Hybrid life-cycle and hierarchical archimedean copula analyses for identifying pathways of greenhouse gas mitigation in domestic sewage treatment systems.

Electricity consumption and anaerobic reactions cause direct and indirect greenhouse gas (GHG) emissions within domestic sewage treatment systems (DSTSs). GHG emissions in DSTSs were influenced by the sewage quantity and the efficacy of treatment technologies. To address combined effects of these variables, this study presented an approach for identifying pathways for GHG mitigation within the DSTSs of cities under climate change and socio-economic development, through combining life cycle analysis (LCA) and the Hierarchical Archimedean copula (HAC) methods. The approach was innovative in the following aspects: 1) quantifying the GHG emissions of the DSTSs; 2) identifying the correlations among temperature changes, socioeconomic development, and domestic sewage quantity, and 3) predicting the future fluctuations in GHG emissions from the DSTSs. The effectiveness of the proposed approach was validated through its application to an urban agglomeration in the Pearl River Delta (PRD), China. To identify the potentials of GHG mitigation in the DSTSs, two pathways (i.e., general and optimized) were proposed according to the different technical choices for establishing facilities from 2021 to 2030. The results indicated that GHG emissions from the DSTS in the PRD were [3.01, 4.96] Mt CO2eq in 2021, with substantial contributions from Shenzhen and Guangzhou. Moreover, GHG emissions from the sewage treatment facilities based on Anaerobic-Anoxic-Axic (AAO) technology were higher than those based on other technologies. Under the optimized pathway, GHG emissions, contributed by the technologies of Continuous Cycle Aeration System (CASS) and Oxidation Ditch (OD), were the lowest. Through the results of correlation analysis, the impact of socioeconomic development on domestic sewage quantities was more significant than that of climate change. Domestic sewage quantities in the cities of the PRD would increase by 4.10%-28.38%, 17.14%-26.01%, and 18.15%-26.50% from 2022 to 2030 under three Representative Concentration Pathways (RCPs) 2.6, 4.5, and 8.5. These findings demonstrated that the capacities of domestic sewage treatment facilities in most cities of the PRD should be substantially improved from 0.12 to 2.99 times between 2022 and 2030. Under the optimized pathway, the future GHG emissions of the CASS method would be the lowest, followed by the OD method.

Two-year-long high-time-resolution apportionment of primary and secondary carbonaceous aerosols in the Los Angeles Basin using an advanced total carbon-black carbon (TC-BC(λ)) method.

In recent years, carbonaceous aerosols (CA) have been recognized as a significant contributor to the concentration of particles smaller than 2.5 µm (i.e., PM2.5), with a negative impact on public health and Earth's radiative balance. In this study, we present a method for CA apportionment based on high-time-resolution measurements of total carbon (TC), black carbon (BC), and spectral dependence of absorption coefficient using a recently developed Carbonaceous Aerosol Speciation System (CASS). Two-year-long CA measurements at two different locations within California's Los Angeles Basin are presented. CA was apportioned based on its optical absorption properties, organic or elemental carbon composition, and primary or secondary origin. We found that the secondary organic aerosols (SOA), on average, represent >50 % of CA in the study area, presumably resulting from the oxidation of anthropogenic and biogenic volatile organic components. Remarkable peaks of SOA in summer afternoons were observed, with a fractional contribution of up to 90 %. On the other hand, the peak of primary emitted CA, consisting of BC and primary organic aerosol (POA), contributed >80 % to the CA during morning rush hours on winter working days. The light absorption of BC dominated over the brown carbon (BrC), which contributed to 20 % and 10 % of optical absorption at the lower wavelength of 370 nm during winter nights and summer afternoons, respectively. The highest contribution of BrC, up to 50 %, was observed during the wildfire periods. Although the uncertainty levels can be high for some CA components (such as split between primary emitted and secondary formed BrC during winter nights), further research focused on the optical properties of CA at different locations may help to better constrain the parameters used in CA apportionment studies. We believe that the CASS system combined with the apportionment method presented in this study can offer simplified and cost-effective insights into the composition of carbonaceous aerosols.

Comparison between hospital- and community-acquired septic shock in children: a single-center retrospective cohort study.

BACKGROUND: We explored the differences in baseline characteristics, pathogens, complications, outcomes, and risk factors between children with hospital-acquired septic shock (HASS) and community-acquired septic shock (CASS) in the pediatric intensive care unit (PICU). METHODS: This retrospective study enrolled children with septic shock at the PICU of Beijing Children's Hospital from January 1, 2016, to December 31, 2019. The patients were followed up until 28 days after shock or death and were divided into the HASS and CASS group. Logistic regression analysis was used to identify risk factors for mortality. RESULTS: A total of 298 children were enrolled. Among them, 65.9% (n = 91) of HASS patients had hematologic/oncologic diseases, mainly with Gram-negative bacterial bloodstream infections (47.3%). Additionally, 67.7% (n = 207) of CASS patients had no obvious underlying disease, and most experienced Gram-positive bacterial infections (30.9%) of the respiratory or central nervous system. The 28-day mortality was 62.6% and 32.7% in the HASS and CASS groups, respectively (P < 0.001). Platelet [odds ratio (OR) = 0.996, 95% confidence interval (CI) = 0.992-1.000, P = 0.028], positive pathogen detection (OR = 3.557, 95% CI = 1.307-9.684, P = 0.013), and multiple organ dysfunction syndrome (OR = 10.953, 95% CI = 1.974-60.775, P = 0.006) were risk factors for 28-day mortality in HASS patients. Lactate (OR = 1.104, 95% CI = 1.022-1.192, P = 0.012) and mechanical ventilation (OR = 8.114, 95% CI = 1.806-36.465, P = 0.006) were risk factors for 28-day mortality in patients with CASS. CONCLUSIONS: The underlying diseases, pathogens, complications, prognosis, and mortality rates varied widely between the HASS and CASS groups. The predictors of 28-day mortality were different between HASS and CASS pediatric patients with septic shock.

Ceftolozane/tazobactam sensitivity patterns in Pseudomonas aeruginosa isolates recovered from sputum of cystic fibrosis patients.

Ceftolozane/tazobactam is a combination intravenous antibiotic with potentially important activity against drug-resistant Gram-negative organisms. Ceftolozane/tazobactam's in vitro activity was evaluated in 30 samples collected from 23 adult cystic fibrosis patients with extended and pan-resistant Pseudomonas aeruginosa in 2015. Testing results demonstrated that 30% of the isolates were susceptible,13% were intermediate, and 57% were resistant. This suggests that ceftolozane/tazobactam may be a useful antibiotic in carefully selected, multidrug-resistant Pseudomonas isolates.

Campylobacter jejuni and Pseudomonas coinfection in the setting of ulcerative colitis.

A 66-year-old woman presented with 2 days of fever and severe diarrhoea. She has a history of ulcerative colitis (UC), well controlled with medication. She also has a history of Ehlers-Danlos syndrome, infective endocarditis following aortic valve replacement and pulmonary embolism. She had complained of passing stool with traces of blood about 30 times per day. Stool testing for Clostridium difficile, routine culture and microscopy was done. She was started on ceftriaxone. CT scan revealed thick-walled colon consistent with UC flare. Flexible sigmoidoscopy showed active continuous colitis extending from the rectum to the proximal descending colon. Campylobacter jejuni was isolated from the stool and blood cultures yielded Pseudomonas aeruginosa. The antibiotic was transitioned to intravenous piperacillin/tazobactam and azithromycin followed by 2 weeks of intravenous cefepime. Her diarrhoea was controlled, and she was discharged for follow-up in 2 months.

Generalized fixed drug eruption to piperacillin/tazobactam and review of literature.

Fixed drug eruption (FDE) is an adverse drug reaction characterized by the development of well-circumscribed, round, dusky erythematous macules and plaques on cutaneous or mucosal surfaces. The reaction occurs on the same mucosal or cutaneous site with subsequent exposures to the offending drug. Although FDE usually manifests as a single lesion, in rare instances, more than one lesion may arise and this is referred to as a generalized eruption. Herein, we present a 31year-old man with history of cystic fibrosis who developed a generalized fixed drug eruption to piperacillin/tazobactam (Zosyn, Pfizer). We discuss our patient's course and review causes and outcomes of generalized fixed drug eruptions in the literature.

Liver abscess caused by Clostridium haemolyticum infection after transarterial chemoembolization for hepatocellular carcinoma: A case report.

RATIONALE: Liver abscesses caused by Clostridium species infection are extremely rare. PATIENT CONCERNS: The authors report the first case of a liver abscess due to Clostridium haemolyticum, which occurred after transarterial chemoembolization (TACE) for hepatocellular carcinoma, in a 76-year-old woman who presented with right upper quadrant pain and fever. DIAGNOSES: Computed tomography of the abdomen after the second TACE showed an air-filled abscess around a compact, lipiodolized lesion in the right hepatic lobe. Pus culture showed the growth of C haemolyticum. INTERVENTIONS: Broad-spectrum antibiotics, including piperacillin/tazobactam and metronidazole, were administered, and a percutaneous 10-French pigtail catheter for pus drainage and culture was inserted in the liver abscess. OUTCOMES: Despite administering intensive treatments, she presented with rapid deterioration in mental status, liver function, and infection markers. She was transferred to the local hospital for palliative conservative treatment. LESSONS: Clostridia infections, including those involving C haemolyticum, are extremely rare, but should be considered as one of the causative organisms of liver abscess formation after TACE because of its rapid and fatal clinical course.

Onset of Hemophagocytic Lymphohistiocytosis during Piperacillin-Tazobactam Therapy in Three Children with Acute Focal Bacterial Nephritis.

Hemophagoytic lymphohistiocytosis (HLH) is a rare life-threatening disorder caused by overactivation of the immune system, associated with infections, autoimmune disorders, and malignancies. The pathological hallmark of HLH is phagocytosis of blood cells and platelets by activated macrophages and histiocytes. In this report, we describe the onset of HLH in three children, aged 2, 5 and 7 years old, during the treatment of acute focal bacterial nephritis (AFBN) with an antibiotic, piperacillin-tazobactam (PIPC-TAZ). AFBN is acute localized bacterial infection of the kidney without abscess formation. PIPC-TAZ was chosen for the treatment of AFBN, because it not only has indications for complicated urinary tract infections, but also covers most of the causative bacteria of urinary tract infections, including ß-lactamase-producing Escherichia coli. The clinical courses of the three patients were similar, and they were treated with PIPC-TAZ and amikacin (AMK) for AFBN. Fever went down 2 to 5 days later, and AMK was discontinued by day 6. However, fever recurred on 13 to 15 days after introduction of PIPC-TAZ therapy, even though all of the patients had no signs of recurrence of AFBN. The clinical features and laboratory tests of two patients fulfilled the criteria of HLH, whereas the other patient had initiated therapy before fulfilling the criteria. Cessation of PIPC-TAZ combined with corticosteroid therapy improved clinical symptoms. HLH of our patients was probably induced by PIPC-TAZ, as judged by the timing of the onset of HLH and the positivity of the drug-lymphocyte stimulation test. In conclusion, prolonged antibiotic therapy with PIPC-TAZ could be a cause of HLH.

The use of broad-spectrum antibiotics reduces the incidence of surgical site infection after pancreatoduodenectomy.

PURPOSE: The development of surgical site infection (SSI) after biliary reconstruction is highly influenced by the presence of preoperative bacteria in the bile juice. We selected vancomycin and piperacillin/tazobactam (VCM + PIPC/TAZ) as perioperative prophylactic antibiotics for patients undergoing pancreaticoduodenectomy. This study aimed to retrospectively analyze the effectiveness of VCM + PIPC/TAZ compared to cefmetazole. METHODS: Seventy-two patients who underwent pancreaticoduodenectomy between April 2015 and March 2017 at our department were evaluated. Forty patients were administered cefmetazole as the perioperative prophylactic antibiotic, and 32 were administered VCM + PIPC/TAZ. The intraoperative VCM blood concentration (incision, biliary reconstruction, and wound closure) was measured during surgery to confirm the hemodynamics. RESULTS: The frequency of SSIs was significantly lower in the VCM + PIPC/TAZ group (8/32 patients) than in the cefmetazole group (20/40 patients, P = 0.031). Postoperatively, significantly fewer patients in the VCM + PIPC/TAZ group (4/32 patients) required ≥ 15 days of additional antibiotic administration compared to those in the cefmetazole group (14/40 patients, P = 0.033). Six of 32 patients in the VCM + PIPC/TAZ group showed redneck syndrome symptoms. There was no significant difference in the VCM blood concentration between patients with and without SSIs. CONCLUSIONS: The use of VCM + PIPC/TAZ can reduce the incidence of SSI after pancreaticoduodenectomy and also reduce the need for the additional administration of antibiotics for ≥ 15 days after surgery.

Simplification of first-line antibacterial regimen for complicated appendicitis in children is associated with better adherence to guidelines and reduced use of antibiotics.

Acute appendicitis in children requires early surgery and short-course antibiotics active against Enterobacteriaceae and anaerobes. Although an aminoglycoside-containing three-drug regimen has been used successfully for decades, simpler regimens with similar efficacy are increasingly used. This study evaluated the impact of a switch from the combination of cefotaxime, metronidazole and gentamicin (regimen 1) to piperacillin/tazobactam (regimen 2) as first-line regimen for complicated acute appendicitis in children. In total, 171 children were enrolled [median (IQR) age, 10 (6-13) years], treated with regimen 1 (n = 80) or regimen 2 (n = 91) following surgery for complicated acute appendicitis. The two groups were comparable except for surgical approach (through laparoscopy in 46% vs. 88% for regimens 1 and 2, respectively; P < 0.001). Post-operative complications and duration of hospital stay were similar. Deviations from antibacterial treatment protocol decreased from 36% (29/80) to 14% (13/91) (P < 0.001), with a dramatic reduction in antibacterial treatment duration from median (IQR) of 15 (12-16) days to 5 (5-8) days (P < 0.001). Post-operative intra-abdominal abscess developed in 32 children (18.7%). Female sex (OR = 2.76, 95% CI 1.18-6.48; P = 0.02) and sepsis/septic shock on admission (OR = 4.72, 95% CI 1.12-19.97; P = 0.035) were independently associated with post-operative intra-abdominal abscess, but not antibacterial regimen. This study shows that simplification of first-line antibacterial regimen for complicated appendicitis in children was associated with reduced protocol deviation, reduced duration of antibiotics, and similar outcomes (post-operative complications and duration of hospital stay).

Validated HPLC-UV detection method for the simultaneous determination of ceftolozane and tazobactam in human plasma.

AIM: A simple, rapid, economical and sensitive HPLC-UV method was developed for the simultaneous quantification of ceftolozane and tazobactam in plasma samples. METHODOLOGY: After deproteinization followed by a liquid-liquid back-extraction, the compounds were separated on a C18 column (150 mm × 4.6 mm, 5 µm) with UV-visible detection at 220 nm. The mobile phase consisted of acetonitrile and potassium dihydrogenphosphate buffer at pH 3.0 (8:92, v/v), delivered isocratically at a flow rate of 1.0 ml/min and at a column oven temperature of 30°C. Cefepime was used as an internal standard. RESULTS: Linearity was achieved in the concentration range of 0.50-100.00 µg/ml for ceftolozane and 0.25-50.00 µg/ml for tazobactam. The intra- and interday precision showed good reproducibility with coefficients of variation of less than 9.26% for ceftolozane and 9.62% for tazobactam. CONCLUSION: The sample preparation procedure avoids expensive or time-consuming steps used by other previously published methods. The methodology was validated according to standard guidelines and was used for quantification of ceftolozane and tazobactam in plasma samples from critically ill patients.

Propionibacterium acnes and Staphylococcus epidermidis olecranon bursitis/osteomyelitis: a case involving surgical and antibiotic treatment.

This report describes a 63-year-old generally healthy male with septic olecranon bursitis caused by Propionibacterium acnes The patient sustained a small laceration after striking the posterior aspect of his left elbow on a metal railing when he was at a public swimming pool. We concluded that P. acnes was not initially detected because cultures were only kept for 5 days. Consequently, initial antibiotic treatment failed. P. acnes and Staphylococcus epidermidis grew in a subsequent tissue culture. The infection did not respond to intravenous vancomycin although soft-tissue debridements were done. This likely reflected the presence of olecranon osteomyelitis (seen on MRI scans) in addition to inadequate treatment with this antibiotic in the setting of a polymicrobial infection. Eventually, the infection was eradicated with multiple soft-tissue debridements in addition to the continuation of vancomycin with daily intravenous piperacillin/tazobactam that was added for the final 4 weeks of antibiotic treatment.

Ceftolozane-tazobactam therapy for multidrug-resistant Pseudomonas aeruginosa infections in patients with hematologic malignancies and hematopoietic-cell transplant recipients.

Multidrug-resistant (MDR) Pseudomonas aeruginosa infection causes significant mortality among patients with hematologic malignancies and hematopoietic-cell transplant recipients. Ceftolozane-tazobactam (C-T) is a novel therapeutic option for MDR-P. aeruginosa infections but clinical experience in these patients is limited. We report favorable clinical outcomes and lack of limiting toxicities using C-T monotherapy to treat invasive MDR-P. aeruginosa infections in these patient populations.

Role Of Conservative Management In Emphysematous Gastritis.

Emphysematous gastritis (EG) is a rare disease of the stomach that is caused by gas-forming bacteria, and it can be lethal. There have been <70 reported cases in the English literature of this disease which carries a mortality rate up to 60%. Early recognition and treatment through conservative management have been a popular and successful choice in today's medicine. Studies have shown that surgical intervention does not confer a statistical benefit on mortality in this condition. We present another case of EG in a 33-year-old woman who was successfully managed conservatively.

Meropenem versus piperacillin/tazobactam with or without immunoglobulin as second-line therapy for febrile neutropenia in pediatric patients.

BACKGROUND: Although survival of children with hematological diseases and cancer has increased dramatically, life-threatening complications due to bacterial infections occur in 5-10% of febrile episodes in pediatric cancer patients. A prospective randomized study was performed to clarify the usefulness of meropenem (MEPM) and piperacillin/tazobactam (PIPC/TAZ) with or without intravenous immunoglobulin (IVIG) as second-line therapy for pediatric patients with febrile neutropenia (FN). PROCEDURE: As first-line therapy for FN, 105 patients with 434 episodes were randomly assigned to receive MEPM or PIPC/TAZ. A total of 71 pediatric patients and 144 episodes were judged as failures and enrolled for second-line treatment. In second-line treatment, patients were randomized to a group of MEPM and PIPC/TAZ with or without IVIG. MEPM was given to patients who received PIPC/TAZ as first-line treatment, and PIPC/TAZ was given to patients who received MEPM as first-line treatment. RESULTS: The total success rate of second-line therapy was 49.3%. MEPM with or without IVIG was effective in 44.3% of cases, and PIPC/TAZ with or without IVIG was effective in 55.3%; this difference was not significant. The success rate in patients with serum IgG under 1000 mg/dl was 41.3% in the MEPM or PIPC/TAZ group and 64.3% in the MEPM + IVIG or PIPC/TAZ + IVIG group (p = 0.028). CONCLUSIONS: The present results suggest that PIPC/TAZ is as effective as MEPM and safe for second-line treatment of FN in pediatric patients. Furthermore, IVIG appears very effective for patients with low serum IgG levels.

Empiric antibiotic protocols for cancer patients with neutropenia: a single-center study of treatment efficacy and mortality in patients with bacteremia.

BACKGROUND: There are several empiric antibiotic treatment options for febrile neutropenia, yet there is no universally-accepted initial protocol. We aimed to assess the performance of a protocol (piperacillin, gentamicin and cefazolin) introduced over 40 years ago and compare its coverage against bacteria isolated from blood of neutropenic patients with that of various commonly used antibiotic treatment protocols. METHODS: Adults with neutropenia admitted between 2003 and 2012 to the hemato-oncologic departments and in whom blood cultures were taken on admission were included. Appropriateness of several common antibiotic protocols was assessed based on the susceptibility of the blood isolates. Crude mortality rates were computed by the susceptibility of bacteria isolated from patients' blood to the actual treatment given. RESULTS: In total, 180 admissions of neutropenic patients (95 in patients who had fever above 38 °C) with positive blood cultures were analyzed. The actual antibiotic regimen prescribed was deemed appropriate in 82% of bacteremia episodes. The recommended institutional protocol was used in 62% of bacteremia episodes in neutropenic patients. This protocol would have been appropriate in 85% of all neutropenic bacteremia episodes and 89% of episodes in febrile neutropenia patients compared with piperacillin/tazobactam (79%, P = 0.13 and 76%, P = 0.002, respectively) and imipenem (93%, P = 0.004 and 92%, P = 0.74, respectively). Isolation of bacteria resistant to the actual antibiotic treatment given was associated with higher mortality at one week and at 30 days. CONCLUSION: Common current antibiotic regimens provide similar coverage among febrile neutropenic patients, whereas broad spectrum antibiotic combinations maximize coverage among neutropenic patients.

Improvement of Bolton broth by supplementation with tazobactam for the isolation of Campylobacter from chicken rinses.

Overgrowth of extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (E. coli) on Campylobacter media prevents the latter's selective isolation, thereby making the improvement of Campylobacter-selective media necessary. We evaluated tazobactam (an ESBL inhibitor) to supplement Bolton enrichment broth (Tz-Bolton broth) for the selective isolation of Campylobacter in chicken carcass rinses. First, using 20 strains of ESBL-producing E. coli and 13 Campylobacter strains, we found 4 µg/mL of tazobactam to be optimal for inhibiting the ESBL-producing E. coli while allowing the growth of all tested Campylobacter strains. Next, 80 whole chicken carcasses were rinsed with buffered peptone water (BPW), and 25 mL of BPW rinse was mixed with 2 × blood-free Bolton broth (25 mL) with or without tazobactam followed by incubation at 42°C for 48 h under microaerobic conditions. A loopful of the incubated broth was inoculated on modified charcoal-cefoperazone-deoxycholate agar (mCCDA) and microaerobically incubated at 42°C for 48 h. The tazobactam supplemented Bolton broth showed a higher Campylobacter isolation rate (38.8%, p < 0.05) than normal Bolton broth (15%). Moreover, the number of mCCDA plates with non-Campylobacter was much lower (p < 0.05) after enrichment in Tz-Bolton broth (0%) than in the normal Bolton broth (80%), suggesting that selectivity of the modified broth was superior to normal Bolton broth.

Ceftolozane-tazobactam activity against drug-resistant Enterobacteriaceae and Pseudomonas aeruginosa causing healthcare-associated infections in Latin America: report from an antimicrobial surveillance program (2013-2015)

ABSTRACT This study evaluated the in vitro activity of ceftolozane-tazobactam and comparator agents tested against Latin American isolates of Enterobacteriaceae and Pseudomonas aeruginosa from patients with health care-associated infections. Ceftolozane-tazobactam is an antipseudomonal cephalosporin combined with a well-established β-lactamase inhibitor.A total of 2415 Gram-negative organisms (537 P. aeruginosa and 1878 Enterobacteriaceae) were consecutively collected in 12 medical centers located in four Latin American countries. The organisms were tested for susceptibility by broth microdilution methods as described by the CLSI M07-A10 document and the results interpreted according to EUCAST and CLSI breakpoint criteria. Results: Ceftolozane-tazobactam (MIC50/90, 0.25/32 µg/mL; 84.2% susceptible) and meropenem (MIC50/90, ≤0.06/0.12 µg/mL; 92.6% susceptible) were the most active compounds tested against Enterobacteriaceae. Among the Enterobacteriaceae isolates tested, 6.6% were carbapenem-resistant Enterobacteriaceae and 26.4% exhibited an extended-spectrum β-lactamase non-carbapenem-resistant phenotype. Whereas ceftolozane-tazobactam showed good activity against extended-spectrum beta-lactamase, non-carbapenem-resistant phenotype strains of Enterobacteriaceae (MIC50/90, 0.5/>32 µg/mL), it lacked useful activity against strains with a (MIC50/90, >32/>32 µg/mL; 1.6% S) carbapenem-resistant phenotype. Ceftolozane-tazobactam was the most potent (MIC50//90, 0.5/16 µg/mL) β-lactam agent tested against P. aeruginosa isolates, inhibiting 86.8% at an MIC of ≤4 µg/mL. P. aeruginosa exhibited high rates of resistance to cefepime (16.0%), ceftazidime (23.6%), meropenem (28.3%), and piperacillin-tazobactam (16.4%). Conclusions: Ceftolozane-tazobactam was the most active β-lactam agent tested against P. aeruginosa and demonstrated higher in vitro activity than available cephalosporins and piperacillin-tazobactam when tested against Enterobacteriaceae.

Susceptibilidad de enterobacterias a piperacilina/tazobactam en un hospital pediátrico de Chile / Enterobacteriaceae susceptibility to piperacillin/tazobactam in a Chilean pediatric hospital

Resumen Introducción: Las enterobacterias son bacilos gram-negativos responsables de infecciones graves en el ser humano. Se reporta una susceptibilidad en Klebsiella pneumoniae de 79,4% a piperacilina/tazobactam (PIP/TAZO) en hospitales pediátricos de Chile, pero según nuestro conocimiento, no existen datos publicados a la fecha respecto a la susceptibilidad de otras enterobacterias a PIP/TAZO en la población pediátrica chilena. Objetivo: Determinar la susceptibilidad in vitro a PIP/TAZO en cepas obtenidas de infecciones por Enterobacteriaceae en un hospital pediátrico de Chile. Material y Método: Estudio descriptivo y prospectivo de cepas de Enterobacteriaceae en Hospital de Niños Roberto del Río (HRRIO) entre 1 de enero de 2013 y el 27 de agosto de 2014. Se definió la susceptibilidad a PIP/TAZO por método de gradiente (E-test®) según puntos de corte CLSI 2014. Resultados: Se incluyeron 163 casos. El promedio de edad fue de 4 años 15 días. 70,6% de sexo femenino. El 79,7% de las cepas fueron aisladas en urocultivos. La susceptibilidad de Enterobacteriaceae a PIP/TAZO fue 95,1% (n = 155). La susceptibilidad intermedia fue 1,8% (n = 3). Discusión: Los aislados estudiados presentan alta susceptibilidad a PIP/TAZO. Este hallazgo puede explicarse por la baja circulación de microrganismos productores de BLEE y el limitado uso de PIP/TAZO en esta población pediátrica.

Introduction: Enterobacteriaceae are a group of gram-negative rods that can cause serious infections in humans. A susceptibility in Klebsiella pneumoniae of 79.4% to piperacillin/tazobactam (PIP/TAZO) is reported in pediatric hospitals in Chile. There is no published data published to date regarding PIP/TAZO susceptibility to other Enterobacteriaceae species in this population. Aim: To measure the in vitro PIP/TAZO susceptibility in Enterobacteriaceae isolates from patients in a pediatric hospital in Chile. Methods: Descriptive and prospective study of Enterobacteriaceae positive cultures from patients assisting to the "Hospital de niños Roberto del Río" (HRRIO) between January 2013 and August 2014. PIP/TAZO susceptibility was established by gradient diffusion method (E-test®) according to the 2014 CLSI standards. Results: 163 cases were included. The average age was 4 years and 15 days. 70.6% were female. 79.7% of samples were urine cultures. PIP/TAZO susceptibility in Enterobacteriaceae was 95.1% (n = 155). The intermediate susceptibility was 1.8% (n = 3). Discussion: The isolates studied present high susceptibility to PIP/TAZO. This finding could be explained by the fact that this population has not been exposed to this antimicrobial therapy and also the low rates for ESBL in pediatric infections.

Case Report: Strongyloides stercoralis Hyperinfection in a Patient with Chronic Lymphocytic Leukemia.

Strongyloides stercoralis is an intestinal nematode that can cause disseminated infection in an immunocompromised host. It is most commonly acquired in developing countries. It was previously a common infection in many parts of the United States, particularly in the Appalachian region, but is rarely identified currently. Here, we describe a patient born and raised in Appalachia, with no history of travel outside the United States, who presented with chronic lymphocytic leukemia and S. stercoralis hyperinfection characterized by acute respiratory failure, altered mental status, and extended-spectrum-beta-lactamase Klebsiella pneumoniae bacteremia. Despite prompt identification of the parasite on sputum microscopy and initiation of therapy with oral ivermectin and meropenem, the patient subsequently died. This case highlights the continued possibility of S. stercoralis infection in patients from Appalachia.