Brucella anthropi infection in a 5-week-old infant

Congenital brucellosis in infants is well described but occurs rarely and very few cases have been reported till now. Acquired brucellosis in young infants has rarely been reported. A 5-week-old infant weighing 3340 gm, presented to the emergency with complaints of fever, abdominal distension, lethargy, and decreased feeding for five days. A clinical diagnosis of septicemia was made. Laboratory parameters were suggestive of septicemia. There was a history of ingestion of unpasteurized buffalo抯 milk. Empirical antibiotics started after withdrawing the blood culture. Blood culture came positive for Brucella anthropi. Ultrasonography of the abdomen showed a small abscess in the left iliac fossa measuring 44� mm. The antibiotics were changed to piperacillin-tazobactam and amikacin as per the blood culture and sensitivity report. Supportive care was given, and the baby gradually improved. The child was discharged on oral rifampicin and trimethoprim-sulfamethoxazole for 4 weeks and is being followed up and is doing well. Young infants may acquire Brucella infection from breastmilk or ingesting unpasteurized animal milk. Prompt diagnosis and treatment is the key to management. Exclusive breastfeeding is the best way to prevent not only animal milk-acquired Brucella but most other types of infection.

Enteric fever masquerading as parotitis

Parotitis is commonly associated with viral infections, while some cases can be bacterial. Parotitis with enteric fever is very rare and has not been reported in pediatric population. An 8-years-old girl presented with parotitis, high grade fever, abdominal pain and vomiting. Salient examination findings were bilateral parotitis, cervical lymphadenopathy on right side, tonsillar hypertrophy with exudates over the right tonsil. Abdominal examination did not reveal any hepatosplenomegaly. Blood culture showed Salmonella paratyphi A., while other test for etiology of parotitis were non-conclusive. Parenteral ceftriaxone was given for a total duration of 14 days. The child responded well clinically and was kept under close follow-up. Presence of parotitis with enteric fever is a very rare finding. Blood culture is a gold standard test for diagnosing enteric fever. It should be incorporated in first line investigations in cases presenting with high grade fever and parotitis.

Clinical application and evaluation of rapid detection of carbapenem resistance genes in blood cultures by Xpert Carba-R / 中华检验医学杂志

This work aims to evaluate a rapid detection method of carbapenem resistance genes in blood cultures based on Xpert Carba-R and preliminarily evaluate its clinical application.Methods:Sixteen strains of Enterobacterales carrying different carbapenem resistance genes were selected to prepare simulated positive blood culture samples and Xpert Carba-R was used to directly detect carbapenem resistance genes in the simulated positive blood culture. From January 2022 to June, a prospective study was conducted on a total of 117 Enterobacteriaceae-positive blood culture samples in the First Affiliated Hospital of Nanjing Medical University. Xpert Carba-R, detecting five kinds of carbapenem resistance genes in these samples, was evaluated in sensitivity and specificity compared to polymerase chain reaction sequencing. Meanwhile clinical data of positive patients was collected for prognostic analysis. Results:Of the 16 simulated specimens, 14 strains had carbapenem resistance genes detected by Xpert Carba-R, including 8 bla KPC, 5 bla NDM and 1 bla IMP, showing 100% agreement with the known results. As of the 117 clinical specimens, 28 cases were determined to be Enterobacterales harboring carbapenem resistance genes, including 24 bla KPC, 2 bla NDM and 2 bla KPC+ bla NDM. In comparison to the PCR sequencing, the sensitivity and specificity of Xpert Carba-R were both 100% for blood culture samples, and furthermore, the detection time was significantly reduced. Of the 25 positive patients, 9 cases were treated with monotherapy and 5 cases were effective, other 16 cases received combined treatment and 12 cases were effective. A total of 17 cases were effective, 8 cases were ineffective and 3 of them died, the mortality rate was 12% (3/25). Conclusion:Xpert Carba-R can rapidly and accurately detect carbapenem resistance genes in blood culture, which can provide evidence for rational drug therapy in early clinical stage.

Application of droplet digital PCR in etiological diagnosis of severe acute pancreatitis patients with suspected bloodstream infection / 中国感染控制杂志

Objective To explore the value of droplet digital polymerase chain reaction(ddPCR)in the etiological diagnosis of severe acute pancreatitis(SAP)patients with suspected bloodstream infection(BSI).Methods SAP patients admitted to the department of critical care medicine in a hospital July to September 2022 were enrolled.When BSI was suspected,venous blood was collected for both ddPCR detection and blood culture(BC)with antimi-crobial susceptibility testing(AST)simultaneously.The time required for two detection methods was recorded,and the detection results of ddPCR and BC were compared.The etiological diagnostic efficacy of ddPCR was calculated,and the correlation between the value of pathogen load detected by ddPCR and the level of infection parameters was explored.Results A total of 22 patients were included in the analysis,and 52 venous blood specimens were collec-ted for detection.BC revealed 17 positive specimens(32.7％)and 29 pathogenic strains,while ddPCR showed 41 positive specimens(78.8％)and 73 pathogenic strains.Detection time required for ddPCR was significantly lower than that of BC([0.16±0.03]days vs[5.92±1.20]days,P＜0.001).Within the detection range of ddPCR and taking BC results as the gold standard,the sensitivity and specificity of ddPCR were 80.0％and 28.6％,respective-ly.With the combined assessment of BSI based on non-blood specimen microbial evidence within a week,the sensi-tivity and specificity of ddPCR detection increased to 91.9％and 76.9％,respectively.ddPCR detected resistance genes of blaKPC,blaNDM/IMP,VanA/VanM,and mecA from 19,9,6,and 5 specimens,respectively.Correlation analysis showed a positive correlation between pathogen load and levels of C-reactive protein as well as procalcitonin(r=0.347,0.414,P＜0.05).Conclusion As a supplementary detection method for BC in BSI diagnosis,ddPCR has the advantages of higher sensitivity and shorter detection time,and is worthy of further exploration in clinical application.

Evaluation of an enzyme immunoassay technique on detecting urinary Histoplasma capsulatum antigen in the diagnosis of disseminated histoplasmosis in Argentina / Evaluación de una técnica de inmunoensayo enzimático para la detección del antígeno urinario de Histoplasma capsulatum en el diagnóstico de histoplasmosis diseminada en Argentina

Abstract Introduction : Histoplasmosis is a systemic mycosis of universal distribution, highly endemic in the Americas. It is caused by a dimorphic fungus Histoplasma capsulatum var. capsulatum. It affects both immunocompetent and immunocompromised individuals where progressive and disseminated forms are observed. A very important risk factor is HIV infection/AIDS, with a mortality rate of 20-40% in Latin America. The diagnosis of this mycosis is made by conventional and molecular methods or by antigen and antibody detection. Methods : In this retrospective, longitudinal and ana lytical study, carried out over a period of 2 years, the sensitivity (S) and specificity (E) of a commercial kit for the detection of Histoplasma antigen by EIA technique (HC-Ag) was evaluated in 50 patients with AIDS-associated histoplasmosis. In addition, its performance was compared with that of other diagnostic techniques routinely used in our laboratory. Results : HC-Ag had a S of 94%, E 96%, positive likeli hood coefficient (CVP): 20.68 and negative likelihood coefficient (CVN): 0.06. The delay time of the results was 4 days, similar to that of antibody detection and n-PCR and much less than that of blood cultures. The combination of methods improved S to 100%; with simi lar values in E. Conclusion : The HC-Ag method demonstrated its usefulness in the diagnosis of progressive disseminated histoplasmosis and the combination of methods is a good option to increase sensitivity and decrease the time to reach the diagnosis of certainty. This allows improv ing the strategy in the management of the disease and decreasing its case-fatality rate.

Resumen Introducción : La histoplasmosis es una micosis sis témica de distribución universal, altamente endémica en las Américas. Es causada por un hongo dimórfico: Histoplasma capsulatum var. capsulatum. Afecta tanto a inmunocompetentes como a inmunocomprometidos, se observan formas progresivas y diseminadas. Un factor de riesgo muy importante es la infección por HIV/sida, con una tasa de mortalidad del 20-40% en América Latina. El diagnóstico de esta micosis se realiza por métodos convencionales y moleculares o por detección de antígenos y anticuerpos. Métodos : En este estudio retrospectivo, longitudinal y analítico, realizado en un periodo de 2 años, se evaluó la sensibilidad (S) y especificidad (E) de un kit comercial para la detección de antígeno de Histoplasma por técnica de EIA (HC-Ag) en 50 pacientes con histoplasmosis aso ciada a sida. Además, se comparó su rendimiento con el de otras técnicas diagnósticas utilizadas habitualmente en nuestro laboratorio. Resultados : HC-Ag tuvo una S del 94%, E del 96%, coeficiente de verosimilitud positiva (CVP) de 20.68 y coeficiente de verosimilitud negativa (CVN) de 0.06. El tiempo de demora de los resultados fue de 4 días, simi lar al de la detección de anticuerpos y n-PCR y mucho menor que el de los hemocultivos. La combinación de métodos mejoró la S a 100%; con valores similares en E. Conclusión : El método HC-Ag demostró su utilidad en el diagnóstico de histoplasmosis diseminada progresiva y la combinación de métodos es una buena opción para aumentar la sensibilidad y disminuir el tiempo para llegar al diagnóstico de certeza. Esto permite mejorar la estrategia en el manejo de la enfermedad y reducir su tasa de letalidad.

Cross sectional study of risk factors, clinical and bacteriological profile of neonatal sepsis in tertiarty care hospital

Background: The neonatal period is the most vulnerable time for a child's survival. Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge. Signs and symptoms of infection in neonates are subtle and non-specific hence further research is needed to identify a biomarker with high diagnostic accuracy and validity.Methods: This was a descriptive cross sectional study conducted in the department of paediatrics ESICMC and PGIMSR from March 2021 to August 2022.Results: In this study there were total of 130 neonates, of whom 78 were male. 82 (63.1%) newborns were premature and prematurity emerged to be the most common risk factor followed by LBW (53.8%), maternal gestational diabetes (24.6%) and MSL (22.3%). Majority of the newborn had EOS 63.1%. The most common presenting feature was lethargy, respiratory distress and feed intolerance. Blood culture positivity rate was 23.1%. The most common organism isolated was Klebsiella pneumonia. Mortality in the study was 9.2% (n=12).Conclusions: Early diagnosis and treatment is of paramount importance to prevent mortality. High index of suspicion is required to detect sepsis at earliest. Prematurity, low birth weight, prolonged rupture of membranes, MSL are major risk factors predisposing neonate to sepsis. Gram negative organism like Klebsiella and E. coli are the common causative organism in neonatal sepsis.

Utilidad diagnóstica de los tiempos de positividad de hemocultivos para distinguir verdaderas bacteriemias de contaminantes en base a un sistema automatizado / Diagnostic performance of the time to positivity of blood cultures to distinguish true bacteremia from contaminants based on an automated system

RESUMEN Objetivo. Determinar la utilidad diagnóstica de los tiempos de positividad de hemocultivos para distinguir verdaderas bacteriemias de contaminantes en el sistema automatizado «BACT/ALERT®¼. Materiales y métodos. Se realizó un estudio transversal de tipo pruebas diagnósticas, a partir de una base de datos de muestras de hemocultivos procesadas entre enero del 2016 y agosto del 2021. Se incluyeron todas las muestras de hemocultivos de pacientes con sospecha de bacteriemia, las muestras de hemocultivos fueron ingresadas al sistema «BACT/ALERT®¼ para diferenciar verdaderas bacteriemias de contaminantes. Resultados. Se analizó un total de 33 951 frascos de hemocultivos y se obtuvieron 3875 frascos positivos. El 75,2% (n=2913) del total de hemocultivos positivos fueron verdaderas bacteriemias y 24,8% (n=962) fueron contaminantes. La mediana de tiempo de positividad en los hemocultivos con verdaderas bacteriemias fue significativamente menor (16,3 horas; RIC: 11,2 - 24,9) que la mediana de tiempo de positividad de hemocultivos con contaminantes (22,5 horas; RIC: 18,4 - 31,8; p<0,001). El tiempo de positividad demostró capacidad discriminante para diferenciar verdaderas bacteriemias de contaminantes, con un AUC-ROC de 0,73 (IC95%: 0,71 - 0,75), con 85% y 63% de sensibilidad y especificidad respectivamente para el diagnóstico de contaminantes cuando el tiempo de positividad supera las 16,5 horas. La administración de antibióticos previos a la toma retrasó el tiempo de positividad, en cambio, haber presentado fiebre antes de la toma de muestra acortó el tiempo de positividad. Conclusiones. Nuestros resultados muestran un buen desempeño de los tiempos de positividad de hemocultivos para diferenciar verdaderas bacteriemias de contaminantes utilizando el sistema «BACT/ALERT®¼ cuando el tiempo de positividad fue superior a 16,5 horas.

ABSTRACT Objective. To determine the diagnostic performance of blood culture positivity times for distinguishing true bacteremia from contaminants in the automated "BACT/ALERT®" system. Materials and methods. A cross-sectional, diagnostic test-type study was conducted from a database of blood culture samples processed between January 2016 and August 2021. All blood culture samples from patients with suspected bacteremia were included; blood culture samples were entered into the "BACT/ALERT®" system to differentiate true bacteremia from contaminants. Results. We obtained 33,951 blood cultures samples, of which 3875 were positive. Of the total number of positive blood cultures, 75.2% (n=2913) were true bacteremia and 24.8% (n=962) were contaminants. The median time to positivity in blood cultures with true bacteremia was significantly shorter (16.3 hours; IQR: 11.2 - 24.9) than the median time to positivity of blood cultures with contaminants (22.5 hours; IQR: 18.4 - 31.8; p<0.001). The positivity time showed the capacity to differentiate true bacteremia from contaminants, with an AUC-ROC of 0.73 (95%CI: 0.71 - 0.75), with 85% and 63% sensitivity and specificity respectively for the diagnosis of contaminants when the positivity time exceeds 16.5 hours. The use of antibiotics prior to sampling delayed the time to positivity, while having fever before sampling shortened the time to positivity. Conclusions. Our results show good diagnostic performance of blood culture positivity times to differentiate true bacteremia from contaminants using the "BACT/ALERT®" system when the positivity time was longer than 16.5 hours.

Optimizing the number of blood cultures for lower and middle income countries: a large scale study in a public sector tertiary care teaching hospital of Southern India

Background: Blood culture is widely accepted as the gold standard investigation for the diagnosis of blood stream infections (BSI). The number of blood cultures collected has a considerable impact on the organism isolation. This study aims to optimize the number of blood cultures needed, for an optimal diagnostic yield in BacT/ALERT VIRTUO system mainly in a resource limited setting. Methods: All the blood cultures (BCs) obtained in BacT/Alert bottles per patient during a 24-h period were included as ‘one episode’ and categorized as single bottle, 1-set (2 aerobic bottles), 2 sets and 3 sets. BC bottles were incubated in the BacT/ALERT VIRTUO (bioMérieux) for a period of five days. Bottles flagged positive were subjected to Gram staining and culture plating. Colonies grown were identified by MALDI-TOF MS, VITEK MS, bioMérieux. Results: Cumulative positivity rate increased (21.7%, 41.4%, 56.1%, 60.6%) and pathogen isolation rate increased (10.3%, 21.8%, 30.4% and 33.8%) progressively when collected in single bottle, 1, 2 and 3 sets respectively. The pathogen detection rate for GNB and GPC were 45.1% and 42.6% respectively with one bottle and this got upsurged to 85.6% and 98.9% for GNB and 83.6% and 98.2% for GPC when collected in ?1 set and ?2 sets respectively. Conclusions: Two BC sets over a 24-h period can detect approximately 98% of the pathogens with a cumulative positivity rate of 60% and hence it is a justifiable alternative approach to the standard practice of 3-sets of BCs.

Diagnostic accuracy of procalcitonin as a marker of neonatal sepsis

Background: Sepsis is defined as “life-threatening organ dysfunction, caused by a dysregulated host response to infection”. Neonatal sepsis is the most common cause of morbidity and mortality in the neonatal period. Early diagnosis of neonatal sepsis is difficult. Therefore, this study was conducted with the objective to assess the diagnostic accuracy of procalcitonin as marker of neonatal sepsis and its comparison with C-reactive protein.Methods: The present study was a hospital-based descriptive comparative study. A total of 59 neonates were enrolled. All suspected neonates for the sepsis admitted to NICU were enrolled in study on the basis of inclusion and exclusion criteria. A detailed clinical examination was done. Blood sample was collected for procalcitonin, C-reactive protein and blood culture. Statistical analysis was performed.Results: In our study diagnostic accuracy of procalcitonin in diagnosis of neonatal sepsis was sensitivity (88.46%), specificity (87.88%), positive predictive value (85.19%), negative predictive value (90.63%) and diagnostic accuracy (88.14%). Diagnostic value of C-reactive protein in diagnosis of neonatal sepsis was sensitivity (88.46%), specificity (69.70%), positive predictive value (69.70%), negative predictive value (88.46%) and diagnostic accuracy (77.97%). Diagnostic accuracy of procalcitonin is maximum followed by C-reactive protein.Conclusions: In our study all patient with gram negative organism were procalcitonin positive whereas 50% Staphylococcus aureus were procalcitonin positive and in candida positive cases out of 6 cases, 5 (83.3%) were procalcitonin positive.

A study of microbial pattern and antibiotic susceptibility in blood cultures among children aged upto thirty six months

Background: Sepsis is the most common cause of high morbidity and mortality among newborn, infants and young children. The organisms implicated in these infections vary with geographical alteration.so antibiotics used should be decided by local prevalence of microbial pathogen, and its bacterial susceptibility pattern. Methods: a prospective observational study among the different neonates and children aged 0 to 36 months. Blood samples are taken under aseptic precaution. Inocluted onto blood culture media (brain heart infusion broth). It is incubated at 37°C. Turbidity is observed daily and it is sub cultured on alternate days. If there is growth, the organism is identified by routine biochemical reactions and the antibiotic susceptibility test was done on the Muller Hinton agar using appropriate antibiotic discs. For testing antibiotic susceptibility, criteria defined by the clinical and laboratory standards institute (CLSI) were followed. Results: Among 148 subjects 102 found to be culture positive with positive rate of 69%. Gram negative organism is more prevalence in this study, most common isolates from gram negative sepsis was Klebsilla species (22.2%) followed by E. coli (18.1%). Conclusions: Gram negative organism form the majority of isolates in our setup with Klebsilla as the most common species among them, which was least sensitive to most of the drugs. Among gram positive organism MRSA as the most common isolates in our setup. Most of the antibiotic were sensitive. Limited and objective use of antibiotic therapy is a much-needed statergy and the new guidelines.

The Bacterial Profile of Aortic Infectious Endocards: Experience of the Cardiology Department, Mohammed VI University Hospital of Marrakech, Morocco

Introduction: Infective endocarditis is defined as infection of a native or prosthetic heart valve, endocardial surface, or cardiac device. The causes and epidemiology, as well as the microbiology of the disease have evolved over the last few decades with the doubling of the average age of patients and an increased prevalence in patients with indwelling cardiac devices. Patients and Methods: This is a retrospective study, including all subjects over 20 years of age who presented with infective endocarditis of the aortic valve, hospitalized between January 2019 and December 2022, in the Department of Cardiology and Vascular Diseases at ERRAZI Hospital-Mohammed VI University Hospital in Marrakech. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form. Results: Over the study period, 46 patients had presented with aortic positional AR, with a sex ratio that was equal to 1.8. The mean age of the patients was 43±12.5 years. Endocarditis on aortic prosthesis was found in 15%. The valves were rheumatic in 85%. The presumed portal of entry was cutaneous in 45%, oral and ENT in 33%, urinary in 15%, and digestive in 7%. In our series, 21 out of 26 patients presented a biological inflammatory syndrome. At least one or more blood cultures were positive in 38% of cases. Coagulase-negative Staphylococcus was the most common germ in aortic infective endocarditis, found in 40% of positive blood cultures. All the patients in our series had received a combination of broad-spectrum intravenous antibiotic therapy, initially probabilistic, taking into consideration the portal of entry. Adapted after antibiogram results. The evolution during the hospitalization, was marked by an improvement of the clinical state in only 12%, a perioperative death in 38%, and a worsening of the clinical state in 50%, with an average duration of hospitalization of 14 days. In our series, 60% of the patients with positive blood cultures died, whereas there was 75% survival in the group with negative blood cultures. Conclusion: Infective endocarditis is a serious disease because of its high morbidity and mortality. Despite improvements in diagnostic testing, antimicrobial therapy, and surgical intervention, changes in the epidemiology of IE, including the increase in healthcare-associated infections and the virulence of staphylococcus aureus as the causative organism, increase the risk of complications and death in the acute phase of IE. Action must be taken to prevent infective endocarditis, especially in this rheumatically endemic area.

Sacroileítis piógena en pediatría: reporte de caso y revisión de la literatura / Pediatric Pyogenic Sacroiliitis: Case Report and Literature Review / Sacroileíte piogênica em pediatria: relato de caso e revisão da literatura

Resumen: Las infecciones osteoarticulares en pacientes pediátricos están asociadas a morbilidad significativa y riesgo de secuelas funcionales o anatómicas, que requieren intervenciones quirúrgicas, en ciertas ocasiones. La sacroileítis piógena (SP) es una infección bacteriana osteoarticular que abarca un pequeño porcentaje del total de las artritis sépticas. La sintomatología es imprecisa, lo que hace retrasar el diagnóstico de la enfermedad y, consecuentemente, llevar a posibles complicaciones como abscesos, sepsis y deformación de las articulaciones. En la actualidad, la resonancia magnética nuclear (RMN) es el método diagnóstico más útil en razón a su relativamente fácil acceso y alta sensibilidad. El inicio del manejo antibiótico adecuado implica una rápida regresión de los síntomas. Presentamos el caso clínico de una paciente escolar atendida en un hospital de Bogotá, Colombia, quien presentó un cuadro de SP, sospechado con base en la anamnesis y examen físico para finalmente ser confirmado por imagenología y cultivo microbiológico.

Abstract: Osteoarticular infections in pediatric patients are associated with significant morbidity and the risk of functional and/or anatomical sequelae, often requiring surgical interventions. Pyogenic sacroiliitis is a rare bacterial infection affecting the osteoarticular region, accounting for a small percentage of all septic arthritis cases. The symptomatology is imprecise, leading to delayed diagnosis and potential complications such as abscesses, sepsis and joint deformities. Currently, nuclear magnetic resonance is the most useful diagnostic method due to its relatively easy accessibility and high sensitivity. Initiating appropriate antibiotic treatment results in a rapid regression of symptoms. We present the clinical case of a school- aged patient treated at a hospital in Bogotá, Colombia. The patient exhibited symptoms indicative of pyogenic sacroiliitis, suspected based on the anamnesis and physical examination, and later confirmed through imaging and microbiological culture.

Resumo: As infecções osteoarticulares em pacientes pediátricos estão associadas a morbidade significativa e risco de sequelas funcionais ou anatômicas, que podem requerer intervenções cirúrgicas em certas ocasiões. A sacroileíte piogênica (SP) é uma infecção bacteriana osteoarticular que abrange uma pequena porcentagem do total de artrites sépticas. A sintomatologia é imprecisa, o que pode atrasar o diagnóstico da doença e, consequentemente, levar a complicações como abscessos, sepse e deformação das articulações. Atualmente, a ressonância magnética nuclear (RMN) é o método diagnóstico mais útil devido ao seu acesso relativamente fácil e alta sensibilidade. O início do manejo antibiótico adequado implica uma rápida regressão dos sintomas. Apresentamos o caso clínico de uma paciente escolar atendida em um hospital em Bogotá, Colômbia, que apresentou um quadro de SP, suspeito com base na anamnese e exame físico, sendo posteriormente confirmado por imagem e cultura microbiológica.

Healthcare-associated blood stream infections: An evaluation of blood culture as indicator

Background: A nosocomial infection or healthcare-associated illness that develops in patients after they are admitted to the hospital but was not present or incubating at the time of admission is referred to as a hospital acquired infection. In patients with severe viral and fungal infections today, it is one of the most prevalent and life-threatening consequences. Blood culture is one of the most important diagnostic tools for the diagnosis of hospital acquired infections. It can also help in providing a clinical as well as an etiological diagnosis. Aims and Objectives: The aim of the study is early detection of blood stream infections along with its antibiotic susceptibility pattern. Materials and Methods: All samples were obtained and processed using conventional microbiological techniques, and an antibiotic sensitivity test was carried out in accordance with CLSI recommendations. Results: Total 160 samples were processed, out of which 54 (34%) samples were positive. Out of 54 positive blood sample, maximum samples were from NICU (28) 52%, followed by causality (10) 18%, PICU (4) 7%, HDU (2) 3%, intensive careunit (4) 7%, surgery (6) 11%, and overall males contributed to higher positivity rate. Total nine different organisms were isolated, out of which Gram negative bacilli were comprised 40 (74%), Gram positive cocci 8 (14%) and Candida were 6 (11%). Among Gram-negative bacilli of most common species were Klebsiella pneumonia (30%), Acinetobacter baumanii (18%), Pseudomonas aeruginosa (11%), Burkhoderia cepacia (11%), and Serratia fonticola (3%). The most prevalent isolated species of gram-positive cocci were Staphylococcus aureus (11%), Coagulase negative S. aureus (3%), and Enterococcus faecalis (3%). Conclusion: This study on blood culture gives insight to magnitude of hospital acquired infections in our set up. Again result of antibiotic susceptibility tests gives overview of drug resistance problem at our set up. This may help in antibiotic stewardship program.

Infective Endocarditis: Experience of the Cardiology Department of the Mohammed VI University Hospital

Introduction: Infective endocarditis (IE) is a rare but potentially serious disease. It causes a high mortality and a high level of morbidity and complications. Its epidemiological, clinical and microbiological characteristics have changed in recent years. The Aim of our Work: Is to study the epidemiological, clinical, bacteriological, ultrasonographic, therapeutic and evolutionary data of IE between January 2017 and October 2022 in the Mohammed VI University Hospital and to compare them to the global profile. Materials and Methods: Retrospective study including 110 patients hospitalized for a definite IE, according to the modified DUKE criteria, in the cardiology department of the Mohammed VI University Hospital over a period of 5 years and 10 months from January 2017 to October 2022. Results: The average age of our patients was 43 years with a male predominance. The bacterial graft was on native valve in 80% with predominance of rheumatic origin (69%), on cardiac prosthesis in 10% of patients, on healthy heart (4%) and congenital heart disease (6%). The most frequent portal of entry was dental (30%). Blood cultures were positive only in 33% of patients, isolating a staphylococcus (16%), a streptococcus (14%) and a GNB (3%). Transthoracic echocardiography (TTE) showed vegetation in 108 cases, valve perforation in 7 cases, cord rupture in 1 patient and perivalvular abscess in 10 cases. Seventy-seven percent of patients had surgical treatment with a mean delay of 29 days. The overall mortality was 24% with heart failure (p<0.001), renal failure (p=0.004) and neurological complications (p=0.002) as predictive factors of mortality. Conclusion: Infective endocarditis remains a real health problem with a consequent mortality and morbidity. The population is often young, revealing the IE by complications; its prevention is the best way to improve its prognosis.

Prevalência de leveduras do gênero Candida isoladas de hemocultura de pacientes hospitalizados / Prevalence of yeasts of the genus Candida isolated from blood cultures of hospitalized patients

Introdução: A infecção da corrente sanguínea (ICS) por leveduras, tem como principal gênero a Candida. As principais espécies que causam a candidemia no Brasil são Candida albicans, Candida parapsilosis e Candida tropicalis, sendo a C. albicans a mais prevalente. Todavia, nas últimas décadas tem aumentado a prevalência de espécies de Candidanão albicans (CNA) e principalmente a emergência de Candida auris, que possuem mecanismos de resistência aos antifúngicos mais usados, caracterizando um cenário de preocupação mundial. Objetivo: Avaliar a prevalência de candidemia e das principais espécies de Candida spp. isoladas de amostras de hemocultura e sua distribuição por setores de internação de um hospital de ensino. Material e Métodos: Trata-se de um estudo observacional e retrospectivo, em que foram analisadas, através de bancos de dados, hemoculturas positivas para Candida spp. de pacientes internados em um hospital de ensino da cidade de Juiz de Fora, Minas Gerais, no período de janeiro de 2021 a dezembro de 2022. Resultados: Foram analisadas 3.262 hemoculturas, sendo 1.059 (32,46%) positivas. Destas, 1.008 (95,18%) tiveram crescimento bacteriano e 51 (4,82%) tiveram crescimento de Candida spp. divididos em, 20 (39,22%) C. albicans e 31 (60,78%) CNA. Das CNA isolados, 14 foram C. tropicalis (45,16%), 10 C. parapsilosis(32,26%), 3 C. glabrata (9,68%), 2 Candida kefyr (6,45%) e 2 Candida lusitaniae (6,45%). Dos 51 isolados de Candida spp., 25 (49,02%) foram no centro de tratamento intensivo, 11 (21,57%) no bloco cirúrgico e 15 (29,41%) foram nas enfermarias. Conclusão: Candida albicans é a principal espécie relacionada a candidemia em pacientes hospitalizados, porém espécies do grupo CNA têm apresentado elevada prevalência em isolados de hemocultura, principalmente em pacientes de centro de tratamento intensivo.

Introduction: Bloodstream infection (BSI) by yeasts has Candida as its main genus. The main species that cause candidemia in Brazil are Candida albicans, Candida parapsilosis and Candida tropicalis, and C. albicans referred as the most prevalent. However, in recent decades, the prevalence of non-albicans Candida species (NAC) has increased and especially the emergence of Candida auris, which have mechanisms of resistance to the most used antifungals, characterizing a scenario of global concern. Objective: To evaluate the prevalence of candidemia and the main species of Candida spp. isolated from blood culture samples and their distribution by hospitalization sectors of a teaching hospital. Material and Methods: This is an observational and retrospective study, of positive blood cultures for Candida spp. of patients admitted to a teaching hospital in the city of Juiz de Fora, Minas Gerais, from January 2021 to December 2022. Results: Among 3262 blood cultures analyzed, 1059 (32.46%) of which were positive. Of these, 1008 (95.18%) had bacterial growth and 51 (4.82%) had Candida spp. divided into, 20 (39.22%) C. albicans and 31 (60.78%) NAC. Of the NAC isolated, 14 were C. tropicalis (45.16%), 10 C. parapsilosis (32.26%), 3 C. glabrata (9.68%), 2 Candida kefyr (6.45%) and 2 Candida lusitaniae (6.45%). Of the 51 Candida spp. isolates, 25 (49.02%) were in the intensive care unit, 11 (21.57%) in the operating room and 15 (29.41%) were in the wards. Conclusion: Candida albicans is the main species related to candidemia in hospitalized patients, but species from the NAC group have shown high prevalence in blood culture isolates, especially in the intensive care unit patients.

Comparison of yield of microorganisms in cord blood between two automated blood culture systems / 中国输血杂志

【Objective】 To compare the difference in the detection rate of microorganisms in cord blood between BACTEC FX and BacT/ALERT 3D automated blood culture systems, and to compare the influence of incubation time and different types of culture sample on the detection rate of microorganisms in cord blood. 【Methods】 Cord blood samples prepared from April to August 2020 in Sichuan Cord Blood Bank(n=4 358) were selected, and 20 mL of plasma was used as culture samples for microbial detection. In addition, cord blood samples prepared in the same months of 2021(n=4 057) were selected, and 19 mL of plasma plus 1 mL of final product was used as culture samples for microbial detection. The total sample size was 8 415, of which 4 849 samples(2 458 in plasma group and 2 391 in plasma plus final product group) were assigned to the BACTEC FX system, and 3 566 samples(1 900 in the plasma group and 1 666 in the plasma plus final product group) to the BacT/ALERT 3D system. All samples were cultured for 7 days, and culture data were recorded on day 5 and day 7. Positive results were confirmed by Gram staining. 【Results】 The positive rate detected by the BACTEC FX system was higher than that of the BacT/ALERT 3D system(4.08% vs 2.69%), with statistically significant difference(P0.05) detected by the BacT/ALERT 3D system. With quality control strains, there were significant differences in TTP between these two systems for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Clostridium sporogenes, and Bacillus subtilis(P0.05). 【Conclusion】 This study suggests that the selection of BACTEC FX blood culture system with incubation time of not less than 7 days and plasma plus final product as culture samples may improve the detection rate of microorganisms in cord blood.

Rapid bacterial identification and antimicrobial susceptibility testing assay in positive blood cultures / 预防医学

Objective@#To establish a rapid bacterial identification and antimicrobial susceptibility testing assay in positive blood cultures, so as to provide insights into timely diagnosis and treatment of bloodstream infections.@*Methods@#A total of 1 154 blood culture samples were collected from inpatients in Zhejiang Hospital from February to May, 2022. The bacterial isolates were enriched and purified using improved separation gel method, and bacterial identification and antimicrobial susceptibility tests were performed using VITEK2 mass spectrometry system and VITEK2 Compact automated microbiology system. The accuracy of the new assay for bacterial identification and antimicrobial susceptibility tests was evaluated with the conventional VITEK 2 compact system as the standard. @*Results@#Of 1 154 blood culture specimens, the conventional VITEK 2 compact system detected 174 positives and 980 negatives. The new assay and the conventional VITEK 2 compact system identified consistent bacterial isolates in 165 out of 174 positive blood culture samples, and the accuracy of bacterial identification was 94.83% for the new assay, with a 99.21% accuracy for identifying Gram-negative bacteria and 82.22% for Gram-positive bacteria. Antimicrobial susceptibility tests were performed in 158 bacterial isolates, and the new assay presented a 90.17% accuracy, with a 90.27% accuracy for Gram-negative bacteria and 89.74% for Gram-positive bacteria. The conventional VITEK 2 compact system required 30 hours and longer to complete bacterial identification and antimicrobial susceptibility tests, and the new assay required 9 to 18 hours.@*Conclusions@#The new rapid bacterial identification and antimicrobial susceptibility testing assay shortens the time of bacterial culture, achieves rapid bacterial identification and antimicrobial susceptibility testing in blood culture specimens and has a high accuracy that meets clinical needs, which facilitates rapid diagnosis and treatment of bloodstream infections.

Species distribution and antifungal susceptibility of fungi originating from positive blood cultures in Guangdong, 2019-2021 / 中国热带医学

@#Abstract: Objective　To investigate the species distribution and the antifungal susceptibility of fungi originating from positive blood cultures in Guangdong, so as to provide a basis for the rational use of antifungal drugs in clinical fungal bloodstream infections. Methods All data were collected for retrospective study from monitoring units of the Guangdong Fungal Disease Surveillance Network between 2019-2021, including clinical characteristics, species distribution and antifungal susceptibility. Results A total of 3 589 fungi strains were isolated, most of which were Candida spp. (86.5%, 3 105/3 589). The most common species was Candida albicans (36.6%, 1 315/3 589), followed by Candida tropicalis (17.4%, 1 626/3 589) and Candida parapsilosis (14.5%, 520/3 589). There were 42.1%(1 512/3 589) of strains isolated from ICU. The proportions of Candida albicans strains were 40.0%-50.0% among ICU, general surgery, organ transplantation and emergency department. Candida tropicalis (60.0%, 144/240) was the most common species in hematology department. Both Cryptococcus neoformans (35.4%, 69/195) and Talaromyces marneffei (35.9%,70/195) were common in infection department. All of the Candida isolates were of wild-type (WT) phenotype to amphotericin B. Resistance rates of caspofungin and micafungin for Candida spp. ranged from 0.0% to 4.2%. The resistance rates of Candida tropicalis to fluconazole and voriconazole were 42.3% and 38.9%, which were significantly higher than other common Candida spp. The cryptococcus neoformans strains were totally of WT phenotype to fluconazole and voriconazole. Conclusions Candida albicans is the most common species originating from positive blood cultures in Guangdong Province. Common Candida strains are highly sensitive to echinocandins and amphotericin B. Candida tropicalis has a high resistance rate to triazole drugs.

Distribution and drug resistance analysis of pathogenic bacteria in a hospital blood culture, 2018-2022 / 中国热带医学

@#Abstract: Objective　To analyze the distribution and drug resistance of pathogenic bacteria in blood culture specimens of patients with bloodstream infections before and after COVID-19 (2018-2019 and 2020-2021), and to provide scientific basis and reference for rational treatment and effective control of bloodstream infections in the post-epidemic period. Methods Blood culture specimens were collected from patients in Zhongnan Hospital of Wuhan University in the two years before and after the COVID-19 outbreak (2018-2021). The Automated Blood Culture Systems were used to perform blood culture on blood specimens sent for clinical inspection, and the Vitek MS automatic bacterial identification mass spectrometer was used for strain identification and the Vitek 2 automatic bacterial drug susceptibility analyzer was used for drug susceptibility testing and drug resistance analysis. Results　Blood culture specimens were performed on 28 736 patients with suspected bloodstream infection submitted for inspection from January 2018 to December 2019, and a total of 2 181 strains of pathogenic bacteria were detected after removing duplicate strains, with a positive rate of 7.69%, including 1 046 strains of Gram-negative bacteria, accounting for 47.96%. From January 2020 to December 2021, blood culture specimens from 26 083 patients with suspected bloodstream infection were submitted for inspection, and a total of 2 111 strains of pathogenic bacteria were detected after excluding duplicate strains, with a positive rate of 8.09%, including 1 000 strains of Gram-negative bacteria accounted for 47.37%. The drug resistance of Klebsiella pneumoniae was relatively serious, and the sensitivity rate to ertapenem, polymyxin B and tigecycline was more than 90%. The main non-fermentative bacteria Acinetobacter baumannii was more than 50% sensitive to piperacillin/tazobactam, amikacin and polymyxin B. The sensitivity rates of Pseudomonas aeruginosa to piperacillin/tazobactam, ceftazidime, cefepime, amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, piperacillin and meropenem were more than 50%. Conclusions　In the two years before and after COVID-19, there are many types of pathogenic bacteria in bloodstream infection, but the distribution do not differ significantly. The pathogens of bloodstream infection are mainly distributed in ICU, hepatobiliary research institute, and nephrology department. Among them, Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii are the main ones, and different pathogens showed great differences in drug resistance.

The efficiency of molecular methods compared to traditional methods in identifying bacteria from blood and cerebrospinal fluid samples

Aims@#This study was aimed to directly diagnose bacterial pathogens from clinical specimens by amplifying and sequencing their 16S rRNA gene compared with traditional methods.@*Methodology and results@#A total of 100 specimens, including blood (50 samples) and cerebrospinal fluid CSF (50 samples) were collected from patients hospitalized in Mosul city hospitals for the period from December 2021 to April 2022. Traditional methods based on cultural characteristics and simple biochemical tests were used to detect pathogens from these samples, as followed by hospital laboratories. Bacterial genomic DNA (deoxyribonucleic acid) was extracted directly from the samples and PCR (polymerase chain reaction) was conducted to amplify their 16S rRNA gene using 16S universal primers. PCR products from samples that showed positive results were purified and sent for sequencing. Sequences were compared to counterpart sequences submitted in NCBI to identify the bacterial pathogen. Our results showed that traditional methods for bacterial isolation and identification from CSF detected 5 positive bacterial cultures out of 50 samples tested (10%), while the remaining cultures (90%) did not show any bacterial growth after 7 days of incubation. The 45 negative samples were subjected to molecular identification, and it was found that 28/45 (62.2%) successfully amplified 16S rRNA bands indicating the presence of bacterial genomic DNA. Sequencing results showed that the highest prevalent genera in CSF samples were Bacteroides (41.1%), followed by Lactobacillus (17.6%), Pseudomonas (11.7%), Janibacter (11.7%), Achromobacter (11.7%) and Planococcus (5.8%). Traditional methods for bacterial isolation and identification from blood were capable of isolating 2 pathogens from 50 samples tested (4%). When testing the 48 negative samples using molecular methods, 25/48 (52%) successfully amplified 16S rRNA bands. The 16S rRNA sequences belonged to 9 different genera, the most dominant was Pseudomonas (16.6%) and the least dominant was Bacteroides (5.5%). @*Conclusion, significance and impact of study@#Our results clearly show the power of molecular diagnosis compared to traditional methods used at hospitals and show the danger of misdiagnosis. The study showed that the molecular approach is much more efficient than the conventional methods in identifying pathogens as it identified new pathogens that were not previously detected.