Candida parapsilosis meningitis associated with Gliadel (BCNU) wafer implants.

A 58-year old male presented with meningitis associated with subgaleal and subdural collections 6 weeks following a temporal craniotomy for resection of recurrent glioblastoma multiforme and Gliadel wafer implantation. Candida parapsilosis was cultured from cerebrospinal fluid (CSF) and Gliadel wafers removed during surgical debridement. He was successfully treated with liposomal amphotericin B. To our knowledge, this is the first reported case of Candida parapsilosis meningitis secondary to Gliadel wafer placement.

Molecular analysis of OXA-48-carrying conjugative IncL/M-like plasmids in clinical isolates of Klebsiella pneumoniae in Ireland.

This study characterized an IncL/M-like plasmid containing a bla(OXA-48)-encoding gene from a clinical isolate of Klebsiella pneumoniae, denoted as E71T. Investigation of this plasmid sequence identified unique regions of interest along with conserved regions detected in eight other clinical carbapenem-resistant isolates. A 63-kb plasmid (pE71T) from K. pneumoniae E71T was sequenced and found to be highly similar to the recently published K. pneumoniae pOXA-48a (JN626286). Two copies of the insertion sequence element IS1R were identified, one of which was located adjacent to the bla(OXA-48)-encoding gene forming part of a composite transposon Tn1999.2 and the second located 16-kb downstream. Plasmid profiling and PCR assays confirmed that the pE71T backbone was conserved among the eight other clinical bla(OXA-48)-positive isolates, and in all cases, the OXA-48 genes were part of the Tn1999.2 composite transposon. This is the first report of a bla(OXA-48) and IS1R arrangement-containing plasmid in Ireland.

Brevibacterium otitidis: an elusive cause of neurosurgical infection.

Coryneform bacteria are usually considered as non-pathogenic when isolated from clinical specimens. We present a case of Brevibacterium otitidis neurosurgical infection in an immunocompetent patient, and highlight the difficulty with identification and interpretation of antimicrobial susceptibility results for this unusual pathogen.

A national survey of infection control and antimicrobial stewardship structures in Irish long-term care facilities.

BACKGROUND: Information on infection prevention and control (IPC) and antimicrobial stewardship activities in Irish long-term care facilities (LTCFs) is limited. METHODS: A survey detailing IPC and antimicrobial stewardship activities, including staffing and bed capacity, was circulated to Irish LTCFs. RESULTS: Sixty-nine LTCFs (61 public, 8 private) were surveyed, 56 (81%) of which had an IPC practitioner. Thirty-five (51%) LTCFs had an IPC committee that met on average 5 times (range, 1-10) during the previous year. LTCFs with IPC practitioners based solely in the facility (n = 17) were more likely to have an IPC committee (P = .027). Antimicrobial guidelines were available in 28% (n = 19) and 16% (n = 11) had an antimicrobial stewardship committee in place. Medical care was provided by general practitioners in 51% (n = 35), by physicians employed by the LTCFs in 35% (n = 24), or by both in 14% (n = 10). Medical care and activities were coordinated in 45% (n = 31) of LTCFs. These LTCFs were more likely to have an IPC committee (P < .001), medical staff training (P < .001), and antimicrobial guidelines (P = .005) in place. CONCLUSION: There are significant gaps in Irish LTCFs' IPC and antibiotic stewardship programs and governance structures, highlighting the need for specific LTCF national initiatives.

Low predictive value of positive transplant perfusion fluid cultures for diagnosing postoperative infections in kidney and kidney-pancreas transplantation.

AIMS: Infection following transplantation is a cause of morbidity and mortality. Perfusion fluid (PF) used to preserve organs between recovery and transplantation represents a medium suitable for the growth of microbes. We evaluated the relevance of positive growth from PF sampled before the implantation of kidney or kidney-pancreas (KP) allografts. METHODS: Between January 2007 and January 2011, 548 kidney/KP transplants were performed in our centre. A retrospective review of patient records with culture-positive PF was performed. RESULTS: PF was received from 483 (88%) patients, of which 35 (7%, 95% CI 5.3% to 9.9%) were positive for bacteria (31/483, 6.4%, 95% CI 4.6% to 9.8%) and fungi (4/483, 0.8%, 95% CI 0.3% to 2.1%). Thirty-two of the 35 culture-positive PF (91.4%, 95% CI 77.6% to 97%) were considered insignificant. The remaining three patients developed sepsis postoperatively, which was considered to be possibly related to growth in PF; Escherichia coli in one and Klebsiella pneumoniae in two. Of the non-skin flora bacteria cultured from PF, six were resistant to the prophylactic antibiotic given intraoperatively, but only one developed infection postoperatively (E coli, resistant to the co-amoxiclav). CONCLUSIONS: Significant attributable morbidity associated with PF-positive culture results was relatively rare. Culture of organisms other than Enterobacteriaceae or fungi are likely to represent contamination.