Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection (HAI) among neonatal patients in the intensive care units (ICUs) and is a serious challenge for neonatologists because it affects critically ill patients who need prolonged mechanical ventilation. In Bulgaria, there is no detailed data at regional and national levels on the characteristics of VAP in newborns, which imposes a necessity for specific studies of risk factors and etiology of VAP. The aim of the study was to analyze the frequency, characteristics and risk factors for the occurrence of VAP in newborns hospitalized in intensive care unit. This was a prospective study, conducted between January 2017 and June 2018 in the NICU of University Hospital “St. George” Plovdiv, Bulgaria. The sample consisted of 507 neonates, followed up prospectively, 107 of whom were placed on mechanical ventilation for ≥48 h. VAP was diagnosed in 33 out of 107 neonates (31%). The VAP incidence rate was 35.06/1.000 ventilator days. We confirmed differences between the median birth weight (1,310 vs. 1,690 g, p = 0.045) and average gestational age (31.08 g.w. vs. 33.08 g.w, p = 0.04) of the patients with and without VAP. The average stay of patients with VAP in the NICU was statistically significantly longer than the hospital stay of non-VAP patients (35.70 ± 21.84 days vs. 21.77 ± 17.27 days (t = 3.241, p = 0.002). In neonates with VAP, the duration of mechanical ventilation was statistically significantly longer compared with non-VAP patients (16.88 ± 11.99 vs. 5.42 ± 4.48; t = 5.249, p = 0.000). A statistically significant prevalence of Gram-negative bacteria among VAP patients was demonstrated (91%) compared to the Gram-positive (9%), p < 0.05. The leading causative agent of VAP was Klebsiella pneumoniae ESBLs + (27%), followed by Acinetobacter baumannii (14%), Pseudomonas aeruginosa (12%) and Escherichia coli (12%). In multivariate logistic regression, mechanical ventilation >7 days was established as an independent risk factor for VAP (OR 3.6; 95% CI: 1.7–6.5, p = 0.003). VAP remains a serious and outstanding issue in pediatric and neonatal intensive care units. The findings of the current study emphasize that the birth weight, gestational age, and duration of hospital stay have a significant association with ventilator-associated pneumonia.

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A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necrotizing fasciitis. A 57-year-old man was admitted on an emergency basis with evidence of a deep anorectal abscess of 5-day duration. The clinical presentation involved an unbounded purulent destructive inflammation spreading onto the adjacent areas, with the development of a septic condition. Following a short preparation, a radical surgical debridement of a subfascial purulent necrotic phlegmon of the pelvic space was performed. Since the lower part of the abdomen, retroperitoneum and scrotum were involved, 4 additional subsequent necrectomies were performed at 48-hour intervals. The aggressive radical operative treatment and the combined intensive therapy were the main contributors to the favorable outcome of the disease.

Background: Elizabethkingia spp. are Gram-negative, non-spore-forming bacteria that used to be rarely encountered but now they are of growing clinical significance. Furthermore, the diagnostic challenges to identification impede the complete elucidation of their epidemiology and association with human diseases. Case report: A 64-year-old man with liver cirrhosis due to alcohol abuse presented with fatigue, abdominal swelling, and bilateral scrotal edema. A peritoneal fluid sample was cultured and subject to a number of identification methods – API 20 NE (bioMerieux), automated Vitek-2 Compact (bioMerieux), MALDI-TOF MS (Vitek-MS, bioMerieux), and 16S rRNA gene sequencing. A final diagnosis of bacterascites was made on the basis of clinical, laboratory, and microbiological findings. Conclusion: To the best of our knowledge this is the first report of Elizabethkingia miricola being cultured from a peritoneal fluid sample in an immune-compromised host thus pointing to the emerging pathogenic role of the bacterium in patients with liver cirrhosis and ascites.

De la peau au cerveau: une suggestion pour diagnostiquer la méningite à virus de l'herpès simplex de type 2Introduction. Le virus de l'herpès simplex de type 2 est reconnu comme l'une des causes les plus fréquentes de méningite aseptique. C'est aussi une complication bien connue de l'herpès génital. Nous rapportons un cas de méningite récidivante à virus de l'herpès simplex de type 2 sans séquelles génitales mais aux lésions cutanées simultanées qui ont constitué un indice de diagnostic. Présentation du cas. Un jeune homme a connu deux épisodes de méningite aseptique en 2019 et 2021, respectivement. Dans les deux épisodes, les manifestations neurologiques ont été précédées de lésions cutanées herpétiques récurrentes sur son bras droit. L'ADN du virus de l'herpès simplex de type 2 n'a été dépisté dans le liquide céphalo-rachidien que lors du