A case of late-onset Klebsiella oxytoca keratitis treated with topical imipenem after deep anterior lamellar keratoplasty / Caso de ceratite de início tardio por Klebsiella oxytoca tratado com imipenem tópico após ceratoplastia lamelar anterior profunda

ABSTRACT The aim of this study was to discuss a case of late-onset Klebsiella oxytoca keratitis after deep anterior lamellar keratoplasty and its treatment. A 21-year-old female patient presented with redness and effluence in the left eye at 5 months after uncomplicated deep anterior lamellar keratoplasty surgery. In the examination, a single suture was loosened in the superior nasal region and there was an infiltration area and epithelial defect in the graft and recipient bed junction in the area of the loose suture. Topical fortified vancomycin and fortified ceftazidime treatment was started empirically hourly, but there was insufficient response. After K. Oxytoca growth in a swab and suture culture taken from the patient, fortified vancomycin was replaced with fortified imipenem. It was observed that the infiltration area rapidly regressed and the epithelial defect was closed after fortified imipenem treatment. Fortified imipenem may be considered as an alternative treatment, especially in cases in which there is no response to treatment and culture growth is detected.(AU)

RESUMO O objetivo deste estudo é discutir um caso de ceratite tardia por Klebsiella oxytoca, após ceratoplastia lamelar anterior profunda, bem como seu tratamento. Uma paciente de 21 anos apresentou vermelhidão e efluxo no olho esquerdo 5 meses após cirurgia de ceratoplastia lamelar anterior profunda sem complicações. Ao exame, havia uma única sutura solta na região nasal superior e uma área de infiltração com defeito epitelial no enxerto e na junção com o leito receptor na área da sutura solta. Iniciou-se empiricamente um tratamento tópico com vancomicina e ceftazidima fortificada de hora em hora, porém com resposta insuficiente. Após o crescimento de K. oxytoca a partir de cultura de swab e sutura retirados da paciente, a vancomicina fortificada foi substituída por imipenem fortificado. Observou-se que a área de infiltração regrediu rapidamente e que o defeito epitelial foi fechado com o tratamento com imipenem fortificado. O imipenem fortificado pode ser considerado um tratamento alternativo, especialmente nos casos sem resposta ao tratamento e detecção de crescimento na cultura.(AU)

Potential virulence of Klebsiella sp. isolates from enteral diets

We aimed to evaluate the potential virulence of Klebsiellaisolates from enteral diets in hospitals, to support nosocomial infection control measures, especially among critical-care patients. Phenotypic determination of virulence factors, such as capsular expression on the external membrane, production of aerobactin siderophore, synthesis of capsular polysaccharide, hemolytic and phospholipase activity, and resistance to antibiotics, which are used therapeutically, were investigated in strains ofKlebsiella pneumoniae and K. oxytoca. Modular industrialized enteral diets (30 samples) as used in two public hospitals were analyzed, and Klebsiella isolates were obtained from six (20%) of them. The hypermucoviscous phenotype was observed in one of the K. pneumoniae isolates (6.7%). Capsular serotypes K1 to K6 were present, namely K5 and K4. Under the conditions of this study, no aerobactin production, hemolytic activity or lecithinase activity was observed in the isolates. All isolates were resistant to amoxicillin and ampicillin and sensitive to cefetamet, imipenem, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim. Most K. pneumoniae isolates (6/7, 85.7%) from hospital B presented with a higher frequency of resistance to the antibiotics tested in this study, and multiple resistance to at least four antibiotics (3/8; 37.5%) compared with isolates from Hospital A. The variations observed in the antibiotic resistance profiles allowed us to classify theKlebsiella isolates as eight antibiotypes. No production of broad-spectrum β-lactamases was observed among the isolates. Our data favor the hypothesis that Klebsiella isolates from enteral diets are potential pathogens for nosocomial infections.

A Case of Acute Phlegmonous Gastritis Causing Gastroparesis and Cured with Medical Treatment Alone / 대한소화기학회지

Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.

Occurrence of klebsiella species in raw milk market in Assiut city and the effect of low temperature on its viability [with 8 tables]

One hundred and twenty random samples of raw buffalo's, cow's, goat's and sheep's milk [30 of each] were collected from different farmer's houses and dairy shops in Assiut City to be examined for the presence of Klebsiella organisms on MacConkey Inositol Carbenicillin agar. The results revealed that K. pneumoniae was the most prevalent species among the Klebsiella organisms isolated [10 and 13.33%] for buffalo's and cow's milks. K. oxytoca [66.6%] in cow's milk only, K. ozaenae [2.66, 3.33 and 3.33%] for buffalo's, goat's and sheep's milk respectively, K. planticola [6.66 and 6.66%] in buffalo's and cow's milk respectively and K. terrigena revealed 1.33% in buffalo's milk Klebsiella organisms isolated from raw milk of different animals were [18] 15%, and they were 26.66% for buffalo's and cow's milks. Concerning the second part dealing with the effect of cold temperature [5 +/- 1°C] on the viability of K. pneumoniae in sterile butter samples revealed that, there is a gradual increase in the number of K. pneumoniae from 17x10[8] cells/g as an initial count to 91x10[8], 206x10[8], 217x108 and 224x108 cells/g in the first, second, third and seventh day respectively. While a remarkable decrease in case of freezing temperature [O°C] from 17x10[8] cells/g as an initial count to 10x10[8], 1.13x10[7], 220x10[5] and 37x10[3] in the first, second, third and seventh day respectively. K. pneumoniae inoculated in sterile butter completely disappeared and could not be detected after the first week in both chilling and freezing temperatures due to the high acidity percentages which reach from 4.3% at the zero time to 4.3, 4.3, 4.5 and 6.5%. Most of the isolated K. pneumoniae strains were highly sensitive to Norfloxacin, moderately to Gentamicin and weakly to cefotaxime but were resistant to other antibiotics used. The public health hazard and suggestive measures were discussed to prevent milk and milk products from contamination with Klebsiella organisms

Incidencia de beta-lactamasas de espectro extendido en el Hospital Clínico de la Universidad de Chile / Incidence of extended-spectrum beta-lactamases in University of Chile Clinical Hospital

Las Betalactamasas de espectro extendido (BLEE) son enzimas de configuración plasmídica producidas por bacterias que hidrolizan los antibióticos betalactámicos. La aparición de cepas bacterianas productoras de BLEE, constituye un problema de salud pública que afecta a todo tipo de instituciones y a la comunidad en general. Este estudio tiene como objetivo determinar las incidencia de BLEE en pacientes hospitalizados del Hospital Clínico de la Universidad de Chile. Se estudió un total de 238 cepas en el periodo julio-agosto 2004; de las cuales 184 correspondieron a de E. coli, 39 a K. pneumoniae y 15 a K. oxytoca, utilizándose el test confirmatorio de BLEE según estándar NCCLS 2004. Se encontró una incidencia de BLEE para E. coli de un 10.3 por ciento, para K. pneumoniae de 28.2 por ciento y de K. oxytoca de 20 por ciento, respectivamente. La distribución de los aislamientos de las cepas BLEE (+) en los distintos servicios del Hospital fue diversa: E. coli se encontró principalmente, en los servicios de medicina y cirugía, y K. pneumoniae en los servicios críticos. Los resultados del estudio permitieron conocer la incidencia y distribución de BLEEs en el Hospital Clínico de la Universidad de Chile y justificaron la implementación de esta técnica de diagnóstico como parte de la rutina del laboratorio de microbiología.