Introduction Peritonitis refers to the inflammation of the peritoneum and peritoneal cavity. Causes of peritonitis can be bacterial (gastrointestinal or non-gastrointestinal), chemical, traumatic, or ischemic. Peritonitis can be localized or diffuse, acute or chronic. Peritonitis can be primary, secondary, or tertiary, according to the pathogenesis. Peritonitis developed secondary to hollow viscus perforation is a life-threatening condition and a common cause of emergency surgery in India. The Mannheim peritonitis index (MPI) is a simple scoring system that can accurately predict the outcome of peritonitis. This study aimed to evaluate the effectiveness of MPI in predicting mortality risk or prognosis in patients with peritonitis due to hollow viscus perforation. Materials and methods This observational cross-sectional study at the Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, involved 111 patients with peritonitis due to hollow viscus perforation from December 2021 to March 2022. Detailed history, clinical examination, relevant blood tests, and radiological investigations established a diagnosis of perforation peritonitis, followed by a score assessment. Data were analyzed using SPSS software (IBM Corp., Armonk, NY, USA). Results Patients >50 years had higher mortality (i.e., 18/43) than patients <50 years (i.e., 13/68). Overall mortality was 31, which included one in low risk, 12 in intermediate risk, and 18 in the high-risk group. Mortality was lowest in the low-risk group (i.e., 1/30), highest in the high-risk group (i.e., 18/40), and 12/41 in the intermediate-risk group; the p-value was <0.05, which was highly significant. Mortality was higher in patients presenting after 24 hours, having organ failure, and non-colonic sepsis. Conclusion The MPI scoring system is simple, easy to calculate, cost-effective, precise, and effective in assessing mortality and morbidity risk in patients with peritonitis due to hollow viscus perforation. It can also guide further management strategies.

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Subdural empyema is the collection of purulent material between the dura mater and arachnoid. Subdural empyema most often occurs due to the direct extension of local infection. But spontaneous subdural empyema is a rare entity. In literature, not many cases of spontaneous subdural empyema by Escherichia coli are reported. Here we report a case of spontaneous subdural empyema along with a review of literature who was previously treated on the suspicion of encephalitis with urinary tract infection and then brought to our hospital.

Objective: The objective of this case report is to describe utilization of area under the curve (AUC)/minimum inhibitory concentration (MIC) vancomycin dosing with variable MIC results in a patient with methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis. Case: A 57-year-old Caucasian male presented with cardiac tamponade and pulmonary emboli. Echocardiogram showed moderate-large pericardial effusion with signs of early tamponade physiology. Pericardiocentesis removed serosanguinous, straw yellow fluid. Blood and pericardial cultures revealed MRSA. Patient was then initiated on vancomycin with an initial AUC of 415. MIC of repeat blood cultures were inconsistent. After 8 days of persistent bacteremia, patient was transitioned to daptomycin and ceftaroline with blood culture clearance within 48 hours. Discussion/Conclusion: Guidelines recommend AUC/MIC vancomycin dosing in patients with MRSA bacteremia. Literature regarding treatment of MRSA purulent pericarditis is limited to case reports. Evidence shows variation in MIC results dependent on analysis methods. Further studies on obtaining accurate MIC values and use of AUC/MIC dosing for MRSA purulent pericarditis are prudent to provide appropriate therapy in these patients as mortality is high.

Shewanella putrefaciens is a Gram-negative, non-fermenting, motile and oxidase-positive bacillus. Its incrimination in human pathology is very rare, although there has been a resurgence in Shewanella infections in recent years. We report the first case in Morocco of a purulent otorrhoea caused by S. putrefaciens , resistant to conventional treatment, occurring in a 25-year-old female, afebrile, without deterioration of the general state and possibly acquired during sea bathing. We also describe the bacteriological characteristics of and antibiotic susceptibility results for the isolate.

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Skin and soft tissue infections (SSTIs) are often caused by gram-positive bacteria that colonize the skin. Given the overuse of antibiotics, SSTIs are increasingly caused by resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Guidance on the utility of MRSA nasal screening for MRSA SSTI is limited.
To determine whether MRSA nasal screening predicts the risk of MRSA SSTIs.
This was a single-center, retrospective cohort study of adult patients with an SSTI diagnosis that had MRSA nasal screening and wound cultures obtained within 48 hours of starting antibiotics. Sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios were calculated using VassarStats. Pretest and posttest probabilities were estimated with Microsoft Excel.
A total of 884 patient encounters were reviewed between December 1, 2018, and October 31, 2021, and 300 patient encounters were included. The prevalence of MRSA SSTI was 18.3%. The MRSA nasal colonization had a sensitivity of 63.6%, specificity of 93.9%, positive predictive value of 70.0% (95% CI = 55.2%-81.7%), negative predictive value of 92.0% (95% CI = 87.7%-94.9%), positive likelihood ratio of 10.39 (95% CI = 6.12-17.65), negative likelihood ratio of 0.39 (95% CI = 0.27-0.55), positive posttest probability of 70.0%, and negative posttest probability of 8.0%.
Given the high positive likelihood ratio, a positive MRSA nasal screen was associated with a large increase in the probability of MRSA SSTI at our institution, and a negative MRSA nasal screen was associated with a small but potentially significant decrease in the probability of MRSA SSTI.

Achromobacter xylosoxidans is an aerobic, Gram-negative rod with a broad intrinsic and acquired antimicrobial resistance, usually isolated in patients with cystic fibrosis (CF), immunodeficiencies, or those undergoing invasive procedures. We report a case of a previously healthy 14-year-old girl who was hospitalized in our institution due to a prolonged, progressive cough and exertional dyspnea, which started after a mild viral respiratory tract infection. To elucidate the cause of her symptoms, a bronchoscopy was finally performed, showing bilateral purulent bronchitis caused by A. xylosoxidans, isolated from bronchoalveolar lavage (BAL) sample. Since the patient had positive serological testing for coronavirus disease 2019 (COVID-19), we concluded that it was the initial viral infection, although of a mild clinical course, the one that created favorable conditions for proliferation and further inflammation caused by A. xylosoxidans.

BACKGROUND: Infection is a common complication after the thread-lifting procedure, but the late-onset chronic purulent skin and soft tissue infection (SSTIs) after nonabsorbable thread lifting is quite rare.
OBJECTIVE: To alert physicians should be aware of this kind of late-onset complication after nonabsorbable thread lifting.
METHODS: A 54-year-old woman who accepted a facial lifting procedure 4 years ago visited our hospital with three recurrent abscesses protruding masses on the right side of the parietal area for 8 months. Bacterial culture of the white pus was positive for Staphylococcus aureus (S. aureus). During the drainage and excisional biopsy, two knots of barbed threads and three smooth threads were detected and removed. Consequently, she was treated with systemic antibiotics for 72 h and partial wound dressing changes.
RESULTS: The wound was fully healed 7 days after surgery.
CONCLUSIONS: Removal, drainage, and antibiotics are effective methods of this kind of late-onset complication after nonabsorbable thread lifting.

Purulent pericarditis is a rare bacterial illness in the post-antibiotic era that is defined as pericardial infection with gross or microscopic purulence in the pericardium. Common causes include nosocomial bloodstream infections, direct spread through thoracic surgery, or immunosuppression. We present a case of a 66-year-old male with a history of mantle cell lymphoma status post chemotherapy, completed about 4 years before presentation, in general, good health presented with acute typical chest pain associated with dyspnea on exertion. 12-lead EKG demonstrated ST elevations in anterolateral and lateral leads. Patient was initially being managed as Acute Coronary Syndrome, though, preliminary bedside echocardiogram demonstrated a large pericardial effusion with pretamponade physiology, which was confirmed with a STAT transthoracic echocardiogram. He underwent an emergent pericardial window which drained 350-400 ml of yellow murky pericardial fluid. Blood cultures and pericardial fluid cultures grew Haemophilus influenzae (H. influenzae). Upon further history taking, patient revealed experiencing upper respiratory symptoms and being diagnosed with pansinusitis 2 months before his admission. He was treated with IV ceftriaxone for 4 weeks from the day of negative blood cultures. H. influenzae upper respiratory infection is usually seen in the unvaccinated pediatric population, or in immunocompromised individuals; however, few cases in vaccinated adults have been reported, as in the above case. Sequalae from H. influenzae infection is usually limited to upper respiratory symptoms and mastoiditis, but rarely, pericarditis could occur. It is important to include pericarditis in the differential for chest pain in a patient with a recent history of upper respiratory symptoms. Pericarditis is a rare but potentially serious complication of recent upper respiratory tract infection, and needs to be promptly identified and treated to avoid further morbidity.