Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment

Pyogenic vertebral osteomyelitis (PVO) may result in neurological deficits and sequelae, so early diagnosis and appropriate treatment are critical. Many previous studies on PVO exist, but our paper has aimed to comprehensively summarize the clinical aspects of PVO. Through review of the vast literature on the clinical research of PVO an overview of the clinical characteristics, diagnostic methods, treatment and prognosis is provided.

Analysis of microbiological trends and antibiotic susceptibility in 711 episodes of peritoneal dialysis-related peritonitis / 中华肾脏病杂志

Objective To investigate the microbiological trends and antibiotic susceptibility of peritoneal dialysis(PD)-related peritonitis (PDAP).Methods All patients who developed PDAP between 2004 and 2015 in Renji Hospital,Shanghai Jiao Tong University School of Medicine were enrolled.Demographic data,results of dialysate pathogen culture and drug susceptibility test were recorded.The trend of peritonitis incidence was measured by Poisson regression and the chi-square test or Fisher exact test method was used to compare the composition of causative organisms and their antimicrobial susceptibilities over time.Results During the study period,a total of 711 episodes of PDAP were occurred in 386 patients.The culture positive rate of pathogens rose from 52.0％ in 2004 to 77.0％ in 2015 (P ＜ 0.001).The distribution of causative organisms of the culture positive peritonitis was gram-positive bacteria (270,59.5％),followed by gram-negative bacteria (129,28.4％),polymicrobial(39,8.6％),fungi (15,3.3％) and mycobacteria (1,0.2％).From 2004 to 2015,the incidence of peritonitis decreased from 0.214 to 0.160 episodes/patient·year (P=0.034).The incidence of coagulase-negative staphylococcus peritonitis decreased from 0.049 to 0.027 episodes/patient · year (P=0.025),while others had no significant change;A significant decline was observed in the sensitivity of Gram-positive strains to the first generation cephalosporin and ampicillin/sulbactam in 2010-2015 group compared with those in 2001-2009 group (61.3％ vs 88.2％,P ＜ 0.001;61.7％ vs 85.5％,P=0,001),whereas the sensitivity to vancomycin remained the same.The sensitivity of Gram-negative strains to ceftazidime and amikacin showed no significant change.As for the gram-positive peritonitis treated with cefradine as empirical treatment,compared with those in 2004-2009 group,in 2010-2015group the proportion of patients requiring to change their treatment regime was significantly higher,and the treatment course was longer.Conclusions A gradual decline is observed in the incidence of PDAP and the culture positive rate of pathogens improves.Peritonitis caused by coagulase-negative staphylococcus decreases overtime.The present empirical treatment protocols may need re-evaluation considering the decreased rate of the first generation cephalosporin sensitivity in recent years.

Study to determine the prevalence of urinary tract infection and to identify the causative organism and their antibiotic sensitivity pattern in severe acute malnourished children

Background: Malnutrition generally implies under-nutrition and refers to all deviations from adequate and optimal nutritional status in infants, children and in adults. In children, under-nutrition manifests as underweight and stunting (short stature), while severely undernourished children present with the symptoms and signs that characterize conditions known as kwashiorkor, marasmus or marasmic-kwashiorkor. Materials and methods: The present study was carried out in the department of pediatrics and microbiology at UP Rural Institute of Medical Sciences and Research, Saifai, Etawah (U.P) during April 2014 to March 2015. Total 85 children were included in study. Results: Although under reported UTI is common in children with SAM as came out in our study. Prevalence of UTI is common (22.4%) in children with SAM in our study. In our study, Urinary tract infection was more common in females than males in SAM children with maximum prevalence among 37-59 months of age .but there is no significant difference between sex. Sharma IK, Garg KK, Saxena D, Sharma N. Study to determine the prevalence of urinary tract infection and to identify the causative organism and their antibiotic sensitivity pattern in severe acute malnourished children. IAIM, 2017; 4(7): 89-104. Page 90 Conclusion: Most sensitive first line oral Antibiotic was Nitrofurantoin and parentral antibiotic was Amikacin for UTI in children with SAM, in our study.

Causative Agents and Antimicrobial Sensitivity of Neonatal Sepsis: Ten-year Experience in One Neonatal Intensive Care Unit

PURPOSE:To identify trends in causative bacterial organisms for neonatal sepsis and antimicrobial susceptibilities over 10 years in one neonatal intensive care unit. METHODS:We retrospectively reviewed the cases of culture-proven neonatal sepsis between January 1998 and December 2007. The 10-year period was divided into two phases (phase I, 1998-2002; phase II, 2003-2007) to distinguish the differences during the entire period. RESULTS:Total 350 episodes of neonatal sepsis were identified in 315 neonates. The common pathogens of early-onset sepsis were S. epidermidis, S. aureus, P. aeruginosa, and E. cloacae in phase I, and S. epidermidis and E. cloacae in phase II. In cases of late- onset sepsis, coagulase negative Staphylococcus, S. aureus, and K. pneumoniae were isolated frequently in both phases. The incidence of sepsis caused by multi-drug resistant organisms decreased with strict infection control. Gram positive organisms showed 0-20% susceptibility to penicillin, ampicillin, and cefotaxime in both phases. Sensitivity to amikacin for Enterobacter spp. increased, whereas P. aeruginosa showed decreased sensitivity in phase II. Between 50% and 60% of other gram negative bacteria, except P. aeruginosa, were susceptible to cefotaxime in phase II in contrast to phase I. Greater than 80% of gram negative bacteria were sensitive to imipenem except P. aeruginosa and ciprofloxacin in both phases. CONCLUSION:The trend in causative microorganisms and antimicrobial susceptibilities can be used as a guideline for selection of appropriate antibiotics. A particular attention should be paid to infection control, especially to reduce sepsis caused by multi-drug resistant organisms.

A 5-year retrospective study on onychomycosis and its causative organisms in University Malaya Medical Centre (UMMC)

Introduction Onychomyosis is a common infection of the nails, caused by dermatophytes, nondermatophyte moulds or yeasts. There are four main types of onychomycosis which include lateral and distal onychomycosis, proximal onychomycosis, superficial white and total dystrophic onychomycosis. We performed a retrospective analysis looking into the recent trends of onychomycosis in a University Hospital in Malaysia. Materials and methods Data was collected from all patients who had their nail clippings cultured for fungal infection from January 2004 to December 2008, and were analysed. Results There were 272 nail specimens in total. The majority of specimens were from adults (65.8%), followed by the elderly (23.9%) and children and adolescents made up 10.3%. The mean age of the study population was 49.9 ± 19SD years. Of the 189 specimens with positive fungal culture, 110 (40.4%) were non-dermatophyte moulds, followed by yeasts predominantly Candida species (17.6%), 3 (1.1%) were dermatophytes, and 28 (10.3%) were a mixed infection of dermatophytes, non-dermatophyte moulds and yeasts. Conclusion From this study, it was found that onychomycosis in our hospital from 2004 to 2008 were mainly caused by non-dermatophyte moulds. Treatment may be challenging as nondermatophyte onychomycosis are more resistant to treatment.

Study of Causative Organisms in Pitted Keratolysis / 대한의진균학회지

BACKGROUND: Pitted keratolysis is a superficial bacterial infection which usually affects the pressure bearing areas of the feet. Some bacterial organisms were identified as etiologic agents, including Corynebacterium species, Micrococcus species and Dermatophilus congolensis. However, in Korea, studies to prove the causative organisms have not been performed. OBJECTIVE: We performed this study to identify causative organisms of pitted keratolysis in Korea. METHOD: Twelve normal healthy men and 27 pitted keratolysis patients were enrolled. We cultured the scraped specimens of the stratum corneum and identified the cultured organisms. We compared the cultured organisms of pitted keratolysis group with those of control group. We also compared the distribution of cultured organisms in pitted keratolysis with and without tinea pedis. RESULT: Micrococcus species and Corynebacterium species were identified in pitted keratolysis group much more frequently than in normal control group. In most cases of pitted keratolysis combined with tinea pedis, the identified organisms were Micrococcus species. CONCLUSION: Micrococcus species and Corynebacterium species are thought to be the major causative organisms of pitted keratolysis in Korea. Micrococcus species might play a certain antagonistic role, especially in patients of pitted keratolysis with tinea pedis.

A Nationwide Survey on the Causative Organisms of Neonatal Sepsis in Korea

PURPOSE: A nationwide survey was conducted to investigate the most common causative organisms in neonatal sepsis in Korea. METHODS: By reviewing medical records of newborn infants who were confirmed as neonatal sepsis by isolating organisms from blood culture during a one year study period from January to December in 1997, data for causative organisms, risk factors, accompanying focal infections and combinations of antibiotics were collected. RESULTS: 112,351 neonates were born at 55 hospitals in 1997 and 30,767 neonates were admitted to the neonatal units. During this period, 1,175 episodes of neonatal sepsis were recorded in 1,116 neonates. The male to female ratio was 1.17:1. 424 cases(36%) were born prematurely. The main pathogens of early-onset sepsis were coagulase negative Staphylococcus(CONS, 19.3%), S. aureus (16.1%), S. epidermidis(16.1%) and Gram negative bacilli(19.2%) including Pseudomonas(5.9%), Klebsiella(3.9%), E. coli(3.9%), Enterobacter spp(3.5%), Acinetobacter(2.0%). Only six cases of group B beta-hemolytic Streptococcus were isolated. Common obstetric factors were premature rupture of membranes(17.3%), maternal leukocytosis(14.6%), fetal tachycardia(10.2%), chorioamnionitis(3.1%) and maternal fever(3.1%). The main pathogens of late-onset sepsis were S. aureus (20.3%), S. epidermidis(18.9%) and CONS(13.7%). Frequent focal infections accompanying sepsis were arthritis(12.8%), meningitis(7.0%), pneumonia(5.4%) and urinary tract infection(3.1%). The most common combination of antibiotics used in early and late neonatal sepsis was ampicillin and gentamicin. When a nosocomial infection was suspected, a combination of vancomycin and cefotaxime was used most frequently. CONCLUSION: S. aureus and S. epidermidis were the most common pathogens in the neonatal sepsis.

Causative organisms of neonatal sepsis / 영남의대학술지

A nationwide survey was conducted to investigate the annual occurrence rate of neonatal sepsis, maternal risk factor in neonatal sepsis, localized infection in neonate, causative organism in nosocomial infection and the most common causative organism in neonatal sepsis in Korea. Clinical and bacteriological data were collected from thirty seven neonatal units through retrospective review of the medical records of the newborn infants who were confirmed as neonatal sepsis by isolating organisms from blood culture during one year study period from January to December in 1997. 78,463 neonates were born at 37 hospital in 1997 and 20,869 neonates were admitted to the neonatal units. During this period, 772 episodes of neonatal sepsis were recorded in 517 neonates. The occurrence rate of neonatal sepsis was 0.73%(0~2.95%). Male to female ratio was 1.15:1 and 303 cases(42.1%) were born prematurely. The main pathogens of early onset sepsis were S. aureus(20%), S. epidermidis(14.4%) and coagulase negative Staphylococcus( 14.4%). Gram negative bacilli including Enterobacter spp (7.2%), E.coli(5.1%), Klepsiella(4.5%), Pseudomonas(3.7%) Enterobacter faecium(3.6%) constitute 24.1%. Only two cases of group B beta-hemolytic Streptococcus were isolated. Common obstetric factors were PROM(21.1%), difficulty delivery(18.7%), fetal tachycardia(5.3%), chorioamnionitis(4.9%), maternal fever(4.7%). The main pathogens of late-onset sepsis were S. aureus(22.3%), S. epidermidis(20.4%) and CONS(9.9%). There were 6 cases (1.0%) of Candida sepsis. Frequent focal infections accompanying sepsis were pneumonia(26.1%), urinary tract infection(10.5%), meningitis(8.2%), and arthritis(3.6%). S. epidermidis(22.0%) and S. aureus(21.7%) were also the most common pathogens in 373 nosocomial infection.

A study for the isolation of the causative organism,antimicrobial susceptibility tests and therapeutic aspects in patients with impetigo / 대한피부과학회지

BACKGROUND: It is traditiqnally considered that the non-bullous fonn of impetigo is primarily of streptococcal origin and the bullous form is of staphylococcal origin. However, recent reports have shown that Staphylococcus aureus (SA) has become the predominant cauative pathogen of non-bullous impetigo as well as of bullous impetigo. Objective. Our purpose was to evaluate the predominant causativi. pathogen, and to establish a therapeutic guideline for impetigo. METHOD: We described the characteristics of lesions and gerformed bacterial culture and susceptibility tests in patients with impetigo. Patients were treatecl by one of three frequently used antibiotics(erythromycin, cefuroxime, fusidic acid). RESULTS: Of 77 patients, there were 47 cases of crusted type(61.9%), 18 cases of mixed type with crusted and bullous lesiona(23.3%), 7 cases of mixed type with crusted and pustular lesions(9.1%) and 5 cases of bullous type(6.6%). SA was grown from 90.1% af the cases, in 83.1% of cases it was the only organism to be foind and no gowth of streptococcus was faund even in mixed infections. An antimicrobial susceptibility test of 63 strains of SA demonstrated high susceptibility to vancomycin(98.4%), cefuroxime(97.1%), oxacillin(96.4%), cephalothin(95.2%), fusidic acid(91.7%) etc, and high resistance to penicillin(93.7%), gentamicin(90.5%), tobramycin(88.9%) and erythromicin(80.9%). Of 19 patients treated with erythrornycin, 12(63.1% ) showed treatment failure at a weeks, while no treatment failure occured in groups treated with cefuroxime and usidic acid. There were statistically significant differences iri therapeutic effect between cefuroxirne and erythromycin(P=0.005 by two tailedy test), and betweer fusidic acid and erythromycin(P=0.0040. But there was no significant difference between cefuroxime and fusidic acid. CONCLUSION: The predominant pathogen of non-bullous impetigo a well as bullous impetigo was SA which were highly resistant to erythromycin and highly sensitive to efuroxime and fusidic acid. In the clinical response, cefuroxinie and fusidic acid treatment were most effective and erythromycin was inadequate for treatment of impetigo.