Focus of infection and microbiological etiology in community-acquired infections in hospitalized adult patients in the Faroe Islands

Role of FDG PET/CT in bacteremia and fever of unknown origin: a pictorial overview of finding the culprit

18F fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has established itself as a critical diagnostic tool in the evaluation of patients with bacteremia and fever of unknown origin (FUO), particularly following futile conventional investigations. These conditions are often challenging due to diverse underlying etiologies, including infections, inflammatory conditions and malignancies. PET/CT has the advantage of being a whole-body imaging technique with high sensitivity for detecting areas of increased metabolism often associated with infection or inflammation. In bacteremia, [18F]FDG PET/CT can help identify metastatic infections, endocarditis, or abscesses which may be clinically silent and missed on conventional imaging. In FUO, it helps to identify underlying etiologies, directing treatment and management strategies. This review aims to describe the role of PET/CT imaging in these diverse clinical scenarios. Perspectives in the field, including novel equipment and tracers, will be briefly discussed.

Bacterial, Clinical, and Antimicrobial Profile of Gram-Negative Community-Acquired Infections in a Rural Tertiary Care Hospital in India

Background Gram-negative bacilli, such as Escherichia coli, Pseudomonas aeruginosa, Klebsiella species (spp.), and Proteus species (spp.), are major causes of community-acquired infections (CAI). The rise in antibiotic use, especially in low- and middle-income countries, has led to increased antimicrobial resistance, with multidrug-resistant Gram-negative bacilli (MDR-GNB) becoming a global concern. This resistance contributes to longer hospital stays, increased mortality rates, and higher healthcare costs. The study aims to evaluate the bacterial, clinical, and antimicrobial profile of Gram-negative community-acquired infections (CAI) in a hospital setting to understand the prevalence better and inform strategies to tackle antibiotic resistance. Material and methods This study at Krishna Hospital and Medical Research Centre, Karad, focused on outpatient department (OPD) patients with suspected clinical infections. Non-repetitive Gram-negative bacilli isolates were included. After obtaining ethical approval and patient consent, clinical specimens were obtained aseptically first. The specimens were Gram-stained, cultured on various agars, and further confirmed. Species identification and testing for antimicrobial susceptibility were performed using the VITEK® 2 (bioMérieux, Marcy-l'Étoile, France) COMPACT Automated System to determine susceptibility profiles. Result A total of 518 specimens were processed, resulting in 102 Gram-negative bacilli isolates. The study revealed that community-acquired infections were most common in individuals aged 51-60 years (22, 21.57%). Men were more affected (62, 60.78%) than female patients (40, 39.22%). The most frequent pathogen was Pseudomonas aeruginosa (33, 32.35%), followed by Escherichia coli (29, 28.43%) and Klebsiella species (27, 26.47%). Discharge/pus was a frequent specimen source (66, 64.71%), followed by urine (30, 29.41%). These findings highlight age, gender, bacterial distribution, and the importance of pus and urine samples in diagnosis. The most sensitive drugs found in the study were fosfomycin (n = 54, 79.41%) and amikacin (n = 61, 67.03%); also, the most resistant drugs were cefuroxime (n = 43, 84.31%) and ciprofloxacin (n = 78, 76.47%). Conclusion Community-acquired infections represent a major public health challenge, shaped by factors such as age, gender, and pathogen diversity. These are more common in the 51-60 age group and show a male predominance due to behavioral and exposure factors in the study. Frequent pathogens include Pseudomonas aeruginosa, Escherichia coli, and Klebsiella spp., often involving skin and soft tissue infections (SSTI) and urinary tract infections (UTI). The study emphasizes the importance of understanding epidemiological trends, microbiological profiles, and trends of antibiotic resistance to improve treatment and prevention.

Aerobic bacteria study, clinical spectrum, and outcome of patients with community-acquired multidrug-resistant pathogens

Context

Infectious diseases are the leading cause of death in developing countries like India. Hence, even small relative increases in the mortality rate for infections due to multidrug-resistant pathogens would lead to substantial increases in the number of deaths as a result of infections worldwide.

Aims

The aim of the study was to study the microbiological data of community-acquired pathogens and the corresponding outcomes due to antibiotic-resistant versus antibiotic-susceptible bacterial microorganisms.

Settings and Design

A single-center prospective cohort study for two years undertaken during the study period of March 2022 to 31 October 2023.

Materials and Methods

All clinical samples of 402 patients diagnosed microbiologically as community-acquired infections were included. Culture samples were collected and processed according to standard operating procedures and clinical details were recorded.

Statistical Analysis Used

Categorical variables were expressed as counts and percentages. Fisher's exact test was used for testing differences in proportions. Two-sided distribution P values of <0.05 were considered significant.

Results

Among Gram-positive organisms, Staphylococcus aureus and Streptococcus pyogenes were predominant isolates. Escherichia coli and Klebsiella species were the majority of the pathogens among Gram-negative isolates. Mortality rates observed in community-acquired respiratory tract infections (CA-RTIs), community-acquired urinary tract infections (CA-UTIs), community-acquired skin and soft tissue infections (CA-SSTIs), and community-acquired bloodstream infections (CA-BSIs) were 13.6%, 6.56%, 4.5%, and 31.5%, respectively. The length of hospital stay of more than three days was found as 56.06%, 36.2%, 40.9%, and 73.6% in CA-RTIs, CA-UTIs, CA-SSTIs, and CA-BSIs, respectively.

Conclusions

Performing cultures earlier during hospitalization and determining the timing of colonization can allow more targeted choices and reduce morbidity and mortality rates among infected patients.

Mortality in Community-Acquired Sepsis and Infections in the Faroe Islands-A Prospective Observational Study

The aim of this study was to collect data and analyze mortality among patients hospitalized with community-acquired infections in the Faroe Islands. A prospective observational study was conducted in the Medical Department of the National Hospital of the Faroe Islands from October 2013 to April 2015. Cumulative all-cause, in-hospital, short-term, intermediate-term and long-term mortality rates were calculated. Kaplan-Meier survival curves comparing infection-free patients with infected patients of all severities and different age groups are presented. A log-rank test was used to compare groups. Mortality hazard ratios were calculated for subgroups using Cox regression multivariable models. There were 1309 patients without infection and 755 patients with infection. There were 51% female and 49% male patients. Mean age was 62.73 ± 19.71. Cumulative all-cause mortality and in-hospital mortality were highest in more severe forms of infection. This pattern remained the same for short-term mortality in the model adjusted for sex and age, while there were no significant differences among the various infection groups in regard to intermediate- or long-term survival after adjustment. Overall and short-term mortality rates were highest among those with severe manifestations of infection and those with infection compared to infection-free patients.

[18F]FDG-PET/CT in patients with bacteremia: Clinical impact on patient management and outcome

Bacteremia is the presence of viable bacteria in the bloodstream, a complicated and potentially dangerous systemic medical condition that may range from asymptomatic and clinically relatively indolent cases to more severe bloodstream infection (BSI) and ultimately life-threatening septic shock with fatal outcome. BSI is classified as simple (bacteremia only) or complex (BSI with metastatic spread), and the morbidity is higher in the latter, probably due to insufficient eradication. Treatment of simple BSI is usually short-term antibiotic courses, whereas complex BSI with metastatic foci requires more advanced treatment including long-term antibiotics or invasive drainage to gain infection control. Thus, identifying metastatic infection has an important clinical impact but remains a challenge; only half of the patients progress to complex BSI, and many patients present without relevant signs or symptoms, so imaging is pivotal. This review summarizes the potential role and recommendations of [18F]FDG-PET/CT in BSI, based on the relatively sparse and heterogeneous literature. [18F]FDG-PET/CT should be considered in suspected complex BSI, in patients at high risk of metastatic spread, and in BSI in ICU patients. [18F]FDG-PET/CT has an impact on patient management, treatment strategy, and patient outcome, mainly by directing the diagnostic process toward more specific diagnostics or by modifying treatment regimens resulting in reduced relapse rates and reduced mortality. Finally, a negative scan may obviate the need for further workup.

Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal

SETTING

Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal.

OBJECTIVES

1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures.

DESIGN

This was a cohort study using secondary data (December 2017 to April 2018).

RESULTS

Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common.

CONCLUSION

We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.

Telemedicine based remote monitoring after liver transplantation: Feasible in a select group and a more stringent control of immunosuppression

Telemedicine gained interest in liver transplant patients but focused until now on the early post‐operative period. This prospective cohort study assessed feasibility, safety, and clinical beneficial effects of a telemedicine based remote monitoring program (TRMP) for the chronic follow‐up of adult liver transplant recipients. Between November 2017 and August 2019, a total of 87 of the 115 selected patients (76%) started the TRMP. Over the 2 years study period, none of the patients switched to standard follow‐up: 39/87 (45%) continued to do this autonomously and 48/87 (55%) stopped to report their data personally but communicated their lab values to the nurse. The other 28/115 (11%) patients who did not accept the TRMP continued the standard follow‐up. There was no difference in educational level between the three groups. Remote monitoring did not result in an increase in liver graft rejection and need of hospitalization. TRMP was associated with a higher number of tacrolimus level determinations and tacrolimus blood level concentrations could be kept lower. In conclusion, our results show that in patients with a stable clinical condition there is a high willingness to participate in TRMP and that this approach is safe. Remote monitoring allowed a stringent follow‐up of tacrolimus levels.

Incidence and epidemiological characteristics of COVID-19 among health care workers in Saudi Arabia: A retrospective cohort study

INTRODUCTION

Novel coronavirus (SARS-CoV-2) is a highly infectious serious acute respiratory syndrome that has emerged in Wuhan, China, and has spread rapidly throughout the world including Saudi Arabia. An important source of infection of 2019 novel coronavirus (2019-nCoV) is healthcare-associated infection (HAI). Healthcare workers (HCWs) have a greater risk of acquiring COVID-19 infection than the general population. Globally, thousands of HCWs have lost their lives due to COVID-19 infection.

AIM

Identify Incidence Rate and epidemiological characteristics of COVID-19 infection among health workers in Saudi Arabia.

METHODOLOGY

A retrospective cohort study carried from March to November 2020. HCWs selected by a Complete Enumeration Survey method. Data analyzed in frequencies and percentage tables. To test the differences, post hoc after chi-square-(χ²) tests were used.

RESULTS

As of November 30, 2020, a total of 57,159 HCWs tested positive with COVID-19. Their median age was 34 years, and 53% were male. Nurses were the most infected HCWs category (36%). The most common source of infection was from the community (78%). The majority of HCWs who acquired the infection from healthcare facilities got the infection from another HCW (63%). There was a significant difference between community and healthcare-acquired COVID-19 in relation to gender (P < 0.001) nationality (P < 0.001) job categories (P < 0.001) three age groups (<26: P = 0.012, 26-35 and 36-45: P < 0.001), and among HCWs who worked in MOH and private healthcare facilities (P < 0.001). The total number of reported deaths among HCWs during the study period was 198, with a case fatality rate of (0.35%).

CONCLUSION

This study findings show that infected HCWs characteristics were similar to the previous studies and indicate incidence rates of 10% among COVID-19 infected HCWs in Saudi Arabia. Analysis of the infection status of HCWs is critical, to understand their needs and challenges, improve protective measures, and provide effective recommendations for policymakers.

Current spectrum of causative pathogens in sepsis: A prospective nationwide cohort study in Japan

BACKGROUND

There is no one-size-fits-all empiric antimicrobial therapy for sepsis because the pathogens vary according to the site of infection and have changed over time. Therefore, updating knowledge on the spectrum of pathogens is necessary for the rapid administration of appropriate antimicrobials.

OBJECTIVE

The aim of this study was to elucidate the current spectrum of pathogens and its variation by site of infection in sepsis.

METHODS

This was a prospective nationwide cohort study of consecutive adult patients with sepsis in 59 intensive care units in Japan. The spectrum of pathogens was evaluated in all patients and in subgroups by site of infection. Regression analyses were conducted to evaluate the associations between the pathogens and mortality.

RESULTS

The study cohort comprised 1184 patients. The most common pathogen was Escherichia coli (21.5%), followed by Klebsiella pneumoniae (9.0%). However, the pattern varied widely by site of infection; for example, gram-positive bacteria were the dominant pathogen in bone/soft tissue infection (55.7%) and cardiovascular infection (52.6%), but were rarely identified in urinary tract infection (6.4%). In contrast, gram-negative bacteria were the predominant pathogens in abdominal infection (38.4%) and urinary tract infection (72.0%). The highest mortality of 47.5% was observed in patients infected with methicillin-resistant Staphylococcus aureus, which was significantly associated with an increased risk of death (odds ratio 1.88, 95% confidence interval 1.22-2.91).

CONCLUSIONS

This study revealed the current spectrum of pathogens and its variation based on the site of infection, which is essential for empiric antimicrobial therapy against sepsis.