Organisms causing community-acquired bloodstream infection in medical department: A single centre retrospective observational study.

INTRODUCTION: Community acquired bloodstream infection (CA-BSI) is positive blood culture obtained within 48 hours of hospital admission. Bloodstream infections need to be treated with antibiotics. Inappropriate choice of antibiotics will lead to antimicrobial resistance. This is an observational retrospective study to look at the antimicrobial resistance of organisms causing bloodstream infections in patients admitted to the medical wards in our centre. The aim of the study is to determine the appropriate choice of empirical antibiotics for suspected CA-BSI in our hospital. MATERIALS AND METHODS: All patients admitted to medical wards with blood stream infection during the period January 2021 to June 2021 were enrolled. Identification of organisms and antimicrobial susceptibility testing were obtained. Information regarding the severity of the bacteremia was collected by assessing if the patient needed inotropes, mechanical ventilation or renal replacement therapy. Data on comorbidities which were the presence of end-stage renal failure, diabetic mellitus and immunosuppression were collected. RESULTS: Total of 269 cases were screened. Out of these 104 communities acquired cases were included. The pathogens frequently isolated were gram negative organisms most commonly Escherichia coli (43%) and Klebsiella species (30%). Staphylococcus aureus accounts for the majority of gram-positive organisms. Only two out of 20 Staphylococcus aureus were methicillin resistant. Bulkholderia pseudomallei accounts for 7.8% cases. All Burkholderia pseudomallei isolates were sensitive to cotrimoxazole. Escherichia coli (46%) isolates demonstrated a higher resistance pattern to Augmentin compared to klebsiella species (17.4%). The overall mortality rate was 22%, with higher rates for those critically ill (39%). Patients with Enterobacteriaceae infection showed no difference in outcome between the groups of patients according to sensitivity to Augmentin and cefotaxime. These groups of patients who were critically ill did not demonstrate any significant difference in terms of resistance pattern to Augmentin (p = 0.3) and cefotaxime (p = 0.7). Patients who are aged 65 or older have a significantly more resistant pattern to Augmentin and cefotaxime. CONCLUSION: Antibiogram serves as a guide for clinicians to choose appropriate choices of antibiotics based on local data. Empirical antibiotics of choice for patients with sepsis should be narrow-spectrum beta lactam/beta lactamase inhibitors. Broad spectrum beta lactam/beta lactamase inhibitors such as piperacillin tazobactam should be reserved for patients who are critically ill and elderly patients over 65 years. The antibiotics should be deescalated once the organisms and sensitivity of the antibiotics are known.

Decubitus ulcer infection and bacteremia due to tazobactam/piperacillin-resistant Veillonella parvula.

This is the first case report of decubitus infection and bacteremia due to Veillonella parvula (V. parvula). A patient in his 70s with pre-existing diabetes mellitus was admitted with decubitus infection, and tazobactam/piperacillin treatment was initiated. Tazobactam/piperacillin-resistant V. parvula was detected in the blood and decubitus site cultures. The antimicrobial treatment was changed to clindamycin and cefmetazole. Antimicrobial therapy was administered for 28 days. The patient was transferred to a convalescent hospital. V. parvula occasionally causes infection in immunocompromised patients with underlying diseases, such as diabetes. An appropriate evaluation by culture test is important for diagnosis, treatment, and recurrence prevention. Tazobactam/piperacillin is often used in the treatment of multi-bacterial infections such as decubitus infections. V. parvula may be resistant to tazobactam/piperacillin, and this possibility should be taken into account when administering treatment.

Evaluating the impact of rapid antimicrobial susceptibility testing for bloodstream infections: a review of actionability, antibiotic use and patient outcome metrics.

Antimicrobial susceptibility testing (AST) is a core function of the clinical microbiology laboratory and is critical to the management of patients with bloodstream infections (BSIs) to facilitate optimal antibiotic therapy selection. Recent technological advances have resulted in several rapid methods for determining susceptibility direct from positive blood culture that can provide turnaround times in under 8 h, which is considerably shorter than conventional culture-based methods. As diagnostic results do not directly produce a medical intervention, actionability is a primary determinant of the effect these technologies have on antibiotic use and ultimately patient outcomes. Randomized controlled trials and observational studies consistently show that rapid AST significantly reduces time to results and improves antimicrobial therapy for patients with BSI across various methods, patient populations and organisms. To date, the clinical impact of rapid AST has been demonstrated in some observational studies, but randomized controlled trials have not been sufficiently powered to validate many of these findings. This article reviews various metrics that have been described in the literature to measure the impact of rapid AST on actionability, antibiotic exposure and patient outcomes, as well as highlighting how implementation and workflow processes can affect these metrics.

Aspiration Pneumonia Leading to Clostridium ramosum Bacteremia in a Neutropenic Patient: Case Report and Management Strategy.

BACKGROUND Clostridium ramosum is an anaerobic, spore-producing, gram-positive rod, enteric pathogen that is difficult to identify and is rarely pathogenic. We present a case of Clostridium ramosum bacteremia secondary to aspiration pneumonia in a 65-year-old immunocompromised man on chemotherapy for follicular lymphoma. CASE REPORT We report the case of a 65-year-old man, on active chemotherapy for follicular lymphoma, presenting with a fever of 38.3°C, nonproductive cough, fatigue, and confusion. Physical examination was unremarkable except for +2 lower-extremity pitting edema. CT abdomen pelvis showed left lower-lung consolidation and CT chest angiogram showed that the consolidation was concerning for infarct verses abscess and segmental/subsegmental pulmonary emboli despite anticoagulation use. Blood cultures later grew Clostridium ramosum, which was successfully treated with IV piperacillin-tazobactam. Subsequent outpatient imaging demonstrated resolution of the lung consolidation. CONCLUSIONS Our case highlights the rare diagnosis of Clostridium ramosum bacteremia secondary to aspiration pneumonia in an immunocompromised patient and our approach to management. We highlight the difficulties in identification of Clostridium ramosum, rare pathogenicity, risk factors, and potential sources.

Intravenous fosfomycin indications and treatment outcomes in pediatric usage: analysis from a single center in Turkey.

Current data on fosfomycin usage in children are limited. We present data on the clinical use of intravenous (IV) fosfomycin in children. Hospitalized patients who received ≥3 days of IV fosfomycin between April 2021 and March 2023 were analyzed retrospectively. Forty-three episodes of infection in 39 patients were evaluated. The mean age of the patients was 5.35 (10 days to 17.5 years) years, and 54% were male. Infections were hospital-acquired in 79% of the episodes. Indications for fosfomycin were urinary tract infection (35%), bacteremia (32.6%), catheter-related bloodstream infection (16.3%), soft tissue infection (4.7%), sepsis (4.7%), surgical site infection (2.3%), burn infection (2.3%), and pneumonia (2.3%). Klebsiella pneumoniae was identified in 46.5% of the episodes, and a pan-drug or extensive drug resistance was detected in 75% of them. Carbapenem was used before fosfomycin at significantly higher rates in K. pneumoniae episodes (P = .006). Most (88.5%) patients received fosfomycin as a combination therapy. Culture negativity was achieved in 80% of episodes within a median treatment period of 3 (2-22) days, which was significantly shorter in K. pneumoniae episodes (P < .001). Treatment-related side effects were seen in 9.3% of the episodes. Side effects were significant after 3 weeks of treatment (P = .013). The unresponsivity rate to fosfomycin was 23.3%. Nine (21%) of the patients who were followed up in the intensive care units mainly died because of sepsis (56%). IV fosfomycin is an effective agent in treating severe pediatric infections caused by resistant microorganisms. Fosfomycin can be used in various indications and is generally safe for children.

Clinical presentation and microbiological characteristics of community-acquired Staphylococcus aureus bacteraemia at a tertiary hospital in Costa Rica.

Introduction. Staphylococcus aureus is a leading agent in community-acquired bacteraemia (CAB) and has been linked to elevated mortality rates and methicillin resistance in Costa Rica.Gap statement and aim. To update and enhance previous data obtained in this country, we analysed the clinical manifestations of 54 S. aureus CAB cases in a tertiary hospital and delineated the sequence types (STs), virulome, and resistome of the implicated isolates.Methodology. Clinical information was retrieved from patient files. Antibiotic susceptibility profiles were obtained with disc diffusion and automated phenotypic tests. Genomic data were exploited to type the isolates and for detection of resistance and virulence genes.Results. Primary infections predominantly manifested as bone and joint infections, followed by skin and soft tissue infections. Alarmingly, 70% of patients continued to exhibit positive haemocultures beyond 48 h of treatment modification, with nearly a quarter requiring mechanical ventilation or developing septic shock. The 30-day mortality rate reached an alarming 40%. More than 60% of the patients were found to have received suboptimal or inappropriate antibiotic treatment, and there was an alarming tendency towards the overuse of third-generation cephalosporins as empirical treatment. Laboratory tests indicated elevated creatinine levels, leukocytosis, and bandaemia within the first 24 h of hospitalization. However, most showed improvement after 48 h. The isolates were categorized into 13 STs, with a predominance of representatives from the clonal complexes CC72 (ST72), CC8 (ST8), CC5 (ST5, ST6), and CC1 (ST188). Twenty-four isolates tested positive for mecA, with ST72 strains accounting for 20. In addition, we detected genes conferring acquired resistance to aminoglycosides, MLSB antibiotics, trimethoprim/sulfamethoxazole, and mutations for fluoroquinolone resistance in the isolate collection. Genes associated with biofilm formation, capsule synthesis, and exotoxin production were prevalent, in contrast to the infrequent detection of enterotoxins or exfoliative toxin genes.Conclusions. Our findings broaden our understanding of S. aureus infections in a largely understudied region and can enhance patient management and treatment strategies.

Clinical outcome of ampicillin or ampicillin/sulbactam versus glycopeptides in ampicillin-susceptible Enterococcus faecalis/faecium bacteremia: a 10-year retrospective cohort study.

BACKGROUND: Glycopeptides for ampicillin-susceptible Enterococcus faecalis/faecium bacteremia are readily prescribed depending on the severity of the condition. However, there is limited data on the outcomes of glycopeptide use compared to ampicillin-containing regimens for ampicillin-susceptible E. faecalis/faecium bacteremia. From an antibiotic stewardship perspective, it is important to determine whether the use of glycopeptides is associated with improved clinical outcomes in patients with ampicillin-susceptible E. faecalis/faecium bacteremia. METHODS: This retrospective cohort study was conducted at a university-affiliated hospital between January 2010 and September 2019. We collected data from patients with positive blood cultures for Enterococcus species isolates. The clinical data of patients who received ampicillin-containing regimens or glycopeptides as definitive therapy for ampicillin-susceptible E. faecalis/faecium bacteremia were reviewed. Multivariate logistic regression analysis was performed to identify risk factors for 28-day mortality. RESULTS: Ampicillin-susceptible E. faecalis/faecium accounted for 41.2% (557/1,353) of enterococcal bacteremia cases during the study period. A total of 127 patients who received ampicillin-containing regimens (N = 56) or glycopeptides (N = 71) as definitive therapy were included in the analysis. The 28-day mortality rate was higher in patients treated with glycopeptides (19.7%) than in those treated with ampicillin-containing regimens (3.6%) (p = 0.006). However, in the multivariate model, antibiotic choice was not an independent predictor of 28-day mortality (adjusted OR, 3.7; 95% CI, 0.6-23.6). CONCLUSIONS: Glycopeptide use was not associated with improved mortality in patients with ampicillin-susceptible E. faecalis/faecium bacteremia. This study provides insights to reduce the inappropriate use of glycopeptides in ampicillin-susceptible E. faecalis/faecium bacteremia treatment and promote antimicrobial stewardship.

Bacterial co-infections in cancer patients with COVID-19: predictors and antimicrobial resistance trends.

INTRODUCTION: Within the context of the coronavirus disease 2019 (COVID-19) pandemic, this study investigated the multifaceted challenges of bacterial infections in cancer patients with COVID-19. It focuses on clinical predictors, resistance patterns, and microbiological characteristics. METHODOLOGY: Over 18 months, 112 adult cancer patients with coronavirus infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) were enrolled. Bloodstream and respiratory samples were evaluated for bacterial infection using the Phoenix automation system for definitive species identification. In vitro susceptibility testing followed the Clinical Laboratory Standards Institute (CLSI) M100-Ed30 guidelines. RESULTS: Bacterial infections affected 25.0% of patients, encompassing bacteremia (21.4%) and respiratory tract infections (8.0%). Multivariable analysis identified hypertension, age < 60, and critical COVID-19 as significant predictors for bacterial infections (p-values = 0.024, 0.029, and 0.039, respectively). Most patients received antimicrobial therapy (93.8%), including last-resort carbapenems (52.7%) and colistin (8.9%). Thirty-three bacterial isolates were identified, with secondary infections doubling co-infection rates. Escherichia coli, Klebsiella species, and Staphylococcus aureus were the most common co-infecting species, while Klebsiella, Acinetobacter, and Pseudomonas species were more frequently associated with secondary infections. Alarmingly, 84.8% of isolates displayed high resistance patterns. All isolated S. aureus species were methicillin-resistant, and 62.5% of Gram-negative bacteria were exclusively sensitive to colistin. CONCLUSIONS: The dominance of highly transmissible hospital-acquired bacterial species, with increased resistance and extensive antibiotic use in COVID-19 patients, necessitates strict infection control and antimicrobial stewardship. Developing customized antimicrobial strategies for cancer patients with COVID-19 is crucial to managing bacterial infections effectively and improving patient outcomes.

Clinical and microbiological characteristics and follow-up of invasive Listeria monocytogenes infection among hospitalized patients: real-world experience of 16 years from Hungary.

PURPOSE: Invasive Listeria monocytogenes infection is rare, but can lead to life-threatening complications among high-risk patients. Our aim was to assess characteristics and follow-up of adults hospitalized with invasive L. monocytogenes infection. METHODS: A retrospective observational cohort study was conducted at a national referral center between 2004 and 2019. Patients with proven invasive listeriosis, defined by the European Centre for Disease Prevention and Control criteria, were included. Data collection and follow-up were performed using the hospital electronic system, up until the last documented visit. The primary outcome was in-hospital all-cause mortality, secondary outcomes included residual neurological symptoms, brain abscess occurrence, and requirement for intensive care unit (ICU) admission. RESULTS: Altogether, 63 cases were identified (57.1% male, median age 58.8 ± 21.7 years), and 28/63 developed a complicated disease course (44.4%). At diagnosis, 38/63 (60.3%) presented with sepsis, 54/63 (85.7%) had central nervous system involvement, while 9/63 (14.3%) presented with isolated bacteremia. Frequent clinical symptoms included fever (53/63, 84.1%), altered mental state (49/63, 77.8%), with immunocompromised conditions apparent in 56/63 (88.9%). L. monocytogenes was isolated from blood (37/54, 68.5%) and cerebrospinal fluid (48/55, 87.3%), showing in vitro full susceptibility to ampicillin and meropenem (100% each), gentamicin (86.0%) and trimethoprim/sulfamethoxazole (97.7%). In-hospital all-cause mortality was 17/63 (27.0%), and ICU admission was required in 28/63 (44.4%). At discharge, residual neurological deficits (11/46, 23.9%) and brain abscess formation (6/46, 13.0%) were common. CONCLUSION: Among hospitalized adult patients with comorbidities, invasive L. monocytogenes infections are associated with high mortality and neurological complications during follow-up.

[Lactobacillemia: A Rare Entity in Immunocompromised Patients. Description of a Clinical Case and Literature Review].

Bacteremia caused by Lactobacillus is rare, data on its clinical significance are based only on case reports and a limited number of studies, often difficult to interpret. Lactobacillus species is a commensal colonizer of the mouth, gastrointestinal and genitourinary tract. Its significance as a pathogen is overlooked frequently. The diagnosis of these infections requires a mutual relationship between the physician and the microbiologist to rule out contamination risk. Most patients with Lactobacillus bacteremia are immunosuppressed or patients at increased risk of symptomatic bacteremia with comorbidities, treated with broad-spectrum antibiotics and have indwelling venous catheters. Risk factors related to Lactobacillus bacteremia include impaired host defenses and severe underlying diseases, as well as prior surgery and prolonged antibiotic therapy ineffective for lactobacilli. We describe an unusual case of a woman, on chronic hemodialysis treatment, with a sepsis due to Lactobacillus casei and review the literature.