scholarly journals Clinical Presentation and Bacterial Etiology of Adult Community Acquired Pneumonia

2017 ◽  
Vol 34 (3) ◽  
pp. 128-134
Author(s):  
Md Abdus Salam ◽  
Md Robed Amin ◽  
Quazi Tarikul Islam
Keyword(s):  
Streptococcus Pneumoniae ◽  
Blood Culture ◽  
Mycoplasma Pneumoniae ◽  
Chlamydia Pneumoniae ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Gram Positive ◽  
Gram Negative ◽  
The Mean ◽  
Gram Positive Cocci

Introduction: Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. According to recent WHO data, each year 3-4 million patients die from pneumonia. The clinical presentations and bacterial agents responsible for community acquired pneumonia (CAP) varies according to geography and culture.Methods: A cross sectional observational study conducted among the 53 consecutive patients with a clinical diagnosis of CAP in admitted patient in the department of Medicine, DMCH, during January 2010 to December 2010. Hematological measurements (TC of WBC, Hb%, ESR, platelet count), blood culture, chest X-ray P/A view, sputum for Gram staining and culture sensitivity, sputum for AFB, blood urea and random blood sugar were done in all cases. ELISA for IgM antibody of Mycoplasma pneumoniae and Chlamydia pneumoniae were done in sputum culture negative cases.Results: The mean (±SD) age was 38.9±17.3 years and Male female ratio was 3:1. Fever, chest pain and productive cough were the most common clinical features. The mean (±SD) respiratory rate was 23.0±2.8 /minute . COPD and DM were found in 17.0% and 5.7% of patients respectively . Blood culture was found positive in only 1.9% of the study patients. Gram positive Cocci 62.26%, Gram negative Bacilli 9.43%, mixed Gram positive cocci and Gram negative bacilli 11.32% and Gram negative Cocco Bacilli 1.9% were observed and in 15.03 % cases, no bacteria could be seen. Sputum culture revealed 53.8% streptococcus pneumoniae, 26.9% Klebsiella pneumonia as predominant organism. Mycoplasma pneumoniae and Chlamydia pneumoniae were found in 7.4% and 3.7% respectively by serological test. For Streptococcus pneumoniae, sensitive antibiotics were Amoxyclav and Levofloxacin. For Gram negative bacilli and coccobacilli, more sensitive antibiotics were Meropenem, Ceftriaxone, and Clarithromycin. The best sensitive drug were found meropenem. The mean (±SD) duration of hospital stay was 5.0±1.7 days with ranging from 3 to 10 days.Conclusion: Region based bacteroiological diagnosis of Cap is important for selecting the best and sensitive drugs for complete cure.J Bangladesh Coll Phys Surg 2016; 34(3): 128-134

scholarly journals Epidemiology of Community-Acquired Pneumonia

1998 ◽  
Vol 9 (suppl e) ◽  
pp. 27E-29E
Author(s):  
Thomas J Marrie
Keyword(s):  
Nursing Home ◽  
Streptococcus Pneumoniae ◽  
Mycoplasma Pneumoniae ◽  
Chlamydia Pneumoniae ◽  
Community Acquired Pneumonia ◽  
Atypical Pneumonia ◽  
Beta Lactam ◽  
Gram Negative ◽  
Serious Illness

Community-acquired pneumonia (CAP) is a common and a serious illness.Streptococcus pneumoniaeaccounts for about half of all cases of CAP. Atypical pneumonia, ie, pneumonia due toMycoplasma pneumoniae.Chlamydia pneumoniae.Legionespecies or viruses, is more common among patients treated on an ambulatory basis where these pathogens can collectively cause up to half of all cases of pneumonia. Changes in patient and microbe populations alter The epidemiology of pneumonia. Aspiration and Gram-negative rod pneumonia tend to be more common in nursing home populations. The emergence of macrolide- and beta-lactam-resistantS pneumoniaehas major implications for the approach to patients with CAP.

scholarly journals Culturing Periprosthetic Tissues in BacT/Alert® Virtuo Blood Culture Bottles for a Short Duration of Post-operative Empirical Antibiotic Therapy

2020 ◽  
Vol 5 (3) ◽  
pp. 145-150
Author(s):  
Claire Duployez ◽  
Frédéric Wallet ◽  
Henri Migaud ◽  
Eric Senneville ◽  
Caroline Loiez
Keyword(s):  
Blood Culture ◽  
Antibiotic Therapy ◽  
Joint Infection ◽  
Length Of Hospital Stay ◽  
Empirical Antibiotic Therapy ◽  
Gram Positive ◽  
Gram Negative ◽  
Surgical Interventions ◽  
Joint Infections ◽  
Gram Positive Cocci

Abstract. Introduction: A post-operative empirical antibiotic therapy (PEAT) is required in periprosthetic joint infections. It commonly uses broad-spectrum antibiotics to cover most Gram-positive cocci and Gram-negative bacilli. It is currently continued until first microbiological results are available, no less than five days later.Methods: We performed a retrospective study in order to evaluate duration of incubation required for surgical samples using the BacT/Alert® Virtuo blood culture bottles system.Results: Among 216 surgical interventions and 199 clinical strains (53.8% staphylococci, 22,1% streptococci and enterococci, 14,6% Gram-negative bacilli, 5,5% anaerobes), 90.5% of the strains were detected between day 0 and day 2; 15 infective strains are cultured from day 3 including 8 Cutibacterium sp., 4 staphylococci, 2 streptococci and 1 Enterococcus.Conclusions: We suggest that the duration of PEAT in patients operated for a periprosthetic joint infection may be shortened to three days as Gram-negative rods are unlikely to grow after three days of culture by using BacT/Alert® Virtuo blood culture bottles. This is likely to shorten the overall length of hospital stay, to diminish the occurrence of adverse side effects, and the emergence of antimicrobial resistance. However, coverage of Gram-positive cocci should be maintained for 14 days until the definite culture results are available.

scholarly journals Automated Interpretation of Blood Culture Gram Stains by Use of a Deep Convolutional Neural Network

2017 ◽  
Vol 56 (3) ◽  
Author(s):  
Kenneth P. Smith ◽  
Anthony D. Kang ◽  
James E. Kirby
Keyword(s):  
Neural Network ◽  
Blood Culture ◽  
Convolutional Neural Network ◽  
Clinical Laboratory ◽  
Clinical Microbiology Laboratory ◽  
Proof Of Concept ◽  
Gram Stain ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Cocci

ABSTRACTMicroscopic interpretation of stained smears is one of the most operator-dependent and time-intensive activities in the clinical microbiology laboratory. Here, we investigated application of an automated image acquisition and convolutional neural network (CNN)-based approach for automated Gram stain classification. Using an automated microscopy platform, uncoverslipped slides were scanned with a 40× dry objective, generating images of sufficient resolution for interpretation. We collected 25,488 images from positive blood culture Gram stains prepared during routine clinical workup. These images were used to generate 100,213 crops containing Gram-positive cocci in clusters, Gram-positive cocci in chains/pairs, Gram-negative rods, or background (no cells). These categories were targeted for proof-of-concept development as they are associated with the majority of bloodstream infections. Our CNN model achieved a classification accuracy of 94.9% on a test set of image crops. Receiver operating characteristic (ROC) curve analysis indicated a robust ability to differentiate between categories with an area under the curve of >0.98 for each. After training and validation, we applied the classification algorithm to new images collected from 189 whole slides without human intervention. Sensitivity and specificity were 98.4% and 75.0% for Gram-positive cocci in chains and pairs, 93.2% and 97.2% for Gram-positive cocci in clusters, and 96.3% and 98.1% for Gram-negative rods. Taken together, our data support a proof of concept for a fully automated classification methodology for blood-culture Gram stains. Importantly, the algorithm was highly adept at identifying image crops with organisms and could be used to present prescreened, classified crops to technologists to accelerate smear review. This concept could potentially be extended to all Gram stain interpretive activities in the clinical laboratory.

Community acquired pneumonia – causative agents and diagnostic procedures

2001 ◽  
Vol 58 (10) ◽  
pp. 575-581
Author(s):  
Herbert Dusch ◽  
M. G. Täuber
Keyword(s):  
Streptococcus Pneumoniae ◽  
Mycoplasma Pneumoniae ◽  
Chlamydia Pneumoniae ◽  
Diagnostic Procedures ◽  
Community Acquired Pneumonia ◽  
Ambulante Patienten ◽  
Causative Agents ◽  
Molekularbiologische Methoden

Die Pneumonie ist eine der wichtigsten Infektionskrankheiten. Die Liste der bekannten Erreger wurde durch die Entwicklung der mikrobiologischen Methoden in den letzten Jahren deutlich länger, doch bleiben die Pneumokokken (Streptococcus pneumoniae) unangefochten die Spitzenreiter der Häufigkeitsstatistik. Zur diagnostischen Abklärung einer Pneumonie wird bei stationären Patienten neben der Erhebung von Anamnese und klinischem Befund sowie der Durchführung eines Thoraxröntgen die Einsendung von Sputum, Blutkulturen, Urin und Nullserum an das mikrobiologische Labor empfohlen. Für ambulante Patienten kann der Laborteil zurückhaltender gehandhabt werden, aber ein Thorax-Röntgen ist zur Diagnose einer Pneumonie unverzichtbar. Wenn Sputumproben sachgerecht abgenommen, verarbeitet und interpretiert werden, können sie einen relevanten Beitrag zum Erstellen einer ätiologischen Diagnose leisten. Blutkulturen gestatten im positiven Fall eine sofortige Diagnose des ursächlichen Agens. Die Urinprobe dient zur Durchführung eines Antigentests auf Pneumokokken oder Legionellen. Bei beiden Tests steht ein vorläufiges Ergebnis bereits am selben Tag zur Verfügung. Das Nullserum wird im Labor vorerst nicht bearbeitet, sondern wird eingefroren und dient als Ausgangswert für eine Paralleluntersuchung zusammen mit einer späteren Serumprobe. Molekularbiologische Methoden gewinnen zunehmend an Bedeutung für den Nachweis von schwer kultivierbaren Erregern wie etwa Chlamydia pneumoniae oder Mycoplasma pneumoniae sowie auch für den Nachweis von respiratorischen Viren, allerdings sind sie noch nicht ausreichend standardisiert und stehen auch noch nicht kommerziell zur Verfügung.

scholarly journals 285. Evaluation of the ePlex® Blood Culture Identification (BCID) Panels for Gram-positive/Gram-negative bacteria and yeasts

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Kimberle Chapin ◽  
Giannoula Tansarli
Keyword(s):  
Blood Culture ◽  
Gram Positive ◽  
Gram Negative ◽  
Soc Testing ◽  
Percent Agreement ◽  
Culture Identification ◽  
Reduced Time ◽  
Gram Positive Cocci ◽  
Pna Fish ◽  
Vitek Ms

Abstract Background Multiple methods used for blood culture identification create inconsistent to reporting of critical results. Study aim was to evaluate performance characteristics of the ePlex BCID panels compared to current standard of care (SOC) methods used in our lab. Methods Identification sensitivity and specificity were assessed across all targets detected by the ePlex as well as time to final identification (from time of bottle positive Gram stain) between ePlex and SOC testing. SOC included Xpert MRSA/SA or latex agglutination for Gram-positive cocci in clusters (GPCC), Vitek MS + Accelerate Pheno for Gram-negative rods (GNRs), serotyping or optochin disk ± Vitek MS for Gram-positive cocci in chains (GPC chains), Vitek MS or Vitek-2 for Gram-positive rods (GPR), and PNA-FISH or Vitek MS for yeasts. Results 313 unique prospective blood culture specimens were tested with ePlex BCID panels during a 3-month period (January-March 2020). The positive percent agreement was 100% for GNR (n= 98), S. aureus (n= 42), coagulase-negative staphylococci (n= 38), Group A Streptococcus (n= 3), Group B Streptococcus (n= 5), S. pneumoniae (n= 10), GPR (n= 21), and yeasts (n= 20). There was 1 false negative, (S.mutans) which should have been detected. The negative percent agreement was 100% across all targets except for 1 false positive Corynebacterium spp. In total, 6.7% of blood cultures had an off-panel organism which ePlex did not detect. The median time to final identification was 3 (2 – 4) hrs. for ePlex and calculated for all other SOC methods. Compared to SOC molecular methods, the ePlex reduced time to identification 0.5 h compared to Xpert MRSA/SA, 6.7 h compared to Accelerate Pheno for GNR (but Accelerate Pheno provides susceptibilities), and 3 h compared to PNA-FISH for yeasts (p< 0.05). ePlex compared to non-molecular techniques (MALDI-TOF), SOC for Streptococcus spp. and Enteroococcus spp., the time to final identification was reduced by 24 – 30 hours (p< 0.05). Workflow chart comparison eplex to SOC Time to results eplex vs SOC Conclusion The ePlex BCID system provided highly accurate identification results for GP and GN bacteria as well as for yeasts. Our evaluation showed that this system significantly reduced time to final identification compared to SOC testing methods. Disclosures Kimberle Chapin, MD, genmark (Scientific Research Study Investigator) Giannoula Tansarli, MD, GenMark (Grant/Research Support)

scholarly journals Common Pathogens and Their Resistance to Antimicrobials in Community Acquired Pneumonia (CAP): A Single Center Study in Bangladesh

2020 ◽  
Author(s):  
Kausar MA ◽  
Nasir M ◽  
Paul S ◽  
Rahman MH ◽  
Kalam A ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Legionella Pneumophila ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Sputum Culture ◽  
College Hospital ◽  
Female Ratio ◽  
Sensitivity Pattern ◽  
The Mean

Abstract Pneumonia is a worldwide, serious threat to health and an enormous socio-economic burden for health care system. Community-acquired pneumonia (CAP) is associated with a significant mortality and morbidity. Knowledge of predominant microbial patterns in CAP constitutes the basis for initial decisions about empirical antimicrobial treatment. The aim of this study was to identify the bacterial etiology of CAP in adult hospitalized patients and to see their antibiotic sensitivity pattern as well as to observe their clinical profile and short term outcome. It was a hospital based prospective observational study. A total of 87 hospitalized patients diagnosed with CAP were enrolled consecutively from the medicine ward of Chittagong Medical College Hospital (CMCH). Sputum for Gram staining, Z N staining, culture sensitivity, blood culture and sensitivity and PCR for Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumonia and Streptococcus pneumonia were done. Patients were followed up for in-hospital outcome and 30-day mortality. The mean (±SD) age was 49.59±16.97 years and male female ratio was 1.56:1. Fever, chest pain and cough were the most common clinical features. Sputum culture, blood culture and PCR were positive in 60.9%, 1.1% and 4.6% of the samples respectively. Klebsiella pneumoniae was identified in the sputum culture of the majority of the patients (39.1%), followed by Pseudomonas aeruginosa (10.3%), Staphylococcus aureus and Escherichia coli (5.7%). The only one sample which was positive in blood culture and it was Staphylococcus aureus. Streptococcus pneumoniae was identified in all the 4 PCR positive cases. The highly sensitive drugs were meropenem, levofloxacin and amikacin. The mean (±SD) duration of hospital stay was 6.34±2.37. In hospital mortality and 30-day mortality was 6.9% and 16.1% respectively. Gram-negative bacteria pre-dominate in the bacteriologic profile of CAP using conventional sputum and blood culture. There is need for further conventional serologic tests for atypical and viral pathogens in all patients admitted with CAP.

scholarly journals Microbial aspect of aspiration pneumonia in patients with altered consciousness admitted in Dhaka Medical College Hospital, Bangladesh

2015 ◽  
Vol 22 (2) ◽  
pp. 110-114
Author(s):  
Md Rashed Alam Chowdhury ◽  
Khan Abul Kalam Azad ◽  
Mohammad Zaid Hossain ◽  
Md Hafiz Sardar ◽  
Mahmudur Rahman Siddiqui ◽  
...  
Keyword(s):  
Blood Culture ◽  
Aspiration Pneumonia ◽  
Altered Consciousness ◽  
College Hospital ◽  
Gram Negative ◽  
Medical College ◽  
Gram Staining ◽  
Agar Media ◽  
The Mean ◽  
Gram Positive Cocci

Context: Aspiration Pneumonia is a common complication in patients with altered consciousness, if general supportive care is not taken properly. There is no national study on microbial aspect of aspiration pneumonia in hospitalized patients with altered consciousness. This study was done to see the microbial aspect of aspiration pneumonia in patients with altered consciousness admitted in a tertiary level hospital in Bangladesh. Methods: A prospective observational study was done on 50 adult patients of aspiration pneumonia with altered consciousness admitted in the medicine department of medicine, Dhaka Medical College Hospital, Dhaka, between January and December 2010. Aspiration pneumonia was confirmed by clinical examination and laboratory investigations. Hematologic measurements, chest x-ray, blood gas analysis, estimation of blood urea, serum creatinine and random blood sugar were done in all patients. Sputum for gram staining and culture & sensitivity as well as blood culture & sensitivity were done in patients who were diagnosed as aspiration pneumonia clinically and radiologically. Validated sputum was cultured in blood agar, chocolate agar and McConkey’s agar media. Blood culture was done in trypticase soya broth, blood agar, chocolate agar and McConkey’s agar media. Results: The mean age was 38.9±17.3 years. 35 (70%) patients were male and 15 (30%) patients were female. Blood culture was found positive in 30.8% patients who developed aspiration pneumonia among the study patients. In sputum for Gram staining, only Gram positive Cocci was present in 46.15%, only Gram negative Bacilli was present in 38.46%, mixed Gram positive cocci and Gram negative bacilli was present in 7.7% and Gram negative Coccobacilli was found in 7.7% patients who developed aspiration pneumonia among the study patients. In growth positive cases (n=11) sputum culture revealed 45.45% streptococcus pneumoniae, 36.36% Klebsiella pneumoniae, 9% Pseudomonas species and 9% Haemophylus influenzae. The mean duration of hospital stay was 8.12±2.42 days with ranging from 4 to 14 days DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21517 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 110-114

scholarly journals MICROBIAL PATTERN AND ANTIBIOTIC SENSITIVITY TEST OF HOSPITALIZED CHILDREN

2016 ◽  
Vol 51 (3) ◽  
pp. 190
Author(s):  
John Wiwin ◽  
IGAA Putri Sri Rejeki
Keyword(s):  
Blood Culture ◽  
Rectal Swab ◽  
Antibiotic Sensitivity ◽  
Sensitivity Test ◽  
Sensitivity Testing ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Oncology Ward ◽  
Gram Positive Cocci

Infection often occurs in children with malignant hematology and causes morbidity and mortality in the children. Antibiotics given must be based on culture results and antibiotic sensitivity testing. This study was aimed to obtain the microbial pattern and sensitivity test in children hospitalized in the Hemato-Oncology Ward,  dr. Soetomo Hospital from September 2012 - February 2013. This was a descriptive study. Data were obtained from the  patients’ medical records  in Dr. Soetomo Hospital. There were 341 culture examinations (blood, urine, rectum swab, faecal, and others) from 88 patients (44 males and 44 females). Most of patients´ age was < 5 years (58%) and suffered from ALL (50%).There were microbial (83 of culture) and yeast (15 of culture) growth out of 98 cultures. Escherichia coli, Burkholderia cefacea, and Klebsiella oxytoca (Gram negative) dan CONS, Stapyloccocus aureus, and Stapylococcus sapropyticus (gram positive) were found in blood culture. S. aureus (gram positive) and E. coli, Klebsiella pneumoniae, and B. cefacea (gram negative) were found in urine culture. Only E. coli was found in rectal swab culture. CONS of gram positive cocci were mostly found in blood culture of children hospitalized in Hemato-Oncology Ward, Dr. Soetomo Hospital. E. coli was the mostly found gram negative rods. Gram positive cocci showed a high resistant to penicillin and co-trimoxazole. E. coli, mostly found in rectal swab and urine, has a high sensitivity to amikacin and meropenem, but highly resistant to  ampicillin and ampicillin sulbactam.

scholarly journals Autoinducer 2 Signaling via the Phosphotransferase FruA Drives Galactose Utilization by Streptococcus pneumoniae , Resulting in Hypervirulence

mBio ◽  
2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Claudia Trappetti ◽  
Lauren J. McAllister ◽  
Austen Chen ◽  
Hui Wang ◽  
Adrienne W. Paton ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Quorum Sensing ◽  
Capsular Polysaccharide ◽  
The Body ◽  
Gram Negative Bacteria ◽  
Phosphotransferase System ◽  
Gram Positive ◽  
Gram Negative ◽  
Autoinducer 2 ◽  
Leloir Pathway

ABSTRACT Communication between bacterial cells is crucial for the coordination of diverse cellular processes that facilitate environmental adaptation and, in the case of pathogenic species, virulence. This is achieved by the secretion and detection of small signaling molecules called autoinducers, a process termed quorum sensing. To date, the only signaling molecule recognized by both Gram-positive and Gram-negative bacteria is autoinducer 2 (AI-2), synthesized by the metabolic enzyme LuxS ( S -ribosylhomocysteine lyase) as a by-product of the activated methyl cycle. Homologues of LuxS are ubiquitous in bacteria, suggesting a key role in interspecies, as well as intraspecies, communication. Gram-negative bacteria sense and respond to AI-2 via the Lsr ABC transporter system or by the LuxP/LuxQ phosphorelay system. However, homologues of these systems are absent from Gram-positive bacteria and the AI-2 receptor is unknown. Here we show that in the major human pathogen Streptococcus pneumoniae , sensing of exogenous AI-2 is dependent on FruA, a fructose-specific phosphoenolpyruvate-phosphotransferase system that is highly conserved in Gram-positive pathogens. Importantly, AI-2 signaling via FruA enables the bacterium to utilize galactose as a carbon source and upregulates the Leloir pathway, thereby leading to increased production of capsular polysaccharide and a hypervirulent phenotype. IMPORTANCE S. pneumoniae is a Gram-positive bacterium frequently carried asymptomatically in the human nasopharynx. However, in a proportion of cases, it can spread to other sites of the body, causing life-threatening diseases that translate into massive global morbidity and mortality. Our data show that AI-2 signaling via FruA promotes the transition of the pneumococcus from colonization to invasion by facilitating the utilization of galactose, the principal sugar available in the upper respiratory tract. AI-2-mediated upregulation of Leloir pathway enzymes results in increased production of capsular polysaccharide and hypervirulence in a murine intranasal challenge model. This identifies the highly conserved FruA phosphotransferase system as a target for new antimicrobials based on the disruption of this generic quorum-sensing system.

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