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ABSTRACT: Objectives: The objective is to explore the correlation between rectal swab culture and the overall 30-d survival of hematologic patients diagnosed with carbapenem-resistant organism (CRO) bloodstream infection. Methods: A total of 434 haematological patients who were complicated with Gram-negative bacilli (GNB) bloodstream infections (BSIs) caused by Gram-negative bacteria between January 2020 and December 2021 were included in our retrospective study. Based on their drug susceptibility results, we classified patients into CRO BSIs and non-CRO BSIs cases. Through group comparison, to uncover the correlation between the positive screening of rectal swabs and reducing the mortality of CRO BSI in patients with haematological diseases. Results: Among the 434 cases of Gram-negative bacteria bloodstream infection, 96 were identified as carbapenem-resistant bloodstream infection, which consisted of 57 cases of carbapenem-resistant Klebsiella pneumoniae (CR-KP), 19 cases of carbapenem-resistant Pseudomonas aeruginosa (CR-PA), 11 cases of carbapenem-resistant Escherichia coli (CR-CO), 5 cases of carbapenem-resistant Acinetobacter baumannii (CR-AB), and 4 cases of other Enterobacteriaceae. Before the onset of CRO bloodstream infection, rectal swab cultures were conducted on 36 patients, and the positive result rate was 75.0% (27/36), with 20 cases of CR-KP, 6 cases of CR-CO, and one case of carbapenem-resistant Enterobacter cloacae. It was observed that the rectal and blood cultures had matching outcomes in 75.0% of cases. The mortality rate within 30 d for CRO BSIs was 53.1% (51/96), while for carbapenem-resistant Enterobacteriaceae (CRE) BSIs it was 62.5% (45/72). Univariate analysis showed that 30-d mortality was significantly reduced when there were positive rectal culture results preceding bloodstream infection (P < 0.001), as well as preemptive anti-infection treatment (P < 0.001). Multivariate analysis demonstrated that preemptive adjustment to an effective antibiotic regimen, guided by positive rectal culture results, had a significant effect on decreasing 30-d mortality following CRO BSIs (P = 0.002). Furthermore, for the management of CRE BSIs, antibiotic treatments utilising ceftazidime/avibactam (CAV/AVI) may be more beneficial compared to those that use tigecycline (TGC) or polymyxin (PMB). Conclusion: CRO BSI, especially CRE BSI, can be life-threatening for those with haematological diseases. Utilising rectal culture can effectively identify CRO strains with high sensitivity and specificity. Adjusting antibiotic treatment based on the preemptive positive rectal culture results may significantly decrease 30-d mortality rates for haematological patients with CRO BSIs.

Introduction  Improved evidence-based guidelines on the optimal type and duration of antibiotics for patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) are needed. We analyze the infectious complications among a large cohort of EETS patients undergoing a standardized regimen of cefazolin for 24 hours, followed by cephalexin for 7 days after surgery (clindamycin if penicillin/cephalosporin allergic). Methods  A retrospective review of 132 EETS patients from 2018 to 2020 was conducted. Patient, tumor, and surgical characteristics were collected, along with infection rates. Multivariate logistic regression determined the variable(s) independently associated with infectious outcomes. Results  Nearly all patients (99%) received postoperative antibiotics with 78% receiving cefazolin, 17% receiving cephalexin, 3% receiving clindamycin, and 2% receiving other antibiotics. Fifty-three patients (40%) had an intraoperative cerebrospinal fluid (CSF) leak, and three patients (2%) developed a postoperative CSF leak requiring surgical repair. Within 30 days, no patients developed meningitis. Five patients (4%) developed sinusitis, two patients (3%) developed pneumonia, and one patient (1%) developed cellulitis at a peripheral intravenous line. Two patients (2%) developed an allergy to cephalexin, requiring conservative management. After adjustment for comorbidities and operative factors, presence of postoperative infectious complications was independently associated with increased LOS ( β  = 3.7 days; p  = 0.001). Conclusion  Compared with reported findings in the literature, we report low rates of infectious complications and antibiotic intolerance, despite presence of a heavy burden of comorbidities and high intraoperative CSF leak rates among our cohort. These findings support our standardized 7-day perioperative antibiotic regimen.

Objectives: Metagenomic next-generation sequencing (mNGS) technology is helpful for the early diagnosis of infective endocarditis, especially culture-negative infective endocarditis, which may guide clinical treatment. The purpose of this study was to compare the presence of culture-negative infective endocarditis pathogens versus culture-positive ones, and whether mNGS test results could influence treatment regimens for patients with routine culture-negative infective endocarditis. Methods: The present study enrolled patients diagnosed with infective endocarditis and tested for mNGS in the First Affiliated Hospital of Zhengzhou University from February 2019 to February 2022 continuously. According to the culture results, patients were divided into culture-negative group (Group CN, n=18) and culture-positive group (Group CP, n=32). The baseline characteristics, clinical data, pathogens, 30 day mortality and treatment regimen of 50 patients with infective endocarditis were recorded and analyzed. Results: Except for higher levels of PCT in the Group CN [0.33 (0.16-2.74) ng/ml vs. 0.23 (0.12-0.49) ng/ml, P=0.042], there were no significant differences in the basic clinical data and laboratory examinations between the two groups (all P>0.05). The aortic valve and mitral valve were the most involved valves in patients with infective endocarditis (aortic valve involved: Group CN 10, Group CP 16; mitral valve involved: Group CN 8, Group CP 21; P>0.05) while 9 patients had multiple valves involved (Group CN 2, Group CP 7; P>0.05). The detection rate of non-streptococci infections in the Group CN was significantly higher than that in the Group CP (9/18 vs. 3/32, P=0.004). There was no significant difference in patients with heart failure hospitalization and all-cause death at 30 days after discharge (3 in Group CN vs. 4 in Group CP, P>0.05). It is worth noting that 10 patients with culture-negative infective endocarditis had their antibiotic regimen optimized after the blood mNGS. Conclusions: Culture-negative infective endocarditis should be tested for mNGS for early diagnosis and to guide clinical antibiotic regimen. [ABSTRACT FROM AUTHOR]

Summary: This publication provides a thorough analysis of the most relevant topics concerning the management of latent tuberculosis when using biologic and targeted synthetic Disease Modifying Antirheumatic Drugs (DMARDs) by a multidisciplinary, select committee of Austrian physicians. The committee includes members of the Austrian Societies for Rheumatology and Rehabilitation, Pulmonology, Infectiology, Dermatology and Gastroenterology. Consensus was reached on issues regarding screening and treatment of latent tuberculosis and includes separate recommendations for each biologic and targeted synthetic DMARD. [ABSTRACT FROM AUTHOR]

Objective: Opioid abuse is widespread throughout the world. Aspiration pneumonia is a serious problem following opioid overdose and poisoning. This study aimed to evaluate the safety and effectiveness of antimicrobial management of opioid-overdose induced aspiration pneumonia in a referral poisoning management university hospital in Iran. Methods: In an observational cross-sectional study (September–March 2019), opioid poisoned patients diagnosed with aspiration pneumonia within a maximum of 48 h of their overdose were evaluated regarding several variables, including the level of consciousness on admission, drug regimen used for the treatment of aspiration pneumonia, and its appropriateness, and the correctness of the used antibiotics dose and the therapeutic outcome. Findings: During the study, 53 eligible patients were identified and included in the study. The most frequently abused opioids were methadone (60.4%) and opium (17%). “Ceftriaxone + Clindamycin” (54.7%) and “Meropenem + Vancomycin” (9.5%) were the most frequently administered regimens. Regarding treatment outcome, most cases (n = 36, 67.9%) were discharged with a stable and satisfying medical status, while 3.8% of the cases (n = 2) died. Conclusion: The use of antibiotics in the treatment of aspiration pneumonia in hospitalized patients with opioid overdose in our referral university hospital is associated with notable antibiotic regimen choice issues. The implementation of strategies for improving the pattern of antibiotic prescribing for these patients is necessary.

Ronnawich Suphansatit,1 Suriyon Uitrakul2 1Department of Pharmacy, Phang-Nga Hospital, Thai Chang, Phang Nga, Thailand; 2Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Thasala, Nakhon Si Thammarat, ThailandCorrespondence: Suriyon UitrakulDepartment of Pharmaceutical Care, School of Pharmacy, Walailak University, Thasala, Nakhon Si Thammarat 80160, ThailandTel +66 7567 2822Email Suriyon.ui@wu.ac.thPurpose: This retrospective pilot study aimed to investigate the antibiotic regimens used to treat Acinetobacter baumannii infections at a secondary hospital in southern Thailand. Additionally, the clinical outcomes and mortality of each regimen are described.Patients and Methods: The medical charts of all patients admitted to Phang-Nga Hospital, Thailand, between 1 January 2019 and 31 May 2020 due to Acinetobacter baumannii infection were reviewed. Data were collected on the antibiotics that patients received before and after sensitivity testing, along with the clinical cure, mortality rates, and nephrotoxicity.Results: Of the 32 inpatients recruited in the study, the most prescribed antibiotic regimen for empirical therapy was beta-lactam/beta-lactamase inhibitor monotherapy (22%), and for definitive therapy was meropenem monotherapy (28%). Combination therapy with two, three, or four antibiotics was prescribed less than 50% of cases for both empirical and definitive therapy. Moreover, the results indicated that patients receiving combination therapy had a lower clinical response and higher mortality than those receiving monotherapy. Furthermore, regimens containing colistin did not provide a higher clinical cure compared to those without colistin.Conclusion: The results of this pilot study support the use of monotherapy antibiotic regimens, including ceftazidime and meropenem, for the treatment of Acinetobacter baumannii infections in secondary hospitals. However, as these results are from a single hospital with limited number of patients, the application of the results should be done carefully. More patient data from other hospitals will be collected in the next phase of this study.Keywords: Acinetobacter baumannii, antibiotic regimen, southern Thailand

Background: Carbapenemase-producing Klebsiella pneumoniae (CpKP) has been implicated as an increasing threat to public health. CpKP is a ubiquitous, opportunistic pathogen that causes both hospital and community acquired infections. This organism hydrolyzes carbapenems and other β-lactams and thus, leading to multiple resistance to these antibiotics. Despite the difficult to treat nature of infections caused by CpKP, little has been discussed on the mortality, clinical response and microbiological success rates associated with various antibiotic regimen against CpKP. This meta-analysis was designed to fill the paucity of information on the clinical impact of various antibiotic therapeutic regimens among patients infected with CpKP. Materials and Methods: Literature in most English databases such as Medline through PubMed, Google Scholar, Web of Science, Cochrane Library and EMBASE, were searched for most studies published between the years 2015–2020. Data were analyzed using the R studio 2.15.2 statistical software program (metaphor and meta Package, Version 2) by random-effects (DerSimonian and Laird) model. Results: Twenty-one (21) studies including 2841 patients who had been infected with CpKP were analysed. The overall mortality rate was 32.2% (95% CI = 26.23–38.87; I 2 = 89%; p -value ≤ 0.01, Number of patients = 2716). Pooled clinical and microbiological success rates were 67.6% (95% CI = 58.35–75.64, I 2 = 22%, p -value = 0.25, Number of patients = 171) and 74.9% (95% CI = 59.02–86.09, I 2 = 53%, p -value = 0.05, Number of patients = 121), respectively. CpKP infected patients treated with combination therapy are less likely to die as compared to those treated with monotherapy (OR = 0.55, 95% CI = 0.35–0.87, p -value = 0.01, Number of patients = 1,475). No significant difference existed between the mortality rate among 60years and above patients vs below 60years (OR = 0.84, 95% CI = 0.28–2.57, p -value = 0.76, 6 studies, Number of patients = 1,688), and among patients treated with triple therapy vs. double therapy (OR = 0.50, 95% CI = 0.21–1.22, p -value = 0.13, 2 studies, Number of patients = 102). When compared with aminoglycoside-sparing therapies, aminoglycoside-containing therapies had positive significant outcomes on both mortality and microbiological success rates. Conclusion: New effective therapies are urgently needed to help fight infections caused by this organism. The effective use of various therapeutic options and the strict implementation of infection control measures are of utmost importance in order to prevent infections caused by CpKP. Strict national or international implementation of infection control measures and treatment guidelines will help improve healthcare, and equip governments and communities to respond to and prevent the spread of infectious diseases caused by CpKP. [ABSTRACT FROM AUTHOR]

Introduction: Surgical extraction of third molars is carried out in dentistry worldwide and is mostly performed under local anaesthesia on an outpatient basis. In minor oral surgery, various antibiotic regimens have been used. Antibiotic medication can be given immediately after surgery and continued for several days or as single or multiple doses several days before surgery as a preventative measure. Antibiotics can also be given prior to surgery and continued after surgery. Aim: To evaluate the effectiveness of single dose preoperative injection amoxicillin 1 gm administered 1 hour before the procedure, over routine 5 days postoperative peroral antibiotic therapy in decreasing the frequency of postoperative complications after third molar surgery. Materials and Methods: This randomised clinical trial was conducted at JSS Dental College and Hospital, Mysuru, Karnataka, India, during the period of August 2020 to April 2021, among 30 patients with bilaterally impacted mandibular third molars. Each subject underwent removal of impacted tooth on one side with oral amoxicillin 500 mg thrice daily for 5 days postsurgically (Group A) and that on the other side was removed after two weeks with a single dose intravenous (i.v.) 1 gram Inj. amoxicillin 1 hour preoperatively (Group B). Postoperatively each patient was evaluated on the 3rd, 7th and 14th postoperative day for variables like surgical site infection and alveolar osteitis. Oedema, erythema and Purulent Discharge (PD) were the parameters assessed to diagnose surgical site infection. Pain greater than 36 hours, Loss Of Blood Clot (LOBC) and Evidence of Exposed Bone (EEB) were the parameters to diagnose alveolar osteitis. Chi-square test was used for statistical analysis. Results: Amongst 30 patients selected for this study, 14(46.7%) were females and 16 (53.3%) were males with a mean age of 25.17±5.74 years. In 30 subjects, oedema, erythema and pain more than 36 hours were evident by the (p-value=0.559, 0.80, 0.436 respectively on 3rd day) which resolved completely by 14th postoperative day. There was no occurrence of alveolar osteitis and surgical site infection among both groups. Conclusion: Inj. amoxicillin 1 gm administered 1 hour prior surgery was found to be equally effective as compared to capsule amoxicillin 500 mg administered per orally thrice daily for 5 days. Hence, Inj. amoxicillin 1 gm an hour prior surgery was found to be a viable option. [ABSTRACT FROM AUTHOR]

Background: Perforated appendicitis is the most common cause of intraabdominal abscess (IAA) in children. The optimal postoperative antibiotic regimen to reduce IAA has evolved in the last decade from triple-drug to 2- drug therapy (CM). Recent retrospective studies show decreased infectious complications with monotherapy PT. To date prospective comparative data are lacking. Therefore, a prospective randomized trial comparing PT versus CM was conducted. Methods: A multi-institutional prospective randomized trial was performed in children with perforated appendicitis comparing postoperative antibiotic regimens PT or CM. The primary outcome was 30-day postoperative IAA formation. Perforation was strictly defined as a hole in the appendix or fecalith in the abdomen, documented with intraoperative photographs. Results: One hundred sixty-two patients were enrolled during the study period. No differences in age, weight, or duration of presenting symptoms were identified. In addition, length of stay, duration of intravenous antibiotic treatment, discharge oral antibiotic treatment, and antibiotic-related complications did not differ between groups. Compared to the CM group, the PT group had significantly lower IAA rate [6.1% vs 23.8%, odd ratio (OR) 4.80, P = 0.002], lower postoperative computed tomography imaging rate (13.9% vs 29.3%, OR 2.57, P = 0.030), and fewer emergency room visits (8.8% vs 26.4%, OR 3.73, P = 0.022). Multivariate logistic regression analysis found the use of CM versus PT (OR 9.21, P = 0.021) to be the most significant predictor for developing IAA. Conclusions: In children with perforated appendicitis, postoperative monotherapy with PT is superior to standard 2-drug therapy with CM and does not increase antibiotic-related complications or antibiotic exposure duration. [ABSTRACT FROM AUTHOR]

Background: Carbapenemase-producing Klebsiella pneumoniae (CpKP) has been implicated as an increasing threat to public health. CpKP is a ubiquitous, opportunistic pathogen that causes both hospital and community acquired infections. This organism hydrolyzes carbapenems and other β-lactams and thus, leading to multiple resistance to these antibiotics. Despite the difficult to treat nature of infections caused by CpKP, little has been discussed on the mortality, clinical response and microbiological success rates associated with various antibiotic regimen against CpKP. This meta-analysis was designed to fill the paucity of information on the clinical impact of various antibiotic therapeutic regimens among patients infected with CpKP.Materials and Methods: Literature in most English databases such as Medline through PubMed, Google Scholar, Web of Science, Cochrane Library and EMBASE, were searched for most studies published between the years 2015–2020. Data were analyzed using the R studio 2.15.2 statistical software program (metaphor and meta Package, Version 2) by random-effects (DerSimonian and Laird) model.Results: Twenty-one (21) studies including 2841 patients who had been infected with CpKP were analysed. The overall mortality rate was 32.2% (95%CI = 26.23–38.87; I2 = 89%; p-value ≤ 0.01, Number of patients = 2716). Pooled clinical and microbiological success rates were 67.6% (95%CI = 58.35–75.64, I2 = 22%, p-value = 0.25, Number of patients = 171) and 74.9% (95%CI = 59.02–86.09, I2 = 53%, p-value = 0.05, Number of patients = 121), respectively. CpKP infected patients treated with combination therapy are less likely to die as compared to those treated with monotherapy (OR = 0.55, 95%CI = 0.35–0.87, p-value = 0.01, Number of patients = 1,475). No significant difference existed between the mortality rate among 60years and above patients vs below 60years (OR = 0.84, 95%CI = 0.28–2.57, p-value = 0.76, 6 studies, Number of patients = 1,688), and among patients treated with triple therapy vs. double therapy (OR = 0.50, 95%CI = 0.21–1.22, p-value = 0.13, 2 studies, Number of patients = 102). When compared with aminoglycoside-sparing therapies, aminoglycoside-containing therapies had positive significant outcomes on both mortality and microbiological success rates.Conclusion: New effective therapies are urgently needed to help fight infections caused by this organism. The effective use of various therapeutic options and the strict implementation of infection control measures are of utmost importance in order to prevent infections caused by CpKP. Strict national or international implementation of infection control measures and treatment guidelines will help improve healthcare, and equip governments and communities to respond to and prevent the spread of infectious diseases caused by CpKP.

Introduction: Surgical extraction of third molars is carried out in dentistry worldwide and is mostly performed under local anaesthesia on an outpatient basis. In minor oral surgery, various antibiotic regimens have been used. Antibiotic medication can be given immediately after surgery and continued for several days or as single or multiple doses several days before surgery as a preventative measure. Antibiotics can also be given prior to surgery and continued after surgery. Aim: To evaluate the effectiveness of single dose preoperative injection amoxicillin 1 gm administered 1 hour before the procedure, over routine 5 days postoperative peroral antibiotic therapy in decreasing the frequency of postoperative complications after third molar surgery. Materials and Methods: This randomised clinical trial was conducted at JSS Dental College and Hospital, Mysuru, Karnataka, India, during the period of August 2020 to April 2021, among 30 patients with bilaterally impacted mandibular third molars. Each subject underwent removal of impacted tooth on one side with oral amoxicillin 500 mg thrice daily for 5 days postsurgically (Group A) and that on the other side was removed after two weeks with a single dose intravenous (i.v.) 1 gram Inj. amoxicillin 1 hour preoperatively (Group B). Postoperatively each patient was evaluated on the 3rd, 7th and 14th postoperative day for variables like surgical site infection and alveolar osteitis. Oedema, erythema and Purulent Discharge (PD) were the parameters assessed to diagnose surgical site infection. Pain greater than 36 hours, Loss Of Blood Clot (LOBC) and Evidence of Exposed Bone (EEB) were the parameters to diagnose alveolar osteitis. Chi-square test was used for statistical analysis. Results: Amongst 30 patients selected for this study, 14 (46.7%) were females and 16 (53.3%) were males with a mean age of 25.17±5.74 years. In 30 subjects, oedema, erythema and pain more than 36 hours were evident by the (p-value=0.559, 0.80, 0.436 respectively on 3rd day) which resolved completely by 14th postoperative day. There was no occurrence of alveolar osteitis and surgical site infection among both groups. Conclusion: Inj. amoxicillin 1 gm administered 1 hour prior surgery was found to be equally effective as compared to capsule amoxicillin 500 mg administered per orally thrice daily for 5 days. Hence, Inj. amoxicillin 1 gm an hour prior surgery was found to be a viable option.

Biofilms are responsible for most chronic infections and are highly resistant to antibiotic treatments. Previous studies have demonstrated that periodic dosing of antibiotics can help sensitize persistent subpopulations and reduce the overall dosage required for treatment. Because the dynamics and mechanisms of biofilm growth and the formation of persister cells are diverse and are affected by environmental conditions, it remains a challenge to design optimal periodic dosing regimens. Here, we develop a computational agent-based model to streamline this process and determine key parameters for effective treatment. We used our model to test a broad range of persistence switching dynamics and found that if periodic antibiotic dosing was tuned to biofilm dynamics, the dose required for effective treatment could be reduced by nearly 77%. The biofilm architecture and its response to antibiotics were found to depend on the dynamics of persister cells. Despite some differences in the response of biofilm governed by different persister switching rates, we found that a general optimized periodic treatment was still effective in significantly reducing the required antibiotic dose. As persistence becomes better quantified and understood, our model has the potential to act as a foundation for more effective strategies to target bacterial infections.

Objectives: The objective is to explore the correlation between rectal swab culture and the overall 30-d survival of hematologic patients diagnosed with carbapenem-resistant organism (CRO) bloodstream infection., Methods: A total of 434 haematological patients who were complicated with Gram-negative bacilli (GNB) bloodstream infections (BSIs) caused by Gram-negative bacteria between January 2020 and December 2021 were included in our retrospective study. Based on their drug susceptibility results, we classified patients into CRO BSIs and non-CRO BSIs cases. Through group comparison, to uncover the correlation between the positive screening of rectal swabs and reducing the mortality of CRO BSI in patients with haematological diseases., Results: Among the 434 cases of Gram-negative bacteria bloodstream infection, 96 were identified as carbapenem-resistant bloodstream infection, which consisted of 57 cases of carbapenem-resistant Klebsiella pneumoniae (CR-KP), 19 cases of carbapenem-resistant Pseudomonas aeruginosa (CR-PA), 11 cases of carbapenem-resistant Escherichia coli (CR-CO), 5 cases of carbapenem-resistant Acinetobacter baumannii (CR-AB), and 4 cases of other Enterobacteriaceae. Before the onset of CRO bloodstream infection, rectal swab cultures were conducted on 36 patients, and the positive result rate was 75.0% (27/36), with 20 cases of CR-KP, 6 cases of CR-CO, and one case of carbapenem-resistant Enterobacter cloacae. It was observed that the rectal and blood cultures had matching outcomes in 75.0% of cases. The mortality rate within 30 d for CRO BSIs was 53.1% (51/96), while for carbapenem-resistant Enterobacteriaceae (CRE) BSIs it was 62.5% (45/72). Univariate analysis showed that 30-d mortality was significantly reduced when there were positive rectal culture results preceding bloodstream infection (P < 0.001), as well as preemptive anti-infection treatment (P < 0.001). Multivariate analysis demonstrated that preemptive adjustment to an effective antibiotic regimen, guided by positive rectal culture results, had a significant effect on decreasing 30-d mortality following CRO BSIs (P= 0.002). Furthermore, for the management of CRE BSIs, antibiotic treatments utilising ceftazidime/avibactam (CAV/AVI) may be more beneficial compared to those that use tigecycline (TGC) or polymyxin (PMB)., Conclusion: CRO BSI, especially CRE BSI, can be life-threatening for those with haematological diseases. Utilising rectal culture can effectively identify CRO strains with high sensitivity and specificity. Adjusting antibiotic treatment based on the preemptive positive rectal culture results may significantly decrease 30-d mortality rates for haematological patients with CRO BSIs., (Copyright © 2023. Published by Elsevier Ltd.)

Objectives: To evaluate and compare the effect of nonsurgical periodontal therapy in conjunction with 2 different antibacterial agents on clinical and immunological parameters in aggressive periodontitis (AgP) patients. Method and Materials: Thirty-one AgP patients underwent clinical examination that included plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). GCF (gingival crevicular fluid) samples were collected and assayed for PGE2, IL-1β, and TNFα. Nonsurgical periodontal therapy was performed. The patients received doxycycline (doxy group) or metronidazole plus amoxicillin (am-met group). After completion of the mechanical phase of therapy, patients were seen biweekly for oral hygiene reinforcement. After 12 weeks, clinical measurements and GCF sampling were repeated. Results: The combined mechanical and antimicrobial therapy resulted in overall improvement in all clinical parameters; mean PPD reduction of 0.74 ± 0.1 mm and mean CAL gain 0.86 ± 0.1 mm were both statistically significant (P = .0001). Marked reduction was observed for PGE2 and IL-1β, but not TNFα. There was no significant difference between the 2 groups at baseline or final examination, except for PGE2 at final examination: It was significantly lower for the doxy group (83.61 ± 5.8 ng) than for the am-met group (124.08 ± 15.8 ng), P = .0202. Conclusion: Both treatment protocols resulted in significant improvements in the clinical and immunological parameters. When combined mechanical and antimicrobial protocol is desired and microbial cultures are not available, the use of both antibiotic regimens is recommended; the treatment of choice should be based on compliance, allergies, and potential side effects. [ABSTRACT FROM AUTHOR]

Background Context: There is growing concern that the microbial profile of surgical site infection (SSI) in the setting of prophylactic vancomycin powder may favor more resistant and uncommon organisms.Purpose: To demonstrate the impact of prophylactic intraoperative vancomycin powder on microbial profile, antibiotic regimen, length of stay (LOS), and reoperation rate in spine surgical site infection.Study Design And/or Setting: Retrospective cohort study.Patient Sample: the study included 115 postoperative spine patients who were required to return to the operating room for SSI.Outcome Measures: The outcome measures were microbial profile, reoperation rate, antibiotic regimen, and LOS for patients with postoperative spine infection who either did (treated) or did not (untreated) receive prophylactic vancomycin powder during their index procedure.Methods: A retrospective review of patients who underwent posterior thoracic and/or lumbar spine surgery between 2010 and 2017 was conducted. Those undergoing surgical treatment of SSI were identified, and patients were divided into two groups - those who were treated with intraoperative vancomycin (treated) and those who were not (untreated). The organism profile for each group was compared. The average LOS, reoperation rate, and number of patients requiring more than 1 antibiotic were calculated for each patient in both groups.Results: There were 5,909 procedures performed. One hundred and fifteen SSIs were identified, resulting in a 1.9% infection rate. Prophylactic vancomycin powder was used in the index procedure for 42 of those cases. 23.8% of cultures in the vancomycin group were polymicrobial and 16.7% were gram-negative compared with 9.6% (p=0.039) and 4.1% (p=0.021) in the untreated group, respectively. In the vancomycin-treated group, 26.1% of patients underwent repeat irrigation and debridement compared with 38.4% in the untreated group (p=0.184). The percentage of patients in the treatment and untreated group who required more than 1 antibiotic was 26.0% and 26.1%, respectively (p=0.984). Mean LOS in the treatment group was 8.0 versus 7.9 for the untreated group (p=0.945) CONCLUSIONS: In this series, vancomycin powder was associated with a higher prevalence of gram-negative and polymicrobial organisms in patients that ultimately developed postoperative SSI. However, this did not adversely affect the need for multiple reoperations, antibiotic regimen, or LOS for these patients. [ABSTRACT FROM AUTHOR]

Objective: Various prophylactic antibiotic regimens are used in the management of preterm premature rupture of membranes. We investigated the efficacy and safety of these regimens in terms of maternal and neonatal outcomes., Data Sources: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 20, 2021., Study Eligibility Criteria: We included randomized controlled trials involving pregnant women with preterm premature rupture of membranes before 37 weeks of gestation and a comparison of ≥2 of the following 10 antibiotic regimens: control/placebo, erythromycin, clindamycin, clindamycin plus gentamicin, penicillins, cephalosporins, co-amoxiclav, co-amoxiclav plus erythromycin, aminopenicillins plus macrolides, and cephalosporins plus macrolides., Methods: Two investigators independently extracted published data and assessed the risk of bias with a standard procedure following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Network meta-analysis was conducted using the random-effects model., Results: A total of 23 studies that recruited a total of 7671 pregnant women were included. Only penicillins (odds ratio, 0.46; 95% confidence interval, 0.27-0.77) had significantly superior effectiveness for maternal chorioamnionitis. Clindamycin plus gentamicin reduced the risk of clinical chorioamnionitis, with borderline significance (odds ratio, 0.16; 95% confidence interval, 0.03-1.00). By contrast, clindamycin alone increased the risk of maternal infection. For cesarean delivery, no significant differences were noted among these regimens., Conclusion: Penicillins remain the recommended antibiotic regimen for reducing maternal clinical chorioamnionitis. The alternative regimen includes clindamycin plus gentamicin. Clindamycin should not be used alone., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: The impact of E. coli in causing peripartum infections has been increasing due to rising ampicillin resistance. In this study, we compared maternal and neonatal outcomes of women with prolonged rupture of membranes (ROM >18h) and intrapartum fever, according to two antibiotic regimens they received, and describe the bacterial distribution focusing on risk factors for Enterobacteriaceae-related infectious morbidity., Study Design: This 10-year retrospective study of women with ROM >18h and intrapartum fever included 62 women who were treated with ampicillin and gentamicin due to suspected intraamniotic infection and 79 without these signs who were treated with ampicillin alone. The primary outcomes were endometritis and neonatal early-onset sepsis (EOS) rates. Outcomes were compared using univariate and multivariate analyses., Results: Among women who received ampicillin alone compared with dual therapy, rates were higher of endometritis (16.5% vs. 3.2%, p<0.001), neonatal early onset sepsis (7.5% vs. 0%, p=0.03), Enterobacteriaceae positive placental swab culture (67.9% vs. 15.7%, p<0.001), and histopathological subchorionitis (25.3% vs. 8.0%, p=0.008). Over 83% of Enterobacteriaceae isolates were ampicillin-resistant. Gestational age at delivery >41 weeks, meconium at delivery, ROM >24h and treatment with a single antibiotic agent were associated with the presence of a positive Enterobacteriaceae placental swab culture., Conclusion: Ampicillin compared to dual treatment in women with prolonged ROM and fever might promote the growth of ampicillin-resistant Enterobacteriaceae (including E.coli) and increase risks of maternal and neonatal infectious morbidity., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: Cardiovascular implantable electronic device (CIED) infections are increasing in numbers. The objective was to review the clinical presentation and outcome in patients affected with CIED infections with either local pocket or systemic presentation.Design: All device removals due to CIED infection during the period from 2005 to 2012 were retrospectively reviewed. CIED infections were categorized as systemic or pocket infections. Treatment included complete removal of the device, followed by antibiotic treatment of six weeks.Results: Seventy-one device removals due to infection (32 systemic and 39 pocket infections) were recorded during the study period. Median follow-up time was 26 (IQR 9-41) months, 30 day and 12 month mortality were 4% and 14%, respectively. There was no long-term difference in mortality between patients with pocket vs. systemic infection (p = 0.48). During follow-up no relapses and two cases of new infections were noted (2.8%).Conclusions: CIED infection with systemic or pocket infection was difficult to distinguish in clinical presentation and outcome. Complete device removal and antibiotic treatment of long duration was safe and without relapses. [ABSTRACT FROM AUTHOR]

Fungal infections have a crude mortality rate of 40% among immunocompromised patients, who are very susceptible due to drug resistant yeast strains and delayed diagnosis. In fact, in the United States alone, annual therapeutic treatments cost $2.8 billion. This study aims to develop preventive treatments to complement established infection control for fungal infections. The hypothesis was that the combination of probiotics with cinnamon would be the most effective treatment. Various combinations and concentrations of overthe- counter supplements were evaluated in their ability to inhibit yeast and detrimental bacterial growth while proliferating beneficial bacteria. Saccharomyces, E. coli, and B. megaterium were grown in petri dishes to represent detrimental yeast, beneficial bacteria, and detrimental intestinal bacteria respectively. By measuring the zone of inhibition, this study shows that probiotics recreate an oxygenated, nonacidic, and beneficial bacterial habitat without interfering with the antifungal. The combination of oil of oregano (Origanum syriacum var. bevanii) with acidophilus was the most effective treatment, not supporting the hypothesis. Overall, taking oil of oregano and acidophilus with the antibiotic regimen may reduce the risk of developing fungal infections. Further research into understanding the underlying mechanism of these results and evaluating the clinical implications of this combination is recommended. [ABSTRACT FROM AUTHOR]

Objectives: Metagenomic next-generation sequencing (mNGS) technology is helpful for the early diagnosis of infective endocarditis, especially culture-negative infective endocarditis, which may guide clinical treatment. The purpose of this study was to compare the presence of culture-negative infective endocarditis pathogens versus culture-positive ones, and whether mNGS test results could influence treatment regimens for patients with routine culture-negative infective endocarditis., Methods: The present study enrolled patients diagnosed with infective endocarditis and tested for mNGS in the First Affiliated Hospital of Zhengzhou University from February 2019 to February 2022 continuously. According to the culture results, patients were divided into culture-negative group (Group CN, n=18) and culture-positive group (Group CP, n=32). The baseline characteristics, clinical data, pathogens, 30 day mortality and treatment regimen of 50 patients with infective endocarditis were recorded and analyzed., Results: Except for higher levels of PCT in the Group CN [0.33 (0.16-2.74) ng/ml vs . 0.23 (0.12-0.49) ng/ml, P=0.042], there were no significant differences in the basic clinical data and laboratory examinations between the two groups (all P>0.05). The aortic valve and mitral valve were the most involved valves in patients with infective endocarditis (aortic valve involved: Group CN 10, Group CP 16; mitral valve involved: Group CN 8, Group CP 21; P>0.05) while 9 patients had multiple valves involved (Group CN 2, Group CP 7; P>0.05). The detection rate of non-streptococci infections in the Group CN was significantly higher than that in the Group CP (9/18 vs . 3/32, P=0.004). There was no significant difference in patients with heart failure hospitalization and all-cause death at 30 days after discharge (3 in Group CN vs . 4 in Group CP, P>0.05). It is worth noting that 10 patients with culture-negative infective endocarditis had their antibiotic regimen optimized after the blood mNGS., Conclusions: Culture-negative infective endocarditis should be tested for mNGS for early diagnosis and to guide clinical antibiotic regimen., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Li, Zhao, Tao, Yue and Zhao.)

Objectives: Urinary tract infections (UTIs) are one of the most common infections encountered in ambulatory care and inpatient settings. Although these infections are common, not all patients are prescribed an appropriate antibiotic or duration of therapy. The primary objective of this analysis was to evaluate the appropriateness of antibiotic selection and duration of therapy for patients in an adult internal medicine clinic diagnosed as having a UTI. Methods: We conducted a retrospective chart review (July 1, 2012-June 30, 2013) of adult patients in an internal medicine clinic who were diagnosed as having a UTI. Pediatric and pregnant patients were excluded from the analysis. Data pertaining to the classification of UTI, antibiotic regimen, urine culture, and renal function were collected. All of the data were analyzed to determine whether the prescribing habits at the internal medicine clinic aligned with Infectious Diseases Society of America (IDSA) guidelines for antibiotic selection and duration of therapy for acute uncomplicated cystitis, complicated cystitis, catheter-associated UTI, and pyelonephritis. Results: There were 269 records available for the analysis, with the majority of the cases being uncomplicated and complicated UTIs. Of 128 cases of patients with uncomplicated UTIs and 116 cases of patients with complicated UTIs, 64.1% and 42.2%, respectively, were prescribed appropriate first- or second-line therapy, which aligned with the recommendations of the IDSA. Regarding the individual components of the UTI treatment regimen, antibiotic selection had the highest frequency of appropriateness, with 97.6% of uncomplicated UTI cases and 90.5% of complicated UTI cases having been treated with a recommended antibiotic. In contrast, the treatment duration for uncomplicated and complicated UTIs had the lowest frequency of appropriateness, at 71.9% and 58.6%, respectively. Conclusions: Receiving an adequate antibiotic regimen for a UTI is important to prevent treatment failure and the emergence of resistant organisms. Overall, the studied antibiotic regimens prescribed for various UTIs diagnosed in the clinic did not align with the IDSA recommendations. [ABSTRACT FROM AUTHOR]

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