Antibiotic resistance of blood cultures in regional and tertiary hospital settings of Tyrol, Austria (2006-2015): Impacts & trends.

Blood stream infections rank among the top seven causes of death of the general population. The aim of our study was to better understand the epidemiology of BSI in order to improve diagnostics and patient outcome. We used retrospective aggregated laboratory data of blood samples received from all public hospitals in Tyrol, Austria between 2006 and 2015. Microorganisms were categorized into obligatory, facultative, unusual pathogens and contaminants. The distribution, the cumulative incidence and antimicrobial susceptibility patterns were compared between the tertiary (TH) and regional peripheral hospitals (PH). Among 256,364 blood samples, 76.1% were from the TH The incidence of obligatory pathogens was 1.7 fold, and up to 3 times higher for facultative, unusual pathogens and contaminants in the TH and increased mainly due to an increase of E.coli, which was the most common isolated pathogen (n = 2,869), followed by Staphylococcus aureus (n = 1,439), Enterococcus sp. (n = 953) and Klebsiella sp. (n = 816). The distribution of obligatory pathogens differed between the hospital settings: In the TH Enterococcus sp. accounted for 40.8% and E.coli for 70.4%, respectively, whereas in the PH for 25.4% (p<0.0001) and 57.8%, respectively (p<0.0001) Antibiotic resistance of Gram negative bacteria and Staphylococcus aureus did not change during the observation period. Carbapenem resistance of Klebsiella sp. and vancomycin and linezolid resistance of Enterococcus faecium showed a non-significant increase since 2010 in the TH setting. We concluded that the incidence of BSI in TH was higher compared to PH. We observed higher contamination rates in the TH. We could not interpret the data of coagulase negative staphylococci due to lack of clinical data. We strongly recommend enhancement of training on blood culture sampling to decrease the rate of contamination. Due to differences in pathogen distribution and antimicrobial resistance between different hospital settings we recommend separate treatment guidelines for BSI by hospital setting.

Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents.

Diseases causing hematochezia range from benign to potentially life-threatening. Systematic pediatric data on the causes of hematochezia are scarce. We studied the underlying causes and long-term outcome of hematochezia in children. We further investigated the relevance of antibiotic-associated hemorrhagic colitis in children, especially if caused by Klebsiella oxytoca.Infants, children, and adolescents with hematochezia were recruited prospectively. Patients were grouped according to age (<1 year, 1-5 years, 6-13 years, >14 years). In addition to routine diagnostics, K oxytoca stool culture and toxin analysis was performed. We collected data on history, laboratory findings, microbiological diagnostic, imaging, final diagnosis, and long-term outcome.We included 221 patients (female 46%; age 0-19 years). In 98 (44%), hematochezia was caused by infectious diseases. Endoscopy was performed in 30 patients (13.6%). No patient died due to the underlying cause of hematochezia. The most common diagnoses according to age were food protein-induced proctocolitis in infants, bacterial colitis in young children, and inflammatory bowel disease in children and adolescents. Seventeen (7.7%) had a positive stool culture for K oxytoca. Antibiotic-associated colitis was diagnosed in 12 (5%) patients: 2 caused by K oxytoca and 2 by Clostridium difficile; in the remaining 8 patients, no known pathobiont was identified.Infections were the most common cause of hematochezia in this study. In most patients, invasive diagnostic procedures were not necessary. Antibiotic-associated hemorrhagic colitis caused by K oxytoca was an uncommon diagnosis in our cohort. Antibiotic-associated colitis with hematochezia might be caused by pathobionts other than C difficile or K oxytoca.

Fibrates ameliorate the course of bacterial sepsis by promoting neutrophil recruitment via CXCR2.

Bacterial sepsis results in high mortality rates, and new therapeutics to control infection are urgently needed. Here, we investigate the therapeutic potential of fibrates in the treatment of bacterial sepsis and examine their effects on innate immunity. Fibrates significantly improved the survival from sepsis in mice infected with Salmonella typhimurium, which was paralleled by markedly increased neutrophil influx to the site of infection resulting in rapid clearance of invading bacteria. As a consequence of fibrate-mediated early control of infection, the systemic inflammatory response was repressed in fibrate-treated mice. Mechanistically, we found that fibrates preserve chemotaxis of murine neutrophils by blocking LPS-induced phosphorylation of ERK. This results in a decrease of G protein-coupled receptor kinase-2 expression, thereby inhibiting the LPS-mediated downregulation of CXCR2, a chemokine receptor critical for neutrophil recruitment. Accordingly, application of a synthetic CXCR2 inhibitor completely abrogated the protective effects of fibrates in septicemia in vivo. Our results unravel a novel function of fibrates in innate immunity and host response to infection and suggest fibrates as a promising adjunct therapy in bacterial sepsis.

Emergence of VIM-1-carbapenemase-producing Enterobacter cloacae in Tyrol, Austria.

The rapid emergence and dissemination of carbapenemase-producing Enterobacter species and other members of the Enterobacteriaceae poses a considerable threat to the care of hospitalized patients and to public health. In this study, Enterobacter isolates demonstrating decreased susceptibility to carbapenems detected at the Division of Hygiene and Medical Microbiology, Innsbruck Medical University, between January 2006 and December 2010 were tested for bla(VIM-1), bla(NDM-1), bla(IMP), bla(KPC) and bla(OXA-48) using a multiplex PCR with published primers. PFGE was performed to determine the genetic relatedness. In total, 33 isolates (28 Enterobacter cloacae and 5 Enterobacter aerogenes) were collected during the study period. From 2006 to 2009, between two and seven isolates were found per year. In 2010, a significant increase of carbapenem-resistant strains was observed (n = 12). The bla(VIM-1) gene was detected in all 28 isolates of E. cloacae. Typing of E. cloacae by PFGE revealed three distinct clusters, the biggest of which contained 18 isolates. These findings demonstrate the emergence of VIM-1-producing Enterobacter in Tyrol, western Austria. The clonal relationship confirms the risk of spread of these organisms and their possible persistence over time.

Epidemiology of listeriosis in Austria.

A total of 150 human cases of listeriosis (case definition based on isolation of Listeria monocytogenes from normally sterile material) were reported in Austria between 1997 and 2007. Of these, 14 cases (9.3%) were pregnancy-associated (mother/child illness considered as a single case) with a mean age of 29.3 years (median: 26.5; range 24-36). Among the non-pregnancy-associated cases (n = 136), 75 were male (55.2%) and 61 female (44.9%); patients in this group had a mean age of 64.3 years (median: 66.2; range 1-93). The average incidence of listeriosis in Austria in the period studied was 0.168 cases per 100,000 population. The majority of cases (90.7%) were caused by systemic infection, only 9.3% of cases were local infections. Among non-pregnancy-associated cases the fatality rate was 28.7% (39/136) and among the pregnancy-associated cases 35.7% (5/14: miscarriage x3, stillbirth x1, and one death in a newborn within 15 days of birth). Serotyping results for the 150 isolates revealed serovar (SV) 4b: 54%, SV 1/2a: 31.3%, SV 1/2b: 10%, SV 1/2c: 2.7%, 4d: 1.3% and SV 3a: 0.7%. Predisposing risk factors were determined for 131 of the 150 cases: age > or = 65 years (n = 73), pregnancy (n = 14) and 44 cases of carcinoma, blood malignancies, autoimmune diseases and status post solid organ transplants (7 patients had more than one underlying illness). During the period studied, the incidence of listeriosis doubled, despite a drastic reduction in the frequency of pregnancy-associated cases.

Monitoring hygiene on- and at-line is critical for controlling Listeria monocytogenes during produce processing.

The prevalence of Listeria monocytogenes in different types of produce and on processing plant environments was investigated over a 4-year period in a large produce processing plant in Poland. Prevalence of L. monocytogenes was 46% in frozen vegetables and 41.3% in swab samples taken from the plant environment. Survival studies using artificial inocula demonstrated that the number of Listeria in frozen produce stored for 100 days did not significantly decrease in relation to the initial contamination level. A subset of 129 L. monocytogenes isolates originating from produce and the plant environment were typed by pulsed-field gel electrophoresis. Seventy-six of these isolates were retyped by ribo- and serotyping. Thirteen pulsotypes and 18 ribotypes were distinguished. Persistent Listeria isolates were found even when cleansing and sanitization was applied on a daily basis. Nine (69.2%) of 13 pulsotypes were recovered during a period of more than 2 years. L. monocytogenes of the same pulsotype was isolated from broccoli sampled directly before and after blanching, thus suggesting that blanching at 92 to 95 degrees C for 4 to 8 min did not result in a Listeria-free product, most likely due to massive recontamination. This finding is of importance since blanching is the only critical control point in produce processing. Cross-contamination between the two lines was demonstrated through isolating L. monocytogenes strains indistinguishable by pulsed-field gel electrophoresis from contaminated gloves and floor surfaces.

A comparison of Listeria monocytogenes serovar 4b isolates of clinical and food origin in Austria by automated ribotyping and pulsed-field gel electrophoresis.

In this study, two typing methods, automated ribotyping and pulsed-field gel electrophoresis (PFGE), were evaluated for the subtyping of Listeria monocytogenes serotype 4b. The strains originated from patients and food samples collected in Austria during 2001-2005 and from Europe and North America in the World Health Organization collaborative study on the subtyping of this species. The largest group of Austrian clinical isolates was of the same PFGE subtype as those isolated from foodborne outbreaks in Switzerland and in the United States. Another subtype of clinical isolates from Austria was indistinguishable to that obtained from isolates responsible for a foodborne outbreak in the United States in 1985. Although the discriminatory power of PFGE was higher than that of automated ribotyping, some PFGE types were differentiated by ribotyping. Thus, combining data obtained by both automated ribotyping and PFGE increases the strain discrimination. Still, many of the Austrian strains remain indistinguishable from strains of foodborne outbreaks in other countries although there is no known epidemiological relation. This complies to previous studies which show the highly clonal nature of L. monocytogenes 4b strains which are responsible for both large outbreaks and sporadic cases.