scholarly journals Serial Detection of Circulating Mucorales DNA in Invasive Mucormycosis: A Retrospective Multicenter Evaluation

2019 ◽  
Vol 5 (4) ◽  
pp. 113 ◽  
Author(s):  
Toine Mercier ◽  
Marijke Reynders ◽  
Kurt Beuselinck ◽  
Ellen Guldentops ◽  
Johan Maertens ◽  
...  
Keyword(s):  
Positive Culture ◽  
Final Diagnosis ◽  
Diagnostic Tools ◽  
Kinetic Properties ◽  
Appropriate Treatment ◽  
Positive Culture Result ◽  
Appropriate Therapy ◽  
Low Sensitivity ◽  
Culture Positive ◽  
Missed Diagnoses

Invasive mucormycosis is a fungal infection with high mortality. Early diagnosis and initiation of appropriate treatment is essential to improve survival. However, current diagnostic tools suffer from low sensitivity, leading to delayed or missed diagnoses. Recently, several PCR assays for the detection of Mucorales DNA have been developed. We retrospectively assessed the diagnostic and kinetic properties of a commercial Mucorales PCR assay (MucorGenius®, PathoNostics) on serial blood samples from patients with culture-positive invasive mucormycosis and found an overall sensitivity of 75%. Importantly, a positive test preceded a positive culture result by up to 81 days (median eight days, inter-quartile range 1.75–16.25). After initiation of appropriate therapy, the average levels of circulating DNA decreased after one week and stabilized after two weeks. In conclusion, detection of circulating Mucorales DNA appears to be a good, fast diagnostic test that often precedes the final diagnosis by several days to weeks. This test could be especially useful in cases in which sampling for culture or histopathology is not feasible.

The Auckland Endophthalmitis Study

2017 ◽  
Vol 1 (3) ◽  
pp. 175-180 ◽  
Author(s):  
William James Cunningham ◽  
Eugene Michael ◽  
Sarah Welch ◽  
Niall Crosby ◽  
Benjamin Host ◽  
...  
Keyword(s):  
Rare Complication ◽  
Intravitreal Bevacizumab ◽  
Positive Culture ◽  
Primary Treatment ◽  
Primary Vitrectomy ◽  
Clinical Notes ◽  
Bevacizumab Treatment ◽  
Positive Culture Result ◽  
Vitrectomy Surgery ◽  
Culture Positive

Purpose: To report on the incidence and management of endophthalmitis following intravitreal bevacizumab in Auckland, New Zealand. Method: A survey of facilities in Auckland performing intravitreal bevacizumab between January 2007 and December 2014 was undertaken. The clinical notes of patients presenting with bevacizumab-related endophthalmitis were analyzed. Results: During the study period, 39 657 intravitreal bevacizumab injections were performed, with 21 patients undergoing treatment for bevacizumab-related endophthalmitis. The incidence of endophthalmitis was 0.053% (1 per 1888 injections). Most patients (76%) were treated within 4 hours from admission to hospital. Fifteen patients received vitreous tap and inject as primary treatment. From 2013 onward, there was a trend toward vitrectomy surgery as the primary intervention, with 72% of cases receiving vitrectomy as first-line treatment. Those who underwent vitrectomy were more likely to return a culture-positive result ( P = .030). After treatment, the majority of patients displayed an improvement in visual acuity (67%). Conclusion: Endophthalmitis is a rare complication of intravitreal bevacizumab treatment, with an incidence of 1 per 1888 injections in our region. There has been a shift favoring primary vitrectomy surgery in the treatment of endophthalmitis, with those undergoing vitrectomy more likely to return a positive culture result.

Next-generation Diagnostics for Melioidosis: Evaluation of a Prototype i-STAT Cartridge to Detect Burkholderia pseudomallei Biomarkers

2018 ◽  
Vol 69 (3) ◽  
pp. 421-427 ◽  
Author(s):  
Kevin L Schully ◽  
Charles C Young ◽  
Mark Mayo ◽  
Amy L Connolly ◽  
Vanessa Rigas ◽  
...  
Keyword(s):  
Blood Culture ◽  
Burkholderia Pseudomallei ◽  
High Sensitivity ◽  
Diagnostic Tools ◽  
Next Generation ◽  
Blood Samples ◽  
Life Threatening ◽  
Low Sensitivity ◽  
Culture Positive ◽  
Culture Negative

AbstractBackgroundInfection with the gram-negative bacterium Burkholderia pseudomallei can result in melioidosis, a life-threatening disease that can be difficult to diagnose. Culture remains the gold standard for diagnosis but requires laboratory resources not available in many endemic regions. A lateral flow immunoassay has shown promise for POC diagnostics but suffers from low sensitivity when used on blood samples. PCR also has low sensitivity on blood, attributed to the low bacterial numbers in blood observed in melioidosis patients, even when bacteraemic.MethodsA prototype i-STAT cartridge was developed to utilize the monoclonal antibody specific for the capsule of pathogenic Burkholderia species employed on the LFI. The resulting POC assay was evaluated on 414 clinical specimens from Darwin, Australia and Cambodia.ResultsThe i-STAT assay accurately distinguished Australian blood culture positive melioidosis patients from Australian patients hospitalized with other infections (AUC = 0.91, 95% CI 0.817 - 1.0). We derived an assay cutoff with 76% sensitivity and 94% specificity that correctly classified 88% (n = 74) of the Australian patients. Interestingly, only 46% (6/13) of the culture-positive melioidosis patients in Cambodia were classified correctly. Of great importance however, the assay detected capsule from blood samples for 32% of blood culture negative melioidosis patients in both cohorts and previously undiagnosed melioidosis patients in Cambodia. In addition the assay showed high sensitivity and specificity for urine, pus and sputum.ConclusionsDiagnostic tools that are not dependent upon the growth kinetics or the levels of bacteremia of B. pseudomallei represent the next-generation of diagnostics and must be pursued further.

scholarly journals Percutaneous Bone Biopsy for Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Marcos C Schechter ◽  
Mohammed K Ali ◽  
Benjamin B Risk ◽  
Adam D Singer ◽  
Gabriel Santamarina ◽  
...  
Keyword(s):  
Adverse Events ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Meta Analysis ◽  
Positive Culture ◽  
High Yield ◽  
Analysis Model ◽  
Antibiotic Management ◽  
Culture Positive ◽  
Diabetic Foot Osteomyelitis

Abstract Background Diabetes is the leading cause of lower extremity nontraumatic amputation globally, and diabetic foot osteomyelitis (DFO) is usually the terminal event before limb loss. Although guidelines recommend percutaneous bone biopsy (PBB) for microbiological diagnosis of DFO in several common scenarios, it is unclear how frequently PBBs yield positive cultures and whether they cause harm or improve outcomes. Methods We searched the PubMed, EMBASE, and Cochrane Trials databases for articles in any language published up to December 31, 2019, reporting the frequency of culture-positive PBBs. We calculated the pooled proportion of culture-positive PBBs using a random-effects meta-analysis model and reported on PBB-related adverse events, DFO outcomes, and antibiotic adjustment based on PBB culture results where available. Results Among 861 articles, 11 studies met inclusion criteria and included 780 patients with 837 PBBs. Mean age ranged between 56.6 and 71.0 years old. The proportion of males ranged from 62% to 86%. All studies were longitudinal observational cohorts, and 10 were from Europe. The range of culture-positive PBBs was 56%–99%, and the pooled proportion of PBBs with a positive culture was 84% (95% confidence interval, 73%–91%). There was heterogeneity between studies and no consistency in definitions used to define adverse events. Impact of PBB on DFO outcomes or antibiotic management were seldom reported. Conclusions This meta-analysis suggests PBBs have a high yield of culture-positive results. However, this is an understudied topic, especially in low- and middle-income countries, and the current literature provides very limited data regarding procedure safety and impact on clinical outcomes or antibiotic management.

scholarly journals 183. Optimization of an Outpatient Antimicrobial Stewardship Process for Patients Discharged from the Emergency Department at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Hannah Kafisheh ◽  
Matthew Hinton ◽  
Amanda Binkley ◽  
Christo Cimino ◽  
Christopher Edwards
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Positive Culture ◽  
Culture Result ◽  
Academic Medical ◽  
Positive Culture Result ◽  
Therapy Modification

Abstract Background Suboptimal antimicrobial therapy has resulted in the emergence of multi-drug resistant organisms. The objective of this study was to optimize the time to antimicrobial therapy modification for patients discharged from the emergency department (ED) of an academic medical center through implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative (ASI). Methods This was a pre-post, quasi-experimental study that evaluated the impact of a pharmacist-driven outpatient antimicrobial stewardship initiative at a single academic medical center. The pre-cohort was evaluated through manual electronic medical record (EMR) review, while the post-cohort involved a real-time notification alert system through an electronic clinical surveillance application. The difference in time from positive culture result to antimicrobial therapy optimization before and after implementation of the pharmacist-driven ASI was collected and analyzed. Results A total of 166 cultures were included in the analysis. Of these, 12/72 (16%) in the pre-cohort and 11/94 (12%) in the post-cohort required antimicrobial therapy modification, with a 21.9-hour reduction in median time from positive culture result to antimicrobial optimization in the post-cohort (43 h vs. 21.1 h; p < 0.01). Similarly, the median time from positive culture result to review was reduced by 20 hours with pharmacist-driven intervention (21.1 h vs. 1.4 h; p < 0.01). Conclusion The implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative resulted in a significant reduction in time to positive culture review and therapy optimization for patients discharged from the ED of an academic medical center set in Philadelphia, PA. Disclosures All Authors: No reported disclosures

scholarly journals Application of Volatilome Analysis to the Diagnosis of Mycobacteria Infection in Livestock

2021 ◽  
Vol 8 ◽  
Author(s):  
Pablo Rodríguez-Hernández ◽  
Vicente Rodríguez-Estévez ◽  
Lourdes Arce ◽  
Jaime Gómez-Laguna
Keyword(s):  
Analytical Techniques ◽  
Diagnostic Techniques ◽  
Diagnostic Tools ◽  
Future Research ◽  
Control Programs ◽  
Targeted Analysis ◽  
Low Sensitivity ◽  
And Control

Volatile organic compounds (VOCs) are small molecular mass metabolites which compose the volatilome, whose analysis has been widely employed in different areas. This innovative approach has emerged in research as a diagnostic alternative to different diseases in human and veterinary medicine, which still present constraints regarding analytical and diagnostic sensitivity. Such is the case of the infection by mycobacteria responsible for tuberculosis and paratuberculosis in livestock. Although eradication and control programs have been partly managed with success in many countries worldwide, the often low sensitivity of the current diagnostic techniques against Mycobacterium bovis (as well as other mycobacteria from Mycobacterium tuberculosis complex) and Mycobacterium avium subsp. paratuberculosis together with other hurdles such as low mycobacteria loads in samples, a tedious process of microbiological culture, inhibition by many variables, or intermittent shedding of the mycobacteria highlight the importance of evaluating new techniques that open different options and complement the diagnostic paradigm. In this sense, volatilome analysis stands as a potential option because it fulfills part of the mycobacterial diagnosis requirements. The aim of the present review is to compile the information related to the diagnosis of tuberculosis and paratuberculosis in livestock through the analysis of VOCs by using different biological matrices. The analytical techniques used for the evaluation of VOCs are discussed focusing on the advantages and drawbacks offered compared with the routine diagnostic tools. In addition, the differences described in the literature among in vivo and in vitro assays, natural and experimental infections, and the use of specific VOCs (targeted analysis) and complete VOC pattern (non-targeted analysis) are highlighted. This review emphasizes how this methodology could be useful in the problematic diagnosis of tuberculosis and paratuberculosis in livestock and poses challenges to be addressed in future research.

Non-touch Aseptic technique Maintains Sterility of Antibiotic-Admixed peritoneal Dialysis Fluid

2018 ◽  
Vol 38 (1) ◽  
pp. 65-67
Author(s):  
Louis L. Huang ◽  
Ellen Ramas ◽  
Priti Prasad ◽  
Jenny Catania ◽  
Pauline Meade ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Room Temperature ◽  
Positive Culture ◽  
Coagulase Negative Staphylococcus ◽  
Dialysis Fluid ◽  
Aseptic Technique ◽  
Sterile Technique ◽  
Peritoneal Dialysis Fluid ◽  
Culture Positive ◽  
Positive Controls

There is a paucity of data on the sterility of peritoneal dialysis fluid (PDF) after drug admixture. International Society for Peritoneal Dialysis (ISPD) guidelines suggest using sterile technique when admixing antibiotics; however, the degree of sterility remains unclear. This issue is most pertinent when preparing take-home PDF for outpatient treatment of peritonitis. This study compares the sterility of PDF admixed with antibiotics using a non-touch aseptic technique (NTAT) versus sterile technique. Groups of 8 PDF mixtures (1.5% Dianeal or Icodextrin [Baxter International Inc., Spring Grove, IL, USA]) were admixed with 1 g/L ceftazidime and vancomycin, or 20 mL saline, either by a pharmacist using sterile technique in a sterile suite, or a nurse in a clinical room using NTAT. Dianeal inoculated with 1 x 106 colony-forming units (CFU)/L of coagulase-negative Staphylococcus (CNS), with and without antibiotics, served as positive controls. Admixed PDFs were left at room temperature for 72 hours, then cultured using the BacT/ALERT system. A positive culture by day 5 constituted a contamination. Differences in proportion of contamination between groups were assessed using the Chi-squared test. Eighty PDF bags underwent microbiological testing. Sterility was maintained in all bags, independent of technique (NTAT versus sterile technique), type of PDF (Dianeal versus Icodextrin), or whether antibiotics were admixed. Of the positive controls, CNS-inoculated PDFs without antibiotics were all culture positive; however, when inoculated into antibiotic-admixed PDFs, only S. haemolyticus remained culture-positive ( p < 0.0001). In conclusion, PDF sterility can be maintained using NTAT for up to 3 days at room temperature. Currently, there is insufficient evidence to adopt sterile technique in sterile suites when admixing take-home PDF.

Epidemiology of Nontuberculous Mycobacterial Infection in Tuberculosis Suspects

2021 ◽  
Author(s):  
Parasmal Suresh ◽  
Anil Kumar ◽  
Raja Biswas ◽  
Divya Vijayakumar ◽  
Swathy Thulasidharan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Species Diversity ◽  
Mycobacterial Infection ◽  
Opportunistic Pathogens ◽  
Appropriate Treatment ◽  
Wide Range ◽  
High Species Diversity ◽  
Nontuberculous Mycobacterial Infection ◽  
Low Prevalence ◽  
Culture Positive

Nontuberculosis mycobacteria (NTM) are opportunistic pathogens that cause a wide range of illnesses. Here, the species distribution and prevalence of NTM infections in tuberculosis suspects was analyzed. A total of 7,073 specimens from pulmonary and extrapulmonary sites were analyzed, and 709 (10%) were found to be culture positive for mycobacteria. Of these, 85.2% were identified as Mycobacterium tuberculosis complex and 14.8% as NTM (65.7% rapid growers and 34.3% slow growers). Speciation of the NTM isolates (n = 69) identified 19 NTM species. M. abscessus (33.3%) and M. fortuitum (24.6%) were the most dominant NTM species isolated from the patients, followed by M. porcinum (5.8%) and M. parascrofulaceum (4.3%). We also report peritonitis caused by rapidly growing NTM among the patients undergoing continuous ambulatory peritoneal dialysis and a case of M. senegalense peritonitis. A low prevalence but high species diversity of NTM was detected in our study. The high species diversity of NTM necessitates the need to unequivocally identify mycobacterial isolates for appropriate treatment.

scholarly journals Surveillance for Invasive Salmonella Disease in Bamako, Mali, From 2002 to 2018

2020 ◽  
Vol 71 (Supplement_2) ◽  
pp. S130-S140
Author(s):  
William L Still ◽  
Milagritos D Tapia ◽  
Sharon M Tennant ◽  
Mamadou Sylla ◽  
Aliou Touré ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Tertiary Care ◽  
Case Fatality ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Hospitalized Children ◽  
Childhood Morbidity ◽  
Invasive Bacterial Infection ◽  
Microbiological Techniques ◽  
Culture Positive

Abstract Background Salmonella enterica bloodstream infections are an important cause of childhood morbidity and mortality, including in Mali. We report 17 years of surveillance for nontyphoidal and typhoidal S. enterica infections among inpatients and outpatients at l’Hôpital Gabriel Touré, the main source of pediatric tertiary care in Bamako, Mali. Methods Between June 2002 and December 2018, a blood culture was collected from 54 748 children aged ≤15 years with fever and/or suspected invasive bacterial infection who provided consent (38 152 inpatients, 16 596 outpatients). Bacterial pathogens were identified using standard microbiological techniques and serovars of S. enterica were determined by PCR and/or agglutination with antisera. Results Nontyphoidal Salmonella (NTS) was identified in 671 enrolled inpatients (1.8% of all enrolled inpatients, 13.8% of enrolled inpatients with a positive culture). S. Enteritidis, the most common NTS serovar, accounted for 38.5% of all NTS isolates (n = 258), followed by S. Typhimurium (31.7%, n = 213). The median (SD) age of children with a culture positive for NTS was 1.8 (3) years. Overall case fatality was 20.9%. An additional 138 inpatients (0.4%) had a positive culture for typhoidal Salmonella. NTS was identified in 11 outpatients (0.07%), while typhoidal Salmonella was found in 49 outpatients (0.3%). The annual incidence of invasive NTS disease decreased over the study period, but case fatality remained high. Conclusions Although incidence decreased, NTS remained a major cause of invasive bacterial infection and mortality among hospitalized children in Bamako, while typhoidal Salmonella was uncommon. Because 87% of NTS belonged to only 4 serovars, a multivalent vaccine may be an effective strategy to reduce the burden and mortality of invasive NTS.

Expression in Plants of a Bacterial Gene Coding for Glyphosate Resistance

Weed Science ◽  
1987 ◽  
Vol 35 (S1) ◽  
pp. 19-23 ◽  
Author(s):  
Gregory A. Thompson ◽  
William R. Hiatt ◽  
Daniel Facciotti ◽  
David M. Stalker ◽  
Luca Comai
Keyword(s):  
Single Amino Acid ◽  
Kinetic Properties ◽  
Epsp Synthase ◽  
Bacterial Gene ◽  
Gene Coding ◽  
Bacterial Enzyme ◽  
Genetically Engineer ◽  
Single Amino Acid Change ◽  
Low Sensitivity ◽  
Dna Vectors

The target site of glyphosate [N-(phosphonomethyl)glycine] inhibition in plants and bacteria is 5-enolpyruvylshikimate 3-phosphate (EPSP) synthase. Our strategy for developing glyphosate-resistant crops has been to genetically engineer plants with a gene that codes for EPSP synthase with low sensitivity in glyphosate. We cloned such a gene from thearoAlocus of a glyphosate-resistant mutagenized strain ofSalmonella typhimurium.The enzyme encoded by this gene has a single amino acid change resulting in lower affinity for glyphosate and higher affinity for substrates than either plant or wild-type bacterial counterpart. A chimaeric gene containing the mutantaroAgene behind the octopine synthase promoter was constructed and integrated intoAgrobacteriumT-DNA vectors. Analysis of gall tissue fromBrassica campestrisL. (turnip rape) infected withA. tumefaciensK12 containing this chimaera showed mRNA and protein expressed from the bacterial gene; 50% of the total EPSP synthase activity present had kinetic properties of the mutant bacterial enzyme. Tobacco (Nicotiana tabacumL. ‘Xanthi′) plants have been regenerated from cocultivation withA. rhizogenescontaining the same construct; analysis indicates expression of the gene and enhanced tolerance to glyphosate.

scholarly journals Fatores Clínico-Laboratoriais Associados ao Internamento Prolongado em Doentes com Celulite/Erisipela

2019 ◽  
Vol 32 (6) ◽  
pp. 448
Author(s):  
Ângela Roda ◽  
Ana Marcos Pinto ◽  
Ana Rita Filipe ◽  
Ana Rita Travassos ◽  
João Pedro Freitas ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Clinical Investigation ◽  
Positive Culture ◽  
Length Of Hospital Stay ◽  
Dermatology Department ◽  
Prolonged Stay ◽  
Reactive Protein ◽  
Prolonged Hospitalization ◽  
Positive Culture Result ◽  
Santa Maria

Introduction: Cellulitis and erysipelas represent the most frequent cause of hospitalization in the dermatology department of Santa Maria Hospital in Lisbon, Portugal. The aim of this study was to investigate whether patient demographics, comorbidities, previous episodes of cellulitis/erysipelas, the presence of complications, laboratory markers at admission, microbial isolation or previous use of antibiotics, are associated with prolonged stays.Material and Methods: Retrospective analysis, including patients admitted with cellulitis/erysipelas in the inpatient dermatology department of Santa Maria Hospital between July 1st 2012 and June 30th 2017.Results: There were 372 admissions, corresponding to 348 patients. The median length of stay was 11 days. Increased age (p = 0.002, OR 1.03, 95% CI 1.01 – 1.04), previous episode of cellulitis/erysipelas requiring hospitalization (p = 0.005, OR 4.81, 95% CI 1.63 – 14.23), the presence of cellulitis/erysipelas-associated complications (p = 0.001, OR 3.28, 95% CI 1.63 – 6.59), leukocytosis (p = 0.049, OR 1.81, 95% CI 1.00 – 3.30), high levels of C-reactive protein (p = 0.035, OR 1.03, 95% CI 1.00 – 1.06) and a positive culture result (p = 0.002, OR 2.59, 95% CI 1.41 – 4.79) were associated with prolonged hospitalization.Discussion: Prolonged hospitalization for cellulitis/erysipelas is associated with higher costs, additional clinical investigation, invasive treatments, prolonged courses of antibiotic therapy, risk of nosocomial infections, and delayed return to activities of daily living. Thus, the investigation of clinical-laboratory factors associated with prolonged hospitalization for cellulitis / erysipelas is essential and may beuseful for the construction of a severity score.Conclusion: The knowledge of the characteristics that are associated with prolonged stay among patients with cellulitis/erysipelas may be relevant to improve health care, by reducing the length of hospital stay and associated risks and costs.

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