Cutting Ties With an Old Friend: Omphalitis and Bacteremia With Umbilical Cord Nonseverance.

Umbilical cord nonseverance (UCNS) is the practice of leaving the umbilical cord attached to the placenta after delivery. Limited case reports exist revealing adverse outcomes of UCNS. We report a case of neonatal omphalitis associated with Escherichia coli bacteremia and urinary tract infection after UCNS.

Neonatal Omphalitis After Lotus Birth.

Lotus birth, or umbilical nonseverance, is the practice wherein the umbilical cord is not separated from the placenta after birth, but allowed instead to dry and fall off on its own. Lotus birth may result in neonatal omphalitis. This article describes the history and rationale for lotus birth as well as the etiology, incidence, clinical presentation, and management of neonatal omphalitis. Recommendations for educating families how to perform lotus birth safely are presented. Additionally, signs and symptoms that warrant newborn assessment and treatment are reviewed.

[Pyogenic streptococcal omphalitis and foot's cellulitis in an 11 day old infant]. / Omphalite à Streptococcus pyogenes et cellulite du pied chez un nourrisson de 11 jours.

Omphalitis is a rare infection in our countries. Streptoccus pyogenes is one of the most frequently encountered germs. Complications are rare but include septicemia and necrotizing fasciitis with a high mortality rate. The case reported in this article is that of an 11 days old infant with pyogenic streptococcal omphalitis who developed cellulitis of left food. An intravenous antibiotic treatment allowed complete resolution of the symptoms. The article is the opportunity to review of the risk factors of this affection, its complications and treatments.

L'omphalite est une infection rare dans nos pays. Le streptocoque pyogène est un des germes les plus fréquemment rencontrés. Les complications sont rares mais incluent les septicémies et la fasciite nécrosante avec un taux important de mortalité. Le cas rapporté dans cet article est celui d'un nourrisson de 11 jours présentant une omphalite à Streptocoque pyogène ayant développé une cellulite du pied gauche. Un traitement antibiotique intraveineux a permis une résolution complète des symptômes. Cet article est l'occasion d'une revue des facteurs de risques de cette affection, de ses complications et traitements.

Umbilical Microbiome and Laparoscopic Surgery: A Descriptive Clinical Study.

BACKGROUND: The human skin microbiome consists of colonizing and pathogen germs. The umbilical dimple is a humid environment prone to bacterial colonization and growth. In the laparoscopic era, the umbilicus has become the most common site of entrance into the peritoneum. The aim of this study was to describe the characteristics of umbilical microflora before antiseptic skin preparation. METHODS: Descriptive single-center study. A series of patients who underwent laparoscopic/open and elective/urgent abdominal surgery over a 2-month period were included. Patients were admitted the same day or the day before surgery. Before antiseptic skin preparation, microbiological samples were taken from the umbilicus, left upper abdominal quadrant, and nostril. A delayed referral time (>30 minutes) of the skin swabs to the microbiology laboratory was an exclusion criterion. RESULTS: Overall, 70 patients were included. The median age was 64 years (range 16-89) and a laparoscopic approach was used in 82.8% of cases. The most commonly performed operation was laparoscopic fundoplication for gastroesophageal reflux (25.8%). In the umbilicus, the most frequent colonizing bacteria were coagulase-negative Staphylococcus species and Corynebacterium. Opportunistic pathogens were found in 10 umbilical swabs compared with 8 in the left upper quadrant (14.2% versus 11.4%, p = .800). Overall, 50% of patients with umbilical opportunistic pathogens had a medium/high bacterial load compared with 62.5% in the left upper quadrant (p = .958). No postoperative surgical site infection was recorded in the study sample. CONCLUSIONS: Both the umbilicus and the left upper quadrant appear to be safe entry sites in laparoscopic surgery. Meticulous hygiene of these anatomical areas is strongly recommended before surgery regardless of the type of antiseptic solution and the short-term antibiotic prophylaxis. In-hospital preoperative showers may be unnecessary for well-educated patients.

Clinical evaluation of early acquisition of Staphylococcus aureus carriage by newborns.

BACKGROUND: Little is known about neonatal Staphylococcus aureus carriage. Sites and clinical outcomes of S. aureus colonization during the first month of life were evaluated in this study. METHODS: A cohort of 279 infants born at term to 277 mothers was included. Maternal S. aureus colonization status was examined before labor. Newborns were screened for nasal, auricular, umbilical, and rectal colonization, one to three times within 100h after birth, and infants of carrier mothers were re-screened at 1 month. Medical data were recorded from the medical charts at discharge and at the 1-month follow-up interview. RESULTS: Overall 43 out of 279 (15.4%) infants acquired S. aureus within the first days of life. The only two predictors of S. aureus carriage in the postnatal period were maternal S. aureus carriage (odds ratio 7.905, 95% confidence interval 3.182-19.638) and maternal antibiotic treatment during labor (odds ratio 0.121, 95% confidence interval 0.016-0.949). Among colonized children, the nose (56%) and rectum (40%) were more frequently colonized, while ear (26%) and umbilicus (16%) colonization were less common. Co-colonization at two sites was rare (4%), but always predicted carriage at 1 month of age. Maternal and neonatal characteristics, including neonatal outcomes, were similar between S. aureus carrier and non-carrier infants during the first month of life. CONCLUSIONS: Maternal carriage is the major predictor of neonatal S. aureus carriage. The nose and rectum are the main sites of neonatal carriage. S. aureus carriage was not associated with neonatal complications throughout the first month of life. The long-term significance of early S. aureus carriage is yet to be determined.

Umbilical infections in foals: microbiological investigation and management.

This study aims to investigate the bacteria involved in equine omphalitis and their susceptibility to antimicrobial drugs, and consequently to provide guidelines concerning the most suitable treatment protocol in accordance with the clinical, ultrasound and laboratory findings. Forty foals aged between one and 30 days were evaluated in the course of this investigation. An ultrasound examination of all umbilical remnants was carried out carefully in all foals; umbilical swabs were collected for bacteriological examination, and blood samples were collected for blood culture from 19 foals with fever and abnormal blood values. Bacterial omphalitis was observed in 95 per cent of foals and bacterial septicaemia was diagnosed in 11 cases. Enterobacteria and coccoid Gram-positive bacteria were isolated more frequently than Serratia marcescens, Pantoea agglomerans and Trueperella pyogenes Omphalectomy was performed in 77.5 per cent of the foals examined; the remainder were treated only medically with antimicrobial drugs as recommended by antibiotic susceptibility testing performed for all bacteria isolated. Antibiotic therapy was successful in all foals that only received medical treatment; nevertheless, omphalectomy was performed in most cases particularly in situations of clinical decline despite antibiotic therapy and when involvement of umbilical vein, fever and joint disorders were observed.

Abdominal tuberculosis manifested as tuberculosis of the urachal sinus in an adolescent and the role of laparoscopy in the management: a rare case report.

BACKGROUND: Abdominal tuberculosis (TB) is an uncommon affliction in adolescence. It is usually associated with pulmonary tuberculosis. The disease is caused by lymphohaematogenous spread after primary infection in the lung or ingestion of infected sputum and has a typically protean and nonspecific presentation. The occurrence of TB in an urachal remnant is probably from the contiguous spread of an abdominal focus or mesenteric lymph node. Urachal TB is a rare entity, with only two reported cases in the literature. We report here a case of clinically silent pulmonary and abdominal TB that manifested in the infection of an urachal sinus and highlight the role of laparoscopy in its diagnosis and treatment. CASE PRESENTATION: A 14-year-old boy presented to our institution with peri-umbilical swelling and purulent discharge from his umbilicus for 2 weeks duration. There were no radiological, microbiological or clinical evidences of TB in the initial presentation, though he had close social contact with someone who had TB. A computed tomography scan of the abdomen confirmed the diagnosis of an urachal abscess. An incision and drainage procedure was performed followed by a course of antibiotics. A scheduled laparoscopic approach later showed that the peritoneum and serosal surface of the small and large intestines were studded with nodules of variable sizes, in addition to the urachal sinus. The histology of the resected tissues (urachal sinus and nodules) was consistent of TB infection. He recovered fully after completing 6 months of anti-tuberculous therapy. CONCLUSION: This report highlights a rare case of TB urachal abscess in an adolescent boy, the difficulties in the diagnosis of abdominal tuberculosis, the need to consider TB as a cause of urachal infection in endemic areas and the use of laparoscopy in both diagnosis and treatment.

Umbilical Microflora, Antiseptic Skin Preparation, and Surgical Site Infection in Abdominal Surgery.

BACKGROUND: Surgical site infections (SSI) following abdominal surgery are frequent and a major cause of postoperative morbidity and prolonged hospital stay. Besides antibiotic prophylaxis, antiseptic skin preparation is an important measure to prevent SSI. METHODS: Here we prospectively analyzed the effectiveness of antiseptic skin preparation in a cohort of 93 patients undergoing laparotomy, with special emphasis on the umbilical region. RESULTS: The microflora of the umbilicus contained a large number of resident (mostly staphylococci species and corynebacteria) and transient germs (including enterococci species). Following antiseptic skin preparation, bacteria could still be cultured from 24.7% of the patients' umbilici. In case of postoperative SSI, only one of seven SSI was caused by the microorganism that was present in the umbilicus before and after skin preparation. CONCLUSION: Antiseptic skin preparation fails to completely eradicate the microflora of the umbilical region in one quarter of the patients. However, at least in abdominal surgery, the vast majority of SSI are caused by intra-abdominal contamination rather than the skin microflora.

Outcome of surgical treatment for umbilical swellings in bovine youngstock.

Umbilical swellings are commonly identified in calves and can be caused by hernia formation, infection of the remnants of umbilical vessels or a combination of both. Ninety-one cases with umbilical swellings were admitted to the Leahurst Farm Animal Practice (LFAP) between July 2004 and February 2012; 55 were simple hernias and 36 had associated infection. Eighty-seven cases underwent surgery of which 86 survived until discharge. Postoperative complications occurred in 65/86 animals (73 per cent). In 51 cases (81 per cent) this was classified as minor requiring no additional treatment. Placement of a prosthetic mesh was associated with a higher OR for developing severe postoperative complication when compared with those not receiving a mesh (OR=19.3; 95% CI 4.5 to 83.5). Long-term survival results were available for 49 animals, 22 of which were remaining in the herd with a median age of 1346 days (3.7 years). Of the 27 animals which had exited the herd, 16 were adult dairy cows, 7 were dairy heifers, 2 were beef animals and 2 exited at an unknown stage. Umbilical surgery in calves carries a good prognosis, although placement of a mesh increases the risk of complications occurring in the postoperative period.

Prevalence and molecular characterization of Staphylococcus aureus colonization among neonatal intensive care units in Taiwan.

BACKGROUND: Staphylococcus aureus, particularly methicillin-resistant (MRSA), is an important pathogen in neonatal intensive care units (NICUs). Carriage of S. aureus is a significant risk factor for subsequent infection. OBJECTIVES: To determine the current status of MRSA prevalence among NICU-hospitalized infants in Taiwan, we conducted this pilot island-wide survey. METHODS: On two designated dates in 2011, each patient who stayed in the NICUs of 7 participating hospitals was included. Nasal and umbilical swabs were obtained and sent for detection of S. aureus. The prevalence and risk factors for MRSA carriage were analyzed. MRSA strains were tested for antimicrobial susceptibility and underwent molecular characterization. RESULTS: A total of 251 subjects were included. The overall prevalence of S. aureus and MRSA carriage was 13 and 4.4%, respectively. Previous skin and soft tissue infection was the only predictor in multivariate analysis (OR 40.36; 95% CI 2.32-702.64; p = 0.011). Among 11 MRSA isolates, 3 pulsotypes were identified, with one major type (73%). Nine isolates carried a type IV staphylococcal chromosomal cassette, and 2 carried the type VT. All but one MRSA isolate belonged to linage sequence type 59, the community clone in Taiwan. CONCLUSIONS: On a designated date, 4.4% of the infants staying in NICUs in Taiwan carried almost genetically identical community strains of MRSA. MRSA colonization in these infants was significantly associated with previous skin and soft tissue infection.

Trueperella abortisuis, an emerging pathogen isolated from pigs in Germany.

In the present study four Trueperella (T.) abortisuis strains isolated from an umbilical swab, two anal swabs and from a placenta after abortion of four pigs, respectively, could successfully be identified phenotypically, by MALDI-TOF MS analysis and genotypically by amplification and sequencing of 16S rRNA gene sequence and gene sodA encoding superoxide dismutase A as additional molecular target. All four T. abortisuis were isolated together with various other bacterial species indicating that the pathogenic importance of this novel species remains unclear. However, according to the literature and to the results of the present study T. abortisuis could be recovered from samples of animals in Japan and in different microbiological laboratories in Germany emphasizing its increasing importance.

Screening cultures for detection of methicillin-resistant Staphylococcus aureus in a population at high risk for MRSA colonisation: identification of optimal combinations of anatomical sites.

This retrospective study analysed the diagnostic yield of single-site, two-site, and three-site anatomical surveillance cultures in a population of 4,769 patients at high risk for methicillin-resistant Staphylococcus aureus (MRSA) colonisation. Cultures of seven anatomical sites were used as the gold standard against which to measure the sensitivity of MRSA detection. Detection rates for the seven single-sites, 21 two-site, and 35 three-site combinations are presented. Single-site swabbing only detected 50.5% (nose) of total cases, while three-site surveillance achieved a 92% (groin + nose + throat) sensitivity of detection at best. It is recommended that at least three anatomical sites should be screened for MRSA colonisation in these high-risk patients.

Summertime Bacillus cereus colonization of hospital newborns traced to contaminated, laundered linen.

BACKGROUND: Routine screening of premature newborns for haemolytic streptococci, Staphylococcus aureus and enteric Gram-negative bacteria done at birth using umbilical swabs identified clustering of babies colonized with Bacillus cereus in summers of 2009 and 2010 at a 400-bedded UK general hospital. AIM: To determine the source of this organism by focusing on the clinical environment. METHODS: Umbilical swab screening was extended to all newborns and the labour ward environment, including construction-related dust, was sampled for B. cereus. FINDINGS: During the summer of 2009, 65% of newborns had umbilical swabs which were culture positive for B. cereus. Blood agar and B. cereus selective agar impression plates of unused labour ward linen, and freshly received linen from the hospital's external laundry, gave mainly confluent growth of B. cereus in >85% of items sampled. In-use and exposed healthcare products including liquid handwashing agents, paper hand-towels, vaginal lubricants, labour ward dust and air were culture negative. Linen contamination and umbilical swab culture positivity both approached zero in autumn. B. cereus colonization of newborn umbilici recurred in summer 2010 and unused laundered linen was again found to be as contaminated. Washing linen at the laundry in a washer-extractor, with higher dilution than the continuous tunnel washer normally used, coincided with lowering of detectable B. cereus numbers in unused washed linen and no clustering in newborns the following summer (2011). CONCLUSION: Freshly laundered linen can be contaminated with B. cereus with subsequent spread and colonization of newborns. This contamination appears to be associated with low-dilution washing and high ambient temperatures.

Maternal and neonatal colonization in Bangladesh: prevalences, etiologies and risk factors.

OBJECTIVE: To estimate the prevalence of maternal colonizers in South Asia and their potential to colonize the umbilicus, an important precondition causing neonatal sepsis. STUDY DESIGN: We conducted a cross-sectional study at a maternity center in Dhaka with 1219 pregnant women and a subset of 152 newborns from 15 January to 31 October 2011. During labor, study paramedics collected vaginal swabs for bacterial culture and rectal swabs for Group B Streptococcus (GBS) testing. Community health workers collected neonatal umbilical swabs. Log-binomial regression models were used to estimate risk ratios. RESULT: In all, 454 women (37.2%, 95% confidence interval (CI) 34.5 to 40.0%) were colonized. The most common organisms isolated were Staphylococcus aureus, Non-GBS and GBS. A total of 94 women (7.7%, 95% CI 6.2 to 9.2%) were colonized with GBS. The risk of GBS umbilical colonization was higher (RR=12.98, 95% CI 3.97 to 42.64) among newborns of mothers with GBS colonization. CONCLUSION: Newborns of mothers colonized with GBS are at higher risk of developing umbilical colonization.