em 88% dos vidros positivos com desenvolvimento polimicrobiano. Os resultados do presente estudo demonstraram que o protocolo baseado em MALDI-TOF MS permite a identificação microbiana diretamente de hemoculturas positivas em um curto espaço de tempo, com alta precisão, com exceção de bacilos gram-positivos.

Time to blood culture positivity as a predictor of clinical outcome among septic patients

@#<p style="text-align: justify;"><strong>Introduction:</strong> In the setting of Sepsis, Blood Culture is one of the important diagnostic tools in aiding a clinician to determine the offending pathogen. Following the Sepsis Bundle, Blood Culture is obtained at two sites before initiation of antibiotics. However, blood Cultures are one of the expensive tests wherein some clinicians find it unnecessary and costly. This study would provide more information regarding positive blood cultures among septic patients as a prognostic tool regarding the time to positivity. Reporting Time to Positivity would aid clinicians in the severity of the infection and could be used as a clinical predictor of mortality. This study investigated the optimal cutoff point of the time to positivity to predict mortality and the association between time to positivity of blood cultures with mortality among septic patients.</p><p style="text-align: justify;"><strong>Methods:</strong> This was a single-center cross-sectional study with a retrospective chart review of septic patients with positive blood cultures. The optimal cutoff point of time to positivity was determined and associated with mortality.</p><p style="text-align: justify;"><strong>Results:</strong> 405 adult in-patients with sepsis in Makati Medical Center from April 1, 2017, to April 30, 2018, were reviewed. The suggested optimal cutoff TTP is ?19.1 hours, with sensitivity 79.78%, specificity 28.48%, accuracy 39.75%, Youden's index 8.26%. The overall mortality rate is 21.98%. The mortality rate was higher in the TTP < 19.1 group at 23.91% compared to the >19.1 hours group. Predictors associated with mortality are age, liver comorbidity, genitourinary source of infection, and short TTP.</p><p style="text-align: justify;"><strong>Conclusion:</strong> A short TTP was associated with higher mortality rates. TTP can be clinically used to predict poorer outcomes. Therefore, patients with a short TTP should be monitored more closely, and appropriate antibiotics should have been initiated.</p>

Coagulase-negative staphylococci isolates from blood cultures of newborns in a tertiary hospital in southern Brazil

Abstract Neonatal sepsis continues to be a major cause of morbidity and mortality worldwide. Coagulase-negative staphylococci (CoNS), commonly found on the skin, being the main agents isolated. The aim of this study was to evaluate CoNS isolated from blood cultures of newborn (NB) infants. The study took place between 2014 and 2016/2017 in a tertiary hospital in southern Brazil. Using the VITEK 2 system (bioMérieux, Marcy l'Etoile, France), the microorganisms were identified and had their sensitivity profiles determined. The minimum inhibitory concentrations of linezolid, tigecycline, and vancomycin were also determined. The clinical parameters and mortality rates of NBs were evaluated. From January to December 2014, 176 CoNS isolates were obtained from 131 patients and from June 2016 to July 2017, 120 CoNS isolates were obtained from 79 patients. Staphylococcus epidermidis was most prevalent in both periods. Resistance rates increased between 2014 and 2016/2017, especially against ciprofloxacin (52.27% and 73.11%, p = 0.0004), erythromycin (51.40% and 68.07%, p = 0.0054), gentamicin (50.59% and 67.23%, p = 0.0052), and penicillin (71.3% and 99.17%, p = 0.0001), respectively. With 100% susceptibility to linezolid, tigecycline, and vancomycin in both periods and methodologies tested. In 2014, 53.44% of the NBs received antibiotic therapy, and of these, 77.14% used a catheter; in 2016/2017, these were 78.48% and 95.16%, respectively. Regarding laboratory tests, a hemogram was ineffective, since patients with sepsis presented normal reference values. In 2014 and 2016/17, 15.71% and 17.74% of the NBs died, respectively. S. epidermidis was the predominant microorganism, related to catheter use in most cases. The resistance rates have increased over time, demonstrating the importance of adopting control and prevention measures in this hospital. CoNS are responsible for a significant neonatal sepsis mortality rate in infants.

Blood culture contamination in the departments of paediatrics and child health at two tertiary training hospitals in central South Africa

Background. Bloodstream infections are an important cause of mortality in children. Blood cultures (BCs) remain the primary means of identifying organisms and their antibiotic susceptibility profiles. A shortcoming of BCs is that up to 56% of positive cultures will represent contaminants. Poor adherence to standard practices applicable to BC sampling could explain an unacceptable contamination rate. Objectives. To determine: (i) the BC contamination rate in the departments of paediatrics and child health at two tertiary hospitals in central South Africa; and (ii) BC sampling practices among paediatric clinicians. Methods. The author determined the prevalence of BC contamination by analysis of laboratory data for the period 1 May - 27 August 2019, and assessed possible factors contributing to BC contamination by surveying paediatric medical staff with a self-administered BC practices questionnaire. Results. Of the 244 BCs reviewed, 25.4% were positive. The most commonly isolated pathogens were coagulase-negative staphylococci (CoNS) (33.3%), Escherichia coli (22.2%), Enterococcus faecium (16.7%) and Acinetobacter baumannii (11.1%). In total, 15.2% of the BCs yielded contaminants and 2.9% had polymicrobial growth. The most common contaminant was CoNS. Approximately 68% of clinicians were not aware of BC sampling guidelines, and even among those who were aware of the guidelines, non-compliance was reported. Conclusions. The BC contamination rate was higher than internationally accepted rates. Educating clinicians on specific BC sampling guidelines is strongly recommended to decrease the high rate of contamination observed in this study.