79. Clinical Utility of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal PCR Assays Beyond Respiratory Infections

Abstract Background Empiric use of vancomycin is common in clinical practice. Currently there is strong evidence to support the use of MRSA nasal screening to predict the absence of MRSA in respiratory infections; however, minimal data exists regarding its utility as a de-escalation tool beyond pulmonary indications. Furthermore, MRSA nasal PCR has been shown to be a more efficient way to detect the presence of MRSA colonization than traditional culture methods. The purpose of this study was to evaluate the correlation between results of MRSA nasal PCR assays and blood or bone/soft tissue cultures. Methods This was a retrospective study of patients who presented to any of three hospitals part of an integrated health system in Des Moines, Iowa, from March 1, 2019 to February 29, 2020. Included patients were those who underwent MRSA nasal PCR screening and had a clinical culture (blood, bone, tissue, deep podiatric wound, joint aspirate, or synovial fluid) obtained within 3 days of the MRSA nasal PCR. Data on age, sex, diabetes mellitus and dialysis were collected. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for all cultures, and blood and bone/soft tissue cultures separately were estimated. Results A total of 1989 patients were included in the study. Of these patients, 1953 patients had a blood culture obtained and 171 patients had a bone/soft tissue culture obtained. The median age was 66 years, and 1086 (54.6%) patients were male. At baseline, 33.1% and 3.8% of patients had diabetes or were on dialysis, respectively. The overall prevalence of MRSA colonization was 12.3%. The sensitivities of the MRSA nasal PCR screening were 67.5% for all clinical cultures, 81.8% for blood cultures, and 55% for bone/soft tissue cultures. Specificities were 88.8%, 88.5%, and 92.7% for all cultures, blood cultures, and bone/soft tissue cultures, respectively. The PPVs were 11%, 7.5%, and 50% for all cultures, blood cultures, and bone/soft tissue cultures, respectively, and the NPVs were 99.3%, 99.8%, and 92.7%, respectively. Conclusion MRSA nasal PCR screening showed high NPV across blood and bone/soft tissue cultures. These results indicate the clinical utility of MRSA nasal PCR assays beyond respiratory infections and can further support antimicrobial stewardship activities. Disclosures All Authors: No reported disclosures

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Sensitivity, Specificity and Predictive Value of Modified Assays for Activated Protein C Resistance in Children

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614946 ◽

1998 ◽

Vol 79 (03) ◽

pp. 567-570 ◽

Cited By ~ 19

Author(s):

Greg Brandt ◽

Charles Glueck ◽

Davis Stroop ◽

Ann Becker ◽

Ann Pillow ◽

...

Keyword(s):

Predictive Value ◽

Clinical Utility ◽

Activated Protein C ◽

Factor V Leiden ◽

Factor V ◽

Assay Sensitivity ◽

Factor V Leiden Mutation ◽

Pcr Screening ◽

Apc Resistance ◽

Sensitivity Specificity

SummaryVery little data is available assessing the clinical utility of coagulation-based APC resistance assays compared to DNA-based analysis for the factor V Leiden mutation in children. Therefore, the clinical utility of four aPTT-based assays for APC resistance was evaluated in 169 children, ages 3 months through 16 years. The prevalence of the Arg506 to Gln mutation was 7/169 (4.1%). Using cutoff points derived from the normal PCR-screened population (n = 162), two assays for APC resistance (APC-SR and n-APC-SR) gave poor concordance with the PCR assay (sensitivity 29% and 57%, respectively). Two modified assays (FDAPC-SR and n-FDAPC-SR), in which patient plasma was prediluted 1:5 in factor V deficient plasma, gave excellent concordance (sensitivity 100%). The predictive value of a positive test was 0.25, 0.44, 1.00 and 0.88 for the APC-SR, n-APC-SR, FDAPC-SR and n-FDAPC-SR, respectively. The FDAPC-SR and n-FDAPC-SR tests gave excellent discrimination using cutoff values derived from the total population (n = 169) without regard to previous PCR screening results.

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Ultrasound evaluation of the fetal fat tissue, heart, liver and umbilical cord measurements in pregnancies complicated by gestational and type 1 diabetes mellitus: potential application in the fetal birth-weight estimation and prediction of the fetal macrosomia

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00634-7 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Paweł Jan Stanirowski ◽

Agata Majewska ◽

Michał Lipa ◽

Dorota Bomba-Opoń ◽

Mirosław Wielgoś

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Birth Weight ◽

Soft Tissue ◽

Type 1 Diabetes Mellitus ◽

Umbilical Cord ◽

Predictive Value ◽

Fetal Macrosomia ◽

Fetal Birth Weight

Abstract Background The aim of the study was to evaluate the ultrasound-derived measurements of the fetal soft-tissue, heart, liver and umbilical cord in pregnancies complicated by gestational (GDM) and type 1 diabetes mellitus (T1DM), and further to assess their applicability in the estimation of the fetal birth-weight and prediction of fetal macrosomia. Methods Measurements were obtained from diet-controlled GDM (GDMG1) (n = 40), insulin-controlled GDM (GDMG2) (n = 40), T1DM (n = 24) and healthy control (n = 40) patients. The following parameters were selected for analysis: fetal sub-scapular fat mass (SSFM), abdominal fat mass (AFM), mid-thigh fat/lean mass (MTFM/MTLM) and inter-ventricular septum (IVS) thicknesses, heart and thorax circumference and area (HeC/HeA; ThC/ThA), liver length (LL), umbilical cord/vein/arteries circumference and area (UmC/UmA; UvC/UvA; UaC/UaA) together with total umbilical vessels (UveA) and Wharton's jelly area (WjA). Regression models were created in order to assess the contribution of selected parameters to fetal birth-weight (FBW) and risk of fetal macrosomia. Results Measurements of the fetal SSFM, AFM, MTFM, MTFM/MTLM ratio, HeC, HeA, IVS, LL, UmC, UmA, UaC, UaA, UveA and WjA were significantly increased among patients with GDMG2/T1DM as compared to GDMG1 and/or control groups (p < .05). The regression analysis revealed that maternal height as well as fetal biparietal diameter, abdominal circumference (AC), AFM and LL measurements were independent predictors of the FBW (p < .05). In addition, increase in the fetal AFM, AC and femur length (FL) was associated with a significant risk of fetal macrosomia occurrence (p < .05). The equation developed for the FBW estimation [FBW(g) = − 2254,942 + 17,204 * FL (mm) + 105,531 * AC (cm) + 131,347 * AFM (mm)] provided significantly lower mean absolute percent error than standard formula in the sub-group of women with T1DM (5.7% vs 9.4%, p < .05). Moreover, new equation including AC, FL and AFM parameters yielded sensitivity of 93.8%, specificity 77.7%, positive predictive value 54.5% and negative predictive value of 97.8% in the prediction of fetal macrosomia. Conclusions Ultrasound measurements of the fetal soft tissue, heart, liver and umbilical cord are significantly increased among women with GDM treated with insulin and T1DM. In addition to standard biometric measurements, parameters, such as AFM, may find application in the management of diabetes-complicated pregnancies.

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The PCL Envelope Lack Sign (PELS) Is a Direct Arthroscopic Sign of Chronic Posterior Cruciate Ligament Insufficiency

Applied Sciences ◽

10.3390/app11083608 ◽

2021 ◽

Vol 11 (8) ◽

pp. 3608

Author(s):

Adrian Góralczyk ◽

Marcin Mostowy ◽

Michał Ebisz ◽

Robert F. LaPrade ◽

Aleksandra Sibilska ◽

...

Keyword(s):

Soft Tissue ◽

Predictive Value ◽

Femoral Condyle ◽

Cruciate Ligament ◽

Normal Space ◽

Control Group ◽

Study Group ◽

Post Injury ◽

Diagnostic Characteristics ◽

Posterior Knee

Purpose: To present the arthroscopic “PCL envelope lack sign” (PELS) and to calculate its diagnostic characteristics in chronic PCL insufficiency. Methods: Recordings of knee arthroscopies performed in a single clinic between April 2015 to March 2020 were retrospectively evaluated, searching for the “PCL envelope”. It was defined as a “soft tissue cuff coursing around the PCL tibial attachment, visible with the arthroscope positioned between the PCL, medial femoral condyle and posterior horn of the medial meniscus at the level of its shiny white fibers”. PELS was defined as “the PCL adhering to the proximal tibia adjacent to the medial meniscal posterior root attachment, inability to observe the normal space between the PCL and posterior tibia and no soft tissue cuff around the PCL tibial attachment”. Inclusion criteria were possibility to evaluate the PELS presence on recordings. Patients who underwent PCL reconstruction were assigned to the study group. The rest of the patients were controls. Criteria to operate on symptomatic PCL patients were at least 5 mm of posterior instability in physical examination and at least 6 months post-injury. Results: Out of 614 available recordings, 592 patients (205 females, 387 males; mean age 45.2 years, SD = 14.36, range 14–81) were included: 38 in the study group and 554 in the control group. In the study group, PELS was positive in 36 of 38 cases (94.7%). In the control group, PELS was negative in 554 PCL-efficient patients (100%). Calculated PELS sensitivity was 94.7%, specificity 100%, positive predictive value 100%, negative predictive value 99.6%. The PELS was present significantly more often in PCL-insufficient patients, p < 0.001. Conclusions: The PCL envelope lack sign was found to be a highly effective tool to arthroscopically confirm chronic PCL insufficiency, and should be considered a direct sign of chronic posterior knee instability.

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A Case of Fusobacterium necrophorum without Lemierre’s Syndrome Mimicking Acute Leptospirosis

Case Reports in Infectious Diseases ◽

10.1155/2019/4380429 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Ryo Yasuhara ◽

Shunichi Shibazaki ◽

Takayoshi Yamanouchi

Keyword(s):

Anaerobic Bacteria ◽

Kidney Injury ◽

Pulmonary Nodules ◽

Fusobacterium Necrophorum ◽

Chest Ct ◽

Blood Cultures ◽

Conjunctival Hyperemia ◽

Potential Risks ◽

Pcr Assays ◽

Chest Ct Scan

Jaundice, conjunctival hyperemia, and acute kidney injury (AKI) are the characteristics of leptospirosis. However, it is not well known that Fusobacterium necrophorum infection can have a clinical picture similar to that of leptospirosis. A 38-year-old man was admitted with jaundice, conjunctival hyperemia, and AKI for 7 days. Chest CT scan showed multiple pulmonary nodules, atypical for leptospirosis. We started treatment with IV piperacillin-tazobactam and minocycline. He became anuric and was urgently started on hemodialysis on the second hospital day. Later on, blood cultures grew Fusobacterium necrophorum and other anaerobic bacteria. Antibody and PCR assays for Leptospira were negative. We narrowed the antibiotics to IV ceftriaxone and metronidazole. He responded well to the treatment and was discharged on the 18th hospital day. F. necrophorum infection is known to cause mixed infection with other anaerobic bacteria. The resistance of many anaerobic bacteria continues to progress, and F. necrophorum itself sometimes produces β-lactamase. This case highlights the potential risks of using penicillin before diagnosis of leptospirosis.

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Swimming with the Pigs: A Case of Severe Soft Tissue Infection during a Caribbean Vacation

Case Reports in Infectious Diseases ◽

10.1155/2018/4092609 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Alexandra W. Dretler ◽

Jesse T. Jacob ◽

Nadine G. Rouphael

Keyword(s):

Emergency Department ◽

Soft Tissue ◽

Activities Of Daily Living ◽

Soft Tissue Infection ◽

Daily Living ◽

Complete Resolution ◽

Surgical Intervention ◽

Blood Cultures ◽

The Bahamas ◽

Severe Soft Tissue

A 74-year-old man presented to the emergency department with severe right leg cellulitis following a trip to the Bahamas where he swam in both chlorinated pools and the ocean. His blood cultures grew Shewanella species, a marine pathogen known to cause disease in humans, following exposure to seawater. He was treated with cefepime for a total of two weeks without needing any surgical intervention. The patient had complete resolution of infection and was able to return to his activities of daily living.

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Identification of viral and atypical bacterial pathogens in children hospitalized with acute respiratory infections in Hong Kong by multiplex PCR assays

Journal of Medical Virology ◽

10.1002/jmv.21364 ◽

2008 ◽

Vol 81 (1) ◽

pp. 153-159 ◽

Cited By ~ 37

Author(s):

R.Y.T. Sung ◽

Paul K.S. Chan ◽

Tracy Tsen ◽

A.M. Li ◽

W.Y. Lam ◽

...

Keyword(s):

Hong Kong ◽

Multiplex Pcr ◽

Respiratory Infections ◽

Bacterial Pathogens ◽

Acute Respiratory Infections ◽

Pcr Assays

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Evaluation of MRSASelect™Chromogenic Medium for the Early Detection of Methicillin-ResistantStaphylococcus aureusfrom Blood Cultures

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2013/201516 ◽

2013 ◽

Vol 24 (4) ◽

pp. e113-e116 ◽

Cited By ~ 4

Author(s):

Kanchana Manickam ◽

Andrew Walkty ◽

Philippe RS Lagacé-Wiens ◽

Heather Adam ◽

Barbara Swan ◽

...

Keyword(s):

Early Detection ◽

Antimicrobial Therapy ◽

Predictive Value ◽

Turnaround Time ◽

Blood Cultures ◽

Gram Stain ◽

Chromogenic Medium ◽

Gram Positive ◽

Microbiological Methods ◽

Gram Positive Cocci

INTRODUCTION:Staphylococcus aureusbacteremia is associated with considerable morbidity and mortality. In theory, reducing the turnaround time in reporting of methicillin-resistantS aureus(MRSA) among patients with bactermia could assist with the rapid optimization of antimicrobial therapy.OBJECTIVE: To evaluate the sensitivity and specificity of MRSASelect(Bio-Rad Laboratories, USA), a chromogenic medium, in the early detection of MRSA from blood cultures growing Gram-positive cocci in clusters, and to confirm that routine use of this medium would, in fact, reduce turnaround time for MRSA identification.METHODS: The present study was conducted at three microbiology laboratories in Manitoba. Between April 2010 and May 2011, positive blood cultures with Gram-positive cocci in clusters visualized on Gram stain were subcultured to both MRSASelectand routine media. MRSA isolates were identified using conventional microbiological methods from routine media and using growth with the typical colony morphology (pink colony) on MRSASelectmedium.RESULTS: A total of 490 blood cultures demonstrating Gram-positive cocci in clusters on Gram stain were evaluated.S aureuswas recovered from 274 blood cultures, with 51S aureusisolates (51 of 274 [18.6%]) identified as MRSA. MRSASelectmedium had a sensitivity of 98%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 99.8% for the recovery and identification of MRSA directly from positive blood culture bottles. In addition, use of MRSASelectmedium was found to improve turnaround time in the detection of MRSA by almost 24 h relative to conventional methods.DISCUSSION: These data support the utility of MRSASelectmedium for the rapid identification of MRSA from positive blood cultures. Further clinical studies are warranted to determine whether the improvement in turnaround time will result in a measurable reduction in suboptimal antimicrobial therapy and/or improvement in patient outcome.

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Correlation of Checkerboard Synergy Testing with Time-Kill Analysis and Clinical Outcomes of Extensively Drug-Resistant Acinetobacter baumannii Respiratory Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00981-16 ◽

2016 ◽

Vol 60 (11) ◽

pp. 6892-6895 ◽

Cited By ~ 12

Author(s):

Derek N. Bremmer ◽

Karri A. Bauer ◽

Stephanie M. Pouch ◽

Keelie Thomas ◽

Debra Smith ◽

...

Keyword(s):

Acinetobacter Baumannii ◽

Clinical Outcomes ◽

Clinical Utility ◽

Respiratory Infections ◽

Drug Resistant ◽

Content Type ◽

Extensively Drug Resistant ◽

Time Kill ◽

Synergy Testing

ABSTRACTWe tested 76 extensively drug-resistant (XDR)Acinetobacter baumanniiisolates by the checkerboard method using only wells containing serum-achievable concentrations (SACs) of drugs. Checkerboard results were correlated by time-kill assay and clinical outcomes. Minocycline-colistin was the best combinationin vitro, as it inhibited growth in one or more SAC wells in all isolates. Patients who received a combination that inhibited growth in one or more SAC wells demonstrated better microbiological clearance than those who did not (88% versus 30%;P= 0.025). The checkerboard platform may have clinical utility for XDRA. baumanniiinfections.

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