Uselessness of microbiological samples in acute appendicitis with frank pus: to collect or not to collect?

INTRODUCTION: Current use of antimicrobial therapy is prophylactic, empirical and broad spectrum. But, the age-old practice of obtaining cultures still remain. The aim of this study was to evaluate bacterial etiology and adequacy of antibiotic prophylaxis in patients diagnosed with acute appendicitis to help determine the utility of intraoperative cultures in guiding clinical decision-making. MATERIALS AND METHODS: A retrospective analysis of a prospectively constructed database of all patients who underwent appendectomy from September 2013 to November 2016 was performed. RESULTS: 456 patients underwent surgery for acute appendicitis in our academic hospital. 101 patients (22.1%) had intraoperative swabs taken, and the cultures were positive in 57.4% of patients. These 101 patients comprise our study group. The most commonly recovered species were E. coli, Streptococcus spp., Bacteroides fragilis, Enterococcus faecium, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Proteus. In the comparison between positive and negative swab, there were no differences in terms of surgical site infection, deep infection, and in terms of Clavien-Dindo classification. An appropriate empiric therapy was set in 88.5% and inappropriate in 11.5%. No differences in terms of surgical site infection or in length of stay (p = 0.657) were found, with a median of 7 days in both groups. CONCLUSION: The etiological agents causing peritonitis due to acute appendicitis are predictable and empiric-targeted antibiotic therapy is effective in a high percentage of patients. The postoperative patient outcome may be dependent on the severity of the appendicitis more than on the results of the swab at the time of surgery. In this study, intraoperative culture was not associated with the choice of antibiotics, incidence of SSI, DPI or the length of stay.

Emphysematous osteomyelitis caused by Salmonella typhi in beta thalassemia major.

There have been various cases of salmonella osteomyelitis reported in sickle cell anemia. We present a case of emphysematous osteomyelitis caused by Salmonella typhi in a 29-year-old beta thalassemia major patient. Diagnosis of emphysematous osteomyelitis was confirmed by computed tomography and magnetic resonance imaging, and culture of pus drained during surgical debridement confirmed the causative microorganism, Salmonella typhi. Antimicrobials were given according to microbiological sensitivity for a period of 8 weeks. Our patient also received hyperbaric oxygen therapy. At the end of therapy, he was afebrile and laboratory parameters normalized with a residual joint deformity which developed within 3 months.

[The improvement of complex treatment of odontogenous periostitis in elderly patients].

The paper presents the results of clinical examination of 114 patients aged 60-88 years with acute odontogenous periostitis receiving treatment in in-patient maxillofacial surgery unit. The dynamic of clinical symptoms is used to carry out the comparative effectiveness study of several peroral antibiotics in elderly patients.

Characterization of clinical strains of MSSA, MRSA and MRSE isolated from skin and soft tissue infections and the antibacterial activity of ZnO nanoparticles.

Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA), is an important cause of pyogenic skin and soft tissue infections (SSTIs). MRSA is an important pathogen in the healthcare sector that has neither been eliminated from the hospital nor community environment. In humans, S. aureus causes superficial lesions in the skin and localized abscesses, pyogenic meningitis/encephalitis, osteomyelitis, septic arthritis, invasive endocarditis, pneumonia, urinary tract infections and septicemia. Investigations focused in the search of other alternatives for the treatment of MRSA infections are in progress. Among the range of compounds whose bactericidal activity is being investigated, ZnO nanoparticles (ZnO-NPs) appears most promising new unconventional antibacterial agent that could be helpful to confront this and other drug-resistant bacteria. The aim of present study is to investigate the antibacterial potential of ZnO-NPs against Staphylococcus species isolated from the pus and wounds swab from the patients with skin and soft tissue infections in a tertiary care hospital of north India. ZnO-NPs (≈19.82 nm) synthesized by sol-gel process were characterized using scanning electron microscopy, X-ray diffraction , and Atomic force microscopy. The antibacterial potential was assessed using time-dependent growth inhibition assay, well diffusion test, MIC and MBC test and colony forming units methods. ZnO-NPs inhibited bacterial growth of methicillin-sensitive S. aureus (MSSA), MRSA and methicillin-resistant S. epidermidis (MRSE) strains and were effective bactericidal agents that were not affected by drug-resistant mechanisms of MRSA and MRSE.

Microbial profile and utility of soft tissue, pus, and bone cultures in diagnosing diabetic foot infections.

OBJECTIVE: This study assessed the utility of pus, soft tissue, and bone specimens in diagnosing diabetic foot infections and the spectrum of the microbial flora and in vitro susceptibility to antibiotics. SUBJECTS AND METHODS: This prospective study was carried out in 60 consecutive patients with diabetes having clinically infected foot ulcers. Detailed history, physical examination, and investigation were carried out to diagnose the presence of osteomyelitis and the microbial etiology of foot ulcers. Foot ulcers were classified as per Wagner's classification. Soft tissue, pus, and bone samples were obtained and cultured for aerobic and anaerobic bacteria, and antimicrobial susceptibility testing was carried out as per the standard protocol. RESULTS: Causative bacteria were isolated in 55 of 60 patients, and 157 isolates were cultured from 117 specimens with an average of 1.34 isolates per cases; however, the number of isolates per specimen did not differ among the various types of samples (P=0.78). Pus and soft tissue had predominantly polymicrobial flora, whereas bone infections were monomicrobial. The isolates from soft tissue specimens were different from those from bone and pus in 57% and 54% of cases, respectively. The common bacterial isolates from 117 specimens included Escherichia coli (21%) and Proteus species (15.9%). Nearly 70% of Staphylococcus aureus isolates were methicillin sensitive. All S. aureus and Enterococcus isolates were sensitive to vancomycin. Susceptibility of Gram-negative organisms to ciprofloxacin was 50%. CONCLUSIONS: Diabetic foot infections are mostly polymicrobial with Gram-negative predominance. Multiple sampling from superficial and deep tissues, including bone, when involved, yields more relevant information diagnostically and therapeutically.

Sacroiliitis infected with group A streptococcus in a child presenting with confusion and combativeness.

Group A streptococcus-associated severe invasive infection (streptococcal toxic shock syndrome) has been described. Streptococcal toxic shock syndrome occurs when the infecting strain of group A streptococcus produces superantigens. Confusion and combativeness are well known as the common symptoms of streptococcal toxic shock syndrome. We encountered a child who suffered from pyogenic sacroiliitis, with confusion and combativeness. Group A streptococcus was isolated from the patient's blood culture. However, his disease did not fulfill the criteria of streptococcal toxic shock syndrome. Pyogenic sacroiliitis in children is rare, but patients with pyogenic sacroiliitis due to group A streptococcus infection could show confusion and combativeness as clinical signs, similar to the signs in streptococcal toxic shock syndrome.

[Microflora dynamics in purulent skin wound in rats after ozonized perftorane applications].

In 30 Wistar rats divided in 3 groups with 10 rats in each skin defects were reproduced under anaesthesia and wound surface was fixed with the help of plastic rings. The wounds were contaminated with microbe dredge consisting of St. aureus, Ps. aeruginosa and E. coli in the concentration of 10(9) cells/ml. After 24, 48, 72, 96 and 120 hours the wound was irrigated with 10-15 ml of the following solutions: in the 1st group - commercial perftorane solution, in the 2nd group - ozonized perftorane, in the 3rd group - physiological solution. Hard medium inoculation let determine total number of growing microbe colonies. The material was taken each 3rd day. 9 experimental series were executed with the total length of experiment equal to 30 days. It was established that from 15th day of the experiment in the group with ozonized perftorane irrigations the mean number of microorganisms in the wound was reduced, granulation tissue growth and epithelization were speeded up if compared with the groups of animals irrigated with physiological solution and non-ozonized perftorane. Ozone action was connected not only with its bactericidal properties but in considerable degree with comprehensive local immunity activation.

[The role of ozone therapy in prevention of pyoinflammatory complications after transurethral resection of prostatic adenoma].

The study of efficacy of ozone therapy (OT) in preparation of patients with prostatic adenoma (PA) and cystostoma for transurethral resection (TUR) of PA included 20 PA patients with cystostomic drainage who had undergone PA TUR and preoperative preparation with OT sessions. The control group consisted of similar patients but without ozone pretreatment. OT efficacy was assessed by the rate of pyoinflammatory complications (PIC), results of immunological examination, positive changes in prostatic secretion, urine analysis, total blood count, degree ofbacteriuria. In the study group PIC (acute urethritis) developed in 1 patient, in the control--in 6 patients (3 cases of acute urethritis, 2 cases of acute prostatitis and 1 case of acute epididymitis). OT led to lowering of mean values of leukocyturia from 18.1 +/- 0.6 to 14.3 +/- 0.7 on the day of operation, to 10.9 +/- 0.7 after 4 days and to 8.7 +/- 0.6 on postoperative day 8 versus from 18.8 +/- 0.8 to 15.4 +/- 0.7, to 15.8 +/- 0.6 and 13.5 +/- 0.6, respectively. Mean control count of leukocytes in prostatic secretion fell in both groups. OT reduced bacteriuria. Number of bacteria to the day of operation decreased in both groups, but complete elimination of the agent from urine on day 8 was not achieved in the controls. The study group exhibited a rise in the absolute count of blood leukocytes, lymphocytes and ESR diminishing. OT raised significantly the phagocytic count and activity, concentration of mature T-lymphocytes (CD3), T-helpers (CD4), cytotoxic T-lymphocytes (CD8), B-lymphocytes (CD20), T-NK-cells (CD16), T-lymphocyte activation markers (CD3+, CD16+, CD56+, CD3+, CD25+, HLADR+, CD3+. The concentration of IgG, IgM, IgA remained high. Thus, the results of ozone application before PA TUR appeared promising in prevention of postoperative PIC.

Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis.

PURPOSE: To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. MATERIALS AND METHODS: We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. RESULTS: The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria. Sixteen isolates (39%) were Gram positive and 25 (61%) were Gram negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, Escherichia coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in 2 cases (5%) and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciprofloxacin in 86% and cefuroxime in 50%, with a sensitivity of less than 30% to cefalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidime, 86% were sensitive to ciprofloxacin, while only 20% were sensitive to ampicillin and 14% to cefalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidime. CONCLUSION: This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer, highly resistant, Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.

[Clinical-microbiological evaluation of the efficacy of combined use of chitosan, low intensity laser radiation and photosensitizer in treatment of patients with acute suppurative maxillofacial periostitis].

Results are presented on treatment of 68 patients with acute suppurative periostitis of maxillofacial region. After surgical interventions in patients of the study group (48 patients) the wounds were cleansed by 1% chitosan on 0.2% HC1 in combination with methylene blue and irradiated by IR laser beam. The wounds healed in 2-3 days. In the control group (20 patients) for wound dressing chlorhexidine as a standard procedure was used, length of the healing process was 5-6 days. After combined treatment the number of microflora in the wound was reduced and microflora did not show the signs of pathogenicity.

Zinc, iron, copper, selenium, lactoferrin, and ferritin in human pus.

BACKGROUND: Restriction of zinc and iron available for microbial growth in tissues are well-recognized host defense mechanisms. The present studies were performed to characterize some constituents of human pus that may affect these important host defenses. METHODS: Zinc, iron, copper, calcium, and magnesium in pus were measured using an atomic absorption spectrophotometer; selenium was measured fluorometrically. Ferritin was measured with a fluorometric enzyme immunoassay, and lactoferrin was measured with a radial diffusion assay. The growth of Escherichia coli at 37 degrees C was measured in pus supernate adjusted to pH 5.5 or 7.4, in boiled supernate, or in supernate adjusted with 1.3 mM iron or 0.9 mM zinc singly or together. RESULTS: Zinc and iron concentrations in pus exceeded normal serum. Calcium and magnesium levels were 2- to 3-fold lower and higher, respectively, than normal serum values. Lactoferrin concentrations of were 880 +/- 48 microg/mL and ferritin levels were 20,726 +/- 2,667 ng/mL. Growth of an E coli strain was inhibited in pus at pH 5.5 but not at pH 7.4, and growth was enhanced by addition of iron or zinc to E coli suspended in pus at pH 6.7. CONCLUSIONS: To our knowledge, this is the first report of the zinc, iron, copper, selenium, lactoferrin, and ferritin levels of human pus. These studies provide additional insight into host defense mechanisms mediated by the restriction of the bioavailability of zinc and iron in suppurative infection.

Fatal suppurative mesenteric thrombophlebitis caused by an Enterococcus faecalis highly resistant to aminoglycosides: case report.

A 56-year old man with non-Hodgkin's lymphoma and biliary tract endoprosthesis, developed chronic bacteremia caused by Enterococcus faecalis with high-level resistance to gentamicin and streptomycin. The sources of bacteremia were a device-associated biliary tract infection, a suppurative thrombophlebitis of the confluence of the superior mesenteric vein with the splenic vein as well as multiple liver and pancreatic abscesses. Despite antibiotic therapy and multiple drainages of abscesses, the patient died due to overwhelming infection.

[Susceptibility to antibiotics of Staphylococcus aureus strains isolated from pus specimens obtained from patients referred for autovaccine therapy]. / Lekowrazliwosc szczepów Staphylococcus aureus izolowanych z ropy pacjentów kierowanych do leczenia autoszczepionka.

Autovaccine was prepared for 268 patients treated for: osteomyelitis--95, acne--63, furunculosis--53, and other pyogenic infections--57 patients. 540 bacterial strains were isolated from the specimens obtained from patients. 170 Staphylococcus aureus strains were cultured, what represents 31.5% of the isolated strains. Isolated Staphylococcus aureus strains were most often penicillin-resistant (91.5%), amplicillin-resistant (86%), less frequently tetracycline-resistant (73%), and doxycycline-resistant (53.1%). Staphylococcus aureus strains isolated from outpatients were found to be less resistant to particular antibiotics as compared to the group of strains isolated from the inpatients receiving treatment in different hospital departments. 13.5% of studied Staphylococcus aureus strains were methicillin-resistant.

Concerning the sensitivity of Acinetobacter calcoaceticus.

The strains of Acinetobacter calcoaceticus, var. anitratus (A. c. a.) were isolated in the nosocomial environment as an opportune pathogen. The therapy of choice may be determined after in vitro tests. Our results show following therapeutical possibilities: beta-lactam antibiotics--cephalosporins of IIIrd generation (cefotaxime), also combinations of antimicrobials have shown good results: amoxycillin or ticarcillin with clavulanic acid. Best synergistic effect was found in combination ticarcillin-amikacin.

[Dynamics of the antibiotic sensitivity of the staphylococci in suppurative, inflammatory foci in patients during the period of the hospital stay]. / Dinamika chuvstvitel'nosti k antibiotikam stafilokkov v gnoino-vospalitel'nykh ochagakh bol'nykh v period prebyvaniia v statsionare

The dynamics of staphylococci sensitivity to antibiotics in purulent foci of 242 in patients was studied. Two criteria were used for estimation of the above process, i.e. (I) sensitivity to the antibiotics of the whole staphylococcal population isolated and (2) sensitivity to the antibiotics of separate strains isolated from the population. In 10 or more days the number of the in-patients with staphylococci resistant to streptomycin, monomycin or oxacillin in the purulent foci increased. The number of the in-patients with penicillin, neomycin or chloramphenicol resistant staphylocci was statistically doubtful. The average number of the antibiotic resistant microbial cells in the staphylococcal populations of the foci in the patients during their stay in the hospital increased 2-4 times.