Asymptomatic Fungemia Due to Rhodotorula spp. Caused by a Subcutaneously Implanted Central Venous Port Catheter.

A 66-year-old man was admitted to our hospital for gastrointestinal perforation. He had a history of surgery and chemotherapy for colorectal cancer and had a subcutaneously implanted central venous port catheter. After surgery for gastrointestinal tract perforation, he developed an intra-abdominal abscess, which was treated with broad-spectrum antimicrobial agents and improved. Following this improvement, Rhodotorula spp. was detected in a blood culture and at the catheter tip. He was asymptomatic despite having fungemia. His condition improved after the removal of the catheter and the administration of antifungal drugs. Fungemia due to Rhodotorula spp. is rare, and asymptomatic fungemia is even rarer.

Reduction of 30-day death rates from Staphylococcus aureus bacteremia by mandatory infectious diseases consultation: Comparative study interventions with and without an infectious disease specialist.

OBJECTIVES: Most Japanese hospitals need to keep to higher Staphylococcus aureus bacteremia (SAB) quality-of-care indicators (QCIs) and create strategies that can maximize the effect of these QCIs with only a small number of infectious disease specialists. This study aimed to evaluate the clinical outcomes of patients with SAB before and after the enhancement of the mandatory infectious disease consultations (IDCs). METHODS: This retrospective study was conducted at a tertiary care hospital in Japan. The primary outcome was the 30-day mortality between each period. A generalized structural equation model was employed to examine the effect of the mandatory IDC enhancement on 30-day mortality among patients with SAB. RESULTS: A total of 114 patients with SAB were analyzed. The 30-day all-cause mortality differed significantly between the two periods (17.3% vs. 4.8%, P = 0.02). Age, three-QCI point ≥ 1, and Pitt bacteremia score ≥ 3 were the significant risk factors for 30-day mortality. The intervention was also significantly associated with improved adherence to QCIs. CONCLUSION: Mandatory IDCs for SAB improved 30-day mortality and adherence to QCIs after the intervention. In Japan, improving the quality of management in patients with SAB should be an important target.

Validation of blood culture gram staining for the detection of Staphylococcus aureus by the 'oozing sign' surrounding clustered gram-positive cocci: a prospective observational study.

BACKGROUND: Staphylococcus aureus bacteraemia is a common and significant infection, associated with high rates of mortality. Therefore, early identification is important for the initiation of appropriate treatment. The objective of this study was to evaluate the accuracy of blood culture Gram staining along with the finding of an 'oozing sign' to diagnose either Staphylococcus aureus or coagulase-negative staphylococci. METHODS: This single-centre, prospective observational study was performed from May 2017 to November 2017. We used routine blood culture bottles (BacT/ALERT FA and BacT/ALERT SN; bioMérieux, Inc., Durham, NC). Bacterial species were identified and the minimum inhibitory concentration was determined by using the MicroScan WalkAway 96 SI system (Beckman Coulter, Tokyo, Japan). Bottles showing growth were removed, and Gram staining was performed. RESULTS: A total of 118 samples, including 55 aerobic and 63 anaerobic bottle samples, were analysed. The overall sensitivity of Gram staining was 78.7% (95% CI: 65.8-94.3%), and the specificity was 95.0% (95% CI: 84.7-98.4%). CONCLUSION: The 'oozing sign' observed in Gram staining may be useful for the rapid prediction of S. aureus in BacT/ALERT blood culture bottles.

Gemella haemolysans bacteremia in a patient with secondary peritonitis due to a duodenal ulcer perforation: A case report.

We describe a case of Gemella haemolysans septic shock in a 75-year old Japanese male with a duodenal perforation and secondary peritonitis. Blood cultures on admission were positive for Gram-positive and Gram-variable cocci, and G. haemolysans was identified using whole cell matrix-assisted laser desorpition/ionization mass spectrometry (MALDI-TOF MS), with a score value of 2.12. The 16S rRNA sequencing was difficult to use as a diagnostic test because there was more than 99% sequence homology with related bacterial strains. Based on both the biochemical profiles and whole groEL sequence, we concluded that the strain in our patient was G. haemolysans. The patient was successfully treated with a 16-day course of antimicrobials. His clinical condition improved, and no evidence of a relapse of the infection was noted. Although MALDI-TOF MS and 16S rRNA sequencing are useful for identification of the species, the basic biochemical profile is also important to identify a rare species.

[A case of inactive Escherichia coli isolated from feces initially suspected to be Shigella boydii subgroup C serotype 14 by conventional biochemical tests in tubes].

A small number of colorless colonies grew from DHL agar of feces culture taken as part of a complete physical for a 42 year-old woman who had lived in Singapore for several years. When cultured for first-stage identification using conventional biochemical tests in tubes for Enterobacteriaceae, such as TSI agar slant and SIM medium, the results for lactose reaction (-), saccharose reaction (-), gas (very weak +) and motility (-) were obtained, and Shigella spp. was suspected. Serological tests (by serotype) for Shigella spp. were then conducted. As a result, clear C14 agglutination was observed. Based on these results, the isolate was strongly suspected to be Shigella boydii serotype 14, but since the woman had no symptoms of abdominal pain, diarrhea or fever, such identification was still questionable. When further identification test was carried out using Walk-Away 96 and VITEK 2, non-Shigella spp. identification results were obtained. In second-stage identification, xylolytic activity, acetate salt utilization and use of carbon sources in CA (citrate-acetate) medium were checked, all results were positive, and the isolate was ultimately identified as Inactive Escherichia coli. While Shigella spp. and E. coli are taxonomically similar, they are quite different from each other in terms of pathogenicity. Accurate and rapid identification of Shigella spp. is therefore important.

[Drug sensitivity and beta-lactamase producibility of various types of bacteria clinically isolated during the period from December 1999 to February 2000].

beta-Lactamase activity and drug sensitivity were measured in 744 strains from 8 species of bacteria isolated at medical institutions in Chikugo District of Fukuoka Prefecture during the period from December 1999 to February 2000. Nitrocefin test revealed that beta-lactamase was positive in 48% of S. aureus, 7% of H. influenzae, and 92% of M. catarrhalis, and acidometry revealed that penicillinase/cephalosporinase were positive in 13%/14% of E. coli, 22%/8% of K. pneumoniae, 47%/97% of E. cloacae, 3%/65% of S. marcescens, and 10%/36% of P. aeruginosa. Based on the assessment of the MIC values of various types of antibacterial drugs for beta-lactamase-producing strains, there were 11 strains (1 strain of K. pneumonia, 6 strains of E. cloacae, and 4 strains of P. aeruginosa) of class-B beta-lactamase-producing bacteria out of a total of 496 strains of Enterobacteriaceae and Pseudomonas aeruginosa. The results of PCR analysis suggested that 1 strain of K. pneumonia, 1 strain of E. cloacae, and 4 strains of P. aeruginosa produced metallo-beta-lactamase. There was no strain (E. coli and K. pneumoniae) of ESBL-producing bacteria. BLNAR strains, on the other hand, were found in 9% (9/100) of H. influenzae.