This case report explores the rare occurrence of a needle embolism in the heart among individuals with intravenous drug use (IVDU). The intricate symptomatology, ranging from overt chest pain to asymptomatic cases, poses diagnostic challenges and may lead to underrecognition. Healthcare professionals must navigate varied presentations, emphasizing the need for a nuanced diagnostic approach. The interplay of needle embolisms with infective endocarditis and sepsis adds complexity, requiring a comprehensive understanding. Ongoing education and training are crucial for healthcare professionals to address the evolving challenges of needle embolism management within the broader context of infective endocarditis and sepsis. Our patient is a 31-year-old female with a history of IVDU who presented with heart palpitations and shortness of breath. A CT scan revealed lung lesions and a needle in the right ventricle. The patient was admitted for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia, where she underwent video-assisted thoracoscopic surgery (VATS) involving empyemectomy and wedge resection of the right-middle and lower lobes. However, it was deemed very risky to remove the needle from the right ventricle. Despite extensive discussion and patient education, she left the rehabilitation center without follow-up, highlighting the challenges of managing IV drug-related complications. In conclusion, heightened awareness and a proactive approach are crucial in managing rare complications such as needle embolisms in IVDU patients. This case underscores the significance of staying informed to improve patient care and outcomes amid evolving healthcare practices.

BACKGROUND: Drug-eluting stents (DES) are used to treat lower extremity arterial disease. During DES treatment, aneurysmal degeneration occasionally occurs, especially with fluoropolymer-based DES. However, the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region, although there have been several reports on pseudoaneurysm formation after DES pla-cement in the coronary artery region.
METHODS: We report the case of a 64-year-old man who presented with fever and pain in his left hand after dialysis. Bacteremia was diagnosed by blood culture, and after admission, he developed pain on the medial side of the right thigh. A pseudoaneurysm was observed in the right superficial femoral artery (SFA) at the proximal end of a previously placed DES. The bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery, and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic treatment. The pseudoaneurysm of the right SFA rapidly expanded after admission, but the expansion rate was reduced after infection control. Seven months after the first admission, the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron graft.
CONCLUSIONS: Although pseudoaneurysm after DES placement in the lower extremity region is rare, it must be considered in patients with bacteremia.

Septic pulmonary embolism (SPE) represents the occurrence of septic thrombi in circulation, originating from an extrapulmonary infectious source. Perianal and perirectal abscesses are frequently encountered anorectal issues, often stemming from obstructed anal crypt glands, resulting in pus accumulation within the subcutaneous tissue and intersphincteric plane. Timely surgical drainage is essential upon diagnosis of anorectal abscesses. Adult males exhibit a twofold higher incidence of anorectal abscesses and fistulae compared to females, with common symptoms including excruciating anal or rectal pain. This case report details the presentation and management of a 42-year-old male patient afflicted by Klebsiella pneumonia perianal abscesses that led to SPE. The report underscores the importance of recognizing and treating anorectal abscesses promptly to avert potentially life-threatening complications such as sepsis and fistulae.

Pseudomonas putida (P. putida) is a rare pathogen that primarily causes nosocomial infection. It is usually seen in immune dysfunction or immunocompromised patients and patients with invasive medical devices. Here, we present a rare case of P. putida bacteremia in a patient with cirrhosis of the liver.

BACKGROUND Flavonifractor plautii belongs to the clostridium family, which can lead to local infections as well as the bloodstream infections. Flavonifractor plautii caused infection is rarely few in the clinic. To understand better Flavonifractor plautii, we investigated the drug sensitivity and perform genome sequencing of Flavonifractor plautii isolated from blood samples in China and explored the drug resistance and pathogenic mechanism of the bacteria. CASE REPORT The Epsilometer test method was used to detect the sensitivity of flavonoid bacteria to antimicrobial agents. PacBio sequencing technology was employed to sequence the whole genome of Flavonifractor plautii, and gene prediction and functional annotation were also analyzed. Flavonifractor plautii displayed sensitivity to most drugs but resistance to fluoroquinolones and tetracycline, potentially mediated by tet (W/N/W). The total genome size of Flavonifractor plautii was 4,573,303 bp, and the GC content was 59.78%. Genome prediction identified 4,506 open reading frames, including 9 ribosomal RNAs and 66 transfer RNAs. It was detected that the main virulence factor-coding genes of the bacteria were the capsule, polar flagella and FbpABC, which may be associated with bacterial movement, adhesion, and biofilm formation. CONCLUSIONS The results of whole-genome sequencing could provide relevant information about the drug resistance mechanism and pathogenic mechanism of bacteria and offer a basis for clinical diagnosis and treatment.

江某，女，60岁，因“手麻”于某年11月3日至5日前往某无证经营的个体诊所接受治疗，其中3日外敷中草药，4日静脉滴注黄芪注射液，5日静脉滴注复方氨基酸注射液。11月5日15：00左右，江某在静脉滴注复方氨基酸注射液时突发寒战，诊所医生立即停止输液并予肌内注射维生素B12注射液，未予其他处置。16：45左右，江某自行返家后出现高热，伴呕吐、抽搐、神志不清。18：25左右，江某被送往当地医院抢救，入院时体温高达40.0 ℃，心率升至108次/min，血压低至10.8/6.3 kPa（81/47 mmHg），降钙素原（procalcitonin，PCT）升至32.44 ng/mL（参考值<0.05 ng/mL），初步诊断为败血症、多器官功能衰竭及弥散性血管内凝血。11月6日，江某体温及血压恢复正常，但PCT继续升至>100 ng/mL。20：00左右，江某因昏迷被转入上级医院，予抗感染（抗感染药物中包括亚胺培南）、抗休克、器官功能及营养支持等治疗，PCT稍降，但意识始终未恢复。11月7日21：10，江某呼吸心搏停止。22：10，江某经抢救无效死亡。.

UNASSIGNED: The occurrence of bacteremia is critically important for the survival of cancer patients. Therefore, our study aims to evaluate the efficacy of procalcitonin (PCT) and the procalcitonin to albumin ratio (PAR) in predicting bacteremia among this population.
UNASSIGNED: In this retrospective test-negative case-control study, we included 903 hospitalized cancer patients, divided into two groups: the bacteremia-positive group (BSI group, n = 384) and the bacteremia-negative group (non-BSI group, n = 519). We assessed the diagnostic significance of PCT and PAR through receiver operating characteristic (ROC) analysis and determined the optimal cut-off values using Youden\'s index.
UNASSIGNED: Both the duration of hospital stay and the 30-day mortality rate were significantly higher in the BSI group. The areas under the curve (AUC) for PAR and PCT were 0.749 (95% CI: 0.715-0.782) and 0.742 (95% CI: 0.708-0.776), respectively, indicating higher levels in the BSI group. The optimal cut-off values for predicting bacteremia were 0.72 for PAR and 1.32 for PCT. PAR showed the highest specificity (92.7%) and positive predictive value (PPV = 83.4%), while PCT demonstrated the highest sensitivity (51.3%) and negative predictive value (NPV = 71.6%).
UNASSIGNED: This study is the first in the literature to suggest that PAR and PCT are valuable biomarkers for diagnosing bacteremia in cancer patients. The identified cut-off values offer practical thresholds for bacteremia diagnosis.

This report describes a rare instance of Odoribacter splanchnicus bacteremia secondary to acute appendicitis in a young man. Initially presenting with symptoms typical of appendicitis, he was diagnosed through clinical examination, laboratory tests, and computed tomography imaging, which confirmed an inflamed appendix with sealed perforation and abscess. O. splanchnicus, a Gram-negative anaerobe commonly found in the human gut, was identified as the causative agent through blood culture. The patient underwent successful laparoscopic appendectomy and was treated with intravenous amoxicillin-clavulanate, leading to a full recovery. This case highlights the potential of O. splanchnicus to act as an opportunistic pathogen in the context of intra-abdominal inflammation. It underscores the diagnostic challenges posed by O. splanchnicus, and the efficacy of advanced diagnostic tools like matrix-assisted laser desorption/ionization-time of flight mass spectrometry in identifying such rare infections.

Edwardsiella tarda (E. tarda) is a gram-negative bacillus commonly isolated from aquatic environments and various aquatic animals. It rarely causes infections in humans, but rare human infections occur primarily through ingestion of infected seafood or aquatic animals. Symptoms include fever, gastroenteritis, and diarrhea, but severe extraintestinal infections have also been reported. This report describes a 76-year-old female developing E. tarda infection with iliopsoas abscess following acute pyelonephritis. Her chief complaint was fatigue and difficulty moving. Blood tests showed an increased inflammatory response, but the cause could not be identified from the patient\'s medical history, physical findings, and imaging findings. We diagnosed it as a urinary tract infection from the results of gram staining and started treatment, but the fever persisted thereafter, and a contrast-enhanced CT scan performed for re-evaluation revealed an iliopsoas abscess. After CT-guided abscess drainage, the patient made good progress and was transferred to a rehabilitation hospital on day 48 of the presentation. To the best of our knowledge, this is the first report of a case of E. tarda infection with iliopsoas abscess following acute pyelonephritis. Iliopsoas abscess is often difficult to diagnose. In this case report, we also present how we diagnosed and treated iliopsoas abscesses.

Systemic infections are not always going to present as we expect. The study of bacteremia and febrile syndrome represents one of the most important diagnostic challenges nowadays. This case demonstrates the importance of a multidisciplinary approach and finding a common point that explains all the patient\'s symptoms, no matter how disconnected they may seem. Here, we present the case of a patient where multiple treatments were performed to manage recurrent infective endocarditis due to Enterococcus faecium but the cause of this persistence was never found despite surgical management. With only a few cases reported in literature involving this pathogen, it is of great importance to emphasize how searching for a natural reservoir, such as the gallbladder, for this pathogen helped solve the diagnostic mystery that this patient represented. Here, we present how the culture of biological materials, such as the aortic valve replacement, as well as blood cultures, made it possible to identify the etiological agent associated with the pathology and, in turn, find the cause of recurrent bacteremia.