Assessing tobramycin levels and renal function following the implantation of CaSO4 beads impregnated with tobramycin: A prospective cohort study.

This study aimed to evaluate the risk of serum tobramycin concentrations exceeding therapeutic levels after administration of calcium sulfate (CaSO4) beads containing either 240 mg or 400 mg tobramycin and 1000 mg vancomycin. This single-center, prospective. This single-center, prospective study included included Piedmont Columbus, Regional orthopedic surgery patients. Following the implantation of tobramycin into CaSO4 beads, serially measured serum tobramycin concentrations were evaluated after 6, 12, 24, and 48 hours. In addition to that, serum tobramycin concentration was evaluated after 5 days. None of the patients who received 240 mg tobramycin-impregnated beads had a tobramycin level >2 µg/mL. Six hours after implantation, the tobramycin level in 2 out of 2 (100%) patients who received 400 mg of tobramycin-impregnated beads was >2 µg/mL. One day following the surgery, the median serum creatinine was 0.85 mg/dL, with an interquartile range of 0.73 to 1.04 mg/dL. No cases of acute kidney injury were observed. This cohort demonstrated that non-nephrotoxic serum tobramycin levels could be achieved in CaSO4 beads mixed with 240 mg or 400 mg of tobramycin.

Impact of Rapid Identification of Staphylococcus Species in Positive Blood Culture Using GeneXpert Methicillin-Resistant Staphylococcus aureus/ Staphylococcus aureus Blood Culture Assay Combined with Antibiotic Stewardship.

Staphylococcus aureus bacteremia is a life-threatening condition associated with a substantial financial burden on the health care system. The use of the GeneXpert® methicillin-resistant S. aureus (MRSA)/S. aureus blood culture (BC) test for the identification of S. aureus may influence antibiotic stewardship and clinical outcomes. This study assessed the clinical and financial impact of utilizing GeneXpert MRSA/SA in combination with criterion-based testing. The outcomes between October 1, 2018, and June 30, 2019, were evaluated in 65 adult patients who had positive BCs with Gram-positive cocci in clusters. GeneXpert MRSA/SA significantly shortened the time to optimal antimicrobial therapy by 1.7 days (2.5 vs. 44 hr, p < 0.0001). The cost saved because of interventions based on GeneXpert testing results was $4,121. GeneXpert testing has shortened the time to optimal therapy and positively impacted cost, although it had no significant effect on length of hospital stay and mortality rate.

Diffuse Alveolar Hemorrhage Associated With Severe Acute Respiratory Syndrome Coronavirus 2.

Diffuse alveolar hemorrhage (DAH) is a rare syndrome resulting from the accumulation of intra-alveolar red blood cells originating most often from the alveolar capillaries and, less frequently, from precapillary arterioles or postcapillary venules. The causes of DAH can be divided into infectious and noninfectious. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that has not been previously identified in humans, and it is responsible for coronavirus disease-19 (COVID-19) infection. Here, we present a case of DAH that is believed to be a consequence of COVID-19 infection in a female patient with no known past medical history. The patient was found to be positive for perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) and anti-glomerular basement membrane antibodies. The patient was diagnosed with ANCA-associated vasculitis with glomerulonephritis and was treated successfully with methylprednisolone 500 mg intravenous (IV) daily for three days, followed by rituximab 375 mg/m2 IV once weekly for four weeks. The long-term complications of COVID-19 are not entirely known and are still being investigated. The association between COVID-19 infection and DAH is not fully known. However, the inflammatory process of COVID-19 infection may have a role in vasculitis, leading to DAH.

Influence of the minimum inhibitory concentration of daptomycin on the outcomes of Staphylococcus aureus bacteraemia.

OBJECTIVES: Recent studies have shown that methicillin-resistantStaphylococcus aureus (MRSA) bacteraemia with vancomycin minimum inhibitory concentration (MIC) >1 µg/mL is associated with a higher rate of treatment failure and a higher mortality rate. Daptomycin is an alternative to vancomycin but has not been as well studied. The aim of this literature review was to evaluate the effect of daptomycin MIC on the outcomes of S. aureus bacteraemia. METHODS: We conducted a literature search for the period January 2010 to January 2019 using the MEDLINE and Embase databases. RESULTS: Four studies were included in the review. The outcomes were clinical cure and 30- or 60-day mortality. In two retrospective studies, 60-70% ofS. aureus isolates had a low daptomycin MIC (≤0.5 µg/mL) and patients with MRSA bacteraemia who were treated with daptomycin had a lower mortality rate. In another study, patients with methicillin-susceptible S. aureus bacteraemia with low daptomycin MICs had a lower risk of developing septic thrombophlebitis. One study showed that patients with MRSA bacteraemia had a higher mortality rate if the daptomycin MIC was >0.5 µg/mL. CONCLUSION: The included studies in this review suggest a possible association between high daptomycin MIC and unfavourable clinical outcomes ofS. aureus bacteraemia. Further prospective studies are required to evaluate the impact of the daptomycin MIC on the clinical outcomes of S. aureus bacteraemia.

Treatment of Recurrent Clostridium difficile Infection in an Immunocompromised Patient with Severe Neutropenia Not Responding to Standard Therapy.

One of the most effective strategies in reducing the risk of Clostridium difficile infection (CDI) recurrence is fecal microbiota transplantation (FMT). However, several adverse events have been reported post FMT, and data on the efficacy and safety of FMT in immunocompromised patients with hematological malignancies are rare. This report presents FMT treatment for refractory CDI in a severely immunocompromised patient. A 69-year-old female presented to the emergency department complaining of foul smelling, intractable, watery diarrhea and generalized abdominal pain. She was recently diagnosed with high-risk myelodysplastic Syndrome (MDS) requiring daily blood transfusions and reported multiple CDI episodes in the past treated successfully with metronidazole and vancomycin as mono- or combotherapy. During this admission, treatment with oral vancomycin (high dose) and intravenous metronidazole was unsuccessful, so FMT was administered. The patient recovered well despite an absolute neutrophil count (ANC) < 0.25 × 109/L, and chemotherapy was initiated soon after. FMT was successful and safe in this patient, with no relapse and adverse events seen in 8 weeks of follow-up via phone calls and office visits.

IgA Nephropathy Flare-Up Mimicking Staphylococcus Post-Infection Glomerulonephritis in Patient with Staphylococcus Aureus Infection Treated with Cefazolin: A Case Report and Brief Review of the Literature.

BACKGROUND Glomerulonephritis (GN) associated with post staphylococcus infection (PSIGN) and high serum immunoglobulin A (IgA) has been reported recently. Patients with GN after infection with underlying IgA nephropathy create a challenge to determine the etiology of GN. Therefore, treatment should be accordingly, with steroids used if the IgA nephropathy flare-up is determined to be the etiology. The aim of this case report was to shed light on the difference between PSIGN and IgA nephropathy flare-ups in patients with a history of IgA nephropathy, and how to treat patient cases accordingly. CASE REPORT An 81-year-old male presented to our Emergency Department complaining of increasing pain, swelling, and redness of his left knee since 2 days ago. He had a history of recent methicillin sensitive Staphylococcus aureus (MSSA) left knee arthroplasty infection that was treated with cefazolin, and he had a history of IgA nephropathy diagnosed 1 year ago. CONCLUSIONS In our patient case, renal biopsy studies were not enough to differentiate between PSIGN and IgA nephropathy flare-ups, thus, clinical presentation was important. PSIGN was found to have a delayed onset compared to IgA nephropathy. Lower serum complement 3 (C3) level, heavier proteinuria, and acute renal failure are common with PSIGN compared to IgA nephropathy. Identifying the etiology and treating our patient accordingly with immunosuppressive therapy had a positive impact on the patient, restoring renal function without further damage.