[Meningitis and myelitis by hypervirulent Klebsiella pneumoniae]. / Meningitis y mielitis por Klebsiella pneumoniae hipervirulenta.

Invasive liver abscess syndrome caused by hypervirulent Klebsiella. pneumoniae is a rare disease. This type of K. pneumoniae is aggressive and invasive, despite its sensitivity profile. We report the case of a 62-year-old man with diabetes mellitus, who was admitted to our hospital with meningeal syndrome. Within 24 hours of admission, Gram negative bacilli were isolated blood and cerebrospinal fluid cultures, which were later identified as K. pneumoniae. Liver abscess was detected by computed tomography. Despite early antibiotic treatment, the patient developed back pain that prevented him from moving and right hemiparesis. Increased signal from the central region of the spinal medulla compatible with myelitis was identified by magnetic resonance, for which he received methylprednisolone 1 g/day for 5 days. The patient evolved favorably. Infections caused by hypermucoviscous K. pneumoniae are aggressive and invasive, and more common in men with a history of diabetes mellitus, as in this case. These infections require early antibiotic treatment and the search of metastatic infections.

El síndrome de absceso hepático invasivo causado por cepas hipermucoviscosas de Klebsiella pneumoniae es una enfermedad poco frecuente. Esta serovariedad de Klebsiella se caracteriza por ser agresiva e invasiva pese a su perfil de sensibilidad. Se presenta el caso de un varón de 62 años con antecedentes de diabetes mellitus, que ingresó a nuestro centro con síndrome meníngeo. A las 24 horas del ingreso se aislaron en hemocultivos y en líquido cefalorraquídeo (LCR) bacilos Gram negativos que luego fueron tipificados como Klebsiella pneumoniae. Se identificó la presencia de un absceso hepático mediante tomografía computarizada. Pese al tratamiento antibiótico instaurado de manera temprana, el paciente evolucionó con dolor dorsal que le impedía movilizarse y hemiparesia derecha. En la resonancia magnética nuclear de columna se identificó aumento de la señal de la región central de la médula espinal compatible con mielitis por lo cual recibió tratamiento con metilprednisolona 1g/día por 5 días consecutivos. El paciente evolucionó de manera favorable. Las infecciones por K. pneumoniae hipermucoviscosas son agresivas e invasoras y más frecuentes en varones con antecedentes de diabetes mellitus, como en este caso. Su control requiere de un tratamiento antibiótico temprano y búsqueda de focos a distancia.

Hypermucoviscous Klebsiella pneumoniae invasive syndrome in a patient with diabetes without liver abscess.

Klebsiella pneumoniae is part of the human gastrointestinal microbiota. It is also a well-known cause of community and nosocomial infections, involving mainly the lung and urinary tract. An invasive syndrome with liver abscess due to a new hypervirulent strain of K. pneumoniae was recently described. Several cases have been reported, mainly in Asia. Here, we show a case of a patient with an extrahepatic involvement affecting the lung and prostate.

Successful treatment of ventriculitis caused by Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae with i.v. ceftazidime-avibactam and intrathecal amikacin.

PURPOSE: A patient with carbapenem-resistant Klebsiella pneumoniae infection is described, and treatment options are discussed. SUMMARY: Few antibiotics to treat carbapenem-resistant Enterobacteriaceae (CRE) infection are available, and treatment is further complicated by the limited ability of many antibiotics to penetrate into the cerebrospinal fluid (CSF). Currently, there is a lack of clinical data on the treatment of central nervous system CRE infections, and therapy is based on case reports, case series, and small retrospective studies. A patient was admitted to the emergency department with intracranial hemorrhage and ventriculitis due to traumatic injury. A ventriculostomy and, subsequently, a ventriculoperitoneal (VP) shunt were placed. After approximately a month of treatment with various antibiotic regimens, the patient's VP shunt was externalized, and a CSF culture speciated carbapenem-resistant K. pneumoniae and Pseudomonas aeruginosa. The patient was then switched to i.v. ceftazidime-avibactam and intrathecal amikacin therapy. His CSF cultures were sterile 3 days after initiation of those antibiotics, and subsequent CSF cultures resulted in no growth. After the patient was treated with intrathecal amikacin 30 mg daily for 4 weeks and i.v. ceftazidime-avibactam 2.5 g every 8 hours for 6 weeks, the ventriculitis resolved, the external ventricular drain was removed, and he was transferred to a long-term care facility for rehabilitation. CONCLUSION: A man with ventriculitis caused by P. aeruginosa and carbapenem-resistant K. pneumoniae was successfully treated with i.v. ceftazidime-avibactam and intrathecal amikacin.

Areas of research and clinical approaches to the study of liver abscess.

AIM: To analyze the research activity on liver abscess (LA) and identify the main topic clusters in the area. METHODS: We identified all documents using the medical subject heading "LA" indexed in the MEDLINE database between 2001 and 2015. We performed a descriptive bibliometric analysis, characterizing the evolution of scientific activity, the publication types of the documents, the document categories of clinical interest (case reports, clinical trials, evaluation studies, meta-analysis, observational studies, practice guidelines and validation studies) and the geographic distribution of the research. We also carried out an analysis of networks and research clusters in order to identify the main topic areas of research. RESULTS: Our search yielded a total of 1278 documents, showing a stable scientific production over the study period and a marked multidisciplinary nature. The research was dominated by case reports (65.9% of the documents analyzed). In terms of geographic distribution, researchers from the United States led in the number of signatures (n = 229), followed by those from Taiwan (n = 185), India (n = 145), Japan (n = 144), South Korea (n = 100), and China (n = 84). With regard to amebic LA, the top-producing countries were India and Mexico (n = 69 each), followed by the United States (n = 29). In the case of pyogenic LA, Taiwanese researchers led scientific production (n = 71), followed by the United States (n = 39) and China (n = 29). The most active areas of research in the field are diagnosis via computerized tomography scan, differential diagnosis with regard to liver cancer, treatment with antimicrobial agents, and Klebsiella infections (including bacteremia). CONCLUSION: Clinical case reports associated with diagnosis and treatment are the main topic of study, highlighting the importance of this document type in advancing knowledge.

Resistencia bacteriana en infecciones del tracto urinario de origen comunitario / Bacterial resistance in urinary tract infections of community origin

Antecedentes: Las infecciones del tracto urinario (ITU) representan una de las principales causas de morbilidad. Recientemente ha surgido preocupación por la creciente tasa de resistencia en los patógenos causantes, y el origen comunitario de la infección ya no garantiza susceptibilidad antibiótica. Objetivo: Determinar la tasa de los diferentes patrones de resistencia en infecciones de vías urinarias comunitarias, junto a los principales factores de riesgo asociados. Metodología: Estudio descriptivo prospectivo donde se incluyó a todos los pacientes que consultaron a la emergencia de Medicina Interna con síndrome clínico de ITU y en quienes se demostró la etiología infecciosa mediante urocultivo. Se documentaron las comorbilidades y el consumo previo de antibióti-cos y se buscó la significancia estadística de esto sobre el desarrollo de resistencia.Resultados: Se incluyeron 100 sujetos a estudio, 90% de las infecciones se debieron a E coli y K pneu-moniae, se documentó resistencia en 68% de los casos, 41% resistentes a quinolonas, 27% ESBL(+) y 17% a cefalosporinas de 3ra generación. Se encontró que la DM era la comorbilidad más común (46%) y representó un factor de riesgo para el desarrollo de resistencia a cefalosporinas (p=0.031) y cepas ESBL(+) (p=0.045). El consumo previo de aminopenicilinas, cefalosporinas y quinolonas condicionó para el desarrollo de diferentes resistencias.Conclusiones: Se encontró relación significativa entre la DM y el desarrollo de resistencia bacteriana, al igual que el uso previo de quinolonas, cefalosporinas y aminopenicilinas. El 68% de las cepas mos-tró alguna resistencia. Hay elevada tasa de resistencia a quinolonas, cefalosporinas y cepas ESBL(+). (AU)

Urinary tract infections (UTI's) represent one of the leading causes of disease worldwide. In recent years, great concern has emerged regarding the growing resistance rate among the different bacteria responsible for these infections, and community acquired infections no longer guarantee antibiotic susceptibility. Objective: To determine the rate of antibiotic resistance patterns in community acquired UTI's, and to identify the associated risk factors.Methods: This was a prospective study performed in the Emergency Room of a Reference Hospital in Guatemala City. Every patient that consulted with urinary symptoms and whose diagnosis was con-firmed by urinary culture was included. The patients were questioned about past medical history and previous antibiotic use. The statistical analysis was done using the IBM SPSS ™ software.Results: One-hundred patients were included. 90% were caused by E coli and K pneumoniae. Any resistance was detected in 68% of the cases, 41% were resistant to fluoroquinolones, 27% had ESBL enzymes, and 17% were found to be resistant to 3rd generation cephalosporines. Diabetes was pre-sent in 46% of the patients and prooved to be an important risk factor for the development of cepha-losporines (p=0.031) and ESBL(+) (p=0.045) resistance. Previous use of fluoroquinolones, cephalos-porines and aminopenicillins determined the development of certain resistance patterns.Conclusion: A statistical significant relationship was found between diabetes and ATB resistance as well as with previos ATB consumption and the latter. 68% showed any resistance. A high resistance pattern to quinolones, cephalosporins ESBL+ was documented.(AU)

[Pylephlebitis: a rare but possible complication of intra-abdominal infections]. / Pileflebitis: una extraña pero posible complicación de las infecciones intraabdominales.

BACKGROUND: Pylephlebitis or septic thrombophlebitis of the portal venous system is a rare but serious complication of intra-abdominal infections which drain into the portal venous system. Its diagnosis is based on clinical suspicion and imaging tests, mainly a computed tomography scan, given the lack of specificity of the signs and symptoms. Spread of septic emboli is the major cause of morbidity and mortality. The aim of the study was to analyse patients diagnosed in our hospital. MATERIAL AND METHODS: Retrospective descriptive study of patients diagnosed with pylephlebitis in our hospital. CLINICAL CASES: Four patients were included, 3 men and one woman. In 3 cases it was acute cholecystitis that led to the diagnosis of pylephlebitis at the same time as the intra-abdominal infection. Emergency surgery was performed in one case, whilst the other 2 were treated conservatively. Blood cultures were performed in all cases, and empirical antibiotic treatment was used. In the only case of acute appendicitis, diagnosis of pylephlebitis was achieved during the study of postoperative fever, with empirical antibiotic treatment also being started. The haematologist was requested to start the required anticoagulation therapy in all cases. CONCLUSIONS: Pylephlebitis is a rare complication of intra-abdominal infections that may make lead to a worse outcome. A high level of suspicion is required as well as imaging tests to make an early diagnosis and appropriate treatment.

Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses.

OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K.) pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%), nodules with or without cavities (79%), pleural effusions (71%), peripheral wedge-shaped opacities (64%), patchy ground-glass opacities (50%), air bronchograms within a nodule (36%), consolidations (21%), halo signs (14%), and lung abscesses (14%). Nine (64%) of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14%) patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis.

Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K.) pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%), nodules with or without cavities (79%), pleural effusions (71%), peripheral wedge-shaped opacities (64%), patchy ground-glass opacities (50%), air bronchograms within a nodule (36%), consolidations (21%), halo signs (14%), and lung abscesses (14%). Nine (64%) of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14%) patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis. .

Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients.

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) is an emergent pathogen in healthcare-associated infections (HAIs). The aim of this study was to describe HAIs due to KPC-Kp, as well as identify mortality risk factors in cancer patients. In patients diagnosed with HAIs due to KPC-Kp between January 2009 and July 2013, we evaluated only the first infection episode of each patient, analyzing mortality separately for patients treated for ≥48 h with at least one antimicrobial agent proven to display in vitro activity against KPC-Kp. We evaluated variables related to the malignancy, the severity and characteristics of the HAI, and the antimicrobial therapy. We identified 83 HAIs due to KPC-Kp. The 30-day mortality was 57.8 % for all infections and 72.7 % for bacteremic infections. Of the 83 patients, 60 patients received ≥48 h of appropriate treatment and 44 (53 %) developed bacteremia. Ten patients (12 %) were neutropenic at HAI diagnosis and 33 (39.8 %) had infection at the tumor site. The most common HAI was urinary tract infection, seen in 26 patients (31.3 %), followed by primary bloodstream infection, seen in 24 patients (28.9 %). Forty-four patients (73.3 %) received combination antimicrobial therapy, most often including polymyxin (68.3 %). Risk factors for 30-day mortality are high sequential organ failure assessment (SOFA) score, need for intensive care stay at diagnosis of infection, and acute kidney injury; the removal of invasive devices related to infection and treatment with effective antibiotics for KPC-Kp are protective factors. In cancer patients, high mortality is associated with HAI due to KPC-Kp and mortality risk factors are more often related to acute infection than to the underlying disease.

Purple urine bag syndrome in end-stage chronic kidney disease.

INTRODUCTION: When faced with violet, purple or purplish-blue urine, clinicians should consider urinary tract infection in their differential diagnosis. CASE REPORT: A 60-year-old woman with end-stage kidney disease and non-adherence to renal replacement therapy was admitted to our hospital for placement of hemodialysis catheter. During her hospitalization she had purple urine, and purple urine bag syndrome (PUBS) was diagnosed. She was effectively treated with antibiotics and her urine returned to a dark yellow color. DISCUSSION: Although this condition is often easily treated, diagnosing PUBS in chronic renal patients probably means an increased serum concentration of indoxyl sulfate, metabolite that is involved in the progression of both CKD and cardiovascular disease. CONCLUSION: Hence, in the context of our renal patients, perhaps PUBS is not as benign as supposed.

Klebsiella pneumoniae meningitis induces memory impairment and increases pro-inflammatory host response in the central nervous system of Wistar rats.

Klebsiella pneumoniae meningitis has recently become an increasingly common cause of central nervous system infection. The invasion of bacteria within the subarachnoid space stimulates the release of pro-inflammatory cytokines and chemokines, triggering a host immune response. The aim of the present study was to evaluate memory and pro-inflammatory mediators at different times in the brains of adult Wistar rats with K. pneumoniae meningitis. The animals were sacrificed at 6, 12, 24, 48 and 96 h after meningitis induction. The hippocampus, frontal cortex and cerebrospinal fluid were isolated to determine the cytokine, chemokine and brain-derived neurotrophic factor (BDNF) levels. In the first 6 and 24 h following meningitis induction, there was a significant increase of the TNF-α, IL-1ß, IL-6, cytokine-induced neutrophil chemoattractant-1 and BDNF levels in the central nervous system. Ten days after meningitis induction, cognitive memory was evaluated using an open-field task and step-down inhibitory avoidance task. In the control group, significant differences in behaviour were observed between the training and testing sessions for both tasks, demonstrating habituation and aversive memory. However, the meningitis group did not exhibit any difference between the training and testing sessions in either task, demonstrating memory impairment. As a result of these observations, we believe that the meningitis model may be a good research tool to study the biological mechanisms involved in the pathophysiology of this illness, while recognizing that animal models should be interpreted with caution before extrapolation to the clinic.