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I Streptobacillus moniliformis i , the causative agent of rat bite fever (along with I Spirillum minus i in Asia) and Haverhill fever, exhibits a world-wide distribution and carriage in the oral cavity and upper respiratory of rats and other rodents is common. 13 Torres-Miranda D, Moshgriz M, Siegel M. Streptobacillus moniliformis mitral valve endocarditis and septic arthritis: The challenges of diagnosing rat-bite fever endocarditis. Common clinical features of rat bite fever/Haverhill fever include fever, rash, arthritis, headache and myalgias, with an incubation period of 3-10 days. Nausea and vomiting and pharyngitis are more commonly observed in Haverhill fever than rat bite fever. [Extracted from the article]

Background: The microbiology of pancreatoduodenectomy is challenging and published guidelines regarding perioperative antimicrobial prophylaxis are variable with poor adherence. Methods: A retrospective analysis of the microbiological results of 294 consecutive patients who underwent pancreatoduodenectomy was performed. Intraoperative specimen culture results were available for 50 patients and their medical records were reviewed to determine the following demographics and factors; age; sex; tumour location, histopathology, grade and stage; neoadjuvant chemotherapy and radiotherapy; preoperative biliary stenting; surgeon; surgery type and antimicrobial prophylaxis coverage. Outcomes assessed included; post‐operative infections, mortality (all and 90‐day), and intensive care unit and hospital admission durations. Univariate analysis with chi‐squared testing was performed. Results: Intraoperative specimen cultures were positive in 48 (96%) patients and polymicrobial in 45 (90%) patients with a predominance of Enterobacteriaceae (38/76%), Enterococcus species (27/54%), and Candida species (25/50%). Isolates were potentially susceptible to the current perioperative antimicrobial prophylaxis regimen of ceftriaxone with or without metronidazole in only six patients. However, only neoadjuvant radiotherapy was associated with statistically significant increased intensive care unit and hospital admission durations. Conclusion: Although this study was probably underpowered to detect any statistically significant associations, perioperative antimicrobial prophylaxis coverage of the operative field microbiological milieu of pancreatoduodenectomy is logical and current guidelines may be inadequate. [ABSTRACT FROM AUTHOR]