Mobiluncus curtisii Bacteremia: Case Study and Literature Review

Background: There are few reports of bacteremia caused by Mobiluncus curtisii in the literature. We present a review of the literature in addition to a case study. Method: We describe the case of an 82-year-old patient who underwent gastrointestinal surgery and subsequently presented with dehydration, nausea, and hyperkalemia secondary to diarrhea. Further clinical work included blood cultures, and the patient was started empirically on piperacillin/tazobactam. Results: After five days, the blood culture bottle showed growth of a gram-variable, curved rod-shaped organism. After culture under anaerobic conditions on sheep blood agar, the organism was identified as Mobiluncus curtisii by MALDI-TOF mass spectrometry and enzymatic technology. A review of the literature reveals five additional cases of Mobiluncus curtisii bacteremia. Conclusions: This is the sixth case in the literature describing Mobiluncus species bacteremia. This organism is rarely identified in blood culture and is most often thought of in the context of bacterial vaginosis. However, the reported cases of bacteremia show gastrointestinal symptoms and presumed gastrointestinal source of infection. The pathogenesis of infection of this organism requires further investigation.

Bacteremia caused by Helicobacter cinaedi: a case report

Objectives Helicobacter cinaedi is a Gram-negative, spiral-shaped bacterium that primarily affects immunosuppressed patients. Case presentation A 49-year-old patient with ulcerative colitis diagnosed in 1992, who presented to the ED of our hospital with fever and testicular complaints. The patient was discharged with a diagnosis of left-sided acute epididymitis, which was probably sexually transmitted. At the ED, he was administered intravenous Ceftriaxone and discharged with a prescription of doxycycline for 10 days, with a good progress. Aerobic cultures were positive at three days from collection. Gram staining showed Gram-negative, corkscrew-shaped bacteria. The analysis of the blood culture bottles, and the colonies grown in Campylosel agar incubated in microaerophilic conditions at 42 °C were identified as H. cinaedi on the Maldi-TOF Biotyper 3.0 system (Bruker Diagnostics Inc.). Conclusions Direct analysis of the blood culture bottle on the Maldi-TOF system allowed for the identification of the etiology of the bacteremia since H. cinaedi could not have been grown in standard culture conditions. The treatment of this infection is a matter of debate; however, the combination of ceftriaxone with doxycycline can be ineffective for bacteremia caused by H. cinaedi infection since it occurs by the translocation of the bacteria from the gastrointestinal tract. This type of bacteremia is associated with intestinal mucosal damage secondary to ulcerative colitis, and it primarily affects immunosuppressed patients.

Clinical Significance of Staphylococcus aureus in a Single Positive Blood Culture Bottle

Clinical significance of a single positive blood culture bottle (SPBCB) with Staphylococcus aureus is unclear. We aimed to assess the significance of a SPBCB by looking at the associated outcomes. We performed a retrospective, multicenter study of patients with a SPBCB with S. aureus using data collected from both electronic health records and the clinical microbiology laboratory. Overall, 534 patients with S. aureus bacteremia were identified and 118 (22.1%) had a SPBCB. Among cases with a SPBCB, 106 (89.8%) were classified as clinically significant while 12 (10.2%) were considered contaminated or of unclear significance. A majority (92.4%) of patients received antibiotic therapy but patients with clinically significant bacteremia were treated with longer courses (25.9 vs 5.7 days, P<0.001). Significant differences in both frequency of echocardiography (65.1% vs 84.6%, P<0.001), and infective endocarditis diagnosis (3.8% vs 14.2%, P=0.002) were seen in those with a single positive blood culture bottle compared to those with multiple positive bottles. A longer hospital length of stay, and higher 90-day, 6-month, and 1-year mortality rates were seen in patients with multiple positive blood culture bottles. A SPBCB with S. aureus was common among our patients. While this syndrome has a more favorable prognosis as compared to those with multiple positive blood cultures, clinicians should remain concerned as it portends a risk of infective endocarditis and mortality.

Disseminated cryptococcal infection in a lymphoma suspected patient

Cryptococcus neoformans is an opportunistic pathogen, mainly responsible for meningitis in immunodeficient individuals. We report a rare case of dessiminated cryptococcosis in a six years old boy, patient was being evaluated for lymphoma. In the present case the causative agent was Cryptococcus neoformans. It was diagnosed through Bactec, aerobic blood culture bottle. The cause of hospitalization of the patient was fever with abdominal pain. Blood and CSF culture revealed the presence of Cryptococcus neoformans which was further confirmed by urease test and corn meal tween agar (CMT). In the present case fungus was unusually isolated earlier from blood culture rather than cerebrospinal fluid. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5784 How to cite this:Khursheed N, Umer A, Adnan F. Disseminated cryptococcal infection in a lymphoma suspected patient. Pak J Med Sci. 2022;38(2):430-432. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5784 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Microbial spectrum and antibiotic sensitivity in cirrhotic patients with spontaneous bacterial peritonitis

Objective: There are reports of changing microbial profile of ascitic fluid in spontaneous bacterial peritonitis (SBP) and developing resistance of these bacteria to commonly used antibiotics. This study was done to determine the micro-organism causing SBP and their sensitivity to various antibiotics. Setting and Methods: This observational study was done in Medical department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from March to November 2019. Thirty five cirrhotic patients with ascites admitted in ward for various reasons and having positive ascitic fluid culture were included in the study. Exclusion criteria was presence of secondary bacterial peritonitis. Ten ml of ascitic fluid was inoculated in blood culture bottle and sent immediately to hospital laboratory. Results: The mean age of these 35 patients was 48.94 ± 13.51 years with a range of 19 to 80 years. Twenty (57.1 %) patients were male and 15 (42.9 %) were female. Bacteria that had caused SBP were E.coli (62.9 %), staph aureus (11.4 %), klebsiella (8.6 %), streptococci (8.6 %), gram positive cocci (5.7 %) and pseudomonas aeruginosa (2.8 %). Imipenem had high sensitivity rate (100 %) along with amikacin (82.9 %) and cefoperazone-sulbactam (68.6 %). Sensitivity of these organisms to other commonly used antibiotics were: ciprofloxacin 57.1 %, ofloxacin 40 %, norfloxacin 37.1 %, ceftazidime 34.3 %, ceftriaxone 31.4 % and piperacillin-tazobactam 25.7 %. Conclusion: We found that E.coli was the commonest bacteria causing SBP, and ceftriaxone and ciprofloxacin have significantly high resistance rate in these patients. Key words: cirrhosis, ascitic fluid, spontaneous bacterial peritonitis, antibiotic sensitivity

114. Prospective Trial of Passive Diversion Device to Reduce Blood Culture Contamination

Background Blood culture contaminants can lead to inappropriate antibiotic use, prolonged length of stay, and additional hospital costs. Several devices have been developed to reduce the risk of blood culture contamination by diverting a portion of the initial blood sample from the blood culture bottle. We have assessed the effectiveness of one blood diversion device in a prospective trial performed at the two separate emergency departments (EDs) of a three-campus Academic Medical Center. Methods A multi-phase prospective crossover trial was performed with the blood diversion device initially in use at one ED (Memorial) and standard equipment at the other ED (University) for 10 weeks. After a washout phase, a second 10-week study phase used the blood diversion device in the other ED (University) and standard equipment at the first ED (Memorial). Contaminants were identified by the clinical microbiology lab using standard criteria, and further defined by independent retrospective review by 3 infectious disease physicians prior to statistical analysis. An intention-to-treat analysis was performed, and Chi-square tests were used to compare contaminant rates among samples obtained using the blood diversion device versus standard equipment. Results 5,675 blood samples were obtained with 5,661 samples analyzed after 14 were deemed inconclusive by the ID physician review. There were 1,719 samples obtained at Memorial ED and 3,942 at University ED, with 2,836 samples collected during diversion device periods and 2,825 during standard equipment periods. Based on the ID physician review, the contaminant rates were 1.9% in diversion device periods versus 2.9% in standard equipment periods (P = 0.018). There was a marked difference in blood culture contamination rates between the two EDs with contaminant rates at the Memorial ED of 1.1% and 1.4% (P=0.57), and at the University ED of 2.3% and 3.5% (P=0.024) for the diversion device and standard equipment periods, respectively. Conclusion The blood diversion device was able to significantly lower blood culture contamination rates overall by 1% at the institution’s two EDs (34% relative reduction), with a stronger effect noted at the campus with both a level 1 trauma center and transplant programs. Disclosures All Authors: No reported disclosures

6. Staphylococcus aureus in a Single Blood Culture Bottle: Should We be Concerned?

Background Staphylococcus aureus bacteremia (SAB) is common and is characterized by high rates of morbidity and mortality. The clinical importance of a single positive blood culture bottle (SPBCB), however, is poorly defined despite it being a frequent laboratory finding. We therefore examined patients with SPBCB to determine its clinical significance and to understand the rationale of current practice. Methods We performed a retrospective, multicenter study of patients with a SPBCB for S. aureus in initial cultures from January 2019 to December 2019 using data collected from both electronic health records and the clinical microbiology laboratory. Results Overall, 534 patients with SAB were identified, and 118 (22.1%) had a SPBCB. Among SPBCB cases, 106 (89.3%) were classified as clinically significant while 12 were considered contaminated or of unclear clinical significance. Baseline characteristics were similar between the groups (Table 1). A majority (92.4%) received antibiotic therapy, but patients with clinically significant bacteremia were treated with a longer antibiotic course (25.9 vs 5.7 days, p< 0.001). Outcomes between those with SPBCB (contaminant vs clinically significant) were similar (Table 2). Of note, while there was no difference in use of echocardiography based on PREDICT criteria between the clinically significant SPBCB vs. the multiple positive blood culture bottles (MPBC) cohorts (Table 3), significant differences were seen in both frequency of echocardiography (65.1% vs. 84.6%, P< 0.001) and IE diagnosis (3.8% vs. 14.2%, P=0.002) for patients in the SPBCB vs. MPBC groups, respectively. In addition, those with MPBC had higher 90-day, 6-month and 1-year mortality rates. Conclusion SPBCB was documented in almost one-quarter of SAB cases and should trigger a thorough investigation as its associated mortality was high and complications, including IE, occurred. Although some SPBCB cases may represent contamination, antibiotic treatment of SPBCB was commonplace. Patients with clinically significant SPBCB were less likely to undergo echocardiography and had a reduced prevalence of an IE diagnosis as compared to those with MPBC. Patients with SPBCB may have a more favorable long-term prognosis as compared to that in patients with MPBC. Disclosures Muhammad R. Sohail, MD, Medtronic (Consultant)Philips (Consultant) Larry M. Baddour, MD, Boston Scientific (Individual(s) Involved: Self): Consultant; Botanix Pharmaceuticals (Individual(s) Involved: Self): Consultant; Roivant Sciences (Individual(s) Involved: Self): Consultant

Production of in vitro strawberry (Fragaria × ananassa) plantlets in large-scale system supplemented with silver nanoparticles

The growth of strawberry plantlets in the rooting stage on culture medium supplemented with silver nanoparticles (AgNPs) and the ethylene gas accumulation in plantlet culture bottles were investigated. In addition, different culture systems were first used to produce large-scale Strawberry plantlets. The results showed that shoots (3 cm) were cultured on MS medium supplemented with 0.02 mg/L NAA, 1 g/L activated charcoal, 30 g/L sucrose, 8 g/L agar and 0.5 mg/L AgNPs showed about 4 days earlier rooting formation and the plantlet growth such as plantlet height (5.60 cm), fresh weight (242.67 mg), dry weight (34,67 mg), number of roots/plantlet (6.67), root length (3.40 cm), SPAD (39.30 nmol/cm2) were higher than those in the control after 15 days of culture. Besides, the ethylene gas content in the culture bottle (0.06 ppm) in the 0.5 mg/L AgNPs treatment was lower than as compared to that in the control (0.15 ppm) after 15 days of culture. A shoot density (10 shoots) in 250 mL culture bottle with 40 mL of medium gave optimal growth than those in other treatments after 15 days of culture. Square plastic box culture system (length × width × height: 19 cm × 19 cm × 7 cm; 2.5 L in volume) containing 250 mL MS medium added to 0.5 mg/L AgNPs produced 100 vigorous plantlets; meanwhile, rectangular plastic box system (34 cm × 23 cm × 13 cm; 10 L in volume; 10 L in volume) produced 200 vigorous plantlets. Plantlets derived from 0.5 mg/L AgNPs treatment in the plastic box systems exhibited well acclimatization after 30 and 60 days of culture in the greenhouse.

PSX-B-8 Effect of supplementing red osier dogwood extract on in vitro gas production, feed digestibility and fermentation characteristics of high-forage diet

Red osier dogwood (ROD) is native shrub plant in Canada and rich in bioactive compounds. The objective of this study was to evaluate the effects of ROD extract supplementation in a high-forage (HF) diet on gas production (GP), dry matter (DM) disappearance (DMD) and fermentation characteristics in batch cultures with varying media pH. The study was a completely randomized design with 4 levels of ROD extract (0, 1, 3 and 5% of substrate) × 2 media pH (5.8 and 6.5) factorial arrangement. The study was conducted in three replicate experiments. Substrate contained 60% barley silage and 40% barley concentrate (DM basis). Inoculum was obtained from 2 ruminally fistulated beef heifers offered the HF diet. Substrate (0.5 g DM) ground (1 mm) was incubated for 48 h in a culture bottle. Data were analyzed using Mixed procedure of SAS with fixed effects of treatments and random effect of experiment. There was no interaction between media pH and level of ROD on GP, DMD and fermentation characteristics. Increased media pH (5.8 vs. 6.5) increased (P < 0.01) GP (averaged 164 vs. 275 ml/g substrate), DMD (50.6 vs. 60.6%), and total VFA production (63 vs. 71 mM). Increasing ROD extract levels did not affect GP but linearly (P = 0.05) decreased DMD from 62.1 to 58.9% at pH 6.5. Although total VFA production was not affected, increasing ROD extract linearly (P < 0.01) increased the proportion of acetate (47.9 to 49.7%) and propionate (20.5 to 22.3%) at pH 5.8; whereas at pH 6.5, acetate to propionate ratio quadratically (P = 0.04) changed to be lower with 3% ROD extract (2.08) than other treatments (2.21). These results indicated that supplementation of HF diet with ROD extract may improve fibre digestion at low media pH, and improve fermentation efficiency at high media pH.

Use of Blood Culture Bottles to Incubate Irrigation Water from the Surgical Site May Improve Detection of Causative Organisms in Pyogenic Vertebral Osteomyelitis

【Background】 Identification of pathogenic microorganisms are essential for pyogenic vertebral osteomyelitis (PVO). This study aimed to demonstrate the effectiveness of the blood culture bottle (BCB) system in identifying PVO causative organisms. 【Materials & Methods】 We analyzed retrospectively collected data from patients who underwent full-endoscopic spine surgery for PVO between January 2016 and March 2019. Irrigation water generated in the surgical field was incubated in the BCB system, and compared with blood culture before surgery and tissue culture taken by the conventional method. The microbial identification rate and the time from sample collection to microbial identification of the BCB system were compared with conventional blood culture and tissue cultures using the Wilcoxon signed-rank test. 【Results】 We included 17 patients (12 men, five women; mean age, 72.8 ± 11.9 years). Bacteria were cultured from 3 (17.6%), 13 (76.5%), and 12 (70.6%) patients by blood culture, tissue culture, and the BCB system, respectively. Tissue culture and the BCB system had significantly higher detection rates than blood culture (P = .002, P =.003), and there was no significant difference between tissue culture and BCB system (P = .655). In 15 cases (88.2%), the causative organism was identified by at least one method. In two cases, the causative organism (Escherichia coli) was only identified by the BCB system. The BCB system required amount of time for microbial identification (3.9 ± 3.0 days), compared with the time required for blood culture (5.0 ± 1.4 days, P =.180) and tissue culture (11.9 ± 15.1 days, P =.012). 【Conclusions】 Results suggest the possibility of improving the detection rate and time to detection of causative organisms by the BCB system as an adjunct to the conventional method.