scholarly journals 80. The Utility of Cultures for Isolated Fevers in Patients with Influenza or COVID-19 Receiving Extracorporeal Membrane Oxygenation

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S157-S157
Author(s):  
Joseph E Marcus ◽  
Valerie Sams ◽  
Michal Sobieszcyk ◽  
Alice E Barsoumian
Keyword(s):  
Urinary Tract ◽  
Extracorporeal Membrane Oxygenation ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Admission Diagnosis ◽  
Treatment Team ◽  
Membrane Oxygenation ◽  
Culture Positivity ◽  
Tract Infections ◽  
Culture Positivity Rate

Abstract Background Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are at elevated risk for nosocomial infection. Physiological responses to infection on ECMO are difficult to interpret as many clinical characteristics are controlled by the circuit including temperature. This study aimed to determine the culture positivity rates in patients receiving ECMO with influenza or COVID-19. Methods A single center retrospective study was performed on all patients who received ECMO support at a single institution between December 2014 and December 2020 with influenza or COVID-19. All cultures ordered were reviewed for indication. Patients with fever without specific clinical syndrome or signs of decompensation, such as increasing vasopressor requirement were included. Infections and contaminants were defined by treatment team. Results A total of 45 patients received ECMO with an admission diagnosis of influenza or COVID-19 during the study period. This cohort had a median age of 44 (interquartile range (IQR): 36-53) and was predominantly male (84%). The median time on ECMO was 360 hours (IQR: 183-666). 43/137 (31%) of infectious workups were ordered for isolated fever. The most common workup ordered for fever was combination blood cultures (BC) and urine cultures (UC) (13, 30%), followed by combination BC, UC, and respiratory cultures (RC) (11, 26%). Four (9%) infections were identified (3 blood stream, 1 respiratory) and five (12%) cultures grew contaminants (1 blood, 1 respiratory, 2 urine). Culture positivity rate was greatest for BC (3/35, 9%) followed by RC (1/19, 5%), and lowest for UC (0/26, 0%). Conclusion Although cultures are commonly ordered for isolated fever in patients with influenza and COVID-19 receiving ECMO, culture positivity rate is low. In particular, no urinary tract infections were identified and the screening for urinary tract infection in patients receiving ECMO with isolated fever is not beneficial. Further work identifying signs and symptoms associated with infection is needed to improve diagnostic stewardship in this population that is high risk for nosocomial infections. Disclosures All Authors: No reported disclosures

Incidence of healthcare-associated infections in patients with fever during the first 48 hours after decannulation from veno-venous extracorporeal membrane oxygenation

Perfusion ◽  
2020 ◽  
pp. 026765912094842
Author(s):  
Emily C Esposito ◽  
KM Jones ◽  
SM Galvagno ◽  
DJ Kaczorowski ◽  
MA Mazzeffi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Extracorporeal Membrane Oxygenation ◽  
Urinary Tract Infections ◽  
Blood Stream ◽  
Ventilator Associated Pneumonia ◽  
Healthcare Associated Infections ◽  
Blood Stream Infections ◽  
Membrane Oxygenation ◽  
Tract Infections ◽  
Healthcare Associated

Introduction: Fevers following decannulation from veno-venous extracorporeal membrane oxygenation often trigger an infectious workup; however, the yield of this workup is unknown. We investigated the incidence of post-veno-venous extracorporeal membrane oxygenation decannulation fever as well as the incidence and nature of healthcare-associated infections in this population within 48 hours of decannulation. Methods: All patients treated with veno-venous extracorporeal membrane oxygenation for acute respiratory failure who survived to decannulation between August 2014 and November 2018 were retrospectively reviewed. Trauma patients and bridge to lung transplant patients were excluded. The highest temperature and maximum white blood cell count in the 24 hours preceding and the 48 hours following decannulation were obtained. All culture data obtained in the 48 hours following decannulation were reviewed. Healthcare-associated infections included blood stream infections, ventilator-associated pneumonia, and urinary tract infections. Results: A total of 143 patients survived to decannulation from veno-venous extracorporeal membrane oxygenation and were included in the study. In total, 73 patients (51%) were febrile in the 48 hours following decannulation. Among this cohort, seven healthcare-associated infections were found, including five urinary tract infections, one blood stream infection, and one ventilator-associated pneumonia. In the afebrile cohort (70 patients), four healthcare-associated infections were found, including one catheter-associated urinary tract infection, two blood stream infections, and one ventilator-associated pneumonia. In all decannulated patients, the majority of healthcare-associated infections were urinary tract infections (55%). No central line–associated blood stream infections were identified in either cohort. When comparing febrile to non-febrile cohorts, there was a significant difference between pre- and post-decannulation highest temperature (p < 0.001) but not maximum white blood cell count (p = 0.66 and p = 0.714) between the two groups. Among all positive culture data, the most commonly isolated organism was Klebsiella pneumoniae (41.7%) followed by Escherichia coli (33%). Median hospital length of stay and time on extracorporeal membrane oxygenation were shorter in the afebrile group compared to the febrile group; however, this did not reach a statistical difference. Conclusion: Fever is common in the 48 hours following decannulation from veno-venous extracorporeal membrane oxygenation. Differentiating infection from non-infectious fever in the post-decannulation veno-venous extracorporeal membrane oxygenation population remains challenging. In our febrile post-decannulation cohort, the incidence of healthcare-associated infections was low. The majority were diagnosed with a urinary tract infection. We believe obtaining cultures in febrile patients in the immediate decannulation period from veno-venous extracorporeal membrane oxygenation has utility, and even in the absence of other clinical suspicion, should be considered. However, based on our data, a urinalysis and urine culture may be sufficient as an initial work up to identify the source of infection.

scholarly journals Clinical, Epidemiological and Bacteriological Profile of Culture Positive Urinary Tract Infections in Febrile Children – A Cross Sectional Study

2021 ◽  
Vol 8 (10) ◽  
pp. 522-526
Author(s):  
Bhavani Shankar Rokkam ◽  
Chowdary Babu Menni ◽  
Ramu Pedada ◽  
Deepak Kumar Alikana
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Signs And Symptoms ◽  
Cross Sectional ◽  
Bacteriological Profile ◽  
Tract Infections ◽  
Culture Positive

BACKGROUND Urinary tract infections (UTI) constitute a common cause of morbidity in infants and children. When associated with abnormalities of urinary tract, they may lead to long-term complications including renal scarring, loss of function and hypertension. Most urinary tract infections remain undiagnosed if investigations are not routinely performed to detect them. Prompt detection and treatment of urinary tract infections and any complicating factors are important. The objective of the study is to know the clinical, epidemiological and bacteriological profile (i.e. clinical signs and symptoms, age, sex, family history, associated urinary tract abnormalities, & causative organisms) of urinary tract infections in febrile children with culture positive urinary tract infection. METHODS This descriptive, cross sectional observational study was conducted at outpatient clinics of our “child health clinics” between May 2016 and April 2017 (one year). All children aged 0 to 12 years with culture positive urinary tract infections were included in this study to evaluate the clinical, epidemiological and bacteriological profile. RESULTS A total of 69 children with culture positive urinary tract infections were included in this study. Out of 69 children included in this study, 36 (52.2 %) were females and 33 (47.8 %) were males. Overall female preponderance was seen and the M: F ratio was 0.9:1. But during first year of life in our study group we had more boys (10, 14.49 %) affected with urinary tract infection than girls. 49.3 % of urinary tract infections in the present study belonged to lower socio-economic status. Most common organism causing urinary tract infection in our group was E. coli (56.5 %). Fever (100 %), anorexia or refusal of feeds (52.2 %), dysuria (46.4 %), vomiting (46.4 %) and abdominal pain (39.1 %) were the predominant clinical manifestations observed in our study. CONCLUSIONS Urinary tract infection is a common medical problem in children and it should be considered as a potential cause of fever in children. As febrile children with urinary tract infection usually present with non-specific signs and symptoms, urine culture should be considered as a part of diagnostic evaluation. KEYWORDS Urinary Tract Infections (UTI), Febrile Children, Bacteriological Profile, Urine Culture

#54: Sensitivity and Specificity of Procalcitonin vs C Reactive Protein in Identifying Pediatric Bacterial infections

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S16-S16
Author(s):  
Sara Kim ◽  
Avni Bhatt ◽  
Silvana Carr ◽  
Frances Saccoccio ◽  
Judy Lew
Keyword(s):  
Urinary Tract ◽  
Sensitivity And Specificity ◽  
Urinary Tract Infections ◽  
Bacterial Infections ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Culture Positivity ◽  
Serious Bacterial Infections ◽  
Tract Infections ◽  
Culture Positive

Abstract Background Procalcitonin (PCT) and c-reactive protein (CRP) have been utilized in children to assess risk for serious bacterial infections. However, there have been different cut-offs reported for PCT and CRP, which yield different sensitivity and specificity. This study aims to compare the sensitivity and specificity of PCT and CRP in detecting serious bacterial infections (SBIs), specifically urinary tract infections, bacteremia and meningitis. Methods In this retrospective, single center cohort study from January 2018 to June 2019, we analyzed children with a fever greater than 38C with both PCT and CRP value within 24 hours of admission. Each patient had a blood, urine and/or cerebrospinal fluid culture collected within 48 hours of admission. No antibiotics were administered from the admitting hospital prior to collection of the PCT or CRP. Our gold standard was a positive culture obtained from blood, cerebrospinal fluid, or urine. The statistical analysis included categorical variables as percentages and compared them using the Fisher exact test. The optimal cutoff values for PCT or CRP were based on ROC curve analysis and Youden Index. Sensitivity and specificity analysis were based on literature review cut offs and ROC curves cut offs. Results Among 202 children, we had 45 culture positive patients (11 urinary tract infections, 4 meningitis, and 32 bacteremia). The patients with culture positivity had higher PCT levels (7.9 ng/mL vs 2.5 ng/mL, P=0.0111), CRP levels (110.9 mg/L vs 49.6 mg/L, P&lt;0.0001) and temperature (39.2C vs 39C, P&lt;0.0052). The area under the curve (AUC) comparing culture positivity vs negativity for all culture types was 0.72 (p&lt;0.0001) for PCT and 0.66 (p=0.001) for CRP. In Figure 1, the AUC for culture positive bacteremia was 0.68 (p=0.0011) for PCT and 0.70 (p=0.0003). The AUC for culture positive urinary tract infections (UTI) only was 0.86 (p=0.0001) for PCT and 0.70 (p=0.3607). For the cut-off value for PCT at 0.5 ng/mL, the sensitivity and specificity was 64% (95% confidence interval [CI] 0.5–0.77) and 70% (95% CI 0.62–0.77) respectively in identifying children with bacterial infection. For the cut-off value for CRP at 20 mg/L, the sensitivity and specificity was 67% (95% CI 0.52–0.79) and 52% (95% CI 0.44–0.59) respectively in identifying children with bacterial infection. Conclusion In this study, PCT and CRP are nearly equivalent classifiers for detecting SBIs as a group and bacteremia, but PCT is statistically better for urinary tract infections; however, the clinical utility is unknown.

scholarly journals Multiple-Dose Oral Fosfomycin for Treatment of Complicated Urinary Tract Infections in the Outpatient Setting

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Catherine G Derington ◽  
Nancy Benavides ◽  
Thomas Delate ◽  
Douglas N Fish
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Multiple Dose ◽  
Signs And Symptoms ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Future Research ◽  
Clinical Resolution ◽  
Outpatient Prescription ◽  
Tract Infections

Abstract Background Few published studies exist to describe the off-label use of multiple-dose fosfomycin for outpatient treatment of complicated urinary tract infections (UTI). The purpose of this study was to characterize the patients, infections, drug susceptibilities, and outcomes of multiple-dose fosfomycin episodes for outpatient UTI treatment. Methods This retrospective study evaluated patients who received an outpatient prescription for multiple-dose fosfomycin between July 1999 and June 2018. Multiple-dose fosfomycin prescriptions dispensed for UTI prophylaxis were excluded. The primary outcome was clinical resolution (complete resolution of signs and symptoms) of infection within 30 days. Secondary outcomes included descriptions of antibiotics and cultures before and after treatment, 30-day bacteriologic resolution (posttreatment urine culture &lt;103 colony-forming units of the original pathogen), and 90-day healthcare utilizations for UTI or pyelonephritis. Data were analyzed using descriptive statistics. Results Of 171 multiple-dose fosfomycin treatment episodes, the most common regimen was 1 dose every 3 days, mean duration of 6.1 days. Clinical resolution occurred in 115 of 171 (67.3%) episodes, and bacteriologic resolution occurred in 37 of 76 (48.7%) episodes with posttreatment cultures. Most patients used antibiotics or had urine cultures before treatment (81.9% and 97.7%, respectively). Additional antibiotic use, urine cultures, and healthcare utilizations within 90 days posttreatment occurred in 51.5%, 66.1%, and 24.6% of patients, respectively. Conclusions For treating complicated UTI with multiple-dose fosfomycin, clinical resolution occurred in 2 of 3 treatment episodes and bacteriologic resolution occurred in one-half of treatment episodes. Future research is necessary to determine the relative efficacy and safety and optimal dosing regimen, duration, and population for UTI treatment with multiple-dose fosfomycin.

MANAGEMENT OF URINARY TRACT INFECTION – AN AYURVEDA PERSPECTIVE

2021 ◽  
pp. 1-2
Author(s):  
Shetti U. M. ◽  
Nandigoudar S.S. ◽  
Kalanghot P. S.
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Urine Examination ◽  
Group A ◽  
Clinical Signs And Symptoms ◽  
Group B ◽  
Tract Infections

Urinary tract infections are the second most widespread infection and are elaborated in Ayurveda classical texts. The aim of the study is to compare the effect of the two well recognised and practised Ayurveda preparations in the treatment of urinary tract infection. 34 patients with proven UTI complaints in the age group of 20 to 60 years were randomly selected from out-patient and in-patient departments as per randomization chart and were divided into Group A and group B. Respectively in group A and group B, patients were advised 15 mL of Ardhabilwa kashaya and Brihatyadi kashaya before food thrice daily with equal quantity of water. After seven days follow up, assessment was done based on the clinical signs and symptoms. Urine examination at base th th line, 7 and at 15 day was performed.Study proved both drugs were clinically efcacious and statistically signicant in the management of urinary tract infection.

Undiscovered Urinary Tract Infections

PEDIATRICS ◽  
1967 ◽  
Vol 39 (6) ◽  
pp. 946-947
Author(s):  
MELVYN H. WOLK
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Signs And Symptoms ◽  
Infants And Children ◽  
Tract Infections ◽  
In Infants And Children

The occurrence of urinary tract infections in children has become an increasing problem. Pediatricians, especially those experiencing the "unhappy pediatric syndrome," should delight in investigating the manifold signs and symptoms with which these children may present. We have been taught that urologic symptoms, such as dysuria and frequency, may indicate an underlying urinary tract infection. However we must look further, for signs rather than symptoms in infants and children, for they may not be the best historians.

scholarly journals 2248. Clinical and Microbiological Outcomes Associated with Real-World Use of Ceftolozane/Tazobactam

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S768-S769 ◽  
Author(s):  
Nicolo Cabrera ◽  
Truc T Tran ◽  
William R Miller ◽  
An Q Dinh ◽  
Blake Hanson ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Real World ◽  
Clinical Success ◽  
Therapeutic Option ◽  
Signs And Symptoms ◽  
Outcome Data ◽  
Advisory Board ◽  
Hospital System ◽  
Gram Negative ◽  
Tract Infections

Abstract Background Ceftolozane/tazobactam (C/T) is a novel cephalosporin/β-lactamase inhibitor combination for treating Gram-negative infections, particularly Pseudomonas aeruginosa (PA). C/T has been FDA-approved for complicated intra-abdominal and urinary tract infections and has just completed a trial in ventilator nosocomial pneumonia, but real-world outcome data are still emerging. Methods Demographic, microbiologic, treatment and outcome data of patients who received C/T for ≥48 hours from January 2016 to August 2018 at multiple centers within a single hospital system were retrospectively collected. Available isolates were analyzed for C/T susceptibility (by Etest) and whole-genome sequencing (WGS). Spades v.3.11.1 was used for assembly, multi-locus sequence typing v2.10 performed for in silico MLST with the PubMLST database and Abricate v0.7 was used for resistance gene screening with the CARD database. Results Among 45 patients, 58% were non-white, 53% were female and 13% were immunocompromised. The median age was 64 years (IQR, 50 to 69). At the time of the index event, a high proportion of patients required ICU care (42%) and pressor support (13%) as well as had invasive devices in place (64%). A minority (2.4%) had prior exposure to C/T. Respiratory infections were most common (38%) followed by urinary tract (20%). Concomitant Gram-negative agents were used in 18%. 69% achieved clinical success (i.e., recovery from infection-related signs and symptoms). The in-hospital mortality rate was 16% of which 5 out of 7 were attributed to infection. Microbiology was available for 91% of patients; 84% had PA isolates resistant to at least 3 antipseudomonal classes (Figures 1 and 2). Ten PA isolates were analyzed with WGS (Table 1). C/T resistance arose during therapy in one patient (MIC increase from 1 to 128 µg/mL). WGS showed a substitution in AmpC β-lactamase (A46D) and presence of blaCARB-2. Conclusion Although C/T was used in a critically ill population with highly resistant organisms, cure rates were high and mortality was low. Acquired β-lactamases were not frequently seen among the PA isolates. C/T is a vital therapeutic option, particularly on MDR isolates for which options are limited. Disclosures Samuel L. Aitken, PharmD, Melinta Therapeutoics: Grant/Research Support, Research Grant; Merck, Sharpe, and Dohme: Advisory Board; Shionogi: Advisory Board.

scholarly journals Does cranberry have a role in catheter-associated urinary tract infections?

2017 ◽  
Vol 11 (11) ◽  
pp. E421-4 ◽  
Author(s):  
Dominique Thomas ◽  
Matthew Rutman ◽  
Kimberly Cooper ◽  
Andrew Abrams ◽  
Julia Finkelstein ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Species ◽  
Signs And Symptoms ◽  
Urine Specimen ◽  
Indwelling Catheters ◽  
Resistance Patterns ◽  
Catheter Urine ◽  
Tract Infections

Introduction: Catheter-associated urinary tract infections (CA-UTIs) are a prevalent and costly condition, with very few therapeutic options. We sought to evaluate the efficacy of an oral cranberry supplement on CA-UTIs over a six-month period. Methods: Subjects with long-term indwelling catheters and recurrent symptomatic CA-UTIs were enrolled to take a once-daily oral cranberry supplement with 36 mg of the active ingredient proanthocyanidin (PACs). Primary outcome was reducing the number of symptomatic CA-UTIs. This was defined by ≥103 (cfu)/mL of ≥1 bacterial species in a single catheter urine specimen and signs and symptoms compatible with CA-UTI. Secondary outcomes included bacterial counts and resistance patterns to antibiotics.Results: Thirty-four patients were enrolled in the trial; 22 patients (mean age 77.22 years, 77.27% were men) completed the study. Cranberry was effective in reducing the number of symptomatic CA-UTIs in all patients (n=22). Resistance to antibiotics was reduced by 28%. Furthermore, colony counts were reduced by 58.65%. No subjects had adverse events while taking cranberry.Conclusions: The cranberry supplement reduced the number of symptomatic CA-UTIs, antibiotic resistances, and major causative organisms in this cohort. Larger, placebo-controlled studies are needed to further define the role of cranberry in CA-UTIs.

scholarly journals Antimicrobial Resistance and Sensitivity among Isolates of Esherichia coli from Urine Samples in Denizli, Turkey

2018 ◽  
Vol 5 (1) ◽  
pp. 13-18
Author(s):  
Selma Kirac ◽  
Dilek Keskin ◽  
F. Banu Karahasanoğlu
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Agents ◽  
Signs And Symptoms ◽  
Urine Samples ◽  
Resistance Pattern ◽  
E Coli ◽  
Esherichia Coli ◽  
Tract Infections

Objective: The research was carried out with isolate and determines the antimicrobial sensitivity in E. coli from urinary tract infections in special hospital in Denizli and recorded at specimens. Methods: Urine samples (n=21) were collected from patients with signs and symptoms of Urinary tract infections. Bacteria were isolated and identified by conventional biochemical profile. Antibiotic resistance pattern of E. coli against different antibiotic was determined by Kirby-Baur method. Results: The results revealed that sensitivity rate of antimicrobial agents were in the range of meropenem (100%), norfloxacin and ciprofloxacin (86%), cefotaxime (80%), aztreonam (76%). None of the samples showed no resistance to amikacin, ceftazidime, aztreonam, amoxicillin/clavulanic acid, and meropenem. Out of 21 isolates, 3(14%) isolates showed Multiple Antibiotic Resistance ten to thirteen antibiotics. Conclusion: It is concluded that most of the urinary tract infections in human are caused by E.coli exhibited highest resistance to meropenem (100%), followed by norfloxacin and ciprofloxacin  (86%).

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