Prevalence of bacterial vaginosis in pregnant women attending Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria using the complete Amsel's diagnostic criteria

Background: Bacterial vaginosis (BV) in pregnant women remains a cause for clinical concern among clinicians and health care professionals. BV has been linked to prenatal, antenatal and postnatal challenges in pregnant women. Information on prevalence of BV across trimesters of pregnancy is expected to give better clinical insight into the pathophysiology of this polymicrobial disorder. This study was conducted to determine the prevalence of BV in pregnant women attending the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Methodology: This was a cross-sectional study of 120 pregnant women (40 in each trimester of pregnancy) who had symptoms suggestive of BV, selected by systematic random sampling from among the women attending the Obstetrics and Gynaecology (O & G) clinic of NAUTH, Nnewi. Each subject participant was examined by the attending clinician, and high vaginal swab (HVS) sample was collected for diagnostic analysis of BV using with complete Amsel's clinical criteria, which consists of three of the four criteria; (i) adherent and homogenous vaginal discharge, (ii) vaginal pH > 4.5, (iii) detection of clue cells on saline wet mount, and (iv) amine odor after the addition of potassium hydroxide (positive Whiff test). Results: The mean age of the 120 selected participants was 27.25±6.09 years. The age groups 25-29 (36.7%) and 20-24 years (33.3%) constituted the largest proportion, while age groups <20 (5.0%) and 40-45 years (5.0%) constituted the least. Of the 120 participants, 26 (21.7%) were positive for BV by the Amsel's criteria. Pregnant women in age group <20 years had the highest prevalence of BV (100%, 6/6), followed by those in the age groups 20-24 (27.5%), 40-45 (16.7%), 25-29 (15.9%), 30-34 (9.1%) and 35-39 years (0%) (X 2=28.063, p=0.0001). Prevalence of BV was significantly higher in single (unmarried) pregnant women (45.5%, X 2=4.038, p=0.045), women with primary school education level (66.7%, X 2=14.530, p=0.001), unemployed women (36.1%, X 2=13.278, p=0.0013), and nulliparous women [36.4%, X 2 (for trend) = 4.805, p=0.0274), while there was no significant difference in the prevalence of BV with relation to trimester of pregnancy (X 2=2.750, p=0.253). Conclusion: This study reveals a relatively high prevalence of BV and significant association with factors such as age group, education and occupational status among pregnant women attending NAUTH Nnewi. Regular screening of women for BV prenatally may enable appropriate interventions to prevent adverse pregnancy outcomes

Quorum sensing-induced phenotypic switching as a regulatory nutritional stress response in a competitive two-species biofilm: An individual-based cellular automata model

Competition for nutrients in a polymicrobial biofilm may lead to susceptible species being subjected to nutritionalstress. The influence of bacterial growth rates and interspecies interactions on their susceptibility and response tonutritional stress is not well understood. Pseudomonas aeruginosa and Staphylococcus aureus are two prevalentcausative pathogens that coexist in biofilm-associated infections. Despite being the slower-growing species, P.aeruginosa dominates in a two-species biofilm by inducing phenotypic switching of S. aureusto a metabolicallychallenged small colony variant (SCV) via the release of 2-heptyl-4-hydroxyquinoline N-oxide (HQNO). Wehypothesize that P. aeruginosa experiences nutritional stress in competition with S. aureus, and that the release ofHQNO is an adaptive response to nutritional stress. We present an individual-based two-species biofilm model inwhich interactions between entities induce emergent properties. As the biofilm matured, the difference in growthrates of the two species caused a non-uniform distribution of nutrients leading to nutritional stress for P. aeruginosa and a concurrent increase in the proportion of S. aureus subpopulation. The latter resulted in increasedrelease of autoinducer, and subsequently the upregulation of P. aeruginosa cells via quorum sensing. UpregulatedP. aeruginosa cells released HQNO at enhanced rates, thereby inducing phenotypic switching of S. aureus toSCVs which consume nutrient at a reduced rate. This shifted the nutrient distribution back in favor of P.aeruginosa, thereby relieving nutritional stress. Increase in nutritional stress potentiated the transformation of S.aureus into SCVs. HQNO production decreased once nutritional stress was relieved, indicating that phenotypicswitching acts as a regulatory stress-adaptive response.

A clinical study of commonly isolated organism and its antibiotic sensitivity in diabetic foot ulcers in Sri Manakula Vinayagar Medical College and Hospital, Pondicherry

Background: Diabetic foot ulcer is one of the major surgical problem leading to hospital admission. Diabetic foot ulcer patients with uncontrolled diabetes may end up in forefoot amputation. Early aggressive debridement, control of blood sugar and empirical antibiotic therapy would reduce the morbidities in patients with diabetic foot ulcer. Further the knowledge of commonly isolated microbes and their antibiotic sensitivity pattern would be helpful to start empirical therapy. The purpose of this study was to determine the microbiological profile of diabetic foot infections (DFIs) and assess the antibiotic susceptibility of the causative agents.Methods: This cross-sectional study was conducted in 115 patients admitted with diabetic foot ulcer over a period of 9 months from October 2015 to June 2016 at the department of general surgery, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. Tissue scrapping samples were collected and processed as per standard guidelines.Results: 167 organisms were isolated from 115 patients. 52% of culture showed polymicrobial growth. There was increased prevalence of gram-negative organisms 53% compared to gram positive organisms 47%. When comes to individual isolate, Staphylococcus aureus was the most common organism isolated 24.6% followed by Pseudomonas aeruginosa 21%. All gram-positive aerobes were sensitive to vancomycin and gram-negative isolates were sensitive to amikacin, piperacillin-tazobactum, gentamycin and cefotaxime.Conclusions: Staphylococcus aureus and Pseudomonas were the common pathogens isolated. This study recommends use of vancomycin along with piperacillin-tazobactum as an empirical therapy along with adequate blood sugar control and early debridement of devitalized tissues in patients with diabetic foot infections.

Necrotizing fasciitis: presentation, microbiology and outcomes in a community hospital

Background: Necrotizing fasciitis (NF) is an aggressive and often fatal, soft tissue infection. Delayed surgical therapy leads to worsened outcomes. This study evaluates the mortality, outcomes, and characteristics of patients with NF in a diverse New York City Community Hospital Network.Methods: Retrospective chart review from 2012 to 2019 using ICD-9 and ICD-10 codes of gas gangrene, Fournier’s gangrene, and necrotizing fasciitis was done. Of the 297 patients reviewed 28 met inclusion criteria of imaging findings, operative reports, and clinical diagnosis of NF by an attending surgeon.Results: On average patients in ER were seen by the surgical team within less than 12 hours. Most patients were debrided within 10 hours of surgical consultation and on average received 2.2 procedures. Of the wound cultures obtained 65.38% were polymicrobial in nature. The average length of stay was 17.4 days and 32% of patients required ICU admission. The surgical mortality rate was 7.61%.Conclusions: Necrotizing fasciitis is a rare entity and increasing provider knowledge on patient characteristics as well as the complexity of these patients and the types and number of procedures they require may help guide clinical decision making. We identified that while most of our patients had negative blood cultures on admission, those that had positive blood cultures had multiple organisms growing. Knowing that these patients are complex and likely require multiple procedures, prompt operative intervention is key.

A study of microbiological analysis and its sensitivity pattern of postoperative wound infections in obstetrics and gynecology department: retrospective study in tertiary institute in Mangalore, Karnataka, India

Background: Infections acquired in hospitals are classified as nosocomial infections. Most of these infections are related to surgery, usually at the post-operative wound site. It is also termed Surgical Site Infection (SSI). Staphylococcus aureus is the documented most common organism that infect surgical wounds. This study was focused on identifying the most common microorganism documented in post-operative wound sepsis in abdomen hysterectomy surgery of obstetrics and gynaecology in a tertiary hospital in Mangalore. The aim of this study was to identify postoperative infection and to determine their current antimicrobial resistance to commonly prescribed drugs.Methods: Materials and Methods: This retrospective research was carried out in tertiary hospital with a sample size of 90 wound samples, whose records span from Jan 2014-Jan 2018.  The study involved obtaining records of subjects with cases of contamination and isolation of organisms that frequently infect post-operative wound site in abdomen hysterectomy surgery.Results: A total of 79 bacterial isolates were obtained from 95 wound culture samples. In 41 cases, the isolated culture were mono microbial, 39 cultures were polymicrobial whereas no growth was obtained in 15 cases. The results showed that Staphylococcus Aureus was the most frequently isolated organism (48.1%), followed by Pseudomonas aeruginosa (18.98%) and E. coli (17.72%).Conclusions: The study is therefore important in identifying those at risk of post-operative wound sepsis and the probable causative organisms. This will be useful in the choice of prophylactic antibiotics for treatment of high-risk patients, thereby setting up an empirical antibiogram for use.

Aetiological agents for pulmonary exacerbations in children with cystic fibrosis: An observational study from a tertiary care centre in northern India

Background & objectives: Pulmonary disease is the main cause of morbidity and mortality in cystic fibrosis (CF). The infection occurs with a unique spectrum of bacterial pathogens that are usually acquired in an age-dependent fashion. The objective of this study was to find out the aetiological agents in respiratory specimens from children with CF during pulmonary exacerbation and relate with demographic variables. Methods: In this observational study, airway secretions from children (n=104) with CF presenting with pulmonary exacerbations were collected and tested for bacteria, fungi, mycobacteria and viral pathogens using appropriate laboratory techniques. The frequencies of isolation of various organisms were calculated and associated with various demographic profiles. Results: Bacteria were isolated in 37 (35.5%) and viral RNA in 27 (29.3%) children. Pseudomonas was the most common bacteria grown in 31 (29.8%) followed by Burkholderia cepacia complex (Bcc) in three (2.8%) patients. Among viruses, Rhinovirus was the most common, identified in 16 (17.4%) samples followed by coronavirus in four (4.3%). Fungi and mycobacteria were isolated from 23 (22.1%) and four (3.8%) children, respectively. Aspergillus flavus was the most common fungus isolated in 13 (12.5%) children. Interpretation & conclusions: Pseudomonas was the most common organism isolated during exacerbation. Non-tuberculous mycobacteria were not isolated, whereas infection with Bcc and Mycobacterium tuberculosis was observed, which could probably have a role in CF morbidity. Polymicrobial infections were associated with severe exacerbations.

Fascitis necrosante abdominal en puérpera de once días. A propósito de un caso / Abdominal necrotizing fasciitis in a patient of eleven-days pospartum. A case report

Resumen ANTECEDENTES: La fascitis necrosante es una infección progresiva poco común, con elevada mortalidad, que puede afectar cualquier parte del cuerpo. En la mayoría de los casos se origina por una infección polimicrobiana, con subsecuente afectación de la fascia superficial, tejido y grasa subcutáneos, nervios, arterias, venas y la fascia profunda. CASO CLÍNICO: Paciente de 28 años, obesa, infectada con VIH, que ingresó al servicio de Obstetricia durante el puerperio, con temperatura de 39 °C, escalofríos y dolor abdominal. En la exploración física se observó una lesión negra-azulada, de bordes definidos, de aproximadamente 40 x 20 cm en el área abdominal, alrededor de la herida quirúrgica, con ampollas y olor fétido. Los estudios de laboratorio reportaron hemoglobina 10 g/L, proteína C reactiva 413 y creatinina 110 mg/dL. Se obtuvo una muestra de las ampollas para cultivo. Al día siguiente se repitieron los exámenes de laboratorio y se encontró hemoglobina 8.5 g/L, proteína C reactiva 516 y creatinina 215 mg/dL; el cultivo resultó positivo para Pseudomonas aeruginosa y Staphylococcus aureus. Se prescribió tratamiento endovenoso con antibióticos y la lesión se intervino quirúrgicamente con debridamiento. La evolución de la paciente fue satisfactoria y no reportó secuelas. CONCLUSIONES: El diagnóstico oportuno de la fascitis necrosante permite su tratamiento temprano y la supervivencia del paciente.

Abstract BACKGROUND: Necrotizing fasciitis is an uncommon progressive infection, with high lethality that can affect any part of the body, caused mostly by a polymicrobial infection affecting the superficial fascia, subcutaneous tissue, subcutaneous fat with nerves, arteries, veins and deep fascia. CLINICAL CASE: A 28-year-old woman with a history of obesity and HIV, admitted to the Obstetrics Service with fever (39° C), chills and abdominal pain. A black-bluish lesion was observed, with defined edges of approximately 40 x 20 cm in the abdominal area, around the surgical wound, with blisters and great stench. Hematological study was carried out Hb: 10 g/L, C-reactive protein: 413, and Creatinine: 110 mg/dL. Culture sample of the ampoules is taken. The next day the complementary ones are repeated and Hb is observed: 8.5 g/L, C-reactive protein: 516, and Creatinine: 215 mg/dL; the result of the culture positive for Pseudomonas aeruginosa y Staphylococcus aureus. Endovenous treatment with antibiotics and surgical treatment was used. We observed satisfactory evolution of the patient without sequelae. CONCLUSIONS: The opportune diagnosis of this pathology allows an early action, with the consequent survival of the patients.

The Significant Association between Polymicrobial Diabetic Foot Infection and Its Severity and Outcomes

@#Background: Foot infection is a major complication of diabetes mellitus (DM) and its agents are usually polymicrobial. This study aims to describe the agent and determine the association between polymicrobial infections and the severity of diabetic foot infections (DFI) and their outcomes. Methods: This retrospective cohort study was conducted during one year and it involved 104 patients. Their records were reviewed and assessed. The causative agents and its sensitivity pattern were noted. The results were presented as descriptive statistic and analysed. Results: A total of 133 microorganisms were isolated with 1.28 microorganisms per lesion. The microorganism isolated were 62% (n = 83) GN (Gram-negative) and 38% (n = 50) GP (Grampositive). GN microorganisms include Pseudomonas spp (28%), Proteus spp (11%), Klebsiella spp (8%) and E. coli (4%). Staphylococcus aureus (54%) was predominant among GP, followed by Group B Streptococci (26%) and Enterococcus spp (6%). Thirty patients (28.8%) had polymicrobial infections. The association between the quantity of microorganisms and severity of DFI was significant. Among severe DFI cases, 77.8% with polymicrobial microorganisms underwent amputation compared to 33.3% with monomicrobial infection. Conclusion: GN microorganisms were predominantly isolated from DFIs and remained sensitive to widely used agents. Polymicrobial infections were associated with DFI severity.

Research progress on the interaction between Candida albicans and common bacteria / 国际生物医学工程杂志

Candida albicans is the most prevalent fungal species of the human microbiota.Many nosocomial Candida albicans infections are polymicrobial.The interaction between Candida albicans and other bacteria can be synergistic,antagonistic,and one side benefit,which cause damage of host in different way.Co-infections influence the biochemistry and polybiofilm among pathogenic microorganisms,and then change the drug resistance,response host immunity,and virulence.This makes co-infections more difficult to be cured than mono-infections.The coinfection of Candida albicans and other bacteria has a high incidence rate and mortality rate,which is a serious problem faced by clinicians.The mechanism of interaction between Candida albicans and other bacteria has an important significance in diagnosis and co-infection treatment.In this paper,the research progress of interaction between Candida albicans and Staphylococcus aureus,Pseudomonas aeruginosa,Streptococcus mutans,as well as Lactobacilli was reviewed.

Extrato de Rosmarinus Officinalis l. (Alecrim) reduz a viabilidade de biofilmes de interesse para saúde bucal / Rosmarinus officinalis l. (Rosemary) extract decreases the biofilms viability of oral health interest

Objetivo: No presente estudo foi avaliado o efeito do extrato de alecrim sobre a viabilidade de biofilmes monomicrobianos de Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans e Pseudomonas aeruginosa, bem como, sobre biofilmes polimicrobianos de C. albicans associada com S. aureus, E. faecalis, S. mutans ou P. aeruginosa. Material e métodos: Em placa de microtitulação foram formados os biofilmes mono e polimicrobianos por 48 h. Em seguida, foram expostos por 5 min ao extrato de alecrim (200 mg/mL). Solução salina (NaCl 0,9%) foi utilizada como controle. Após, foram realizadas lavagens com salina para remoção de células não aderidas. Para verificação da viabilidade dos biofilmes, após o tratamento, foi aplicado o teste colorimétrico MTT. A absorbância dos poços foi lida em espectrofotômetro de microplacas (570 nm) e os dados foram convertidos em percentual de redução e analisados estatisticamente por ANOVA e Tukey Test (P ≤ 0,05). Resultados: Após aplicação do extrato de alecrim, com exceção do biofilme de E. faecalis, foram observadas reduções significativas da viabilidade dos biofilmes monomicrobianos e polimicrobianos. Conclusão: Biofilmes monomicrobianos de C. albicans, S. aureus, S. mutans e P. aeruginosa, foram afetados pelo extrato de alecrim, bem como, os biofilmes polimicrobianos de C. albicans associada com S. aureus, E. faecalis, S. mutans ou P. aeruginosa em biofilmes polimicrobianos, apresentando significativas reduções de viabilidade.(AU)

Objective: This study evaluated the effect of rosemary extract on Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans and Pseudomonas aeruginosa monomicrobial biofilms viability, as well as on C. albicans associated with S. aureus, E. faecalis, S. mutans or P. aeruginosa in polymicrobial biofilms. Material and Methods: In microtiter plate, mono- and polymicrobial biofilms for 48 h were formed. Then, they were exposed for 5 min to rosemary extract (200 mg/mL). Saline (0.9% NaCl) was used as control. After, washes were done with saline to remove the non-adhered cells. Biofilm viability was checked by MTT colorimetric assay, after treatment. Absorbance of the wells was read in microplate spectrophotometer (570 nm) and data were converted to reduction percentage and statistically analyzed by ANOVA and Tukey test (P ≤ 0.05). Results: After application of rosemary extract, with exception of the E. faecalis biofilm, significant reductions in mono- and polymicrobial biofilms viability were observed. Conclusion: C. albicans, S. aureus, S. mutans and P. aeruginosa monomicrobial biofilms were affected by rosemary extract, as well as C. albicans associated with S. aureus, E. faecalis, S. mutans or P. aeruginosa in polymicrobial biofilms, presenting significant viability reductions. (AU)

Aerobic bacterial profile and antibiotic resistance in patients with diabetic foot infections

ABSTRACTINTRODUCTION: This study aimed to determine the frequencies of bacterial isolates cultured from diabetic foot infections and assess their resistance and susceptibility to commonly used antibiotics.METHODS: This prospective study included 41 patients with diabetic foot lesions. Bacteria were isolated from foot lesions, and their antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method and/or broth method [minimum inhibitory concentration (MIC)].RESULTS: The most common location of ulceration was the toe (54%), followed by the plantar surface (27%) and dorsal portion (19%). A total of 89 bacterial isolates were obtained from 30 patients. The infections were predominantly due to Gram-positive bacteria and polymicrobial bacteremia. The most commonly isolated Gram-positive bacteria were Staphylococcus aureus, followed by Staphylococcus saprophyticus, Staphylococcus epidermidis, Streptococcus agalactiae, and Streptococcus pneumoniae. The most commonly isolated Gram-negative bacteria were Proteus spp. and Enterobacterspp., followed by Escherichia coli, Pseudomonasspp., and Citrobacterspp. Nine cases of methicillin-resistant Staphylococcus aureus (MRSA) had cefoxitin resistance, and among these MRSA isolates, 3 were resistant to vancomycin with the MIC technique. The antibiotic imipenem was the most effective against both Gram-positive and Gram-negative bacteria, and gentamicin was effective against Gram-negative bacteria.CONCLUSIONS: The present study confirmed the high prevalence of multidrug-resistant pathogens in diabetic foot ulcers. It is necessary to evaluate the different microorganisms infecting the wound and to know the antibiotic susceptibility patterns of the isolates from the infected wound. This knowledge is crucial for planning treatment with the appropriate antibiotics, reducing resistance patterns, and minimizing healthcare costs.

Microbial characteristics in culture-positive sepsis and risk factors of polymicrobial infection in ICU / 中华危重病急救医学

ObjectiveTo investigate the clinical characteristics and pathogenic microorganisms in culture-positive sepsis, to identify its risk factors, and evaluate the prognosis on polymicrobial infection in intensive care unit (ICU).Methods A descriptive retrospective study was conducted. Clinical data of patients aged≥ 18 years, diagnosed as culture-positive sepsis, and admitted to six ICUs of Guangdong General Hospital from October 12th, 2012 to December 1st, 2014 were enrolled. Based on the number of isolated pathogens, patients were divided into polymicrobial infection group (≥two pathogens) and monomicrobial infection group (one pathogen) to investigate the clinical characteristics of patients with culture-positive sepsis and the causative pathogens. Multiple logistic regression was conducted to identify the risk factors for polymicrobial infection. Kaplan-Meier curve was plotted to analyze a 90-day survival rate from the onset of positive blood culture.Results 299 patients with positive blood culture were enrolled. A total of 450 strains of pathogens were isolated including 246 gram-positive cocci (54.67%), 167 gram-negative bacilli (37.11%) and 37 fungi (8.22%). Ninety-one patients had polymicrobial infection, and 208 with monomicrobial infection. Compared with monomicrobial infection group, patients suffering from polymicrobial infection had more advanced age (years: 73.19±18.02 vs. 60.83±18.06,t = -5.447,P = 0.000), also with higher incidence of cerebrovascular diseases [39.56% (36/91) vs. 17.79% (37/208),χ2 = 16.261,P = 0.000] or chronic renal insufficiency [15.38% (14/91) vs. 7.21% (15/208),χ2 = 4.828,P = 0.028], higher incidence of recent hospital stay (≥2 days) within 90 days [73.63% (67/91) vs. 61.54% (128/208),χ2 = 4.078,P = 0.043], longer mechanical ventilation duration [days: 4 (0, 17) vs. 1 (0, 6),U = 7 673.000,P = 0.006], longer length of hospital stay before blood was drawn for culture [days: 21 (7, 40) vs. 9 (3, 17),U = 6 441.500,P = 0.006], and higher incidence of pre-admission intravenous use of antibiotics [84.62% (77/91) vs. 66.83% (139/208),χ2 = 9.989,P = 0.002]. Multiple logistic regression analysis showed that advanced age [odd ratio (OR) = 1.032, 95% confidential interval (95%CI) = 1.015-1.050,P = 0.000], cerebrovascular diseases (OR = 2.247, 95%CI = 1.234-4.090,P = 0.008), prolonged mechanical ventilation (OR =1.041, 95%CI = 1.014-1.069,P = 0.003), and recent hospital stay (≥2 days) within 90 days (OR = 1.968, 95%CI =1.079-3.592,P = 0.027) were the independent risk factors for polymicrobial infection. In the polymicrobial infection group, the length of ICU stay [days: 46 (22, 77) vs. 13 (7, 22),U = 3 148.000,P = 0.000] and hospital stay [days:81 (47, 118) vs. 28 (17, 46),U = 3 620.000,P = 0.000] were significantly longer, and the ICU mortality [65.93%(60/91) vs. 43.75% (91/208),χ2 = 12.463,P = 0.000] and hospital mortality [68.13% (62/91) vs. 45.67% (95/208),χ2 = 12.804,P = 0.000] were significantly higher, and on the other hand the 90-day survival rate was significantly lower than that in the monomicrobial infection group (χ2 = 8.513,P = 0.004).Conclusions The most common pathogen of ICU sepsis is gram-positive cocci. Independent risk factors for polymicrobial infections were found to be advanced age, occurrence of cerebrovascular disease, prolonged mechanical ventilation, and recent hospitalization. Polymicrobial infection is associated with longer length of ICU and hospital stay, as well as higher mortality.

A Case of Polymicrobial Fungal and Bacterial Spondylodiscitis / 대한내과학회지

A 66-year-old female who had undergone surgery for a herniated disc at the L5-S1 level at another hospital 3 months earlier was admitted with persistent back and leg pain. She was diagnosed with spondylodiscitis at the L5-S1 level by magnetic resonance imaging. A biopsy was performed, and Candida parapsilosis and Enterococcus faecium were isolated from the excised material. We report herein a case of successful treatment of polymicrobial spondylodiscitis in accordance with accurate microbiological diagnosis. Based on this case, we hope to encourage physicians to perform biopsies more aggressively or repeatedly to improve the diagnostic yield.

Polymicrobial Purulent Pericarditis Probably caused by a Broncho-Lymph Node-Pericardial Fistula in a Patient with Tuberculous Lymphadenitis

Purulent pericarditis is a rare condition with a high mortality rate. We report a case of purulent pericarditis subsequently caused by Candida parapsilosis, Peptostreptococcus asaccharolyticus, Streptococcus anginosus, Staphylococcus aureus, Prevotella oralis, and Mycobacterium tuberculosis in a previously healthy 17-year-old boy with mediastinal tuberculous lymphadenitis. The probable route of infection was a bronchomediastinal lymph node-pericardial fistula. The patient improved with antibiotic, antifungal, and antituberculous medication in addition to pericardiectomy.

Microbiological profile of diabetic foot ulcers and its antibiotic susceptibility pattern in a teaching hospital, Gujarat.

Background: Diabetic foot lesions are a major medical, social and economic problem and are the leading cause of hospitalization for patients with diabetes worldwide. Infection sometimes leads to amputation of the infected foot if not treated promptly. The present study was conducted to isolate and identify the bacterial pathogens associated with diabetic foot ulcer and to find out its antibiotic susceptibility pattern to reduce the risk of complications. Methods: Total 100 pus samples were collected from patients having diabetic foot ulcer, during July to October 2012. Samples were processed as per standard guidelines. Results: Out of 100 pus samples, 73 (73%) yielded growth of organisms making total of 92 isolates. Out of 92 bacterial isolates, 72 were gram negative and 20 were gram positive. Pseudomonas aeruginosa 25 (27%) was most common isolate causing diabetic foot infections followed by 20 (22%) Klebsiella sp., 17 (19%) E. coli, 15 (17%) S. aureus, 6 (7%) Proteus sp. and 4(3%) Enterococci, 2 (2%) Acinetobacter sp. and 2(2%) CONS and 1(1%) Providencia. Out of 72 GNB, 50 (69.4%) were extended spectrum β lactamase (ESBL) producer. Most gram negative isolates were resistant to levofloxacin, gentamicin, ampicillin-sulbactam and gatifloxacin. All GNB were sensitive to imipenem. Out of 15 S. aureus, 9 (60%) were Methicillin Resistant Staphylococcus aureus (MRSA) and were sensitive to vancomycin and linezolid. Conclusions: Pseudomonas sp. was the most common cause of infections. Most isolates were multi drug resistance.

A Case of Spontaneous Bacterial Peritonitis with Bacteremia Caused by Shewanella algae

Human infection caused by Shewanella algae is rare, which usually occurred after direct contact with seawater or ingestion of raw seafood in the immunocompromised host. There have been anecdotal reports about Shewanella infections in human, but their pathogenic role and microbiologic data are limited. Here, we report a fatal case of spontaneous bacterial peritonitis with bacteremia due to S. algae in a 57-year-old male with liver cirrhosis who had no history of exposure to seawater or raw seafood. Polymicrobial infection with Streptococcus mitis and Escherichia coli was combined and the patient died in spite of early appropriate antimicrobial therapy and early goal-directed therapy for sepsis.

Clinical analysis of dialysis-associated polymicrobial peritonitis / 第二军医大学学报

Objective To investigate pathogens, antibiotics sensitivity and prognosis of dialysis-associated polymicrobial peritonitis, so as to provide evidence for prevention and treatment of polymicrobial peritonitis. Methods A total of 151 peritoneal peritonitis episodes in 81 patients, who received dialysis in our department between January 2008 and September 2010, were analyzed in the present study. The causative pathogens, antibiotics sensitivity and prognosis of polymicrobial peritonitis were retrospectively reviewed in these patients. Results Pathogenic culture of effluent peritoneal dialysate was positive in 98(64. 9%) of the 151 peritoneal peritonitis episodes, and 20(13. 2%) epidoses were polymicrobial peritonitis. The organisms isolated from the effluent peritoneal dialysate included mixed Gram-positive and Gram-negative organisms (30%), mixed Gram-positive and fungi (30%), mixed Gram-negative and fungi (15%), pure Gram-positive organisms (15%), pure Gram-negative organisms infection (5%), and pure fungi (5%). The sensitive rates of Gram-positive organisms in the polymicrobial peritonitis were 100% to vancomycin, 61% to cefazolin sodium, and 52% to levofloxacin; and those of Gram-negative organisms were 100% to meropenem, 100% to cefoperazone-sulbactam, 70% to gentamycin, and 60% to ceftazidime. Fifteen (75%) of the 20 polymicrobial peritonitis episodes were cured and continuously received peritoneal dialysis. One (5%) patient died and 4 (20%) were converted to permanent hemodialysis. Conclusion Polymicrobial peritonitis in our group has been mainly caused by mixed infection of Gram-positive and Gram-negative organisms, mixed infection of Gram-positive organisms and fungi. The Gram-positive organisms are sensitive to vancomycin, and Gram-negative organisms are sensitive to meropenem and cefoperazone-sulbactam. Earlier catheter removal is necessary for fungal peritonitis or refractory peritonitis.

The Clinical Comparison between Monomicrobial and Polymicrobial Urinary Infection in Febrile Pediatric Acute Pyelonephritis

PURPOSE: We investigated the clinical presentation of febrile pediatric patients with acute pyelonephritis (APN) with a mixed urine culture from an aseptic urine sample, and compared with that of those with a single culture. METHODS: We retrospectively reviewed the medical charts of 95 patients diagnosed as APN with fever between January 2008 and October 2010 at Korea University Medical Center. We classified the patients with APN into two groups with a positive single culture (S group) and a positive mixed culture (M group) from an aseptic urine sample of suprapubic bladder aspiration or urethral catheterization and compared the fever duration, laboratory markers such as serum white blood cell (WBC) counts and C-reactive protein (CRP) values in peripheral blood, and the presence of hydronephrosis, renal scar and vesicoureteral reflux (VUR) between the two groups (If presence of hydronephrosis, scar and VUR=1 and no=0). RESULTS: Total pediatric patients with febrile APN were 95 patients, a positive S group was 89 patients and a positive M group was 6 patients. Fever duration (S vs. M, 4.7+/-3.1 vs. 6+/-5.7 days), serum WBC (S vs. M, 18,630+/-6,483 vs. 20,153+/-7,660/microL) and CRP (S vs. M, 100.6+/-2.46 vs. 81.1+/-0.09 mg/L) values, and the presence of hydronephrosis, renal scar and VUR were not different between the two groups. CONCLUSION: Our data shows that there were no specific differences of clinical manifestation between a positive single urine culture and a positive mixed urine culture in pediatric APN. A mixed urine culture from an aseptic urine sample should be interpreted cautiously.

Quando e como valorizar culturas de urina polimicrobianas no laboratório de microbiologia clínica / When and how to enhance polymicrobial urine cultures at the laboratory of clinical microbiology

INTRODUÇÃO: Na maioria dos laboratórios de Microbiologia considera-se contaminação uma cultura de urina com mais de um morfotipo colonial, ignorando-se o desenvolvimento ou solicitando-se novo material. Raramente o isolado é considerado significativo. OBJETIVOS: Com a finalidade de estudar as infecções urinárias polimicrobianas, no período de agosto de 2003 a janeiro de 2004, na cidade de Tubarão, Santa Catarina, foram selecionadas 117 amostras de urina de pacientes internados no Hospital Nossa Senhora da Conceição, de ambos os sexos, com idades que variavam de 14 a 98 anos. MÉTODOS: Realizou-se uma análise minuciosa dos prontuários dos pacientes. Procedeu-se o Gram da gota de urina não centrifugada e a cultura com alça calibrada de 1 ou 10 μl em ágar CLED (cistina-lactose deficiente em eletrólitos). Todas as culturas foram repetidas com nova coleta de urina com supervisão direta. Os clínicos aguardaram a segunda coleta (confirmatória) para iniciar a antibioticoterapia. Descartaram-se os pacientes que iniciaram a antibioticoterapia imediatamente após a primeira coleta ou que estavam utilizando antimicrobianos. RESULTADOS: Obteve-se o total de seis (12,8 por cento) culturas polimicrobianas confirmadas, em um universo de 47 amostras com crescimento bacteriano estudadas. Os resultados foram compatíveis com as indicações clínicas. CONCLUSÃO: É importante ressaltar a correlação entre os achados laboratoriais e as indicações clínicas dos pacientes. Recomenda-se avaliar criteriosamente isolados polimicrobianos em amostras de urina, sejam ambulatoriais ou hospitalares.

INTRODUCTION: In most microbiology laboratories, a urine culture is regarded as contaminated when there is more than one colonial morphotype, thus either it is ignored or a new sample is requested. The isolate is rarely considered significant. OBJECTIVES: In order to study the polymicrobial urinary tract infections, 117 urine samples were selected from inpatients of both genders aged from 14 to 98 years old at Nossa Senhora da Conceição Hospital, Tubarão city, Santa Catarina, Brazil, from August 2003 to January 2004. METHODS: A detailed analysis of patients' records was carried out. Gram test of non-centrifuged urine drop and culture with calibrated loop of 1 or 10 microliters in CLED agar were performed. All cultures were repeated with new urine collection under direct supervision. Physicians waited for the second collection (confirmatory test) to initiate antibiotic therapy. Patients that had started antibiotic therapy immediately after the first collection or those that were using antibiotics were discarded. RESULTS: Six polymicrobial cultures were confirmed from a total of 47 samples with bacterial growth. The results were consistent with clinical indications. CONCLUSION: It is important to emphasize the correlation between laboratory findings and patients' clinical indications. It is recommended that polymicrobial isolates in urine samples from both out-patients and inpatients should be thoroughly investigated.