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Intra-amniotic infection: diagnosis, nomenclature, clinical significance, management, and microbiologic tools used for the diagnosis.

SUMMARYIntra-amniotic infection is the main cause of spontaneous preterm birth and adverse maternal-fetal outcomes; therefore, rapid, robust, and accurate diagnosis remains a clinical priority. Conventional microbiological techniques, especially culture-based methods, are limited by long turnaround times and the inability to detect fastidious or unculturable organisms. This review summarizes the diagnosis, nomenclature, clinical significance, management, and laboratory approaches for diagnosing intra-amniotic infection. Targeted nucleic acid amplification methods, including species-specific polymerase chain reaction and broad-range 16S rRNA gene sequencing, have improved the detection of bacterial DNA and enabled the identification of organisms that evade routine culture in intra-amniotic infection. More recently, whole-genome sequencing and metagenomic next-generation sequencing have provided culture-independent strategies for comprehensive pathogen profiling, allowing simultaneous detection of bacteria, viruses, and fungi, as well as characterization of antimicrobial resistance determinants and virulence-associated genes. However, challenges remain, particularly in low-biomass samples such as amniotic fluid, where contamination, host DNA background, and data interpretation can compromise specificity. This review critically evaluates the advantages and limitations of each molecular modality and discusses pre-analytical, analytical, and bioinformatic considerations essential for reliable implementation. Integration of molecular diagnostics into clinical workflows holds promise for improving etiological diagnosis and guiding targeted therapy in intra-amniotic infection, thereby improving maternal and fetal outcomes.

Humans

Cotrimoxazole and folate metabolism.

Cotrimoxazole 4 tablets daily (1 tablet = trimethoprim 80 mg and sulphamethoxzole 400 mg) was given for a period of six to fourteen days to 13 inpatients, and serum-folate levels were measured before and one day after the course of treatment. The results were compared with those from 8 patients not receiving antibacterial therapy, tested on admission and one week later. Two assay techniques were used, one employing Lactobacillus casei and the other 125I-labelled folate isotope dilution. The microbiological technique showed a significant decline in folic-acid levels in the serum after cotrimoxazole, and this decline was not seen in controls. By contrast, the radioisotope technique showed no significant alteration in serum-folate levels compared with controls. This suggests that cotrimoxazole does not depress true serum-folate and that many low microbiological results obtained during cotrimoxazole therapy reflect interference with the assay organism. There is insufficient evidence to incriminate cotrimoxazole as a significant cause of blood dyscrasias in excess of those which might occur on sulphonamide alone or even with other antibacterials.

Biological Assay

Listeria monocytogenes endophthalmitis.

Listeria monocytogenes and a staphylococcus organism caused a catastrophic endophthalmitis in a patient despite appropriate local and systemic antimicrobial chemotherapy. Although L monocytogenes is widespread in nature and has produced a variety of clinical illnesses, it has only one previously been reported to cause endophthalmitis. If appropriate microbiologic techniques are not employed, the organism may go unrecognized as an ocular pathogen.

Ampicillin

An epizootic of Salmonella typhimurium var. copenhagen in broilers and the use of cultured chicken interestinal flora for its control.

1. An epizootic caused by Salmonella typhimurium var. copenhagen and occurring on the farms of one company was examined with the following factors in mind: the spread of the epizootic, the infection rate of the flocks and the role of the food, hatchery and parent stock. 2. A microbiological technique was used the aim of preventing infection on the farms. 3. The method of control was not as effective the field as in the laboratory; the possible reasons for this are discussed.

Animals

Culture and microscopy of microorganisms in frozen sections.

A simple method is described in which frozen sections are prepared from tissue cell suspensions with added microorganisms and then cultured. The enhanced growth of the organisms makes their indentification easier. A number of applications is suggested.

Culture Media

The role of the microbiology laboratory in surveillance and control of nosocomial infections.

The microbiology laboratory's rapid and consistent identification of nosocomial pathogens is a keystone in the surveillance and control of hospital-acquired infections. In addition, the laboratory serves as a source of expert consultation for clinicians and infection control personnel and as an "early warning center" for infection problems. In making its contributions to infection control most effective, the laboratory must recognize its capabilities and limitations, must insure that the materials and methods it uses and the specimens it processes meet high standards, must provide retrievable records, and must have a good working knowledge of microbiologic technics used to evaluate both endemic and epidemic infections. Moreover, because laboratory workers come into contact daily with potentially infectious specimens and isolates, the laboratory's contributions to infection control should also include the prevention and surveillance of laboratory-acquired infections.

Cross Infection

Unusual effects of penicillin G and chloramphenicol on the growth of Moraxella osloensis.

Growth of exponential-phase liquid cultures of Moraxella osloensis was inhibited by 0.5 U of penicillin G per ml. For this organism, low concentrations of penicillin acted primarily in a bacteriostatic rather than in a bactericidal manner. At higher concentrations of penicillin some killing did take place, but the rate of killing was rather slow and appeared to be independent of penicillin concentration. Microscopic observation of cells from penicillin-treated cultures showed little or no cellular swelling or lysis. The total cell count did not decrease significantly during 6 h of incubation in 5,000 U of penicillin per ml. The rates of respiration, nucleic acid synthesis, and protein synthesis were not affected by the presence of penicillin. Attempts to counteract the bactericidal action of high concentrations of penicillin with growth inhibitory concentrations of chloramphenicol were unsuccessful, since chloramphenicol itself was more bactericidal than penicillin for M. osloensis.

Bacterial Proteins

Premarket evaluation of commercial toxoplasmosis indirect fluorescent-antibody reagents.

The quality of commercial toxoplasmosis indirect fluorescent-antibody reagents was evaluated over a 6-year period. Seven manufacturers voluntarily submitted their products for evaluation in the Center for Disease Control Premarket Evaluation Program. Each product was tested in accordance with the Center for Disease Control performance and labeling specifications and evaluation methods. Only 49% of all of the products tested met the Center for Disease Control requirements. Performance criteria are outlined, and suggestions are offered to assist laboratorians in obtaining toxoplasmosis indirect fluorescent-antibody reagents of high quality.

Antibodies

Performance evaluation of a commercial multiplex pathogen panel for detection of bacteria in sputum specimens from non-ICU patients with suspected lower respiratory tract infection.

Rapid diagnostic testing can improve pathogen detection and lead to targeted antibiotics. The BioFire FilmArray Pneumonia Panel (BFPP) is a multiplex PCR that has displayed strong concordance with traditional microbiologic techniques. However, most existing literature focuses on deep respiratory specimens, and there is sparse literature on performance in sputum specimens. This retrospective, single-center study included adult patients between 1 September 2022 and 31 August 2024 who had collection of a BFPP with standard of care (SOC) culture from a sputum specimen on a non-intensive care unit (ICU) floor or in the emergency department if admitted to a non-ICU floor. Out of 189 BFPPs performed on 189 sputum specimens, a total of 141 bacterial targets were detected. Between the BFPP and SOC culture, the overall positive percent agreement and negative percent agreement (NPA) were 96.3% and 54.9%, respectively. The positive predictive value (PPV) was 26.3% while the negative predictive value was 98.9%. Patients with greater than 24 h of antibiotic exposure prior to BFPP collection had a lower PPV compared to patients with less than 24 h or no exposure (13.6% vs 29.6% vs 30.4%). The lowest concordance was observed for Haemophilus influenzae (15.4%), Moraxella catarrhalis (18.2%), Streptococcus pneumoniae (19%), and Staphylococcus aureus (22.7%), several of which are fastidious in culture. BFPP showed a high NPA, with all bacterial targets having an NPA greater than 90%, except H. influenzae (82%). Based on these data, a negative BFPP in sputum specimens could help to rule out a bacterial pneumonia, but the benefit of a positive test remains unclear.IMPORTANCEThis study evaluates the BioFire FilmArray Pneumonia Panel (BFPP) by comparing its performance to standard of care cultures exclusively in sputum specimens from non-intensive care unit patients with suspected lower respiratory tract infection. Findings show an overall high positive percent agreement and negative predictive value but a low negative percent agreement and positive predictive value, suggesting that a negative test in sputum specimens could be beneficial when attempting to rule out a bacterial infection, but the benefit of a positive test remains unclear, particularly if common airway colonizing bacteria are detected and at low semi-quantitative thresholds. Clinical symptoms should guide test interpretation in patients with positive BFPP results but negative culture growth.

Humans

Genomic and virulence characteristics of Staphylococcus aureus isolates from foodborne outbreak cases.

This study aimed to investigate the genomic characteristics, enterotoxin production, and antimicrobial resistance profiles of Staphylococcus aureus isolates associated with foodborne outbreaks. A total of 19 bacterial isolates were collected from foodborne outbreaks in Guizhou Province, China between 2014 and 2023. Following biochemical identification, all isolates were confirmed as S. aureus. Phylogenetic analysis divided the 19 strains into seven branches. Enterotoxin production was detected using standard microbiological techniques and immunoassays. Antimicrobial susceptibility was evaluated using the broth microdilution method. Whole-genome sequencing and subsequent bioinformatic analyses were conducted to characterize virulence genes, antimicrobial resistance genes, multilocus sequence typing (MLST) genotypes, and phylogenetic relationships among the isolates. This study found that all strains produced classical staphylococcal enterotoxins, with staphylococcal enterotoxin (SEA) showing the highest detection rate (63.16%). Virulence gene profiling revealed widespread presence of hlb, hlgA, nuc, clfB, spa, and set genes. All strains were resistant to penicillin, with high resistance rates for erythromycin and cefoxitin. Multidrug resistance occurred in 11 of the 19 strains, and 22 resistance genes were identified. MLST analysis showed that ST6 and ST59 were the dominant types, with ST59 methicillin-resistant S. aureus (MRSA) strains displaying stronger resistance and more virulence determinants. These findings provide insights into the virulence, resistance, and molecular epidemiology of S. aureus strains involved in foodborne outbreaks, and may provide useful information for future surveillance and risk assessment.

Staphylococcus aureus