Microbiological profiles of tracheostomy patients: a single-center experience

Background: This study compared the prevalence of common microorganisms in obstructed and non-obstructed cases across the four quarters on the first post-tracheostomy year.Methods: A retrospective chart review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between June 2015 and September 2019 at our hospital. Based on the tracheostomy indications, patients were allocated to obstructed or non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter.Results: Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5±16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p=0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%).Conclusions: The most common post-tracheostomy microorganism was P. aeruginosa. MRSA showed a strong association with tracheostomy for obstructive indications.

Matrix Metalloproteinase-9 and Topical Cyclosporine Are Associated with Conjunctival Microbiota Culture Positivity in Korean Patients with Stevens-Johnson Syndrome

BackgroundStevens-Johnson syndrome (SJS) is an abnormal immune-response causing extensive exfoliation of the mucocutaneous tissue including conjunctiva. While several factors are associated with the alteration of conjunctival microbiota, the conjunctiva of SJS patients are found to harbor a different microbiota compared to healthy subjects. We investigated the conjunctival microbiota of Korean SJS patients, and identified factors associated with the conjunctival microbiota and its positive culture.MethodsMedical records were retrospectively reviewed in 30 SJS patients who had undergone conjunctival swab culture sampling. Chronic ocular surface complications score (COCS), tear break-up time (TBUT), tear matrix metalloproteinase 9 (MMP9), and results of conjunctival swab culture were assessed.Results Positive culture was seen in 58.1%. Gram positive bacteria was most commonly isolated, among which Coagulase-negative Staphylococci (45.5%) and Corynebacterium species (40.9%) were predominantly observed. Tear MMP9 positivity was observed significantly more in the positive culture group (100%) compared to the negative culture group (75%) (P = 0.040). In patients who had repetitive cultures, positive- persistence group had more patients using topical cyclosporine compared to the negative-transition group (90.0% vs 33.3%, respectively, P = 0.041). No significant difference was found between COCS and conjunctival swab culture result, and the same as in TBUT and conjunctival swab culture result.ConclusionOur study suggest that tear MMP9 positivity may reflect the presence of an abnormal ocular surface microbiota and topical cyclosporine may be related to persistent culture positivity in SJS patients.

46. Templated Microbiology Comments with Candiduria to Enhance Antimicrobial Stewardship

Background Behavioral interventions have been shown to improve antimicrobial selection. Such practices are low cost and effective means of stewardship promotion. One area of overtreatment that contributes to unnecessary antifungal use is in hospitalized patients with candiduria. We implemented a templated microbiology comment to guide prescribing of antifungals for hospitalized patients with candiduria. Methods This was a quasi-experimental, multi-center, single health system study. When Candida is isolated, the following comment appears in the microbiology result section along with the urine culture result: “In the absence of symptoms, Candida is generally considered normal flora. No therapy indicated unless high risk (pregnant, neonate or neutropenic) or undergoing urologic procedure. If Foley catheter present, remove or replace when able.” We compared a pre-implementation cohort (June 2018-Janurary 2019) to a post-implementation cohort (June 2019-Janurary 2020). Patients were included in the study if they were inpatients, 18 years and older, with candiduria. The primary outcome was the rate of antifungal administration within 72 hours after culture results became available. Secondary outcomes include duration of therapy and rate of antifungal given within 73-240 hours after culture result. Results The study included a total of 297 patients between the two groups (156 pre-implementation, 141 post-implementation). The primary outcome was found to be significantly lower in the post-implementation group (48.1% vs 34.0%, p=0.014). A multivariate adjustment for baseline characteristics that were significantly different between groups revealed that post-implementation group maintained its effect (OR 0.49 (0.29, 0.82), p=0.0067). For secondary outcomes, no difference was found in patients requiring antifungal administration within 73-240 hours after microbiology results were available (1.3% vs 3.5%, p=0.199). There was no difference in mean antifungal duration (4 vs 3 days, p=0.449). Conclusion Adding a templated comment to urine cultures was associated with a significant reduction in the number of antifungals prescribed in patients with candiduria. This strategy is an effective low-cost, passive education technique to improve antimicrobial stewardship. Disclosures All Authors: No reported disclosures

GREENISH PLASMA FROM A MALE BLOOD DONOR : AN UNUSUAL EXPERIENCE

Background: Normally plasma is straw yellow colored, but nding a green colored plasma from a male donor was something unusual. 32 yr old male donor, with no history of any medical illness was reported. Donor met all criterias of blood donation. Method: 450 ml of collected donor's bag was centrifuged in Cryofuge at 4000 rpm for 10 mins. Plasma was extracted using automatic plasma extractor. Donor was recalled and reassessed. There was no history of Sulphonamides or any drug intake. Blood sample of donor after taking consent were sent for investigations like S.ceruloplasmin , S. bilirubin Direct and Indirect , it was also sent for culture. Result: No abnormality was detected in S. ceruloplasmin , S. bilirubin Direct and Indirect. Culture turned out to be normal also. But considering our blood bank's policy of not issuing any discoloured blood product, plasma was discarded. Conclusion: From this we concluded that Green coloured plasma is an interesting entity to study and it is safe to transfuse unless possibility of transfusing Paeruginosa are ruled out.

ETIOLOGY OF LYMPHADENOPTHY AMONG SOUTH INDIAN POPULTION.

Aim: To study the etiological causes of signicant lymphadenopathy among the adults in the South Indian population . Materials & Methods: Patients with signicant lymphadenopathy and age more than 18 years and who t with inclusion criteria are taken into study . Biopsy taken for all the patient t for anaesthesia and sent for Gene Xpert , Histopathological examination, AFB culture . Result: Among the 50 patients with signicant lymphadenopathy, 31 were due to Tuberculous lymphadenitis, 6 were due to malignancy, 13 were due to reactive lymphadenitis. Conclusion: the commonest cause of lymphadenopathy is tuberculosis, and the AFB culture and sensitivity when compared to Gene Xpert had 2.1 times more chances of detecting TB adenitis and HPE for TB adenitis when compared to Gene Xpert had 3.8 times more chances of detecting TB adenitis

Molecular and Cultures based Diagnosis of Infectious Bursal Disease Virus (IBDV) in Vaccinated and Non Vaccinated Poultry Flocks

Background: In recent years, Infectious bursal disease is continuously occurring even after vaccination in India and requires an inclusive diagnosis. Therefore, the present study was undertaken to diagnose IBD through molecular and culture methods. Methods: One pooled sample, from each of 54 flocks having birds with IBD like symptoms, was collected. History of bird type, age and vaccination was recorded. Samples were subjected to RT-PCR, egg embryo culture and chicken fibroblast cells culture. Result: A total of 49669 out of 517900 (9.59 %) of birds, aging 3-6 weeks, were displaying the signs similar to IBD.In RT-PCR, 21 (38.88%) samples were found positive which belonged to11 (52.38%) vaccinated and 10 (47.62%) unvaccinated flocks.The RT-PCR positive samples were successfully cultivated for the virus through egg embryo and cell culture. The CEF culture was found least sensitive compared to egg embryo culture and RT-PCR.

Sonication fluid culture of antibiotic-loaded bone cement spacer has high accuracy to confirm eradication of infection before reimplantation of new prostheses

Background Sonication fluid culture of antibiotic-loaded bone cement spacer has been used to predict reinfection of two-stage revision, but its value remains disputable. This study aims to evaluate the association between the culture result of the sonicated spacer and the status of patients with periprosthetic joint infection receiving two-stage revision. Materials and methods A comprehensive electronic literature search was performed through four databases including PubMed, Embase/Ovid, and EBSCO, and the Cochrane Library to retrieve studies in which sonication fluid culture of the antibiotic spacer was conducted before reimplantation. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to assess the association between the culture result of sonicated spacer and prognosis of the two-stage revision. Results Eleven eligible studies comprising 603 artificial joints with PJI (134 suffering a clinical failure of two-stage revision) were included in the quantitative analysis. The pooled incidences of positive culture of sonicated spacer and intraoperative tissue were 0.14 (95% confidence interval [CI] 0.08–0.21) and 0.14 (95% CI 0.08–0.20), respectively. A positive culture of sonicated antibiotic-loaded bone cement spacer illustrated moderate sensitivity (0.31, 95% CI 0.13–0.58) but high specificity (0.94, 95% CI 0.86–0.98) for the diagnosis of therapeutic failure of two-stage revision; the pooled DOR was 7.67 (95% CI, 3.63–16.22). Meanwhile, the pooled sensitivity, specificity, and DOR of intraoperative tissue culture during the two-stage revision to predict therapeutic failure were 0.32 (95% CI, 0.20–0.47), 0.96 (95% CI, 0.92–0.98), and 10.62 (95% CI, 4.90–23.01), respectively. Conclusions Sonication fluid culture of antibiotic-loaded bone cement spacer revealed high accuracy for confirming eradication of infection before reimplantation of new prostheses and therefore could be used as a supplement for assessing therapeutic effect for PJI. However, both sonication fluid culture and intraoperative tissue culture from antibiotic-loaded bone cement spacer showed restricted yield for the prediction of a septic failure after the two-stage revision of PJI. Large-scale, prospective studies are still needed to testify current findings.

Bloodstream Infection of Double Lumen Catheter among Hemodialysis Patient

Background: Infection is one of complication of vascular access that can lead a higher morbidity, loss of access, and even mortality. Hospitalized hemodialysis patients with double lumen catheter (DLC) have a two to three higher risk for infection and death compared to patients with arteriovenous graft. The aim of this study was to determine the infection rate in dialysis double lumen catheter and its characteristic. Method: A retrospective study was conducted in Sanglah General Hospital. Inclusion criteria was patients aged ≥18 years old who required DLC for hemodialysis access during April 2017 to March 2018. Exclusion criteria were patients without blood culture result and incomplete medical report. Data presented in a demographic data, including microbial pattern of bloodstream culture. Result: Among 42 patients who was diagnosed with bacteremia (41.2%), 57% were male, and mostly using non-tunneled DLC. Coagulase-negative Staphylococci (23.8%) was the commonest pathogen of infected DLC, followed by Staphylococcus aureus (9.5%) and Staphylococcus epidermidis (7.1%). Pseudomonas aeruginosa and Acinetobacter baumanni, and nosocomial pathogen was counted for 4,8 %. Conclusion: Infection rate in DLC among hemodialysis patients of Sanglah General Hospital was 28.6% with the most common etiology was Coagulase-negative Staphylococci (23.8%).

Seven-Year Analysis of Microbial Keratitis Tendency at an Ophthalmology Department in Poland: A Single-Center Study

This study aimed to analyze the frequency, drug susceptibility, and drug resistance of pathogens causing microbial keratitis (a corneal inflammation) in the Clinical Department of Ophthalmology, Medical University of Silesia, Katowice. Despite intensive treatment, severe inflammation causes irreversible blindness in ∼7% of cases and eye loss (evisceration or enucleation of the eyeball) in ∼1% of cases at our hospital. The choice of a targeted drug depends on the culture result and drug resistance of the microorganism. This was a retrospective observation study. Conjunctival swabs and corneal scrapes were collected between January 1, 2013, and December 31, 2019, in the tertiary reference center for keratitis. The collected data included the type of material received, culture result, and antimicrobial susceptibilities. Of the 2482 samples analyzed, 679 were positive and 1803 were negative. Of the total pathogens isolated, 69.9% were Gram-positive bacteria, 20.8% were Gram-negative bacteria, and 7.1% were fungi. A significant increase in the number of Gram-positive methicillin-resistant Staphylococcus aureus and a partial increase in the number of Gram-negative beta-lactams-resistant bacteria were observed. All fungal species were sensitive to amphotericin B, 82.81% were sensitive to voriconazole, and 56.25% were sensitive to fluconazole. Dual drug therapy (levofloxacin and tobramycin) was the first-line treatment. Drug susceptibility testing of the cultured microorganisms is necessary to initiate targeted treatment. Increased drug resistance was observed in this study. In the present study, most bacteria were sensitive to fluoroquinolones. Ciprofloxacin therapy remains the recommended empirical treatment in microbial keratitis. According to our study, voriconazole remains a first-line antifungal drug, when a fungal infection is suspected.