Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock

BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock.AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit.METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited.Patient population characteristics and laboratory data were collected for analysis.RESULTS The study group consisted of 85(39%)inpatients with bloodstream infection,and the control group consisted of 133(61%)with negative results or contamination.The percentage decline in platelet counts(PPCs)in patients positive for pathogens[57.1(41.3-74.6)]was distinctly higher than that in the control group[18.2(5.1–43.1)](P<0.001),whereas the PPCs were not significantly different among those with gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.Using receiver operating characteristic curves,the area under the curve of the platelet drop rate was 0.839(95%CI:0.783-0.895).CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock.However,it cannot identify gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.

Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections

BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The Mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all P<0.001).The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella Pneumoniae Bloodstream Infections in Wuhan,China

Objective:The clinical characteristics and microbiological data of patients with K.pneumoniae bloodstream infections(BSI)from January 2018 to December 2020 were retrospectively analyzed to study the molecular epidemiology of Carbapenem-resistant Klebsiella pneumoniae(CRKP).We also aimed to identify the risk factors for the development of CRKP BSI.Methods:This retrospective study was conducted at Renmin Hospital of Wuhan University from January 2018 to December 2020.The date of non-duplicate K.pneumoniae isolates isolated from blood samples was identified using the microbiology laboratory database.The data from patients diagnosed with K.pneumoniae BSI were collected and analyzed.

Fatal community-acquired bloodstream infection caused by Klebsiella variicola:A case report

BACKGROUND Klebsiella pneumoniae(K.pneumoniae)is an infective microorganism of worldwide concern because of its varied manifestations and life-threatening potential.Genetic analyses have revealed that subspecies of K.pneumoniae exhibit higher virulence and mortality.However,infections with Klebsiella subspecies are often misdiagnosed and underestimated in the clinic because of difficulties in distinguishing K.pneumoniae from its subspecies using routine tests.This case study reports the rapid and fatal effects of K.pneumoniae subspecies.CASE SUMMARY A 52-year-old male patient was febrile and admitted to hospital.Examinations excluded viral and fungal causes along with mycoplasma/chlamydia and parasitic infections.Bacterial cultures revealed blood-borne K.pneumoniae sensitive to carbapenem antibiotics,although corresponding treatment failed to improve the patient’s symptoms.His condition worsened and death occurred within 72 h of symptom onset from sepsis shock.Application of the PMseq-DNA Pro high throughput gene detection assay was implemented with results obtained after death showing a mixed infection of K.pneumoniae and Klebsiella variicola(K.variicola).Clinical evidence suggested that K.variicola rather than K.pneumoniae contributed to the patient’s poor prognosis.CONCLUSION This is the first case report to show patient death from Klebsiella subspecies infection within a short period of time.This case provides a timely reminder of the clinical hazards posed by Klebsiella subspecies and highlights the limitations of classical laboratory methods in guiding anti-infective therapies for complex cases.Moreover,this report serves as reference for physicians diagnosing similar diseases and provides a recommendation to employ early genetic detection to aid patient diagnosis and management.

Bloodstream Infection with Carbapenem-resistant Klebsiella Pneumoniae and Multidrug-resistant Acinetobacter Baumannii:a Case Report

IN the presence of septic shock,every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality.This is especially true for neutropenic patients with septic shock.1 As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients,the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous

Investigation and Analysis of the Status Quo of Prevention and Control Practices of Catheter-Line Associated Bloodstream Infections (CLABSI) in Guangxi, China

The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.

Analysis of Clinical Characteristics and Risk Factors of Pseudomonas aeruginosa Bloodstream Infection in 55 Cases

Objective: Pseudomonas aeruginosa bloodstream infection presents a severe challenge to hospitalized patients. To investigate the clinical characteristics, risk factors and drug resistance of Pseudomonas aeruginosa bloodstream infection. Methods: Clinical data and laboratory results of patients with Pseudomonas aeruginosa bloodstream infection in the First Affiliated Hospital of Yangtze University from January 2019 to December 2022 were retrospectively analyzed. The factors associated with infection and death were analyzed by univariate analysis. Results: A total of 55 patients were enrolled in this study, The 28-day mortality rate was 14.5%. Univariate analysis showed that high procalcitonin, low albumin, ICU admission, central venous catheterization, indwelling catheter, and mechanical ventilation were associated with death. Multivariate Logistic regression analysis showed that hypoproteinemia and central venous catheters were independent risk factors for death in patients with Pseudomonas aeruginosa bloodstream infection. Conclusions: The drug resistance of P. aeruginosa bloodstream infection is not high, but the fatality rate is high. The combination of hypoalbuminemia after the onset of the disease and the use of central vein catheters can lead to increased mortality, suggesting that clinical identification of high-risk patients as early as possible, reducing the use of catheters, preventing the occurrence of P. aeruginosa bloodstream infection and improving the prognosis.

Study on the Risk Factors of Central Venous-Related Bloodstream Infection in Outpatients

Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted central catheter(PICC)from January 2020 to December 2021 were selected for retrospective analysis,and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis.Results:The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%.It was found that age,duration of catheterization,catheter site,number of punctures,and diabetes were all risk factors for catheter-associated bloodstream infection,and the differences were statistically significant.Conclusion:Age,duration of catheterization,catheterization site,and diabetes are all risk factors for catheter-related bloodstream infection,and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection.

多黏菌素B治疗血液系统恶性肿瘤伴CRKP-BSI的临床观察

目的分析多黏菌素B治疗血液系统恶性肿瘤伴耐碳青霉烯类肺炎克雷伯菌(CRKP)-血流感染(BSI)的有效性和安全性。方法回顾性分析2019年9月-2021年6月于我院接受至少3 d多黏菌素B治疗的血液系统恶性肿瘤伴CRKP-BSI患者的资料。所有患者初始均采用以多黏菌素B+替加环素+碳青霉烯类药物为基础的三联治疗方案。结果共纳入10例患者,血培养检出11株CRKP,其中10株CRKP产肺炎克雷伯菌碳青霉烯酶(KPC),1株CRKP同时产KPC和金属β-内酰胺酶;9株对黏菌素敏感,7株对替加环素敏感,5株对阿米卡星敏感,2株对复方磺胺甲噁唑敏感。所有患者均伴有中性粒细胞减少,平均持续时间为(14.1±6.4)d;均表现为发热、寒颤、乏力。经治疗后,有6例患者治愈出院,4例患者因感染性休克治疗无效死亡;所有患者未发生多黏菌素B相关的严重不良事件。结论多黏菌素B可作为血液系统恶性肿瘤伴CRKP-BSI患者的治疗用药,治疗期间均未发生多黏菌素B相关的严重不良事件。

ICU疑似导管相关血流感染拔管后立即重新穿刺中心静脉导管继发CRBSI风险的回顾性分析

目的评估重症医学科(ICU)患者发生疑似导管相关血流感染(CRBSI)时立即重新穿刺中心静脉导管(CVC)发生继发CRBSI的风险。方法回顾性分析2009年1月至2018年12月疑似CRBSI的病例,数据变量来源纸质病历、电子病历和检验报告数据库,患者出现疑似CRBSI拔除CVC后对比分析立即重新穿刺和未立即重新穿刺的相关因素,评估继发CRBSI的风险。结果847例疑似CRBSI患者中,立即重新穿刺的患者病情更危重。在控制基线队列中差异有统计学意义的变量后,多因素Cox比例风险模型显示,疑似CRBSI患者拔除CVC后立即重新穿刺显著增加继发CRBSI的风险(HR=6.316,95%CI 4.244~9.400,P<0.001),而发热(>38.3℃)(HR=1.666,95%CI 1.184~2.344,P=0.003)和平均动脉压降低(<70 mmHg)(HR=1.513,95%CI 1.045~2.191,P=0.028)是发生CRBSI的独立危险因素,在联合使用抗生素(>2种)的患者中发生CRBSI的风险更低(HR=0.570,95%CI 0.376~0.864,P=0.008)。结论ICU疑似CRBSI而未诊断为CRBSI的患者中,立即重新穿刺CVC增加继发CRBSI的风险,并且不能降低这些患者的30 d死亡风险。临床需加强对疑似CRBSI患者的关注,为降低立即重新穿刺CVC继发CRBS风险进行早期干预。

High mortality associated with gram-negative bacterial bloodstream infection in liver transplant recipients undergoing immunosuppression reduction

BACKGROUND Immunosuppression is an important factor in the incidence of infections in transplant recipient.Few studies are available on the management of immunosuppression(IS)treatment in the liver transplant(LT)recipients complicated with infection.The aim of this study is to describe our experience in the management of IS treatment during bacterial bloodstream infection(BSI)in LT recipients and assess the effect of temporary IS withdrawal on 30 d mortality of recipients presenting with severe infection.AIM To assess the effect of temporary IS withdrawal on 30 d mortality of LT recipients presenting with severe infection.METHODS A retrospective study was conducted with patients diagnosed with BSI after LT in the Department of Liver Surgery,Renji Hospital from January 1,2016 through December 31,2017.All recipients diagnosed with BSI after LT were included.Univariate and multivariate Cox regression analysis of risk factors for 30 d mortality was conducted in the LT recipients with Gram-negative bacterial(GNB)infection.RESULTS Seventy-four episodes of BSI were identified in 70 LT recipients,including 45 episodes of Gram-positive bacterial(GPB)infections in 42 patients and 29 episodes of GNB infections in 28 patients.Overall,IS reduction(at least 50%dose reduction or cessation of one or more immunosuppressive agent)was made in 28(41.2%)cases,specifically,in 5(11.9%)cases with GPB infections and 23(82.1%)cases with GNB infections.The 180 d all-cause mortality rate was 18.5%(13/70).The mortality rate in GNB group(39.3%,11/28)was significantly higher than that in GPB group(4.8%,2/42)(P=0.001).All the deaths in GNB group were attributed to worsening infection secondary to IS withdrawal,but the deaths in GPB group were all due to graft-versus-host disease.GNB group was associated with significantly higher incidence of intra-abdominal infection,IS reduction,and complete IS withdrawal than GPB group(P<0.05).Cox regression showed that rejection(adjusted hazard ratio 7.021,P=0.001)and complete IS withdrawal(adjusted hazard ratio 12.65,P=0.019)were independent risk factors for 30 d mortality in patients with GNB infections after LT.CONCLUSION IS reduction is more frequently associated with GNB infection than GPB infection in LT recipients.Complete IS withdrawal should be cautious due to increased risk of mortality in LT recipients complicated with BSI.

Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation

BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers.

Bloodstream Infections Caused by Enterococcus spp：A 10-year Retrospective Analysis at a Tertiary Hospital in China

In order to discover the risk factors for 30-day mortality in bloodstream infections（BSI） caused by Enterococcus spp.strains,we explored the clinical and therapeutic profile of patients with Enterococcus spp.BSI and the characteristics of this condition.A total of 64 patients with BSI caused by Enterococcus spp.who were treated in our hospital between 2006 and 2015 were included in the study.The clinical features of patients,microbiology,and 30-day mortality were collected from the electronic medical records database and analyzed.The results showed that there were 38 patients infected by Enterococcus faecalis（E.faecalis）,24 by Enterococcus faecium（E.faecium）,1 by Enterococcus casseliflavus（E.casseliflavus）,and 1 by Enterococcus gallinarum（E.gallinarum）.A Charlson comorbidity score ≥5,corticosteroid treatment,placement of catheters or other prosthetic devices and history of antibiotic use were found more frequently in E.faecium BSI patients than in E.faecalis patients（P=0.017,P=0.027,P=0.008 and P=0.027,respectively）.Furthermore,the univariate and multivariate analysis showed that corticosteroid treatment（OR=17.385,P=0.008）,hospital acquisition（OR=16.328,P=0.038）,and vascular catheter infection（OR=14.788,P=0.025） were all independently associated with 30-day mortality.Our results indicate that E.faecalis and E.faecium are two different pathogens with unique microbiologic characteristics,which cause different clinical features in BSI,and the empiric antimicrobial treatments are paramount for patients with enterococcal BSI.

Review of the Clinical Applications of Metagenomic Next-Generation Sequencing in Bloodstream Infection

Bloodstream infection (BSI) is an important cause of morbidity and mortality worldwide. If we can make early diagnosis and start effective antibiotic treatment in time, the hospitalization time of patients with bloodstream infection can be significantly shortened. However, the current diagnosis of bloodstream infection cannot achieve the ideal therapeutic effect to a large extent because of the matrix effect of blood and the long turnaround time of blood culture. Therefore, a new detection method with a short turnaround time and high sensitivity is needed for the early diagnosis and timely treatment to improve the prognosis of patients. Metagenomic next-generation sequencing (mNGS) is a recently developed method for the comprehensive analysis of all microorganisms and genetic materials in clinical samples and is expected to be the main method for the early diagnosis of bloodstream infections. This review discusses the clinical application of mNGS in bloodstream infections. We also discuss technical challenges that need to be addressed to improve the diagnostic applicability of mNGS.

Assessment of pathogens and risk factors associated with bloodstream infection in the year after pediatric liver transplantation

BACKGROUND Bloodstream infection(BSI)is one of the most significantly adverse events that can occur after liver transplantation(LT)in children.AIM To analyze the profile of BSI according to the postoperative periods and assess the risk factors after pediatric LT.METHODS Clinical data,collected from medical charts of children(n=378)who underwent primary LT,were retrospectively reviewed.The primary outcome considered was BSI in the first year after LT.Univariate and multivariate analyses were performed to identify risk factors for BSI and respective odds ratios(ORs).RESULTS Of the examined patients,106(28%)experienced 162 episodes of pathogen-confirmed BSI during the first year after LT.There were 1.53±0.95 episodes per children(mean±SD)among BSIcomplicated patients with a median onset of 0.4 mo post-LT.The most common pathogenic organisms identified were Coagulase-negative staphylococci,followed by Enterococcus spp.and Streptococcus spp.About half(53%)of the BSIs were of unknown origin.Multivariate analysis demonstrated that young age(≤1.3 year;OR=2.1,P=0.011),growth failure(OR=2.1,P=0.045),liver support system(OR=4.2,P=0.008),and hospital stay of>44 d(OR=2.3,P=0.002)were independently associated with BSI in the year after LT.CONCLUSION BSI was frequently observed in patients after pediatric LT,affecting survival outcomes.The profile of BSI may inform clinical treatment and management in high-risk children after LT.

Ethanol Lock Therapy as additional treatment of catheter-related bloodstream infections in pediatric patients receiving home parenteral nutrition

Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.

Serum Cholesterol Levels at the Onset of Bloodstream Infection Have Prognostic Value

Objective: The aims of this study were to investigate the changes in serum cholesterol levels at the onset of bloodstream infection (BSI) and to determine whether serum cholesterol levels were associated with patients’ clinical backgrounds and the prognosis of BSI;Methods: A retrospective chart review was done to collect demographic information and the subjects’ medical history, invasive procedures, and medications;Patients and Methods: From April 2003 to March 2006, all patients aged ≥20 years with positive blood cultures in the University of Tokyo Hospital (a tertiary teaching hospital with 1200 beds) were enrolled;Results: Average cholesterol levels before the onset of BSI were 166.5 ± 46.5 mg/dL, and, at the onset of BSI, they decreased to 134.4 ± 45.0 mg/dL (p < 0.001). Thirty-day survivors had higher cholesterol levels both before and at the onset of BSI than non-survivors. Cholesterol levels at the onset of BSI were associated with the organisms of BSI. Patients with lower cholesterol levels tended to have higher 30-day mortality rates and longer medical treatment than patients with higher cholesterol levels (13% vs 3%, p = 0.12;24.3 days vs 18.4 days, p = 0.15);Conclusion: Cholesterol levels at the onset of BSI could be used as a prognostic marker in patients with BSI.

Bloodstream Bacterial Infection in Neutropenic Acute Leukemia Patients

Objective: The rapid detection of blood stream infection has the potential to not only improve patient outcomes due to quicker administration of appropriate antibiotics but also improve antibiotic stewardship by reducing patient exposures to ineffective or unnecessary broad-spectrum antibiotics. Methods: In this study blood samples from acute leukemia neutropenic patients (samples under study) and non neutropenic patients (control) were tested using cultural and non-cultural based techniques via blood culture, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR) and Molecular techniques (bacterial 16S rDNA analysis). Results: About 22% & 15% were shown positive in blood culturing;94% & 85% were positive for CRP;86% and 75% were presented by elevation in ESR rate for the first hour;94% and 80% were presented by elevation in ESR rate for second hour. Treatment response of the positive cases by blood culture only was found to be 72.7% and 100% not in remission for samples under study and control respectively. In cases under study there is statistically significant correlation between culture growth sensitivity and PCR technique with P value 0.005.

Cefoperazone-sulbactam and ornidazole for Gardnerella vaginalis bloodstream infection after cesarean section:A case report

BACKGROUND Gardnerella vaginalis(G.vaginalis)is a facultative anaerobic bacteria known to cause bloodstream infections.However,cases are very rare in clinics.There is very limited clinical experience in the treatment of bloodstream infections caused by G.vaginalis.Therefore,there is an urgent need for effective antibacterial drugs to treat patients with bloodstream infections caused by G.vaginalis.CASE SUMMARY A woman who underwent a cesarean section presented with a sudden onset of high fever 1-d post-surgery.The blood cultures suggested an infection due to G.vaginalis,and treatment with cefoperazone-sulbactam was started.After 5 d of treatment,there was a decrease in the hemogram;however,the temperature and C-reactive protein levels remained high.Based on clinical experience and a review of literature,the treatment was modified to include ornidazole in combination with cefoperazone-sulbactam.Following a week of treatment,the temperature,hemogram and C-reactive protein levels returned to normal,and blood cultures turned negative,suggesting a therapeutic effect of the combination treatment.CONCLUSION This case highlighted the effective use of cefoperazone-sulbactam combined with ornidazole for bloodstream infection caused by G.vaginalis following a cesarean section.

Susceptibility of <i>Staphylococcus aureus</i>Isolates Causing Bloodstream Infection to the Antimicrobial Peptide LL-37

Both bacterial and host factors contribute to complicated bloodstream infection (BSI) caused by Staphylococcus aureus including methicillin-resistant S. aureus (MRSA). One bacterial factor that may affect the persistence of S. aureus in complicated BSI is reduced susceptibility to the innate immune defence peptide LL-37. LL-37 susceptibility among S. aureus isolates causing uncomplicated and complicated BSI was investigated. Following incubation with 2.5 μg/ml LL-37 for 1 h, the mean percentage survival was 67.6% and 74.9% for isolates causing uncomplicated and complicated BSI, respectively. Reduced LL-37 susceptibility may contribute to the persistence of S. aureus in complicated BSI.