scholarly journals Impact of 16S rDNA sequencing on clinical treatment decisions: a single center retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Axel Ursenbach ◽  
Frédéric Schramm ◽  
François Séverac ◽  
Yves Hansmann ◽  
Nicolas Lefebvre ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Antibiotic Treatment ◽  
Invasive Procedure ◽  
Blood Cultures ◽  
Clinical Impact ◽  
University Hospital ◽  
Pcr Analysis ◽  
16S Ribosomal Dna ◽  
Rdna Sequencing ◽  
Culture Negative

Abstract Background PCRs targeting 16S ribosomal DNA (16S PCR) followed by Sanger’s sequencing can identify bacteria from normally sterile sites and complement standard analyzes, but they are expensive. We conducted a retrospective study in the Strasbourg University Hospital to assess the clinical impact of 16S PCR sequencing on patients’ treatments according to different sample types. Methods From 2014 to 2018, 806 16S PCR samples were processed, and 191 of those were positive. Results Overall, the test impacted the treatment of 62 of the 191 patients (32%). The antibiotic treatment was rationalized in 31 patients (50%) and extended in 24 patients (39%), and an invasive procedure was chosen for 7 patients (11%) due to the 16S PCR sequencing results. Positive 16S PCR sequencing results on cerebrospinal fluid (CSF) had a greater impact on patients’ management than positive ones on cardiac valves (p = 0.044). The clinical impact of positive 16S PCR sequencing results were significantly higher when blood cultures were negative (p < 0.001), and this difference appeared larger when both blood and sample cultures were negative (p < 0.001). The diagnostic contribution of 16S PCR was higher in patients with previous antibiotic treatment (p < 0.001). Conclusion In all, 16S PCR analysis has a significant clinical impact on patient management, particularly for suspected CSF infections, for patients with culture-negative samples and for those with previous antibiotic treatments.

scholarly journals The Risk-Benefit Ratio of Leech Therapy: A Single-Center Retrospective Study

2021 ◽  
Author(s):  
A. Fillatre ◽  
Q. Floug ◽  
N. Assaf ◽  
R. Sinna ◽  
K. Hedhli ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Antibiotic Treatment ◽  
Reconstructive Surgery ◽  
Antimicrobial Prophylaxis ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Venous Congestion ◽  
University Hospital ◽  
Leech Therapy ◽  
Prophylactic Antibiotic Treatment

Abstract Background: Venous congestion in transplanted or replanted tissues remains a common and challenging complication of plastic and reconstructive surgery. The local application of medicinal leeches is effective in reducing postoperative venous congestion in skin flaps and restoring normal blood flow. However, leech therapy is associated with a number of risks, including infections; in order to digest blood, leeches have a symbiotic relationship with Aeromonas species in their gut. Aeromonas infections are associated with a dramatic decrease in flap salvage rates. This is why prophylactic antibiotic treatment and external decontamination of the leeches are widely recommended. Methods: We performed a single retrospective study of patients having undergone leech therapy between January 1st, 2010, and December 31st, 2018, at Amiens-Picardie University Hospital, France. Each patient’s medical history, clinical data, laboratory results, prophylactic antibiotic use, and complications were recorded.Results: A total of 37 patients (mean age: 47) had undergone leech therapy after reconstructive surgery. Antimicrobial prophylaxis was documented in 32 (84.6%) patients. However, there are no guidelines on the choice of prophylactic antibiotic treatment. Twenty-four of the 37 (64.8 %) patients had anemia (mean hemoglobin level: 8.5 (6-11.1) g/dL), and 13 of the 24 (54%) required a transfusion. Thirteen of the 37 patients (35.1%) had a post-operative infection mainly due to Aeromonas spp. (76.9%). Leech therapy was effective in 23 of the 37 patients (62%) overall and in 2 of the 10 patients (20%) with an Aeromonas infection. The association between Aeromonas infection and flap salvage failure was highly significant (p = 0.005).Conclusions: The results of the study emphasized that clinical bacteriologists and surgeons should be aware that leeches are potential sources of infection.

scholarly journals Higher Mortality in Bacteremic Sepsis - A Propensity Score Matched Study

2020 ◽  
Author(s):  
Lisa Mellhammar ◽  
Fredrik Kahn ◽  
Caroline Whitlow ◽  
Thomas Kander ◽  
Bertil Christensson ◽  
...  
Keyword(s):  
Propensity Score ◽  
Antibiotic Treatment ◽  
Latent Class ◽  
Propensity Score Analysis ◽  
Significant Proportion ◽  
Blood Cultures ◽  
University Hospital ◽  
Sepsis Diagnosis ◽  
Score Analysis ◽  
Prior Antibiotic Treatment

Abstract BackgroundSepsis is a highly heterogenous disease which needs to be thoroughly mapped. The aim of this study was to describe characteristics and outcome for critically ill patients with sepsis-3 with either culture-positive or -negative sepsis.Methods Patients with severe sepsis or septic shock were retrospectively identified in the local quality registry from a general mixed Intensive Care Unit (ICU) at a University Hospital in 2007-2014. Data were collected through manual review of medical charts. Patients were included if they fulfilled sepsis-3 criteria and at least one blood culture was sampled ±48h from ICU admission. In a propensity score analysis bacteremic and non-bacteremic patients were matched 1:1 with regard to age, comorbidities, site of infection and antimicrobial therapy prior to blood cultures. A Latent Class Analysis (LCA) was performed to identify unmeasured class membership.Results784 patients were identified as treated in the ICU with a sepsis diagnosis. Blood cultures were missing in 140 excluded patients and additionally 95 patients did not fulfill a sepsis diagnosis and were also excluded. In total 549 patients were included, 295 (54%) with bacteremia, 90 (16%) were non-bacteremic but had relevant pathogens detected from another body location and in 164 (30%) no relevant pathogen was detected in microbial samples. After the propensity score analysis (n=172 in each group) 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p =0.04. Patients without antibiotic treatment before sample collection (n=352) were more often bacteremic, 63%. Non-bacteremic patients without prior antibiotic treatment had lower mortality, 31% (n=129), compared to non-bacteremic patients with prior antibiotic treatment, 51% (n=124), p <0.01.The LCA identified 8 classes, with different mortality rates, where pathogen detection in microbial sampleswere important factors for class distinction andoutcome.ConclusionsBacteremic patients had higher mortality than their non-bacteremic counter-parts. Bacteremia is more common in sepsis than previously reported, when studied in a clinical review. Clinical chart review should be considered gold standard since a significant proportion of the patients in the proposed sepsis cohort, did not have sepsis, but would have been included in ICD- or electronic health record (EHR) algorithm approaches.

scholarly journals Application and clinical impact of the RESIST-4 O.K.N.V. rapid diagnostic test for carbapenemase detection in blood cultures and clinical samples

2020 ◽  
Author(s):  
Sophie Roth ◽  
Fabian K. Berger ◽  
Andreas Link ◽  
Anna Nimmesgern ◽  
Philipp M. Lepper ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Rapid Diagnostic Test ◽  
Antibiotic Treatment ◽  
Excess Mortality ◽  
Acute Infection ◽  
Blood Cultures ◽  
Clinical Impact ◽  
Clinical Samples ◽  
Invasive Infections ◽  
Positive Isolate

Abstract Invasive infections caused by carbapenemase-producing bacteria are associated with excess mortality. We applied a rapid diagnostic test (RDT) on clinical samples with an elevated likelihood of carbapenemase-producing bacteria and documented its impact on antibiotic treatment decisions. Among 38 patients, twelve tested positive for infections caused by carbapenemase-producing bacteria (31.6%), mainly in blood cultures. KPC (n = 10) was more frequent than OXA-48 (n = 2). RDT-based carbapenemase detection led to a treatment modification to ceftazidime/avibactam-containing regimens in all patients before detailed antibiotic testing results became available. Eleven patients (92%) survived the acute infection, whereas one patient with a ceftazidime/avibactam- and colistin-resistant OXA-48-positive isolate died.

scholarly journals Higher Mortality in Bacteremic Sepsis - A Propensity Score Matched Study

2020 ◽  
Author(s):  
Lisa Mellhammar ◽  
Fredrik Kahn ◽  
Caroline Whitlow ◽  
Thomas Kander ◽  
Bertil Christensson ◽  
...  
Keyword(s):  
Propensity Score ◽  
Antibiotic Treatment ◽  
Latent Class ◽  
Propensity Score Analysis ◽  
Significant Proportion ◽  
Blood Cultures ◽  
University Hospital ◽  
Sepsis Diagnosis ◽  
Score Analysis ◽  
Prior Antibiotic Treatment

Abstract BackgroundSepsis is a highly heterogenous disease which needs to be thoroughly mapped. The aim of this study was to describe characteristics and outcome for critically ill patients with sepsis-3 with either culture-positive or -negative sepsis.Methods Patients with severe sepsis or septic shock were retrospectively identified in the local quality registry from a general mixed Intensive Care Unit (ICU) at a University Hospital in 2007-2014. Data were collected through manual review of medical charts. Patients were included if they fulfilled sepsis-3 criteria and at least one blood culture was sampled ±48h from ICU admission. In a propensity score analysis bacteremic and non-bacteremic patients were matched 1:1 with regard to age, comorbidities, site of infection and antimicrobial therapy prior to blood cultures. A Latent Class Analysis (LCA) was performed to identify unmeasured class membership.Results784 patients were identified as treated in the ICU with a sepsis diagnosis. Blood cultures were missing in 140 excluded patients and additionally 95 patients did not fulfill a sepsis diagnosis and were also excluded. In total 549 patients were included, 295 (54%) with bacteremia, 90 (16%) were non-bacteremic but had relevant pathogens detected from another body location and in 164 (30%) no relevant pathogen was detected in microbial samples. After the propensity score analysis (n=172 in each group) 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p =0.04. Patients without antibiotic treatment before sample collection (n=352) were more often bacteremic, 63%. Non-bacteremic patients without prior antibiotic treatment had lower mortality, 31% (n=129), compared to non-bacteremic patients with prior antibiotic treatment, 51% (n=124), p <0.01.The LCA identified 8 classes, with different mortality rates, where pathogen detection in microbial sampleswere important factors for class distinction andoutcome.ConclusionsBacteremic patients had higher mortality than their non-bacteremic counter-parts. Bacteremia is more common in sepsis than previously reported, when studied in a clinical review. Clinical chart review should be considered gold standard since a significant proportion of the patients in the proposed sepsis cohort, did not have sepsis, but would have been included in ICD- or electronic health record (EHR) algorithm approaches.

EARLY RESULTS OF SINGLE-PORT LAPAROSCOPIC APPENDECTOMY

2017 ◽  
pp. 103-106
Author(s):  
Minh Duc Pham
Keyword(s):  
Laparoscopic Appendectomy ◽  
Single Port ◽  
Operation Time ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
University Hospital ◽  
Early Results ◽  
Sils Port ◽  
The Mean ◽  
A New Technique

Background: Conventional three–port laparoscopic appendectomy is becoming popular for the treatment of acute appendicitis. In this report, we present the early results of a new technique of laparoscopic appendectomy conducted through a single-port. Patients and Methods: From March 2011 to October 2013, we have performed 86 operations Single Port Laparoscopic Appendectomy at Hue University Hospital and Hue Central Hospital. SILS Port (Covidien) is used, it can be performed with basic laparoscopic instruments. Results: In this study, 86 patients underwent Single-Port laparoscopic appendectomy, among them 52.33% were femele, 47.67% were male, female/male ratio was 1.09. The mean age was 33.09. An orther trocar insertion was required in 2 patients (2.33%). The mean operation time was 42.03 minutes and mean postoperative hospital stay 3.37 days. Postoperative complication occurred in 2 case (2.33%) was of omphalitis. During 2 weeks follow up, 2 case (2.33%) was of omphalitis. Conclusions: Single - port intracorporeal appendectomy is a safe, minimal invasive procedure with excellent cosmetic results. Key words: Single Port Laparoscopic Appendectomy, appendectomy

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lisa Mellhammar ◽  
Fredrik Kahn ◽  
Caroline Whitlow ◽  
Thomas Kander ◽  
Bertil Christensson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Clinical Review ◽  
Pathogen Detection ◽  
Mortality Rates ◽  
Blood Cultures ◽  
Population Heterogeneity ◽  
Sepsis Diagnosis ◽  
Culture Positive ◽  
Culture Negative ◽  
Microbial Samples

AbstractOne can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis in a clinical review. We also aimed to identify subphenotypes of sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in intensive care with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a sepsis diagnosis. Of 549 included patients, 295 (54%) had bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.

scholarly journals 1341. Blood Volume Collected for Blood Cultures in Infants with Suspected Neonatal Sepsis in the NICU

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S682-S682
Author(s):  
Maria S Rueda Altez ◽  
Lamia Soghier ◽  
Joseph M Campos ◽  
James Bost ◽  
Jiaxiang Gai ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Blood Volume ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Volume Calculation ◽  
Culture Negative ◽  
Time Of Collection ◽  
Rule Out

Abstract Background Blood cultures have high sensitivity to detect bacteremia in septic neonates when &gt;=1 ml of blood is collected. Neonatologists often cite low confidence in microbiologic sampling as rationale for continuing antibiotics without a focus of infection despite negative blood cultures, resulting in prolonged antimicrobial therapy. We aim to describe the blood culture sample volumes in NICU patients, to identify factors associated with sample volumes &lt; 1ml, and to compare the sample volumes of patients treated for culture-negative sepsis with those with bloodstream infections and those treated for a ≤72-hour sepsis rule-out Methods Data from this observational cohort study were collected retrospectively and prospectively from NICU patients with blood cultures obtained from September 2018 to February 2019. Clinical data were collected through chart review. All inoculated culture bottles were weighed for volume calculation. We determined the association of age, weight, sample source, and time of collection with volume &lt; 1mL. Continuous variables were analyzed using Wilcoxon-Mann-Whitney, and categorical variables using chi-squared test. For aim 3, the volumes of the groups were compared using analysis of variance. Results A total of 310 blood cultures were identified, corresponding to 159 patients. Of these, 49 (16%) were positive. Among the negative blood cultures, 86% were collected in patients who subsequently received antibiotics (Figure 1). Median inoculated volume was 0.6 ml (IQR: 0.1-2.4). Weight and age at time of culture collection, source of sample, and time of collection were not significantly associated with the inoculation of &lt; 1ml of blood. Median volume of blood was 0.6ml (0.3-0.6) for sepsis rule-out, 0.6ml (0.2-0.6) for bloodstream infection, and 0.6ml (0.6-1.4) for culture-negative sepsis. No difference was found among the three groups (p=0.54) Figure 1. Classification of blood cultures identified during study period Conclusion The blood volume collected for cultures in the NICU is lower than recommended. Clinical and environmental characteristics are not significantly associated with the inoculated volume. The volume of blood sampled does not differ in patients with culture-negative sepsis, bloodstream infection and sepsis rule-out, and should not be a justification for longer duration of antibiotic therapy Disclosures All Authors: No reported disclosures

Prolonged empiric antibiotics and time to full enteral feed in preterm infants less than 29 weeks of gestational age

2021 ◽  
pp. 1-5
Author(s):  
M.R. Alturk ◽  
H. Salama ◽  
H. Al Rifai ◽  
M. Al Qubaisi ◽  
S. Alobaidly
Keyword(s):  
Parenteral Nutrition ◽  
Preterm Infants ◽  
Antibiotic Treatment ◽  
Gestational Age ◽  
Late Onset ◽  
Blood Cultures ◽  
Hospital Death ◽  
Late Onset Sepsis ◽  
Empiric Antibiotic ◽  
Antibiotic Courses

BACKGROUND: Early empiric antibiotic exposure appears to negatively influence feeding tolerance in preterm infants. However, the effect of prolonged antibiotic treatment is unknown. The objective of this study was to investigate whether prolonged antibiotics impact the time to full enteral feed in infants less than 29 weeks of gestational age with negative blood cultures. METHODS: Retrospective data for infants less than 29 weeks gestation age were retrieved from the PEARL-Peristat perinatal registry in Qatar. Exclusion criteria were major congenital anomalies, conditions requiring surgery in the first 10 days of life, positive blood cultures in the first 48 hours of life, and death within the first week of life. Antibiotic courses were categorized as prolonged if continued more than 48 hours. The primary outcome was the duration of total parenteral nutrition. RESULTS: Of 199 study infants, 185 (92.9%) underwent antibiotic treatment for >  48 hours despite negative blood cultures. The median duration of parenteral nutrition was not significantly different between the prolonged and short antibiotic groups (25 and 22 days, respectively; p = 0.139). Infants with prolonged antibiotic courses experienced non-significantly higher levels of necrotizing enterocolitis (7.1% and 18.4%, respectively), bronchopulmonary dysplasia (28.6% and 45.4%, respectively), and retinopathy of prematurity (14.3% and 38.4%, respectively). There were no differences in the late-onset sepsis rate (78.6% and 82.1%, respectively) and the in-hospital death rate (7.1% and 7.6%, respectively). CONCLUSIONS: Prolonged antibiotic treatment in infants less than 29 weeks gestation with negative blood cultures has no significant impact on the time to full enteral feed.

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