INTRODUCTION:Chronic osteomyelitis (COM) is a common infection, especially in developing countries. An adequate bone biopsy specimen processed with appropriate microbiology culture methods for isolation and identification of the causative organisms is considered as the gold standard for the diagnosis of osteomyelitis.MATERIALS AND METHODS:The present study is a retrospective microbiology analysis of the specimen from 219 clinically diagnosed cases of COM between January 2013 and April 2016.RESULTS:The overall culture positivity was 111/219 (50. 6%), colonization was seen in 22/219 (10.5%), while the rest 86/219 (39.3%) were culture-negative specimen; culture positivity was highest from tissue specimen (71/113, 62.8%). Among the swabs, 40/106 (37.7%) were culture positive. About 28/40 (70%) culture-positive swabs showed significant growth of Gram-positive organisms. Colonization with skin flora such as diphtheroids and Coagulase-negative Staphylococci was seen in 22/106 (20.7%) of the swabs. Sterile cultures (44/106, 41.6%) were high among the swab specimen. Gram-positives were most common (75/111, 67.56%). Staphylococcus aureus was the predominant organism isolated in 70/111 (63%) cases. Gram-negative bacilli showed a high level of antibiotic resistance.CONCLUSION:As per our data, the culture yield from wound swabs was low or contaminated with normal skin flora, as compared to the biopsy or tissue specimen. Hence, an appropriate sampling of the infected bone using recommended protocols is highly essential for improving microbiological yield and the outcome of COM.

Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We desired to analyze our patients with Apophysomyces infection reported over 25 years (1992–2017) to understand the epidemiology, management, and outcome of the disease. During the study period 24 cases were reported, and the majority (95.8%) of them presented with necrotizing fasciitis following accidental/surgical/iatrogenic trauma. One patient presented with continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Healthcare related Apophysomyces infection was noted in 29.2% patients. In addition to trauma, comorbidities were noted in 37.5% patients (type 2diabetes mellitus-6, chronic alcoholism-2, and chronic kidney disease-1). Of the 24 isolates, 11 isolates starting from year 2014 were identified as Apophysomyces variabilis by molecular methods. Majority (95.8%) of the patients were managed surgically with or without amphotericin B deoxycholate therapy, while one patient was treated with amphotericin B deoxycholate alone. Among 24 patients, seven (29.1%) recovered, six (25%) patients could not afford antifungal management and left the hospital against medical advice, and 11 (45.9%) patients died.The present case series highlights that necrotizing fasciitis caused by A. variabilis is prevalent in India, and the disease may be healthcare related. Although diagnosis is not difficult, awareness among surgeons is still limited about the infection, leading to a delay in sending samples to the mycology laboratory. Apophysomyces infection must be considered in the differential diagnosis in apatient with progressive necrosis of a wound who is not responding to antibacterial therapy.

Introduction: Pyogenic infections are an important cause of sepsis. These infections are difficult to treat because of the pathogens with increasing antibiotic resistance. It is important to know the pathogens causing the infections and its antibiotic susceptibility for proper management of the patients. Methodology: A retrospective analysis of 1428 culture positive pus and tissue samples received in the department of microbiology from various departments in the hospital between January 2012 to 2017 was performed. Data regarding the pathogen isolated and its antimicrobial susceptibility were collected and analyzed. The specimens were primarily processed, as per standard methods. Identification and susceptibility testing was done using the Vitek-2C system. Results: Among the samples males outnumbered females (M: F-2.5:1) and the median age was 47 years. The total number of patients were 1428 with total number of isolates being 1525 as in our study monomicrobial infections were seen in 93.2% (1331/1428) patients whereas combined infections with growth of two pathogens in 6.8% (97/1428). Gram-negative bacilli were isolated in 68.3% (1042/1525). Among the Gram-negative bacilli Escherichia coli was the major pathogen isolated (38.6%, 403/1042). Gram positive organisms were isolated in 31.6% (483/1525) of cases and Staphylococcus aureus was the predominant organism isolated (91.7%, 443/483). Rare pathogens like Burkholderia pseudomallei in 3 patients and Nocardia in one patient were also isolated. Conclusion: This study emphasizes to understand the common organisms isolated from wound infections and it helps in empirical treatment of patients based on antibiotic susceptibility patterns.

INTRODUCTION:Urinary tract infections (UTIs) are the most common infectious diseases occurring in either the community or healthcare setting. Turnaround time for urine culture is about 24 h, and antimicrobial susceptibility testing (AST) requires another 24 h. Consequently, initial antibiotic therapy is mostly empirical.MATERIALS AND METHODS:This study was conducted at Nizam's Institute of Medical Sciences, Hyderabad. Turbid urine samples which showed pus cells and Gram-negative (GN) bacilli of single morphotype were included. The turbidity of the urine was adjusted to 0.5 McFarland and uploaded directly in the VITEK 2 identification (ID) GN and N-280 panel for AST. The specimen was also inoculated on CHROMagar, and the ID and AST of the isolates from the agar plate were repeated on VITEK 2, and the results were compared.RESULTS:Out of 844 turbid urines screened, 62 met the inclusion criteria. Escherichia coli was the most common isolate (71.9%). Complete agreement for ID was 80.7%, misidentified were 12.2%, and unidentified were 7%. Complete agreement with AST was 94.3%, very major errors 0.5%, major errors 2.2%, and minor errors 3%.CONCLUSION:With a 94.3% agreement for AST and a reduced turnaround time by 24 h, the direct inoculation had a potential clinical benefit for initiating timely and appropriate antibiotic therapy for UTI.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction Trichosporonosis has emerged as an opportunistic pathogen causing invasive infections in immunocompromised patients. Invasive trichosporonosis can involve most organs of the human body. Trichosporon species can colonize many parts of our body and hence it is important to differentiate between colonization and infection for appropriate management of the patients. Objective To understand the clinical and epidemiological features of infections caused by Trichosporon spp. Methods All patients with clinically significant isolation of Trichosporon spp from various samples during a period of one year from January 2019-December 2019 were included in the study. In the present retrospective study demographic data, risk factors, clinical features, microbiological data, treatment, and the outcome of patients with invasive trichosporonosis were analyzed. All the specimens were processed by standard mycological procedures. Identification and susceptibility were done by VITEK 2. The isolates were sent to NCCPF, PGIMER Chandigarh for identification by MALDI-TOF. As no clinical breakpoints for Trichosporon spp. have been established by CLSI and EUCAST, antifungal susceptibility results were interpreted as suggested by Lemes et al. Results There were 14 cases of trichosporonosis during the study period. The predominant age group was 60-70 years and the male: female ratio is 6.5:1. The underlying condition of the patient at admission was accidental trauma in 4/14 (28.7%) chronic kidney disease in 2/14 (14.2%), hematological malignancy in 2/14 (14.2%), pneumonia in 1/14 (7.1%), retroviral disease in 1/14 (7.1%), acute febrile illness in 1/14 (7.1%). The risk factors for acquisition of infections with Trichosporon species in the 14 patients were administration of broad-spectrum antibiotics in 13 (92.8%), urinary catheterization in 11 (78.5%), central venous catheterization, and prolonged ICU stay in 8 (57.1%) each, previous antifungal therapy in 6 (42.8%). The other risk factors were chemotherapy, steroid usage, and neutropenia. The clinical presentations were urinary tract infections in 10/14 (71.4%) patients (9 were catheter-associated UTIs), fungemia in 2/14 (14.2%), and wound infections in 2/14 (14.2%) patients. Trichosporon asahii is the predominant species isolated in 12/14 (85.7%) patients. Other Trichosporon spp. isolated include T. inkin and T. dohaense. All the isolates were correctly identified by VITEK 2 except one which was identified as T. inkin in VITEK 2 and T. dohaense by MALDI-TOF. All the isolates were susceptible to voriconazole and amphotericin B. 9/14 (64.2%) of the isolates were susceptible to fluconazole. Trichosporon spp. is inherently resistant to echinocandins. A total of 7 patients (50%) were successfully treated with voriconazole for a period of 14 days with advice to follow up and discharged. In all, 5 patients (35.7%) died due to underlying diseases before treatment could be started. Conclusion Urinary tract infection, mostly CA-UTI was the commonest clinical presentation of Trichosporonosis in our study followed by bloodstream infection and wound infection. The commonest risk factor was prolonged broad-spectrum antibiotic therapy followed by urinary catheterization. The growth of Trichosporon spp. from various samples has to be interpreted with caution as the organism can also exist as a colonizer in different body sites. Voriconazole was effective in the treatment of trichosporonosis.