Blood cultures in acute surgical admissions

INTRODUCTION

Obtaining blood cultures prior to the administration of antimicrobial therapy was a key recommendation of the 2012 UK Surviving Sepsis Campaign. Few studies have examined the effect blood cultures have on clinical management and there have been none on acute surgical admissions. This retrospective study sought to evaluate the effect of blood cultures on clinical management in acute surgical admissions.

METHODS

Data on acute surgical patients admitted between 1 January and 31 December 2012 were extracted from hospital records. Patients given intravenous antibiotics within 24 hours of admission were identified. Data collected included antibiotics administered, blood culture results, admission observations and white blood cell count. Case notes were reviewed for patients with positive cultures to establish whether the result led to a change in management.

RESULTS

Of 5,887 acute surgical admissions, 1,346 received intravenous antibiotics within 24 hours and 978 sets of blood cultures were taken in 690 patients. The recommended two sets of cultures were obtained in 246 patients (18%). Patients who had blood cultures taken had the same in-hospital mortality as those who had none taken (3.6% vs 3.5%, p=0.97). Blood cultures were positive in 80 cases (11.6%). The presence of systemic inflammatory response syndrome did not increase positivity rates (12.9% vs 10.3%, p=0.28). Overall, cultures altered management in two patients (0.3%).

CONCLUSIONS

Blood cultures rarely affect clinical management. In order to assess the additional value that blood cultures bring to sepsis management in acute surgical admissions, a prospective randomised trial focusing on outcome is needed.

Hortonones A to C, hydroazulenones from the genus Hortonia

The new hexahydroazulenones hortonones A (1) to C (3) were isolated from the leaves of three representative species of the endemic Sri Lankan genus Hortonia that belongs to the family Monimiaceae. Hortonones A (1) and B (2) have the unprecedented rearranged hortonane sesquiterpenoid carbon skeleton, and hortonone C (3) has the unprecedented rearranged and degraded 13-norhortonane skeleton. Hortonone C (3) exhibited in vitro cytotoxicity against human breast cancer MCF-7 cells at 5 μg/mL.

Bioactivity and chemistry of the genus Hortonia

The dichloromethane extracts of the leaves, stem bark, bark and the roots of the three species of the primitive endemic genus Hortonia, H. angustifolia, H. floribunda and H. ovalifolia, collected from nine geographical locations ranging from lower elevations (84-420 m) to higher (2000 m) showed comparable HPLC profiles and mosquito larvicidal and antifungal activities; protein analysis of the leaves of the three species of Hortonia showed identical peaks and bands. The two major metabolites (4S)-4-methyl-2-(11-dodecynyl)-2-butenolide (2) and (4S)-4-methyl-2-(11-dodecenyl)-2-butenolide (3), which were previously reported from all three plants, showed potent larvicidal activities. Compound 2 was excessively high in the extracts of the stem bark and the roots of all three species amounting to approximately 38 and 60%, respectively. A minor new butenolide (4), (4S)-4-methyl-2-((2R)-hydroxy-11-dodecenyl)-2-butenolide, with much reduced larvicidal activity and ishwarane (1), which showed antifungal activity, were also isolated from all three plants. Treatment of compound 2 with H(2)/Pd-C afforded the completely reduced compound 5, which showed no larvicidal activity, indicating that unsaturation in both 2 and 3 is necessary for their bioactivity. The foregoing evidence showed that there are major similarities between the three species of Hortonia.

Four new butanolide derivatives from hortonia, a genus endemic to Sri Lanka

Three new butanolides, (2E,3R,4R,9′Z)-2-(dodec-9′-en-11′-ynylidene)-3-hydroxy-4-methylbutanolide (1), (2E,3R,4R)-2-(dodeca-9′,11′-diynylidene)-3-hydroxy-4-methylbutanolide(2),(2E,3R,4R,9′E)-2-(dodeca-9′,11′-dienylidene)-3-hydroxy-4-methylbutanolide (3) and one new ring-opened butanolide, methyl (2Z,11Z,1′R,2′R)-2-(1′,2′-dihydroxypropyl) tetradeca-2,11-dien-13-ynoate (4) were isolated from the leaves of the three representative species of the endemic primitive genus Hortonia (Monimiaceae), namely H. angustifolia, H. floribunda and H. ovalifolia. Their structures were elucidated on the basis of spectroscopic evidence.

Two new lactones with mosquito larvicidal activity from three Hortonia species

The structures of the butenolides 1 and 2, isolated from the endemic plants Hortonia floribunda, H. angustifolia, and H. ovalifolia, collected in Sri Lanka, have been elucidated by spectroscopic analysis. These compounds exhibited potent mosquito larvicidal activity against the second instar larvae of Aedes aegypti.