RESUMEN
OBJECTIVE: We report an outbreak of Elizabethkingia anophelis infections in France. To the best of our knowledge, this is the first outbreak described in Europe. METHODS: Each E. anophelis-positive microbiological sample was considered a case. All patients were hospitalized in an infectious diseases unit. Clinical, environmental, and microbiological investigations (MALDI-TOF mass spectrometry, PCR, E-test) were performed for each case. RESULTS: Twenty cases were reported from September 2020 to September 2021, mainly community-acquired infections, responsible for nine deaths. The phylogenetic analysis showed a clonal origin and excluded nosocomial transmission. Despite the analysis of multiple environmental specimens, no source of contamination was identified. All strains were highly resistant to cefotaxime, ceftazidime, and imipenem. CONCLUSIONS: Clinicians and microbiologists should be aware of this multidrug-resistant bacterium, capable of causing severe infections. Most strains showed the lowest minimum inhibitory concentration values for cotrimoxazole and ciprofloxacin, making them the best choice for empirical antibiotic therapy.
Asunto(s)
Infecciones por Flavobacteriaceae , Flavobacteriaceae , Brotes de Enfermedades , Infecciones por Flavobacteriaceae/tratamiento farmacológico , Infecciones por Flavobacteriaceae/epidemiología , Infecciones por Flavobacteriaceae/microbiología , Humanos , FilogeniaRESUMEN
Enterococcus hirae, a gram-positive bacterium, is a rare isolate in clinical specimens. We report an unusual case of a relapse of prosthetic valve endocarditis due to E. hirae 6 months after the initial episode. Clonal relationship was proven by genomic analysis.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Técnicas de Tipificación Bacteriana , Electroforesis en Gel de Campo Pulsado , Endocarditis Bacteriana/patología , Enterococcus/clasificación , Enterococcus/genética , Femenino , Genotipo , Infecciones por Bacterias Grampositivas/patología , Humanos , Tipificación Molecular , Infecciones Relacionadas con Prótesis/patología , RecurrenciaRESUMEN
OBJECTIVES: To assess the meningeal penetration of cefazolin and cloxacillin in individuals treated for methicillin-susceptible staphylococcal meningitis. METHODS: We retrospectively identified individuals treated for Staphylococcus meningitis with measurements of cefazolin or cloxacillin concentrations in cerebrospinal fluid (CSF) using a validated assay of liquid chromatography coupled with mass spectrometry at the Nantes University Hospital between January 2009 and October 2019. Staphylococcus meningitis was defined by a compatible clinical presentation and a microbiological confirmation (positive CSF culture or positive specific PCR). Medical charts were retrospectively reviewed to collect microbiological and clinical data, and to assess therapeutic success. RESULTS: Among the 17 included individuals, eight (47%) were treated with cefazolin and nine (53%) with cloxacillin. Median daily dosages of cefazolin and cloxacillin were 8 g (range 6-12 g) and 12 g (range 10-13 g), respectively. Cefazolin and cloxacillin were mainly administered by continuous infusion. Eleven individuals (65%) were men, median (interquartile range (IQR)) age was 54 years (50; 70), 14 (82%) had postoperative meningitis and 3 (18%) had haematogenous meningitis. Median (IQR) antibiotic CSF concentrations were 2.8 mg/L (2.1; 5.2) and 0.66 mg/L (0.5; 0.9) for cefazolin and cloxacillin groups, respectively. Cloxacillin was discontinued in two individuals for therapeutic failure. CONCLUSIONS: Patients with staphylococcal meningitis treated with high-dose continuous intravenous infusion of cefazolin achieved therapeutic concentrations in CSF. Cefazolin appears to be a therapeutic candidate that should be properly evaluated in this indication.
Asunto(s)
Antibacterianos/líquido cefalorraquídeo , Cefazolina/líquido cefalorraquídeo , Cloxacilina/líquido cefalorraquídeo , Meningitis Bacterianas/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Anciano , Antibacterianos/uso terapéutico , Cefazolina/uso terapéutico , Cromatografía Liquida , Cloxacilina/uso terapéutico , Femenino , Humanos , Masculino , Espectrometría de Masas , Persona de Mediana Edad , Estudios Retrospectivos , Staphylococcus aureus/efectos de los fármacosRESUMEN
Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report seven cases, which occurred during a period of 1 year in western France. Six cases were because of Candida albicans, and one pacemaker endocarditis was because of Candida parapsilosis. All patients were men and presented risk factors for candidaemia. Of the six patients with valvular involvement, five received caspofungin and two had surgical valve replacement. Three patients treated with caspofungin antifungal therapy without valve replacement were cured from endocarditis. Antifungal and surgical strategies are discussed, in particular, the possible role of new antifungal therapies and long-term suppression therapy without surgery. One patient died in the acute phase of endocarditis, three patients died of causes unrelated to infective endocarditis and three patients had a favourable outcome.
Asunto(s)
Antifúngicos/uso terapéutico , Candida/aislamiento & purificación , Candidiasis/diagnóstico , Candidiasis/tratamiento farmacológico , Endocarditis/tratamiento farmacológico , Endocarditis/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Candida/clasificación , Candidiasis/microbiología , Candidiasis/cirugía , Caspofungina , Niño , Preescolar , Equinocandinas/uso terapéutico , Endocarditis/cirugía , Resultado Fatal , Femenino , Francia , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/microbiología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Lactante , Recién Nacido , Lipopéptidos , Masculino , Persona de Mediana Edad , Adulto JovenAsunto(s)
Acetamidas/uso terapéutico , Antibacterianos/uso terapéutico , Daptomicina/uso terapéutico , Prótesis de Cadera/efectos adversos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Oxazolidinonas/uso terapéutico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Acetamidas/administración & dosificación , Acetamidas/efectos adversos , Acetamidas/farmacología , Anciano de 80 o más Años , Anestesia , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Antibacterianos/farmacología , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Enfermedades de la Médula Ósea/inducido químicamente , Comorbilidad , Contraindicaciones , Daptomicina/administración & dosificación , Daptomicina/farmacología , Esquema de Medicación , Quimioterapia Combinada , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Humanos , Linezolid , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Oxazolidinonas/administración & dosificación , Oxazolidinonas/efectos adversos , Oxazolidinonas/farmacología , Infecciones Relacionadas con Prótesis/microbiología , Rifampin/administración & dosificación , Rifampin/uso terapéutico , Infecciones Estafilocócicas/microbiología , Síndrome de Respuesta Inflamatoria Sistémica/tratamiento farmacológico , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoAsunto(s)
Encefalopatías/inducido químicamente , Encefalopatías/microbiología , Neuroaspergilosis/inducido químicamente , Infecciones Oportunistas/inducido químicamente , Pirazoles/efectos adversos , Pirimidinas/efectos adversos , Adenina/análogos & derivados , Anciano , Humanos , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Masculino , Piperidinas , Pirazoles/uso terapéutico , Pirimidinas/uso terapéuticoRESUMEN
We report a case of a pulmonary histoplasmosis in an HIV-positive patient usually living in Cambodia, with a positive Aspergillus galactomannan antigenemia resulting from a cross-reaction, that decreased after antifungal therapy. We discuss the potential interest of the detection of fungal DNA by PCR and Aspergillus galactomannan antigenemia for the diagnosis of histoplasmosis, especially in countries where Histoplasma capsulatum antigen testing is not available.
Asunto(s)
Antígenos Fúngicos/sangre , Aspergillus/inmunología , Histoplasmosis/sangre , Histoplasmosis/diagnóstico , Enfermedades Pulmonares Fúngicas/sangre , Enfermedades Pulmonares Fúngicas/diagnóstico , Mananos/inmunología , Galactosa/análogos & derivados , Humanos , Masculino , Persona de Mediana Edad , Biología MolecularRESUMEN
OBJECTIVE: A one-year prospective, observational study was conducted in the west of France, to evaluate the epidemiology of candidemia. METHOD: During the year 2004, each patient with at least one blood culture yielding Candida sp. was included. For each episode of candidemia, mycological, demographical, clinical, and therapeutic data, as well as outcome, were collected. RESULTS: One hundred and ninety-three strains of Candida sp. were isolated in 186 patients, Candida albicans accounting for 54.9%, Candida glabrata for 18.7%, Candida parapsilosis for 12.9%, Candida tropicalis for 4.7% and Candida krusei for 4.1% of these isolates. A percentage of 84% of the Candida isolates were fully susceptible to fluconazole in vitro. Dose-dependent susceptibility or resistance to fluconazole was detected in more than one third of the Candida glabrata strains, of which 36% were also resistant to voriconazole. Two-thirds of the patients were males, and the mean age was 61.5 years. A percentage of 37% of patients were hospitalized in intensive care units. The main predisposing factors for candidemia were broad-spectrum antibiotics (75.8%), central venous catheter (72.6%), cancer or hematologic malignancy (47.3%), recent surgery (42.5%), total parenteral nutrition (37.6%). One hundred and fifty-four patients were treated with antifungal therapy, two-thirds of whom received fluconazole as first-line agent. Mortality was 49% overall, and was significantly higher in case of septic shock, advanced age, and absence of catheter removal.
Asunto(s)
Candidiasis/epidemiología , Fungemia/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Candida/clasificación , Candida/efectos de los fármacos , Candida/aislamiento & purificación , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Venoso Central/efectos adversos , Niño , Preescolar , Comorbilidad , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Farmacorresistencia Fúngica Múltiple , Francia/epidemiología , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Neoplasias/epidemiología , Nutrición Parenteral , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/microbiología , Estudios Prospectivos , Factores de Riesgo , Sobreinfección/epidemiología , Sobreinfección/microbiología , Adulto JovenRESUMEN
We report the case of a 70-year-old diabetic man with spontaneous vertebral osteomyelitis due to Bacteroides fragilis. Diagnosis was obtained on positive blood cultures. The port of entry remained unknown despite extensive investigation. A combination of metronidazole and clindamycin led to a clinical cure with no need for surgical débridement and no relapse after 9 months of follow-up.