Standardizing clinical culture specimen collection in Ethiopia: a training‐of‐trainers

Background Proper specimen collection is central to improving patient care by ensuring optimal yield of diagnostic tests, guiding appropriate management, and targeting treatment. The purpose of this article is to describe the development and implementation of a training-of-trainers educational program designed to improve clinical culture specimen collection among healthcare personnel (HCP) in Ethiopia. Methods A Clinical Specimen Collection training package was created consisting of a Trainer’s Manual, Reference Manual, Assessment Tools, Step-by-Step Instruction Guides (i.e., job aides), and Core Module PowerPoint Slides. Results A two-day course was used in training 16 master trainers and 47 facility-based trainers responsible for cascading trainings on clinical specimen collection to HCP at the pre-service, in-service, or national-levels. The Clinical Specimen Collection Package is offered online via The Ohio State University’s CANVAS online platform. Conclusions The training-of-trainers approach may be an effective model for development of enhanced specimen collection practices in low-resource countries.

Cutaneous Aspergilosis Caused by Aspergillus Flavus: A Case Report

Background: Cutaneous aspergillosis occurs relatively less frequent and therefore remains poorly characterized. Cutaneous aspergillosis can be as primary or secondary infection. Primary cutaneous aspergillosis usually involves sites of skin injury, intravenous catheter, traumatic inoculation, and associated with occlusive dressings. Secondary lesions result from contiguous extension from infected underlying structures or from widespread blood-borne seeding of the skin. Purpose: To know the skin manifestation, efflorence, examination and therapy of cutaneous aspergillosis. Case: A man complaint itchy redness macule and pimples on the right arm since 2 weeks. Initially just felt a little then expands. Patients with post operative brachial injury and uses a cast during one month. On examination there are erythematous macule unsharply marginated with papules. Potassium hydroxide examination, shows conidiophores, dichotomously branching and septate hyphae appropriate description with Aspergillosis Sp. Cultures found grow granular colonies, flat often with radial grooves, yellow at first but quickly becoming bright to dark yellow-green with age, For the identification microscope from the culture specimen there was conidia, phialde, conidiophore and vesicle that suitable with Aspergillus flavus. Patients received itraconazole 2 x 200 mg for 6 weeks and obtained satisfactory results. Discussion: Healthy hosts can develop cutaneous aspergillosis in surgical wounds, by traumatic inoculation, at sites associated with occlusive dressings. In some instances, a presumptive diagnosis of primary cutaneous aspergillosis can be made immediately by examining a potassium hydroxide preparation and culture. Conclusion: Diagnose of cutaneous aspergillosis can establish by potassium hydroxide and culture examination, therapy with itraconazole 2x 200mg give satisfactory results.

Comparison of Antibiotic Regimens in Intra-abdominal Infections

Background Appropriate antimicrobial therapy and sometimes urgent surgery are life-saving in intra-abdominal infections (IAI). Methods We performed a retrospective case control study to evaluate the efficacy of ceftriaxone, ceftriaxone plus metronidazole, tigecycline, and ertapenem regimens in IAI. Patients aged >18 years and diagnosed with IAI between 2015 and 2017 are included in the study. Definitions are based on IDSA IAI guideline. Significant resolution of all signs and symptoms of IAI with no further need for antimicrobial therapy or surgical intervention for infection is accepted as clinical response (CR). Microbiological response (MR) is assessed among patients with positive culture and defined as documented or presumptive microbiological eradication of pathogen. Results 659 patients are included in the study. Mean age was 56 years. Source control was maintained in 45.5% of patients. Among 54 patients with available culture specimen, E.coli was the most isolated pathogen (81% ESBL +). Comparisons of antibiotics in all patients and in complicated IAI are shown in Table 1 and 2, respectively. Conclusion Ertapenem, and especially tigecycline are good options in IAI in the era of high antimicrobial resistance. Disclosures All authors: No reported disclosures.

Diagnosis of Bloodstream Infections in Children

Identification of bloodstream infections is among the most critical tasks performed by the clinical microbiology laboratory. While the criteria for achieving an adequate blood culture specimen in adults have been well described, there is much more ambiguity in pediatric populations. This minireview focuses on the available pediatric literature pertaining to the collection of an optimal blood culture specimen, including timing, volume, and bottle selection, as well as rapid diagnostic approaches and their role in the management of pediatric bloodstream infections.

Unique microbiology of chronically unstable canal wall down tympanomastoid cavities: considerations for surgical revision

Objective:To review the microbiology of open tympanomastoid cavities in patients who underwent revision surgery due to chronic instability.Methods:This paper describes a retrospective chart review of surgical revision cases of chronically unstable open mastoid cavities. Patient records from 2000 to 2010 were reviewed for the type of organism cultured, antimicrobial resistance and the presence of cholesteatoma.Results:In total, 121 revision surgical procedures were performed on 101 patients. Seventy-nine procedures involved culture specimen processing, 37 of which were positive. The most commonly cultured organism was Staphylococcus aureus, which was more than twice as common as any other pathogen. The presence of cholesteatoma had no impact on the likelihood of a positive culture or polymicrobial culture. Antimicrobial-resistant pathogens were uncommon.Conclusion:A positive culture was not an overwhelmingly common characteristic of unstable tympanomastoid cavities. Furthermore, antimicrobial resistance did not appear to play an essential role in leading patients towards revision open mastoid surgery.

Aspergillus Otomycosis in an Immunocompromised Patient

Aspergillus niger, an opportunistic filamentous fungus, was identified as the cause of chronic unilateral otomycosis in a 55-year old, immunocompromised man who had been unresponsive to a variety of treatment regimens. The patient presented with intermittent otalgia and otorrhea and with a perforation of his left tympanic membrane. A niger was identified in a culture specimen obtained from the patient's left ear canal. In immunocompromised patients, it is important that the treatment of otomycosis be prompt and vigorous, to minimize the likelihood of hearing loss and invasive temporal bone infection.