Bloodstream infections in patients with chronic lymphocytic leukemia: a longitudinal single-center study.

Infectious complications in chronic lymphocytic leukemia (CLL) represent a major cause of morbidity and mortality. The aim of the study was to investigate temporal trends in bloodstream infections (BSIs) among patients with CLL. Individuals with blood cultures were linked to Swedish Cancer Registry and divided into three time periods (1988-1993, 1994-1999, and 2000-2006) according to year of CLL diagnosis. CLL patients (n = 275) with 1092 blood culture episodes were identified and linked to the nationwide Cause of Death Registry and Swedish Patient Registry (to retrieve information on splenectomies). The most common causes of BSI among CLL patients were Escherichia coli (11/43, 15/78, and 9/33), Streptococcus pneumoniae (7/43, 13/78, and 6/33), Pseudomonas aeruginosa (2/43, 8/78, and 3/33), Staphylococcus aureus (1/43, 6/78, and 6/33), and Viridans streptococci (5/43, 6/78, and 2/33). Coagulase-negative staphylococci was the most frequent microorganism found in blood cultures (22/70, 23/106, and 5/41, respectively) but is a frequent contaminant. Based on the largest study to date on BSI in CLL patients, we found a stable proportion of Gram-positive to Gram-negative bacteria and no temporal change of distribution was observed for BSIs 1988-2006.

Mycoplasmataceae Colonizations in Women With Urethral Pain Syndrome: A Case-Control Study.

OBJECTIVES: To determine if Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum are more common in premenopausal women with urethral pain syndrome than in asymptomatic controls. METHODS: We used a case-control study design to compare the prevalence of M. genitalium, U. urealyticum, and U. parvum using polymerase chain reaction (PCR) analysis in urine. Urethral pain syndrome was defined as localized urethral pain with or without accompanying lower urinary tract symptoms during the past month or longer and at least one negative urine culture. RESULTS: Among the 28 cases, 46% carried Ureaplasma species compared with 64% of the 92 controls overall (P = 0.09). There were no significant differences in the prevalence of U. parvum and U. urealyticum among controls than in patients with urethral pain syndrome (P = 0.35 and P = 0.33, respectively). Co-colonization with U. parvum and urealyticum was infrequent, and there was only one case of M. genitalium colonization, which occurred among the controls. The symptomatic profile of Ureaplasma carriers with urethral pain syndrome was heterogeneous with no clear pattern and did not differ significantly compared with patients negative for Ureaplasma. CONCLUSIONS: We found no evidence to support the notion that M. genitalium, U. parvum, and U. urealyticum are more prevalent in women with urethral pain syndrome than in women without lower urinary tract symptoms.

Antimicrobial resistance of Escherichia coli isolates from outpatient urinary tract infections in women in six European countries including Russia.

OBJECTIVES: In the Northern Dimension Antibiotic Resistance Study (NoDARS), Finland, Germany, Latvia, Poland, Russia and Sweden collected urine samples from outpatient women (aged 18-65years) with symptoms of uncomplicated urinary tract infection (UTI) to investigate the levels of antimicrobial resistance (AMR) among Escherichia coli isolates. METHODS: A total of 775 E. coli isolates from 1280 clinical urine samples were collected from October 2015 to January 2017. Antimicrobial susceptibility testing was performed and the results were interpreted according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. RESULTS: Overall AMR rates to the commonly used antibiotics nitrofurantoin, fosfomycin and mecillinam (except for Germany that was missing a result for mecillinam) were 1.2%, 1.3% and 4.1%, respectively. The highest overall resistance rates were determined for ampicillin (39.6%), trimethoprim (23.8%), trimethoprim/sulfamethoxazole (22.4%), amoxicillin/clavulanic acid (16.7%) and ciprofloxacin (15.1%), varying significantly between countries. The rate of extended-spectrum ß-lactamase (ESBL) production was 8.7%. None of the isolates showed resistance to meropenem. CONCLUSIONS: In most cases, low AMR rates were detected against the first-line antibiotics recommended in national UTI treatment guidelines, giving support to their future use. These results also support the European Association of Urology guidelines stating that nitrofurantoin, fosfomycin and mecillinam are viable treatment options for uncomplicated UTI.

Cefuroxime non-susceptibility in multidrug-resistant Klebsiella pneumoniae overexpressing ramA and acrA and expressing ompK35 at reduced levels.

OBJECTIVES: The aims were to study if efflux and down-regulation of porins contribute to cefuroxime resistance in Klebsiella pneumoniae and to co-resistance to unrelated antibiotics. METHODS: Ten cefuroxime-non-susceptible but cefotaxime-susceptible blood culture isolates of K. pneumoniae and one multiply antibiotic-resistant (MAR) laboratory strain (selected by chloramphenicol) were examined. Transcription of the genes acrA, ompK35, ramA, marA and soxS was determined with quantitative RT-PCR. RESULTS: All clinical isolates and the MAR laboratory strain had similar antibiograms with non-susceptibility to cefuroxime, tigecycline, chloramphenicol and nalidixic acid. Phenylalanine arginine beta-naphthylamide (PAbetaN) increased susceptibility to tigecycline, chloramphenicol and nalidixic acid, but not to cefuroxime. Increased acrA transcription and decreased ompK35 transcription was seen in all strains. Increased ramA transcription was seen in all strains except one clinical isolate. CONCLUSIONS: This multidrug-resistant phenotype of K. pneumoniae is associated with increased acrA and ramA transcription and decreased ompK35 transcription. Since the cefuroxime resistance was not reversed by PAbetaN, it was probably attributable to decreased levels of OmpK35, rather than to efflux.

[Rare bacteria species found in wounds of tsunami patients. Predominance of gram-negative rods, increased antibiotic resistance]. / Ovanliga bakteriefynd i sår hos tsunamipatienter. Dominans av gramnegativa stavar, ökad andel antibiotikaresistens.

Microbiological cultures from 229 patients seeking medical advise in Stockholm after the tsunami catastrophe December 2004 were analysed at the Clinical microbiology laboratory, Karolinska University Hospital, Stockholm, Sweden. Gram-negative rods were the most common findings from wound cultures. Common human pathogens as Escherichia coli, Proteus species, Klebsiella spp, and Pseudomonas aeruginosa were isolated. However, more rare species of gram-negative rods were also isolated, e.g. Myroides odoratus, Sphingomonas paucimobilis and Bergeyella zoohelcum. Resistance towards ordinary antibiotics was higher compared to our Swedish reference material for Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Acinetobacter spp, but not for Pseudomonas aeruginosa. Possibly, this reflects that the resistant isolates were nosocomially acquired in Asia.

Interplay of efflux, impermeability, and AmpC activity contributes to cefuroxime resistance in clinical, non-ESBL-producing isolates of Escherichia coli.

Cefuroxime resistance in Escherichia coli strains susceptible to extended-spectrum cephalosporins is not uncommon, but the resistance mechanisms have so far not been elucidated. Therefore, 14 clinical non-extended-spectrum beta-lactamase isolates of E. coli were examined, 11 of which were cefuroxime resistant. Quantitative RT-PCR was used to examine the transcription levels of the genes acrA (encoding AcrA, part of the AcrAB-TolC efflux pump system) and ompF (encoding the porin OmpF). Isoelectric focusing was used for detection of beta-lactamases, and a spectrophotometric assay was used to measure AmpC activity. Among the 11 cefuroxime-resistant isolates, 7 had increased acrA transcription (from 2.4 to 38 times the ATCC strain), 3 isolates had very low ompF transcription levels (

Gram-negative bacteria from patients seeking medical advice in Stockholm after the tsunami catastrophe.

Microbiological cultures from 229 patients seeking medical advice in Stockholm after the tsunami catastrophe of December 2004 were analysed at the Clinical Microbiology Laboratory, Karolinska University Hospital, Stockholm, Sweden. Gram-negative bacilli were the most common findings from wound cultures. Common human pathogens such as Escherichia coli, Proteus species, Klebsiella spp., and Pseudomonas aeruginosa were isolated. More rare species of Gram-negative bacilli, e.g. Myroides odoratus, Sphingomonas paucimobilis and Bergeyella zoohelcum were also isolated. Resistance towards ordinary antibiotics was more extensive compared to our Swedish reference material for Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Acinetobacter spp., but not for Pseudomonas aeruginosa, probably reflecting that the resistant isolates were nosocomially acquired in Asia.

Contribution of efflux to cefuroxime resistance in clinical isolates of Escherichia coli.

Retrospective data showed that resistance to cefuroxime among clinical blood culture isolates of Escherichia coli (2.67%) was more common than resistance to cefotaxime (0.59%) and ceftazidime (1.48%). 30 clinical isolates of E. coli with various degrees of resistance to cefuroxime were selected for the present studies. Antibiotic susceptibility to beta-lactam antibiotics was determined with the disc-diffusion method and for cefuroxime also with the E-test. The ability to grow in the presence of organic solvents was determined as a phenotypical measure of efflux. The organic solvent tolerance (OST) was graded on a scale from 1 to 5. Antibiotic susceptibility to cefuroxime, cefotaxime, ceftazidime and loracarbef was also determined in the presence of a known efflux pump inhibitor, MC-207,110. The strains that were organic solvent tolerant had significantly higher minimal inhibitory concentration (MIC) values for cefuroxime than the other E. coli strains (median 24 mg/l, range 4 to > 256 mgn/l vs median 4 mg/l, range 2-64 mg/l) and significantly lower cefuroxime zone diameters (p < 0.02). In the strains with most pronounced organic solvent tolerance, i.e. the cyclohexane-tolerant strains, the cefuroxime MIC values were decreased 2-fold (p < 0.03) and the zone diameters increased (p < 0.02) by the addition of an efflux pump inhibitor, MC-207,110. The findings supported the hypothesis that efflux contributes to cefuroxime resistance in E. coli.