A case of Capnocytophaga canimorsus endocarditis in a non-immunosuppressed host: the value of 16S PCR for diagnosis.

Capnocytophaga canimorsus is a rare cause of endocarditis and is particularly unusual in non-immunosuppressed hosts. It is associated with animal bites, particularly those from dogs. This case describes a healthy 59-year-old woman, with no identifiable risk factors or dog bite history, who presented with fever of unknown origin. Echocardiography demonstrated an aortic valve mass and root abscess, in keeping with endocarditis, requiring urgent valve replacement surgery. Eight sets of blood cultures were drawn in total; after prolonged incubation, one set grew C. canimorusus. There was initial uncertainty over this being the causative organism, given the lack of immunosuppression or dog bite history, but 16S PCR of the valve identified the same organism, permitting targeted treatment. This case highlights the value of valve 16S PCR as a diagnostic tool in endocarditis.

Antibiotic Prophylaxis Protocols and Surgical Site Infection Rates in Trauma Surgery: A Prospective Regional Study of 26,849 Procedures.

INTRODUCTION: Prophylactic antibiotics have been shown to reduce the rate of surgical site infection (SSI) 1, however there is little evidence supporting the effectiveness of one antibiotic over another. We have studied SSI rates and antibiotic prophylaxis protocols in Northern Ireland trauma surgery over a 10-year period to Identify the most effective antibiotic protocol associated with lowest rate of SSI. METHOD: Antibiotic prophylaxis protocols from 2004-2014 were sought from each of the region's 4 trauma hospitals and their dates of introduction recorded. For the same period, the number of trauma procedures carried out quarterly and the number of SSIs were recorded for each hospital from the return of prospectively collected SSI surveillance forms. RESULTS: 26849 trauma procedures were included with an overall SSI rate of 1.34% (95% Confidence interval [CI] 1.21 to 1.49). Single dose flucloxacillin (2 grams) with single dose gentamicin (3mg/kg) was the most commonly used protocol used in 3 different hospitals for a combined 13.5 years covering 11445 procedures. The SSI rate was 0.72% (95% CI 0.58-0.89). Triple dose cefuroxime (1.5 grams) was used in 2 different hospitals for a combined 10 years covering 8864 procedures. The SSI rate for this regime was 2.46% (95% CI 2.16-2.80). Single dose cefuroxime (1.5 grams) was used in 2 different hospitals for a combined 8 years covering 6540 procedures. The SSI rate was 0.92% (95% CI 0.71-1.18). CONCLUSION: In this prospective observational cohort study prophylaxis using flucloxacillin and gentamicin was associated with the lowest SSI rate. Single dose cefuroxime was associated with a lower rate of SSI compared to triple dose (p<0.001). Identification of antibiotic regimes associated with the lowest SSI rates will promote the judicious use of antibiotics, improve antibiotic stewardship while allowing for continued benefit in the prevention of SSI in an era of ever-increasing antibiotic resistance.

Report of an outbreak of Clostridium difficile infection caused by ribotype 053 in a neurosurgery unit.

BACKGROUND: We describe an outbreak of Clostridium difficile infection (CDI) with ribotype 053, a possible hypervirulent strain that causes outbreaks, in a neurosurgical unit. OUTBREAK INVESTIGATION: The outbreak was investigated by creating a timeline of all toxin positive patients with root cause analysis, supplemented with ribotyping results, hand hygiene and environmental audits. There were five cases of CDI, three caused by ribotype 053 indicating transmission. INFECTION PREVENTION MEASURES: These included a short period of ward closure to allow enhanced cleaning, including use of vaporised hydrogen peroxide, isolation of infected patients, reinforcement of hand hygiene, education of all staff on C. difficile, reduction of shared bay occupancy from six to four, and addressing staffing levels. DISCUSSION: The patients with ribotype 053 all had long inpatient stays and had required several courses of broad-spectrum antibiotics for aspiration pneumonia. They also required enteral feeding, which can cause diarrhoea, and during long inpatient stays they had multiple toxin negative faecal samples making clinical diagnosis of CDI difficult. Hence they were not isolated promptly, leading to transmission. This is the first reported outbreak of C. difficile ribotype 053 in the UK and highlights the unique aspects of an outbreak in neurosurgical patients.

Acute respiratory distress syndrome caused by Mycoplasma pneumoniae diagnosed by polymerase chain reaction.

Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen in cases of atypical pneumonia. Most individuals with Mycoplasma pneumonia run a benign course, with non-specific symptoms of malaise, fever and non-productive cough that usually resolve with no long-term sequelae. Acute lung injury is not commonly seen in Mycoplasma pneumonia. We report a case of acute respiratory distress syndrome cause by M. pneumoniae diagnosed by quantitative real-time polymerase chain reaction (RT-PCR).