Evaluation of extensively drug-resistant gram-negative bacteremia among solid-organ transplant recipients: a multicenter study

Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods: A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients' records were evaluated. Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion: Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.

Giant hydatid cyst of spleen: a case report.

Hydatidosis is endemic in many Mediterranean countries, the Middle East, South America, Australia, New Zealand and Africa. It is caused by an infection from the Echinococcus granulosus larvae which can lead to the development of cysts. The most frequently affected organ is the liver. Splenic involvement alone is very rare. In this article, a case of an isolated giant splenic hydatid cyst is reported. The patient underwent splenectomy. The diagnosis of a hydatid cyst was confirmed by histopathology. This case suggests that hydatid disease should be considered as a differential diagnosis in every patient with a cystic mass of the spleen in endemic areas.

[Evaluation of the enrichment broth cultures in the isolation of methicillin-resistant Staphylococcus aureus]. / Metisiline dirençli Staphylococcus aureus izolasyonunda zenginlestirme buyyonu ekimlerinin degerlendirilmesi.

The detection of the methicillin-resistant Staphylococcus aureus (MRSA) carriers and the establishment of isolation precautions are of crucial importance to prevent the development of nosocomial infections due to MRSA. Previous studies have demonstrated that the use of enrichment broths increased the rate of MRSA isolation both in clinical samples and surveillance cultures. The aim of this study was to evaluate the MRSA isolation results obtained by inoculation of surveillance cultures in enrichment broth, for the patients staying in intensive care unit of our hospital during September 2006-January 2007 period. A total of 1536 samples (deep tracheal aspirate, nose, throat, pus, inguinal and axial swabs) from 250 patients were inoculated on routine primary media including sheep blood agar, EMB agar and 6 microg/ml oxacillin containing Mueller-Hinton agar (Ox-MH Agar) and also in an enrichment broth (EB) containing 6.5% NaCl in brain-heart infusion. After incubation for 24 and 48 hours, primary plates were examined for MRSA growth and enrichment broths were examined for turbidity. Turbid tubes were subcultured on Ox-MH agar. Tubes with no turbidity after 48 hours were discarded as negative; MRSA growth in both primary plates and in EBs were evaluated as "parallel growth". Parallel MRSA growth was detected in 15.2% (234/1536), MRSA growth only in EB was detected in 5.9% (91/1536) and MRSA growth only on primary plates was detected in 0.26% (4/1536) of the samples. Among the 71 patients in whom the first MRSA isolation was detected, 19 (27%) yielded MRSA only in EB, 44 (62%) exhibited parallel growth and 8 (11%) yielded MRSA either in EB or as parallel growth of different samples of the same patient. The use of the EB increased MRSA isolation 5.9% (91/1536) on specimen basis and 7.6% (19/250) on patient basis. It can be concluded that, inoculation of surveillance culture samples into an enrichment broth in addition to primary plate media aids to the early isolation of MRSA from colonized patients.

An outbreak of Streptococcus pyogenes surgical site infections in a cardiovascular surgery department.

BACKGROUND: We report an outbreak of surgical site infections due to genetically related strains of Streptococcus pyogenes in a cardiovascular surgery department. METHODS: The practices that were possibly related to the outbreak were investigated through direct observation and interviews with staff by an infection control team. Surveillance sampling from patients, health-care workers, and environment were done for the investigation of the source. Pulsed-field gel electrophoresis was used to investigate a clonal relationship among the S. pyogenes isolates. RESULTS: Four patients operated on in the cardiovascular surgery department developed surgical site infection due to S. pyogenes. Molecular characterization of S. pyogenes done by pulsed-field gel electrophoresis revealed the same strain. CONCLUSIONS: Although a definite source for the outbreak could not be identified, probably lack of adherence to hand hygiene practices during surgical dressings, contamination, and cross contamination led to this outbreak.

Tigecycline as a therapeutic option in Stenotrophomonas maltophilia infections.

Trimethoprim-sulfamethoxazole (TMP-SMZ) is recommended as the treatment of choice for Stenotrophomonas maltophilia infections. However, when the administration of TMP-SMZ is not possible, alternative treatment options for S. maltophilia infections has not been clearly established. We compare the efficacy of tigecycline treatment with TMP-SMZ in nosocomial S. maltophilia infections during a 3-year period. For the treatment of S. maltophilia infection, 26 (57.8%) patients received TMP-SMZ and 19 (42.2%) patients received tigecycline. Culture positivity rate was 95.7% in TMP-SMZ group and 70.6% in tigecycline group at the seventh day (P = 0.028), whereas 26.3% versus 18.8% at the fourteenth day (P = 0.700). Clinical improvement was observed 69.2% in TMP-SMZ group and 68.4% in tigecycline group at the fourteenth day (P = 0.954). Mortality rates at the thirtieth day were respectively, 30.8 and 21.1% in TMP-SMZ and tigecycline groups (P = 0.517). There were no significant differences in mortality and clinical response rates between TMP-SMZ and tigecycline treatment. Tigecycline can be considered as an alternative option beyond TMP-SMZ in treatment of S. maltophilia infections.

Splenic abscess due to Salmonella enteritidis.

Splenic abscess is a very rare complication of non-typhoidal Salmonella infections. We report a case of splenic abscess caused by Salmonella enteritidis. The patient is a 63-year-old woman with diabetes mellitus and underwent splenectomy. This case suggests that the patients with comorbities are at increased risk for invasive infections in non-typhoidal Salmonella infections.

Pan-resistant Acinetobacter baumannii mediastinitis treated successfully with tigecycline: a case report.

BACKGROUND: Mediastinitis due to Acinetobacter baumannii is rare. METHODS: We report a case of mediastinitis caused by pan-resistant A. baumannii in a patient with multiple comorbidities who underwent cardiopulmonary bypass and we also present a literature review. RESULTS: Successful treatment consisted of surgical debridement plus drainage, and tigecycline administration for three weeks. CONCLUSION: Surgical source control along with effective antibiotics is essential in the treatment of mediastinitis. Tigecycline has the potential to be an option for pan-resistant A. baumannii mediastinitis.