scholarly journals 1366. Deep Neck Infections: Bacteriology and Antimicrobial Susceptibilities, Akron Children’s Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S769-S769
Author(s):  
Shankar Upadhyayula ◽  
Caleb habeck
Keyword(s):  
Group A Streptococcus ◽  
Demographic Data ◽  
Empiric Therapy ◽  
Published Data ◽  
Bacterial Isolates ◽  
Older Children ◽  
Local Data ◽  
Staph Aureus ◽  
Empiric Antibiotics ◽  
Deep Neck Infections

Abstract Background Deep neck infections (DNI’s) are uncommon (~45,000 US cases annually) but, potentially serious. Published data regarding bacteriology and antibiotic usage for DNI’s in children is limited. In addition, geographic variation in the incidence of pathogens and their antimicrobial susceptibility limits generalization of treatment guidance. Reviewing our practice at Akron childrens we noted considerable variation in the choice of empiric antibiotics (ampicillin-sulbactam vs piperacillin-tazobactam vs Ceftriaxone and Clindamycin/vancomycin/linezolid). Admission unit (floors vs intensive care) and service (hospitalist vs infectious diseases) were some important determinants that influenced choice of empiric antibiotics. This retrospective study aimed to review local data and come up with standard guidance for empiric therapy. Summary of the predominant bacterial isolates. Methods We reviewed records of 125 patients who underwent surgical drainage of DNI’s from 1/2015 – 12/2019. In addition to demographic data we gathered information on bacterial isolates and their susceptibilities. Chart review was performed for patients with staphylococcus aureus, to look for any unique presenting features. Results Up on reviewing the data- peritonsillar abscesses were common in older children (Median age 11 years). As expected, retropharyngeal and parapharyngeal infections were common in younger ones (< 5 years). Group A streptococcus remained the most common aerobic isolate followed by Hemophilus influenzae/parainfluenzae. MRSA was detected in ~7 % of all cultures (see enclosed table). Notably, none of the MRSA isolates were clindamycin resistant. However, MSSA resistance to clindamycin was about 20%. No clinical characters predicted isolation of S. aureus. Anaerobic infections (polymicrobial) were overwhelmingly common across all abscess types. Conclusion Based on our review, Ampicillin-Sulbactam is a good empiric choice antibiotic for deep neck infections in our institution. Ceftriaxone with clindamycin is another option. Clindamycin monotherapy seems to be inadequate. Staph aureus and especially MRSA, were only isolated in a small percentage of cases. Unless a patient is ill appearing, vancomycin use seems unnecessary. Clinical presentation was not helpful to suspect infection with Staph aureus. Disclosures All Authors: No reported disclosures

Upgrade rates and outcomes of screen-detected atypical intraductal epithelial proliferation (AIDEP) diagnosed on core needle biopsy

2021 ◽  
pp. 1-6
Author(s):  
Emma C. Dunne ◽  
Edel M. Quinn ◽  
Maurice Stokes ◽  
John M. Barry ◽  
Malcolm Kell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Demographic Data ◽  
Screening Mammography ◽  
Published Data ◽  
Epithelial Proliferation ◽  
Core Needle ◽  
In Situ Carcinoma ◽  
Increased Risk

INTRODUCTION: Atypical intraductal epithelial proliferation (AIDEP) is a breast lesion categorised as “indeterminate” if identified on core needle biopsy (CNB). The rate at which these lesions are upgraded following diagnostic excision varies in the literature. Women diagnosed with AIDEP are thought to be at increased risk of breast cancer. Our aim was to identify the rate of upgrade to invasive or in situ carcinoma in a group of patients diagnosed with AIDEP on screening mammography and to quantify their risk of subsequent breast cancer. METHODS: We conducted a retrospective review of a prospectively maintained database containing all patients diagnosed with AIDEP on CNB between 2005 and 2012 in an Irish breast screening centre. Basic demographic data was collected along with details of the original CNB result, rate of upgrade to carcinoma and details of any subsequent cancer diagnoses. RESULTS: In total 113 patients were diagnosed with AIDEP on CNB during the study period. The upgrade rate on diagnostic excision was 28.3% (n = 32). 6.2% (n = 7) were upgraded to invasive cancer and 22.1% (n = 25) to DCIS. 81 patients were not upgraded on diagnostic excision and were offered 5 years of annual mammographic surveillance. 9.88% (8/81) of these patients went on to receive a subsequent diagnosis of malignancy. The mean time to diagnosis of these subsequent cancers was 65.41 months (range 20.18–145.21). CONCLUSION: Our data showing an upgrade rate of 28% to carcinoma reflects recently published data and we believe it supports the continued practice of excising AIDEP to exclude co-existing carcinoma.

scholarly journals (GTG)5-PCR Mediated Molecular Typing of Zoonotic Bacteria

2021 ◽  
Vol 11 (2) ◽  
pp. 279-283
Author(s):  
Daryoush Babazadeh ◽  
Reza Ranjbar
Keyword(s):  
Molecular Typing ◽  
Cost Effective ◽  
Present Review ◽  
Published Data ◽  
Bacterial Isolates ◽  
The Past ◽  
Virulent Strains ◽  
Pcr Method ◽  
Zoonotic Bacteria

The present review aimed to reveal the role of (GTG)5-PCR microbial typing in indicating the routes and source of infections, investigate the outbreaks and genotypes of clinical strains, as well as finding virulent strains and epidemiology of bacterial isolates. All available and published data in Google scholar, PubMed, ResearchGate, and Science Direct during the past two decades that used the (GTG)5-PCR method for genotyping the bacterial isolates were included in the current study. The findings have indicated that (GTG)5-PCR can be recommended as a possible, cost-effective, fast, and easy tool for molecular typing of bacterial isolates.

scholarly journals A Five-Year Data Report of Long-Term Central Venous Catheters Focusing on Early Complications

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Harald Lenz ◽  
Kirsti Myre ◽  
Tomas Draegni ◽  
Elizabeth Dorph
Keyword(s):  
Demographic Data ◽  
Venous Catheter ◽  
Venous Access ◽  
Seldinger Technique ◽  
Published Data ◽  
Main Diagnosis ◽  
Anatomical Landmarks ◽  
Central Venous ◽  
Jugular Veins

Background. Long-term venous access has become the standard practice for the administration of chemotherapy, fluid therapy, antibiotics, and parenteral nutrition. The most commonly used methods are percutaneous puncture of the subclavian and internal jugular veins using the Seldinger technique or surgical cutdown of the cephalic vein. Methods. This study is based on a quality registry including all long-term central venous catheter insertion procedures performed in patients >18 years at our department during a five-year period. The following data were registered: demographic data, main diagnosis and indications for the procedure, preoperative blood samples, type of catheter, the venous access used, and the procedure time. In addition, procedural and early postoperative complications were registered: unsuccessful procedures, malpositioned catheters, pneumothorax, hematoma complications, infections, nerve injuries, and wound ruptures. The Seldinger technique using anatomical landmarks at the left subclavian vein was the preferred access. Fluoroscopy was not used. Results. One thousand one hundred and one procedures were performed. In eight (0.7%) cases, the insertion of a catheter was not possible, 23 (2.1%) catheters were incorrectly positioned, twelve (1.1%) patients developed pneumothorax, nine (0.8%) developed hematoma, and three (0.27%) developed infection postoperatively. One (0.1%) patient suffered nerve injury, which totally recovered. No wound ruptures were observed. Conclusions. We have a high success rate of first-attempt insertions compared with other published data, as well as an acceptable and low rate of pneumothorax, hematoma, and infections. However, the number of malpositioned catheters was relatively high. This could probably have been avoided with routine use of fluoroscopy during the procedure.

scholarly journals Evolution of the United States Military Extracorporeal Membrane Oxygenation Transport Team

2020 ◽  
Vol 185 (11-12) ◽  
pp. e2055-e2060
Author(s):  
Matthew D Read ◽  
Jason J Nam ◽  
Mauer Biscotti ◽  
Lydia C Piper ◽  
Sarah B Thomas ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Demographic Data ◽  
The United States ◽  
Published Data ◽  
Medical Treatment Facility ◽  
Membrane Oxygenation ◽  
Transport Distance ◽  
Primary Indication ◽  
The U.S

Abstract Introduction The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. Materials and methods We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth. Results The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451 miles (median air transport distance = 1,328 miles, median ground transport distance = 16 miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%. Conclusions Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.

scholarly journals 1194. Carbapenem-Resistant Enterobacteriaceae in Kentucky: Initial 6 Months of Mechanism Testing

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S361-S361
Author(s):  
Kevin Spicer ◽  
Katelyn Cox ◽  
Rachel Zinner ◽  
Andrea Flinchum
Keyword(s):  
Public Health ◽  
Rural Areas ◽  
Demographic Data ◽  
Acute Care Hospital ◽  
The United States ◽  
Care Hospital ◽  
Local Data ◽  
Carbapenem Resistant ◽  
State And Local ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background A global rise in carbapenem-resistant Enterobacteriaceae (CRE) has been noted over the past two decades. State and local data on CRE are necessary to better inform public health interventions. Methods Reporting of CRE (i.e., Enterobacteriaceae resistant to any carbapenem or shown to produce a carbapenemase) was mandated in Kentucky in 2015. Voluntary submission of isolates to the Antibiotic Resistance Laboratory Network regional laboratory for carbapenemase testing began September 2017. Demographic data collected as part of reporting included age, sex, county of residence, and inpatient/outpatient status. Descriptive and chi-square analyses were performed. Results Between September 1, 2017 and February 28, 2018, 149 CRE were reported to the Kentucky Department for Public Health. Testing for presence of a carbapenemase was performed on 115 isolates (77.2%); 44 (38.3%) were carbapenemase producing (CP)-CRE and Klebsiella pneumoniae carbapenemase (KPC) was identified from 38 (86.4%). Also identified were Verona integron-encoded metallo-β-lactamase (VIM; 5, 11.4%) and New Delhi metallo-β-lactamase (NDM; 1, 2.3%). Identification of carbapenemase varied among genera: Citrobacter (3/4, 75%), Klebsiella (21/40, 52.5%), Serratia (2/5, 40%), Escherichia (6/20, 30%), Enterobacter (11/41, 26.8%), Proteus (0/4, 0%), other genera (1/2, 50%). CRE isolates from urban or suburban areas were more likely CP-CRE than were those from rural areas (30/65, 46.2% vs. 14/50, 28%, P = 0.047). Carbapenemase was identified more often among CRE isolates from currently hospitalized patients than from patients whose cultures were collected outside of an acute care hospital (37/70, 52.8% vs. 7/45, 15.6%; P < 0.001). Conclusion The percentage of CRE that were CP-CRE in Kentucky was comparable with that reported for the United States (38 vs. 32%). Klebsiella spp., the genera historically associated with CP-CRE, made up less than half of CP-CRE. CP isolates were identified from urban, suburban, and rural settings and more frequently from isolates collected in hospitals compared with the community. The additional epidemiology obtained as part of this reporting system has identified metropolitan areas of the state as targets for CRE prevention efforts. Disclosures All authors: No reported disclosures.

scholarly journals Utility of Diagnostic Bone Biopsies in the Management of Osteomyelitis Through Retrospective Analysis: How Golden Is This Gold Standard?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S91-S91
Author(s):  
Cole Hirschfeld ◽  
Shashi Kapadia ◽  
Joanna Bryan ◽  
Deanna Jannat-Khah ◽  
Benjamin May ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Gold Standard ◽  
Bone Biopsy ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Bone Culture ◽  
Needle Size ◽  
Empiric Antibiotics ◽  
Bone Biopsies ◽  
Bone Cultures

Abstract Background Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to identify predictors of a positive bone culture. Methods We retrospectively reviewed all cases of non-vertebral OM in patients who underwent image-guided bone biopsies between 2009 and 2016. Data on pathologic and microbiologic yield were collected and logistic regression was used to determine potential factors affecting the microbiologic yield. Post-biopsy empiric antibiotics and final antibiotics were compared with determine if there was a change in antibiotic treatment after biopsy results were reported. Results We evaluated 203 bone biopsies in 185 patients. Samples from 115 (57%) cases were sent to pathology, of which 33 (29%) confirmed OM. All samples were sent to microbiology and 57 (28%) yielded a positive result. Diabetes (OR=2.39, P = 0.021) and white blood cell count (OR=1.13, P = 0.006) were significantly associated with positive bone cultures in multivariate analyses. There was no association between positive cultures and number of samples cultured, needle size, prior antibiotic use, or antibiotic-free days. Post-biopsy empiric antibiotics were given in 138 (68%) cases. Therapy was narrowed to target specific organisms in seven cases and changed due to inadequate empiric treatment in three cases. Targeted therapy was initiated in 4/65 cases, in which empiric antibiotics had been initially withheld. While final antibiotics were withheld in 38/146 with negative bone cultures, empiric antibiotics were discontinued in only eight cases. Conclusion In patients with non-vertebral OM, bone biopsy cultures rarely yielded results that necessitated changes in antibiotic management. Identified bone organisms were treated by empiric therapy in most patients. While bone biopsy remains the gold standard diagnostic test for OM, further work is needed to identify patients whose management may be impacted by this procedure. Disclosures All authors: No reported disclosures.

Comparison and Prediction of Local and Average Heat Transfer Coefficients Under an Array of Inline and Staggered Impinging Jets

1996 ◽  
Author(s):  
Kenneth W. Van Treuren ◽  
Zoulan Wang ◽  
Peter Ireland ◽  
Terry V. Jones ◽  
S. T. Kohler
Keyword(s):  
Heat Transfer ◽  
Velocity Ratio ◽  
Impinging Jets ◽  
Published Data ◽  
Correlation Technique ◽  
Transfer Coefficients ◽  
Target Plate ◽  
Local Data ◽  
Adiabatic Wall ◽  
Impingement Plate

Recent work, Van Treuren et al. (1993, 1994), has shown the transient method of measuring heat transfer under an array of impinging jets allows the determination of local values of adiabatic wall temperature and heat transfer coefficient over the complete surface of the target plate. Using this technique, an inline and staggered array of impinging jets was tested over a range of average jet Reynolds numbers (10,000–40,000) for three impingement plate to target plate separations (1, 2 and 4). The array was confined on three sides and spent flow was allowed to exit in one direction. Local and average values are presented. These values for the two array configurations are then compared with each other as well as with previously published data in related geometries. A new correlation technique is presented, based on the local data, which breaks the target surface into jet and crossflow areas of interest, with excellent results. The correlation uses the local jet Reynolds number and local jet-to-crossflow mass velocity ratio. This new technique compared favourably with published correlations. Also presented is the influence of the impingement plate on the target plate heat transfer in the form of an effectiveness parameter. This influence is accounted for in the correlation.

scholarly journals THE INFLUENCE OF NATURA 2000 SITES ON THE INVESTMENT ATTRACTIVENESS OF POLISH REGIONS

2018 ◽  
Author(s):  
Katarzyna PAWLEWICZ ◽  
Adam PAWLEWICZ ◽  
Iwona CIEŚLAK
Keyword(s):  
Administrative Support ◽  
Natura 2000 ◽  
Data Bank ◽  
Linear Ordering ◽  
Basic Unit ◽  
Published Data ◽  
Social Infrastructure ◽  
Local Data ◽  
Order Preference ◽  
Labor Resources

This article evaluates the influence of the Natura 2000 network (N2K) of protected areas on the investment attractiveness of Polish regions. Natura 2000 sites were analyzed with the use of the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), a linear ordering method with a common pattern and anti-pattern of development, and correlation analysis (Pearson’s correlation coefficient). The basic unit of analysis was the county (Polish: powiat, the second-level unit of local government and administration in Poland). Poland is divided into 16 regions (known as voivodeships) with a total of 380 counties. The results of the analysis were used to determine synthetic values describing the level and potential of investment attractiveness in Polish counties, and the strength of correlations between the evaluated phenomena. Indicators of investment attractiveness of Polish counties were selected based on published data and analyzed in view of several criteria: labor resources, technical infrastructure, social infrastructure, market support and administrative support. The correlations between the investment attractiveness of Polish counties and the presence of N2K sites in those counties were analyzed statistically. Data for analysis were acquired from the Local Data Bank of the Central Statistical Office. The analysis revealed that the presence of N2K sites in the examined territorial units does not significantly influence their investment attractiveness.

scholarly journals The role of Biofilm for Pseudomonas aeruginosa to resistance ultraviolet and MIC concentration for antibiotics

2012 ◽  
Vol 36 (0A) ◽  
pp. 13-19
Author(s):  
احمد محمد تركي
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
High Resistance ◽  
The Other ◽  
Bacterial Isolates ◽  
Staph Aureus ◽  
E Coli ◽  
The Impact ◽  
And Staphylococcus Aureus

The present study is conducted to in restigate the bacteria Pseudomonas aeruginosa, the impact of ultraviolet on the bacterial isolates under study and the resistance of these isolates to ultraviolet are studied in comparison to two standard isolates ( E . coli and Staphylococcus aureus ) which are considered sensitive to ultraviolet . The natures of the resistance of the isolates, under study, are also being investigated against the different antibiotics. The isolates are subjected to a test to examine their sensitivity to (12) types of antibiotics used routinely in the treatment of various infection of these bacteria. They are (streptomycin , cephalothin ,Gentamycin , cefotaxime ,nitrofurantion ,ampicillin, amoxicillin, rifampin, lincomycin, tetracycline, erythromycin and ciprofloxacin ).The lowest concentration installer ( MIC ) is also testified in accordance with six types of antibiotics (streptomycin, cefotaxime , rifampin , nitrofurantion , Gentamycin , amoxicillin ).The biologic effectiveness of the overlap between the bacterial isolates , under study, is examined against four bacteria (klebseilla pneumonia , Staphylococcus aureus , Enterobacter , Proteus ) The result of using the ultraviolet with different wavelength show the ability of the five local isolates used to resistance of ultraviolet reaching (180 s.) in comparison to the isolates E.coli and staph. aureus in which the ratio of killing is %100 at a time of exposing 40 , 60 sec. respectively. The results indicated that the five local bacterial isolates have high resistance to the most tested antibiotics, It is shouted that all of them have resistance to (erythromycin , tetracycline , lincomycin , Gentamycin ) but they are sensitive towards antibiotic streptomycin . as for the other antibiotics , over can find that the isolates are varied of them for being resisting or sensitive towards them .The results of testing the inhabited effectiveness of the five bacterial isolates towards some other bacterial isolates show the efficiency of the five local isolates in the inhabitation of growth of the five studied bacterial isolates.

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