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Narra J Apr 2024Empyema poses a significant global health concern, yet identifying responsible bacteria remains elusive. Recent studies question the efficacy of conventional pleural... (Comparative Study)
Comparative Study
Empyema poses a significant global health concern, yet identifying responsible bacteria remains elusive. Recent studies question the efficacy of conventional pleural fluid culture in accurately identifying empyema-causing bacteria. The aim of this study was to compare diagnostic capabilities of next-generation sequencing (NGS) with conventional pleural fluid culture in identifying empyema-causing bacteria. Five databases (Google Scholar, Science Direct, Cochrane, Research Gate, and PubMed) were used to search studies comparing conventional pleural fluid culture with NGS for identifying empyema-causing bacteria using keywords. Positive results identified through conventional pleural fluid culture and NGS were extracted. In addition, bacterial profiles identified by NGS were also documented. Joanna-Briggs Institute (JBI) critical appraisal tool was employed to assess quality of included studies. Descriptive analysis was employed to present outcome of interests. From five databases, three studies, with 354 patients, were included. Findings from three studies showed that NGS outperformed conventional pleural fluid culture in detecting empyema-causing bacteria even in culture-negative samples. Moreover, dominant bacterial profiles identified through NGS included , and anaerobic bacteria. In conclusion, NGS outperforms conventional pleural fluid culture in detection empyema-causing bacteria, yet further studies with larger samples and broader bacterial profiles are needed to increase confidence and urgency in its adoption over conventional pleural fluid culture.
Topics: Humans; High-Throughput Nucleotide Sequencing; Empyema, Pleural; Bacteria
PubMed: 38798844
DOI: 10.52225/narra.v4i1.650 -
Cureus Nov 2023Intra-abdominal complications such as peritoneal abscesses pose significant medical challenges. Over recent years, there has been a heightened focus on refining... (Review)
Review
Intra-abdominal complications such as peritoneal abscesses pose significant medical challenges. Over recent years, there has been a heightened focus on refining treatments for these conditions, such as optimal surgical techniques, drug therapies, and intervention methods. This paper aims to present a comprehensive overview of 10 research studies spanning various countries to highlight recent advancements and findings in the treatment and management of peritoneal abscesses. The paper reviewed 10 trials involving a total of 942 participants, covering diverse methodologies including randomized controlled trials, retrospective analyses, and phase 3 clinical trials. The research spanned countries such as the USA, Finland, Japan, Turkey, India, and China. Key findings included the notable benefits of laparoscopic interventions in appendiceal abscess treatments, which led to quicker recoveries and reduced readmissions compared to conservative approaches. Additionally, certain drug combinations, such as tazobactam/ceftolozane with metronidazole, showcased high clinical efficacy, particularly against resistant bacterial strains. Challenges persist in the early detection of intra-abdominal infections, emphasizing the pivotal role of antimicrobial treatments. Unique therapeutic approaches, like the use of strong acid-electrolyzed water (SAEW) in pediatric appendicitis cases, have proven effective in reducing surgical site infections. Intrabdominal complications such as peritoneal abscesses pose a real challenge. Early detection plays a critical role, which relies on using imaging techniques such as CT scans. Poorly managed mild intra-abdominal diseases can lead to the development of abscesses. Therefore, the implication of highly effective antibiotic combinations such as tazobactam/ceftolozane and metronidazole/ceftriaxone from the start can effectively combat challenging bacterial infections such as Gram-negative and anaerobic bacteria. Surgical procedures remain the most effective method to treat abscesses, and they are usually used as the last resort when drainage, laparoscopy, and other methods fail.
PubMed: 38084178
DOI: 10.7759/cureus.48601 -
Annals of Clinical Microbiology and... Nov 2023Legionnaires' Disease (LD) rarely evolves into pulmonary abscesses. The current systematic review has been designed to explore therapeutical strategies in pulmonary... (Review)
Review
BACKGROUND
Legionnaires' Disease (LD) rarely evolves into pulmonary abscesses. The current systematic review has been designed to explore therapeutical strategies in pulmonary cavitary LD.
METHODS
A research strategy was developed and applied to the databases Embase, Pubmed, and Web of Science from the 1st of January 2000 to the 1st of November 2022. Original articles, case series, case reports, and guidelines written in English, French, German, Italian, and Dutch were considered. Furthermore, medical records of patients treated at the University Hospital UZ Brussel for LD cavitary pneumonia, between the 1st of January 2016 to the 1st of January 2022, were reviewed.
RESULTS
Two patients were found by the UZ Brussel's medical records investigation. Through the literature review, 23 reports describing 29 patients, and seven guidelines were identified. The overall evidence level was low.
RESULT OF SYNTHESIS (CASE REPORTS)
The median age was 48 years and 65% were male. A polymicrobial infection was detected in 11 patients (44%) with other aerobic bacteria being the most commonly found. At diagnosis, 52% of patients received combination therapy, and fluoroquinolones were the preferred antimicrobial class. Anaerobic coverage was neglected in 33% of patients.
RESULT OF SYNTHESIS (GUIDELINES)
Three guidelines favor monotherapy with fluoroquinolones or macrolides, while one suggested an antimicrobial combination in case of severe LD. Four guidelines recommended anaerobic coverage in case of lung abscesses.
CONCLUSION
To date, the evidence supporting cavitary LD treatment is low. Monotherapy lowers toxicity and might be as effective as combination therapy. Finally, anaerobes should not be neglected.
Topics: Humans; Male; Middle Aged; Female; Legionnaires' Disease; Pneumonia; Anti-Bacterial Agents; Fluoroquinolones; Macrolides
PubMed: 38031167
DOI: 10.1186/s12941-023-00652-5 -
Cureus Jun 2023Central nervous system (CNS) actinomycosis is a rare, serious, life-threatening, suppurative infection caused by Actinomyces species. Actinomyces are anaerobic...
Central nervous system (CNS) actinomycosis is a rare, serious, life-threatening, suppurative infection caused by Actinomyces species. Actinomyces are anaerobic Gram-positive bacteria, which can be normally isolated from the polymicrobial flora of the gastrointestinal- and genital tracts. They are considered very low virulent bacteria to humans. However, they can lead to several types of local or disseminated infections, if certain pathologic states or immunodeficiency occur. Intracranial abscesses caused by Actinomyces meyeri are rarely reported in adults. In this case report, we describe a 66-year-old woman who presented to the emergency department due to progressive complaints of altered sensorium and low-grade fever, due to an A. meyeri-related brain abscess. The only risk factor was represented by immunodeficiency due to the therapy with Methotrexate and steroids.
PubMed: 37525793
DOI: 10.7759/cureus.41204