BACKGROUND: Inoculated blood volume and residual antibiotic effects are the key variables that influence successful blood cultures especially in patients receiving antibiotics. In our hospital we have inoculated BacT/Alert blood culture bottles with 5 mL of blood, but recent reports about the BacT/Alert system recommend an inoculation of up to 10 mL of blood. METHODS: We studied about 931 paired aerobic blood culture sets and each set was inoculated with 3 mL (3 mL bottle) and 7 mL (7 mL bottle) of blood. The positive rates, the yield and speed of detecting microorganisms in the culture bottles were compared to the specimen information of antibiotic usage. We also analyzed the antibiotic effect on each set of blood cultures by inoculation with standard microorganisms (E. coli ATCC 25922 and S. aureus ATCC 25923) in the used bottle sets. RESULTS: Positive cultures were obtained from 98 sets (10.5%) and 161 organisms grew. Of 931 blood culture bottle sets, 744 (79.9%) were obtained from patients on antibiotic therapy. The positive rate of blood culture bottles from patients receiving antibiotic therapy was significantly lower than those from patients who were not receiving antibiotic therapy (P<0.05). Irrespective of antibiotic usage before using the blood cultures, the 7 mL bottle showed a better yield and speed of detecting microorganisms than the 3 mL bottles, but it was not statistically significant (P>0.05). When culture bottles with no growth (from patients receiving antibiotic therapy) were used, no differences were found in detection time and positive rates between 3 mL and 7 mL blood culture bottles that were artificially seeded with standard E. coli or S. aureus strains. CONCLUSIONS: Although antibiotic usage rate before using the blood cultures was high in our hospital, the 7 mL bottle showed a better yield and speed of detecting microorganisms than did the 3 mL bottle irrespective of antibiotic usage before using the blood cultures. This data suggests that blood volume elevation (from 5 mL up to 10 mL) can be recommended for BacT/Alert Blood culture systems.
Anti-Bacterial Agents ; Blood Volume* ; Humans

Abstract: The diagnosis of bacteremia relies on the isolation and identification of the bacteria from blood cultures, whether they are community-acquired or nosocomial in origin. However, studies have shown that, in the Philippines alone, physicians have been found to underutilize these laboratory examinations. Objectives: The goal of this study was to determine the influence of positive blood cultures and sensitivity test results on the antibiotic choices of pediatrics residents at the University of the Philippines – Philippine General Hospital (UP-PGH). Methods: A chart review of patients with positive blood cultures, who were 18 years old and below, and admitted initially at the UP-PGH Pediatric Emergency Room (UP-PGH PER) from August 1, 2004 to July 31, 2005 was performed. Excluded were patients who died before the release of the blood culture reports or discharged per request or against medical advice, post-operative patients, patients with presumed polymicrobial sepsis, and patients with contaminated blood cultures. Results: One hundred twenty two (122) patients with positive blood cultures were included: 87 or 71.3% of the isolates were community-acquired, the most common pathogens of which were gram-positive bacteria, Staphylococcus epidermidis (18.3%), followed by gram-negative Salmonella (11.5%). Among the patients diagnosed with bacteremia at the UP-PGH PER, Staph. epidermidis was also the most common pathogen; with 34% of all isolates acquired nosocomially. Other significant isolates included Pseudomonas putida, Pseudomonas aeruginosa, and Klebsiella sp. Prior to the release of the blood culture and sensitivity results, 45 of the 122 patients were already discharged. Therapy at the time of discharge was of questionable efficacy, accounting to 73.3%. Of the 77 patients discharged after the release of blood culture and sensitivity (CS) results, only 21(27%) of the antibiotic therapies were modified, and 56 (73%) were not modified at all. It is imperative to know, however, that 50% of the antibiotic therapies were modified a day after the corresponding blood culture and sensitivity (CS) results came out for patients who presented with nosocomial infection. Conclusion In general, blood culture and sensitivity test results have a limited effect on the antibiotic choices of pediatric residents at the UP-PGH (University of the Philippines – Philippine General Hospital).
Bacteremia ; Blood Culture ; Anti-Bacterial Agents

Platelets not only have hemostatic function, but can also directly or indirectly recognize pathogenic microorganisms and the signals they produce to capture and destroy them through membrane receptors. They can collaborate with various components of the body's immune system by releasing of intraplatelet particulate matter, cytokines and chemokines to perform bactericidal functions. And it can also play a bactericidal role by swallowing pathogens, releasing antimicrobial proteins and chemokines and activating and enhancing other specialized anti-inflammatory cells bactericidal effect, such as leukocytes and so on. However, the bacteriostatic composition and bacteriostatic mechanism of platelets remain unclear, so attention should be paid to the immune mechanism and bacteriostatic effect of platelets.
Blood Platelets ; Anti-Bacterial Agents/pharmacology* ; Cytokines ; Leukocytes ; Particulate Matter

BACKGROUND: Late Onset Neonatal Sepsis (LONS) or nosocomial sepsis has a significant mortality and morbidity that leads to overtreatment. Overtreatment happens when antibiotics are frequently started and/or shifted, eventually leading to increasing antimicrobial resistamce in NICU.
OBJECTIVE: To validate bedside nosocomial sepsis scoringdeveloped by Okascharoen in 2005.
METHODOLOGY: All neonates admitted in NICU suspected of LONS were enrolled. Using Okascharoe scoring, subjects were scored based hypotension/poor perfusion, abnormal body temperature, respiratory insufficiency, complete blood count, and length of umbilical catheter use. Growth of organisms during blood culture is considered positive outcome and is considered confirmed sepsis.
RESULTS: Of the one-hundred-nineteen (119) subjects included in the analysis, 59 were confirmed sepsis and 60 were LONS negative. Subjects with confirmed sepsis had more events of hypotension/poor perfusion (p < 0.001; -0.141, -0.438), thrombocytopenia (p 0.000; -0.169, -0489), and prolonged umbilical catheter usage (p 0.014; -0.051, -0.311). The ROC curve has an AUC of 0.753 (p < 0.001; 0.664-0.842), which means a randomly chosen neonate with LONS will have a higher predicted score than a neonate without LONS. The sensitivity of this tool was 0.92 (0.82-0.97) and specificity of this tool was 0.32 (0.21-0.46) in this setting. The positive LR =1.35 (1.12-1.64) while the negative LR = 0.26 (0.10-0.65)
CONCLUSION: This scoring is a valid tool that can be used in point-of-care scoring for antibiotic stewardship in a neonate with suspected sepsis.
RECOMMENDATION: it is recommended that a score > 5 be used to be predictive of late onset sepsis, and this would have sensitivity of 83.3%, specificity of 61%, positive predictive value of 68.5% and a negative predictive value of 78.3%

Human ; Male ; Adult ; Anti-bacterial Agents ; Neonatal Sepsis ; Anti-infective Agents ; Blood Culture ; Sepsis ; Morbidity ; Hypotension ; Thrombocytopenia ; Blood Cell Count

OBJECTIVE: To evaluate trough serum vancomycin concentrations and identify their influencing factors in critically ill neurosurgical patients. METHODS: A retrospective study was conducted. Adult patients who received vancomycin with at least one appropriate monitoring of trough serum vancomycin concentration and admitted to neurosurgical intensive care unit (ICU) of the First Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2019 were enrolled. General information including gender, age, comorbidities, etc., trough serum vancomycin concentrations, vancomycin dosage, duration of vancomycin therapy, urine output, serum creatinine (SCr), concurrent medications (including mannitol,diuretic, vasopressors, non-steroidal anti-inflammatory drugs, polymyxin, aminoglycosides and contrast medium, etc.) were collected for analysis. Trough serum vancomycin concentrations were evaluated and their influencing factors were analyzed by multiple linear regression method. RESULTS: In total, 81 trough serum vancomycin concentration data sets obtained from 28 patients were evaluated. (1) The initial daily dose of vancomycin was 2.00 (2.00, 2.00) g/d. After 4-6 doses, the trough serum vancomycin concentration obtained from initial blood draw was 10.99 (6.98, 16.25) mg/L, of which only 17.9% (5/28) achieving targeted concentrations (15-20 mg/L), 71.4% (20/28) subtherapeutic level and 10.7% (3/28) supratherapeutic level. (2) The duration of vancomycin therapy was 8.0 (6.0, 15.0) days. With average daily dose of 2.00 (1.75, 3.00) g/d, targeted trough vancomycin concentrations were achieved in only 30.9% (25/81) of all cases, subtherapeutic concentrations in 49.4% (40/81) and supratherapeutic concentrations in 19.7% (16/81). (3) There were significant differences in age, comorbidities, vancomycin dosage, diuretics use and mannitol dosage, etc. among different vancomycin concentration groups. Multiple linear regression analysis suggested that the trough serum vancomycin concentration increased by 0.14 mg/L [95% confidence interval (95%CI) was 0.06-0.22] for every 1 year increase in age, increased by 7.22 mg/L (95%CI was 2.08-12.36) in patients with multiple comorbidities (concomitant hypertension, diabetes and coronary heart disease) compared with those without comorbidities, increased by 2.78 mg/L (95%CI was 0.20-5.35) in patients treated with diuretics compared with those without diuretics. The effect of other variables was not statistically significant. It suggested that age, multiple comorbidities (concomitant hypertension, diabetes and coronary heart disease), and diuretic usage affected trough serum vancomycin concentrations. CONCLUSIONS Targeted trough serum vancomycin level is not often achieved in neurosurgical ICU patients following standard dosing. Younger patients are associated with lower trough serum vancomycin concentrations, while diuretic usage, combined with multiple comorbidities are associated with higher trough serum vancomycin concentrations.
Adult ; Anti-Bacterial Agents/blood* ; Critical Illness ; Humans ; Intensive Care Units ; Retrospective Studies ; Vancomycin/blood*

Traditional biomarkers, including C-reactive protein, leukocytes, erythrocyte sedimentation rate, and clinical signs and symptoms, are not sufficiently sensitive or specific enough to guide treatment decisions in infectious febrile diseases. Procalcitonin (PCT) is synthesized by a large number of tissues and organs in response to invasion by pathogenic bacteria, fungi, and some parasites. A growing body of evidence supports the use of PCT as a marker to improve the diagnosis of bacterial infections and to guide antibiotic therapy. Clinically, PCT levels may help guide the need for empirical antibiotic therapy, source control for infections, and duration of antibiotic therapy. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and to discuss the reliability of this marker in order to provide physicians with an overview of the potential for PCT to guide antibiotic therapy.
Algorithms ; Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/*blood/drug therapy ; Biological Markers/blood ; Calcitonin/*blood ; Humans ; Protein Precursors/*blood ; Sepsis/*blood/drug therapy/microbiology

BACKGROUNDIt has been confirmed that the concentration of cefepime in cerebrospinal fluid (CSF) could reach the 10% of its concentration in plasma, exceeding the inhibitory concentration to 90% of organisms (MIC(90)) for common bacteria. However, the blood-brain barrier (BBB) penetration ability of cefepime is still unclear. The aim of this study was to measure the CSF concentration of cefepime in patients after neurosurgical operations, and to determine the penetration of the drug through an incomplete BBB.

METHODSEight patients who received ventricular drainage (VD group) and 5 who underwent lumbar puncture drainage (LPD group) were enrolled into this study. Cefepime (2 g) was injected intravenously in 30 minutes after the neurosurgeries. The concentrations of cefepime in the CSF and plasma were measured by high-pressure liquid chromatography (HPLC) at different time points.

RESULTSThe CSF concentrations of cefepime at different time points in the VD group were significantly higher than those in the LPD group (P < 0.05). In the VD group, the concentration of cefepime in CSF reached the peak ((22.54 +/- 14.06) microg/ml) at 1 to 2 hours after the injection, while in the LPD group at 4 hours ((5.61 +/- 3.73) microg/ml). In both groups, the peak was higher than the MIC(90) of most common bacteria in intensive care unit. The ratio of CSF to plasma cefepime concentrations ranged from 0.30 to 2.14 in the VD group and 0.03 to 1.14 in the LPD group.

CONCLUSIONAfter neurosurgeries, CSF concentration of cefepime can reach a therapeutic level. Thus, the drug could be used to prevent and treat postoperative intracranial infection.

Anti-Bacterial Agents ; cerebrospinal fluid ; Blood-Brain Barrier ; Cephalosporins ; cerebrospinal fluid ; Humans ; Neurosurgical Procedures

BACKGROUND: Blood culture is essential for the diagnosis and management of bloodstream infections. Blood volume is a key parameter determining the success of blood cultures. Studies comparing compliance between physicians and phlebotomists regarding optimal blood culture procedure are very rare in Korea. METHODS: After educating physicians (interns) and phlebotomists about the correct procedure for blood culturing, the blood volumes of forty-three percent of randomly selected aerobic and anaerobic culture sets for adult patients (> or =18 years old) were compared between these two groups over a period of three months. Physicians obtained blood from all admitted patients except those in the emergency department, where phlebotomists performed blood collection. RESULTS: The numbers of blood culture sets requested during the study period were 3,238 and 2,136 for the physician and phlebotomist groups, respectively. The blood volumes of blood culture sets were significantly higher for the phlebotomists (16.7 mL) than for the physicians (9.2 mL). The positive rate of blood culture was also higher for the phlebotomist group (10.3% vs. 7.9%). The contamination rates (0.8%) were the same for both groups. CONCLUSION: Although the patients' medical conditions, antibiotics prescriptions, or duration of hospitalization may have affected the positive rate of blood cultures, this rate might also have been influenced by the blood volume. The compliance of phlebotomists was greater than that of physicians regarding the blood volume collected for blood cultures.
Adult ; Anti-Bacterial Agents ; Blood Volume ; Compliance ; Emergencies ; Hospitalization ; Humans ; Prescriptions ; Quality Improvement

OBJECTIVE: To analyze the clinical courses and outcomes after anterior lumbar interbody fusion (ALIF) for the treatment of postoperative spondylodiscitis. METHODS: A total of 13 consecutive patients with postoperative spondylodiscitis treated with ALIF at our institute from January, 1994 to August, 2013 were included (92.3% male, mean age 54.5 years old). The outcome data including inflammatory markers (leukocyte count, C-reactive protein, erythrocyte sedimentation rate), the Oswestry Disability Index (ODI), the modified Visual Analogue Scale (VAS), and bony fusion rate using spine X-ray were obtained before and 6 months after ALIF. RESULTS: All of the cases were effectively treated with combination of systemic antibiotics and ALIF with normalization of the inflammatory markers. The mean VAS for back and leg pain before ALIF was 6.8+/-1.1, which improved to 3.2+/-2.2 at 6 months after ALIF. The mean ODI score before ALIF was 70.0+/-14.8, which improved to 34.2+/-27.0 at 6 months after ALIF. Successful bony fusion rate was 84.6% (11/13) and the remaining two patients were also asymptomatic. CONCLUSION: Our results suggest that ALIF is an effective treatment option for postoperative spondylodiscitis.
Anti-Bacterial Agents ; Blood Sedimentation ; C-Reactive Protein ; Discitis* ; Humans ; Leg ; Male ; Spine

Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta (PLEVA) is a very rare cutaneous disorder clinically characterized by the acute onset of erythematous papules, vesicles and large coalescent ulceronecrotic lesions on the whole body accompanied by high fever and severe constitutional symptoms. In general, ulceronecrotic lesion is preceded by a typical rash of PLEVA. Histopathologically, it shows widespread epidermal necrosis and fibrinoid necrosis of blood vessel walls in addition to the superficial and deep perivascular lymphocytic infiltrations. Several regimens including systemic corticosteroid, antibiotics, methotrexate or ultraviolet therapy have been challenged in this disorder . We report a typical case of febrile ulceronecrotic PLEVA in a 10-year-old child who showed a dramatic response to methotrexate.
Anti-Bacterial Agents ; Blood Vessels ; Child* ; Exanthema ; Fever ; Humans ; Methotrexate ; Necrosis ; Pityriasis Lichenoides* ; Pityriasis* ; Ultraviolet Therapy