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1.
Isr Med Assoc J ; 22(2): 71-74, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043321

RESUMO

BACKGROUND: The introduction of pneumococcal conjugate vaccine-13 (PCV-13) has reduced the burden of invasive pneumococcal disease. OBJECTIVES: To characterize true positive blood cultures of children who presented to our hospital following implementation of the PCV-13 vaccine. METHODS: A retrospective study was conducted on positive blood cultures of children presenting with fever from 2010-2017. Subjects were divided into two age groups: a younger group 3-36 months and an older group 3-18 years. Patients were classified as either having or not having a focus of infection at the time of their bacteremia. Pneumococcal isolates were typed at Israel's Streptococcal Reference Laboratory. RESULTS: The samples included 94 true positive blood cultures. Focal infection with concomitant bacteremia was more common than bacteremia without a focus both overall: 67/94 (71%) vs. 27/94 (28.7%), P <0.001 as well as in the two groups: 32/48 (66%) vs. 16/48 (33%), P = 0.02 in the younger group and 35/46 (76%) vs. 11/46 (24%), P = 0.001 in the older group. Streptococcus pneumoniae was the most common pathogen overall, 27/94 (29%), and in the younger group, 21/48 (44%), but rare in the older group, 6/46 (13%). In the latter, Brucella species predominated, 12/46 (26%), along with Staphylococcus aureus 12/46 (26%). CONCLUSIONS: Our findings are consistent with other studies reporting decreased pneumococcal bacteremia, bacteremia primarily accompanying focal infection, and changing etiological agents among PCV-13-vaccinated children. Brucella species was prominent in older children with osteoarticular infections. Ongoing surveillance is warranted to better understand the implications of PCV-13.


Assuntos
Bacteriemia , Infecções Pneumocócicas , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae , Vacinação , Adolescente , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Fatores Imunológicos/administração & dosagem , Incidência , Lactente , Israel/epidemiologia , Masculino , Infecções Pneumocócicas/sangue , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Estudos Retrospectivos , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Vacinação/métodos , Vacinação/estatística & dados numéricos , Vacinas Conjugadas/administração & dosagem
2.
Medicine (Baltimore) ; 99(1): e18494, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895783

RESUMO

INTRODUCTION: Peripherally inserted central catheters (PICC-line) are devices inserted through peripheral venous access. In our institution, this technology has been rapidly adopted by physicians in their routine practice. Bacteremia on catheters remains an important public health issue in France. However, the mortality attributable to bacteremia on PICC-line remains poorly evaluated in France and in the literature in general. We report in our study an exhaustive inventory of bacteremia on PICC-line and their 30 days mortality, over a 7 years period. MATERIAL AND METHODS: From January 2010 to December 2016, we retrospectively matched PICC-line registers of the radiology department, blood culture records of the microbiology laboratory and medical records from the Hospital Information Systems. RESULTS: The 11,334 hospital stays during which a PICC-line was inserted were included over a period of 7 years. Among them, 258 episodes of PICC-line-associated bacteremia were recorded, resulting in a prevalence of 2.27%. Hematology units: 20/324 (6.17%), oncology units: 55/1375 (4%) and hepato-gastro-enterology units: 42/1142 (3.66%) had the highest prevalence of PICC-line related bacteremia. The correlation analysis, when adjusted by exposure and year, shows that the unit profile explains 72% of the variability in the rate of bacteremia with a P = .023. Early bacteremia, occurring within 21 days of insertion, represented 75% of cases. The crude death ratio at 30 days, among patients PICC-line associated bacteremia was 57/11 334 (0.50%). The overall 30-day mortality of patients with PICC-line with and without bacteremia was 1369/11334 (12.07%). On day 30, mortality of patients with bacteremia associated PICC-line was 57/258 or 22.09% of cases, compared to a mortality rate of 1311/11076, or 11.83% in the control group (P < .05, RR 2.066 [1.54-2.75]). Kaplan-Meier survival analysis revealed a statistically significant excess mortality between patients with PICC-line associated bacteremia and PICC-line carriers without bacteremia (P < .0007, hazard ratio 1.89 [1307-2709]). CONCLUSION: Patients with PICC-line associated bacteremia have a significant excess mortality. The implementation of a PICC-line should remain the last resort after a careful assessment of the benefit/risk ratio by a senior doctor.


Assuntos
Infecções Relacionadas a Cateter/mortalidade , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Estudos de Casos e Controles , França/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
APMIS ; 128(1): 20-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31630449

RESUMO

A case of bacteremia with the fastidious bacteria Actinomyces urogenitalis following lengthy urinary retention is reported in a sixty-year-old man. In 2013, the first case of bacteremia due to A. urogenitalis was presented, secondary to a tubo-ovarian abscess following transvaginal oocyte retrieval. To the best of our knowledge, this is the first male bacteremic episode involving A. urogenitalis related to a urinary tract focus. The patient had no prior urogenital medical history. Extensive susceptibility testing was done on isolates from urinary and blood cultures. The organism exhibited fluoroquinolone resistance but was susceptible to most other antibiotics used in the treatment of urinary infections. Due to its unusual growth requirements infections with A. urogenitalis are most likely an underdiagnosed entity.


Assuntos
Actinomicose/diagnóstico , Bacteriemia/microbiologia , Retenção Urinária/complicações , Infecções Urinárias/microbiologia , Actinomyces , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Rev Chilena Infectol ; 36(5): 663-666, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31859809

RESUMO

Bacteremia is an atypical presentation of Campylobacter jejuni infection and it is more frequent in patients with advanced inmunodepression due to HIV or other sistemic diseases. Because of the highly active antiretroviral therapy, in the last decades the number of cases had declined. We report a case of a homeless woman with HIV in C3 stage who was diagnosed with the bacteremia during her hospitalization for pulmonary tuberculosis, and a brief review of C. jejuni bacteremia in HIV patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Bacteriemia/microbiologia , Infecções por Campylobacter/microbiologia , Campylobacter jejuni/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/imunologia , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/imunologia , Feminino , Humanos , Tuberculose Pulmonar/tratamento farmacológico
5.
Rev Chilena Infectol ; 36(5): 667-669, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31859810

RESUMO

Pasteurella species are known to be one of the most frequently isolated in oral microbiota of domestic and wild animals, because of that, they are associated with skin and soft tissues infections secondary to bites and scratches. Systemic infections are uncommon, but are associated with dissemination from localized infections and some risks factors related to immunosuppression. We report a case of Pasteurella multocida bacteremia in an 88 years old patient, associated with food sharing with his dog; a bacteremia mechanism never described before in the medical literature.


Assuntos
Bacteriemia/microbiologia , Cães/microbiologia , Infecções por Pasteurella/microbiologia , Pasteurella multocida/isolamento & purificação , Idoso de 80 Anos ou mais , Animais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Infecções por Pasteurella/tratamento farmacológico , Infecções por Pasteurella/imunologia , Pasteurella multocida/patogenicidade
6.
BMC Infect Dis ; 19(1): 989, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752735

RESUMO

BACKGROUND: A bacteremia diagnosis with speeded-up identification and antimicrobial susceptibility testing (AST) is mandatory to adjust empirical broad-spectrum antibiotherapy and avoid the emergence of multi-resistant bacteria. Alfred 60AST (Alifax, Polverara, PD, Italy) is an innovative automated system based on light scattering measurements allowing direct AST from positive blood cultures with rapid results. In this study we aimed to evaluate the system's performances and turnaround time (TAT) compared to routine AST. METHODS: The study was conducted during 2 non-consecutive 3-month periods at the microbiology laboratory of the Cliniques universitaires Saint-Luc. All blood cultures detected positive in the 0 AM-10 AM time frame with a pure Gram-positive cocci or Gram-negative bacilli stain were included for Alfred 60AST testing. Two customized EUCAST antibiotic panels were set up composed of 1) a "Gram-negative" panel including cefuroxime, ceftazidime Enterobacteriaceae, piperacillin-tazobactam Enterobacteriaceae, ciprofloxacine, and ceftazidime Pseudomonas 2) a "Gram-positive" panel including cefoxitin Staphylococcus aureus, cefoxitin coagulase-negative (CNS) Staphylococci and ampicillin Enterococci. Categorical agreement (CA), very major errors (VME), major errors (ME), minor errors (mE) and TAT to Alfred 60AST results were calculated in comparison with AST results obtained from direct testing on positive blood cultures with the Phoenix system (Becton Dickinson, Franklin Lakes, NJ, USA). RESULTS: Five hundred seventy and one hundred nine antibiotics were evaluated on respectively 166 Gram-negative bacilli and 109 Gram-positive cocci included in the studied population. During the first study period regarding Gram-negative strains a CA of 89.5% was obtained with a high rate of VME (19 and 15.4% respectively) for cefuroxime and piperacillin-tazobactam Enterobacteriaceae. Considering this, Alifax reviewed these antibiotics' formulations improving Gram-negative bacilli total CA to 92.2% with no VME during the second study period. For Gram-positive cocci, total CA was 88.1% with 2.3% VME, 13.8% ME (mainly cefoxitin CNS) and 12% mE rates both study periods combined. Median TAT to AST results was 5 h with Alfred versus 12 h34 with Phoenix. CONCLUSION: The Alfred 60AST system shows correct yet improvable microbiological performances and a major TAT reduction compared to direct automated AST testing. Clinical studies measuring the impact of the approach on antibiotic management of patients with bacteremia are recommended.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/diagnóstico , Bactérias/efeitos dos fármacos , Difusão Dinâmica da Luz/métodos , Testes de Sensibilidade Microbiana/métodos , Bacteriemia/sangue , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bactérias/genética , Bactérias/isolamento & purificação , Hemocultura , Testes Diagnósticos de Rotina , Difusão Dinâmica da Luz/instrumentação , Humanos , Itália , Testes de Sensibilidade Microbiana/instrumentação
8.
Nat Med ; 25(11): 1728-1732, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31700189

RESUMO

Probiotics are routinely administered to hospitalized patients for many potential indications1 but have been associated with adverse effects that may outweigh their potential benefits2-7. It is particularly alarming that probiotic strains can cause bacteremia8,9, yet direct evidence for an ancestral link between blood isolates and administered probiotics is lacking. Here we report a markedly higher risk of Lactobacillus bacteremia for intensive care unit (ICU) patients treated with probiotics compared to those not treated, and provide genomics data that support the idea of direct clonal transmission of probiotics to the bloodstream. Whole-genome-based phylogeny showed that Lactobacilli isolated from treated patients' blood were phylogenetically inseparable from Lactobacilli isolated from the associated probiotic product. Indeed, the minute genetic diversity among the blood isolates mostly mirrored pre-existing genetic heterogeneity found in the probiotic product. Some blood isolates also contained de novo mutations, including a non-synonymous SNP conferring antibiotic resistance in one patient. Our findings support that probiotic strains can directly cause bacteremia and adaptively evolve within ICU patients.


Assuntos
Bacteriemia/genética , Farmacorresistência Bacteriana/genética , Lactobacillus/patogenicidade , Probióticos/efeitos adversos , Bacteriemia/sangue , Bacteriemia/etiologia , Bacteriemia/microbiologia , Diarreia/sangue , Diarreia/etiologia , Diarreia/genética , Diarreia/microbiologia , Variação Genética/genética , Genoma Bacteriano/genética , Genômica , Humanos , Unidades de Terapia Intensiva , Lactobacillus/genética , Mutação , Filogenia , Polimorfismo de Nucleotídeo Único/genética , Probióticos/uso terapêutico , Sequenciamento Completo do Genoma
9.
Pan Afr Med J ; 33: 193, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692677

RESUMO

Introduction: Blood cultures are the best diagnostic tool for the detection of bacteremia. However, false positive results may lead to confusion about antibiotic regimens, putting the lives of patients at risk. The main purpose of this study was to assess the prevalence of coagulase negative Staphylococci (CoNS) as well as of Corynebacterium spp and Bacillus spp in the bags of blood culture analyzed in the microbiology laboratory at the Ibn-Rochd University Hospital in Casablanca. This prevalence was evaluated according to various Hospital Departments over the year 2016. Methods: We conducted a descriptive, retrospective study by analysing the computerized database of the Laboratory of bacteriology and virology at the Ibn-Rochd University Hospital in Casablanca over a 12-month period from 1st January to 31st December 2016. Our study focused on bacteria forming part of the commensal flora (coagulase negative Staphylococcus, Corynebacteria spp and Bacillus spp). The blood culture bags were incubated in the automated blood culture system (Bactec FX). The identification of the germs from a positive culture was performed according to the standard techniques of bacteriology and susceptibility testing was performed according to EUCAST 2015. We conducted an analysis of the computerized database of KALISIL system (Netika) version (2.2.10.) of the Microbiology Laboratory at the Ibn-Rochd University Hospital in Casablanca. Results: Out of 7959 requests for blood cultures obtained from 5801 patients addressed to the laboratory of bacteriology, 2491 were positive, of which 848, reflecting a rate of 34% of positive bags or 10.6% of the whole of bags received over the year 2016, were positive for coagulase negative Staphylococcus, 56 bags of blood cultures, reflecting a rate of 2.2%, were positive for Corrynébacteruim SP, followed by 60 bags of blood cultures, reflecting a rate of 2.4%, which were positive for Bacillus sp. The frequency of isolation of coagulase negative Staphylococcus compared to other bacteria according to Clinical Departments showed a higher frequency in the Paediatric Department (47.2%) followed by the Medicine Department (44.1%). Conclusion: This study shows that coagulase negative Staphylococci are the organisms most frequently isolated from blood cultures. They are a non-negligible cause of nosocomial infections, but they are also the most common blood culture contaminants.


Assuntos
Bacteriemia/epidemiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus/isolamento & purificação , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Hemocultura , Coagulase , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Hospitais Universitários , Humanos , Marrocos/epidemiologia , Prevalência , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus/enzimologia
10.
BMC Infect Dis ; 19(1): 850, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615449

RESUMO

BACKGROUND: To determine, from October 2010 to October 2018, the epidemiology of Deep Neck Infections (DNIs), regarding the detection, the identification and the susceptibility to antimicrobials of causative microorganisms, in Thessaly-Central Greece. METHODS: An analysis of data from a prospective database was conducted on 610 consecutive patients with DNIs treated in the Otolaryngology / Head & Neck Surgery Department of University Hospital of Larissa. Demographics, clinical features and microbiological data were analyzed. RESULTS: Among the 610 patients (1,9/1 male to female ratio, mean age: 39,24 ± 17,25) with DNIs, 579 had a single space (94,9%), while the remaining 31 had a multi-space (5,1%) DNI. The most common areas affected were the peritonsillar space (84,6%) followed by the submandibular space (6,5%). Clinical samples were obtained from 462 patients, and were tested by culture and by the application of 16S rRNA PCR. Two hundred fifty-five samples (55,2%) gave positive cultures, in which Streptococcus pyogenes and Staphylococcus aureus were predominant. The application of the 16S rRNA PCR revealed that 183 samples (39,6%) were positive for bacterial DNA; 22 of them, culture negative, were found to be positive for anaerobic (Fusobacterium necrophorum, Actinomyces israellii etc) and for fastidious microorganisms (Brucella mellitensis, Mycobacterium avium). CONCLUSION: DNIs represent a medical and surgical emergency and evidence-guided empirical treatment with intravenous infusion of antibiotics at the time of diagnosis is mandatory, highlighting the importance of epidemiological studies regarding the causative microorganisms. Although, in our study, the predominant pathogens were S. pyogenes and S. aureus, the combination of culture and molecular assay revealed that anaerobic bacteria play also a significant role in the pathogenesis of DNIs. Based on the local epidemiology, we propose as empirical therapy the intravenous use of a beta-lactam /beta-lactamase inhibitor; metronidazole or clindamycin can be added only in specific cases such as in immunocompromised patients.


Assuntos
Anti-Infecciosos/farmacologia , Bacteriemia/diagnóstico , Bactérias/efeitos dos fármacos , Pescoço/microbiologia , Abscesso/diagnóstico , Abscesso/microbiologia , Adulto , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Feminino , Grécia/epidemiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , RNA Ribossômico 16S/metabolismo , Estudos Retrospectivos , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/efeitos dos fármacos , Streptococcus pyogenes/genética , Streptococcus pyogenes/isolamento & purificação
11.
BMC Infect Dis ; 19(1): 841, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615450

RESUMO

BACKGROUND: The purposes of this study were to determine the incidence of central and peripheral venous catheter-related bacteraemias, the relationship between the suspected and final confirmed bacteraemia origins, and the differences in microbiological, epidemiological, clinical, and analytical characteristics between the groups, including evolution to death. METHODS: This was a 7-year descriptive retrospective populational study of all bloodstream infections, comparing central (CB) and peripheral (PB) venous catheter-related bacteraemias in patients older than 15 years. RESULTS: In all, 285 catheter-related bacteraemia patients, 220 with CBs (77.19%) and 65 with PBs (22.81%), were analysed among 1866 cases with bloodstream infections. The cumulative incidence per 1000 patients-day of hospital stay was 0.36 for CB and 0.106 for PB. In terms of the suspected origin, there was less accuracy in diagnosing catheter-related bloodstream infections (68. 2%) than those of other origins (78. 4%), p <  0.001. The accuracy was greater for PB (75%) than for CB (66. 2%), Coagulase-negative staphylococci were the most frequent microorganisms in both groups but occurred 1.57 times more frequently in CB (64.1%/40.6%) (p = 0.004), while Staphylococcus aureus (23. 4%/9.5%) (p = 0.02) and Enterobacteriae species (15.6%/6. 3%) (p = 0.003) were 2.5 times more frequent in PB. The CB patients stayed at the hospital for an average of 7.44 days longer than did the PB patients; more CB patients had active neoplasia (70. 4%/32.8%), more had surgery in the previous week (29. 2%/8. 3%), and fewer received adequate empirical treatment (53.9%/ 62.5%). Catheter was not removed in 8. 2% of CB and 3.7% of PB. On the other hand, the CB and PB patients had similar Pitt scores at blood extraction (median 0.89 versus 0.84 points, respectively; p = 0.8) and similar survival rates at hospital discharge (91.1% versus 90. 2%; p = 0.81). CONCLUSIONS: Central catheters were more frequent sources of bacteraemias than were peripheral catheters. There were important differences in the microbiological aetiology as well. PB patients received correct empirical antibiotic treatment more frequently and had a higher initial rate of correct determination of the suspected source of bacteraemia. Differences in the microbiological aetiology and empirical antibiotic treatment received, and probably catheter removal and time to catheter removal could explain why CB and PB patients had similar survival rates .


Assuntos
Bacteriemia/diagnóstico , Infecções Relacionadas a Cateter/diagnóstico , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Infecções Relacionadas a Cateter/microbiologia , Cateteres de Demora/microbiologia , Enterobacteriaceae/isolamento & purificação , Humanos , Tempo de Internação , Estudos Retrospectivos , Staphylococcus aureus/isolamento & purificação , Taxa de Sobrevida
12.
N Engl J Med ; 381(21): 2043-2050, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31665575

RESUMO

Fecal microbiota transplantation (FMT) is an emerging therapy for recurrent or refractory Clostridioides difficile infection and is being actively investigated for other conditions. We describe two patients in whom extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli bacteremia occurred after they had undergone FMT in two independent clinical trials; both cases were linked to the same stool donor by means of genomic sequencing. One of the patients died. Enhanced donor screening to limit the transmission of microorganisms that could lead to adverse infectious events and continued vigilance to define the benefits and risks of FMT across different patient populations are warranted.


Assuntos
Bacteriemia/etiologia , Disbiose/terapia , Escherichia coli/isolamento & purificação , Transplante de Microbiota Fecal/efeitos adversos , Fezes/microbiologia , Idoso , Bacteriemia/microbiologia , Farmacorresistência Bacteriana , Disbiose/etiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/metabolismo , Evolução Fatal , Encefalopatia Hepática/complicações , Encefalopatia Hepática/terapia , Humanos , Masculino , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/terapia , beta-Lactamases/metabolismo
13.
BMC Infect Dis ; 19(1): 836, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601195

RESUMO

BACKGROUND: Moraxella nonliquefaciens is a usually non-pathogenic biofilm-producing Gram-negative coccobacillus which may colonize the upper respiratory tract, rarely causing invasive disease. Although very rare, bloodstream infections caused by this organism have been described, showing often a fatal outcome. Here, we report the case of a pediatric cancer patient with bloodstream infection and sepsis due to M. nonliquefaciens showing full recovery after appropriate antibiotic treatment. CASE PRESENTATION: A three-year-old boy with stage IV neuroblastoma was admitted for high-dose chemotherapy with autologous stem cell rescue after standard neuroblastoma treatment. Despite receiving antimicrobial prophylaxis with trimethoprim/sulfamethoxazole, acyclovir and amphothericin B, the patient presented with fever of up to 39.5 °C and neutropenia. Besides a chemotherapy-related mucositis and an indwelling Broviac catheter (removed), no infection focus was identified on physical examination. Moraxella nonliquafaciens was identified in blood cultures. After antibiotic treatment and neutrophil recovery, the patient was fit for discharge. CONCLUSIONS: The case described highlights the importance of an otherwise non-pathogenic microorganism, especially in immunosupressed cancer patients. It should be kept in mind that, although very infrequently, Moraxella nonliquefaciens may cause bloodstream infections that can be successfully treated with prompt focus identification and antibiotic therapy.


Assuntos
Bacteriemia/diagnóstico , Moraxella/isolamento & purificação , Neoplasias/patologia , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Pré-Escolar , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neutropenia/diagnóstico , Neutropenia/etiologia , Sepse/etiologia , Sepse/microbiologia
14.
Medicine (Baltimore) ; 98(40): e17393, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577747

RESUMO

RATIONALE: Bacteremia caused by polymicrobial infections are rare but dangerous. We report a case of hepatic abscess combined with polymicrobial bacteremia in a 49-year-old male patient after surgery and transcatheter arterial chemoembolization (TACE). PATIENT CONCERNS: The patient was admitted to hospital with metastatic liver cancer for periodic chemotherapy and developed a high fever and tenderness to the liver following surgery and TACE. DIAGNOSIS: Hepatic abscess combined with polymicrobial bacteremia. INTERVENTIONS: The clinician formulated a therapy in accordance with the drug susceptibility test and the empirical drug use for anaerobic bacteria. A comprehensive treatment plan was adopted, on the basis of the combination of nitrazole and imipenem as anti-infection drugs as well as continuous abscess drainage. OUTCOMES: After comprehensive therapy, the patient was ultimately discharged without any residual symptoms. LESSONS: Bloodstream infection caused by multiple bacteria increases the difficulty of anti-infection treatments, leading to poor treatment outcome and high mortality. Therefore, a fast and accurate diagnosis of polymicrobial bacteremia is key for initiation of an effective antimicrobial treatment. Additionally, pre-operative prophylactic antibiotics are advisable when patients have a history of abdominal surgery and are immune-compromised.


Assuntos
Bacteriemia/etiologia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Abscesso Hepático/etiologia , Neoplasias Hepáticas/terapia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Carcinoma Hepatocelular/cirurgia , Coinfecção , Drenagem , Humanos , Abscesso Hepático/tratamento farmacológico , Abscesso Hepático/microbiologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica
15.
Infect Immun ; 88(1)2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31611279

RESUMO

Salmonella enterica serovar Typhimurium (S Typhimurium) relies upon the inner membrane protein PbgA to enhance outer membrane (OM) integrity and promote virulence in mice. The PbgA transmembrane domain (residues 1 to 190) is essential for viability, while the periplasmic domain (residues 191 to 586) is dispensable. Residues within the basic region (residues 191 to 245) bind acidic phosphates on polar phospholipids, like for cardiolipins, and are necessary for salmonella OM integrity. S Typhimurium bacteria increase their OM cardiolipin concentrations during activation of the PhoPQ regulators. The mechanism involves PbgA's periplasmic globular region (residues 245 to 586), but the biological role of increasing cardiolipins on the surface is not understood. Nonsynonymous polymorphisms in three essential lipopolysaccharide (LPS) synthesis regulators, lapB (also known as yciM), ftsH, and lpxC, variably suppressed the defects in OM integrity, rifampin resistance, survival in macrophages, and systemic colonization of mice in the pbgAΔ191-586 mutant (in which the PbgA periplasmic domain from residues 191 to 586 is deleted). Compared to the OMs of the wild-type salmonellae, the OMs of the pbgA mutants had increased levels of lipid A-core molecules, cardiolipins, and phosphatidylethanolamines and decreased levels of specific phospholipids with cyclopropanated fatty acids. Complementation and substitution mutations in LapB and LpxC generally restored the phospholipid and LPS assembly defects for the pbgA mutants. During bacteremia, mice infected with the pbgA mutants survived and cleared the bacteria, while animals infected with wild-type salmonellae succumbed within 1 week. Remarkably, wild-type mice survived asymptomatically with pbgA-lpxC salmonellae in their livers and spleens for months, but Toll-like receptor 4-deficient animals succumbed to these infections within roughly 1 week. In summary, S Typhimurium uses PbgA to influence LPS assembly during stress in order to survive, adapt, and proliferate within the host environment.


Assuntos
Bacteriemia/microbiologia , Lipopolissacarídeos/metabolismo , Salmonella typhimurium/metabolismo , Salmonella typhimurium/patogenicidade , Animais , Teste de Complementação Genética , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Camundongos , Salmonelose Animal/microbiologia , Deleção de Sequência , Análise de Sobrevida , Virulência
16.
Medicine (Baltimore) ; 98(38): e17315, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568018

RESUMO

Early differential diagnosis of bloodstream infections (BSIs) caused by different sources and species of bacteria in hospitalized patients is crucial for the timely targeted interventions including appropriate use of antibiotics. The aim of this study was to identify 9 biomarkers for the early differentiation of gram-negative-bloodstream infection (GN-BSI), gram-positive (GP)-BSI, and fungal-BSI.A prospective study was conducted for a total of 390 inpatients who underwent blood culture in the Chinese PLA General Hospital from September 2015 to March 2018. Patients with positive culture of a single pathogen were divided into GN-BSI, GP-BSI, and Fungal-BSI groups, and a culture-negative disease control group was also established. The serum levels of macrophage inflammatory protein 1ß (MIP-1ß), tumor necrosis factor α (TNF-α), interleukin (IL)-3, interferon (IFN)-γ, IL-17A, IL-4, IL-12p70, and P-selectin were detected and the NLR was calculated from routine blood test. Receiver-operating characteristic analysis was used to determine the efficacy of various indicators in the differential diagnosis of BSIs. Prediction and validation experiments on clinical patient samples (263 cases) were also performed.The level of IL-3 in the GP-BSI group was significantly higher than those in the other 3 groups. The level of IFN-γ in the fungal-BSI group was significantly higher than those in the other 3 groups. NLR, MIP-1ß, TNF-α, IL-17A, and IL3 exhibited some efficacy when distinguishing between GN-BSI and GP-BSI and NLR had the largest area under curve (AUC) (0.728), followed by MIP-1ß with an AUC of 0.679. IFN-γ and IL-3 exhibited some value in differential diagnosis between GN-BSI and Fungal-BSI. IL-3, MIP-1ß, TNF-α, IFN-γ, NLR, IL-17A, and IL-4 exhibited some value in distinguishing fungal-BSI and GP-BSI, with IL-3 had the largest AUC (0.722), followed by MIP-1ß with an AUC of 0.703.NLR and MIP-1ß may be valuable in differentiating GN-BSI from GP-BSI in hospitalized patients. IFN-γ and IL-3 may be helpful in differential diagnosis GN-BSI and fungal-BSI. IL-3 and MIP-1ß exhibited some diagnostic efficacy in distinguishing fungal-BSI and GP-BSI. Additionally, IL-3 with high serum level may be a marker for GP-BSI and IFN-γ with high serum level may be a valuable marker for the prediction of Fungal-BSI. The utility of these biomarkers to predict BSIs owing to different pathogens in hospitalized patients needs to be assessed in further studies.


Assuntos
Bacteriemia/diagnóstico , Quimiocina CCL4/sangue , Infecção Hospitalar/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Interferon gama/sangue , Interleucina-12/sangue , Interleucina-17/sangue , Interleucina-3/sangue , Interleucina-4/sangue , Micoses/diagnóstico , Proteínas NLR/sangue , Selectina-P/sangue , Fator de Necrose Tumoral alfa/sangue , Bacteriemia/sangue , Bacteriemia/microbiologia , Biomarcadores/sangue , Infecção Hospitalar/sangue , Infecção Hospitalar/microbiologia , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/sangue , Micoses/microbiologia , Estudos Prospectivos
17.
PLoS Negl Trop Dis ; 13(9): e0007729, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31568511

RESUMO

INTRODUCTION: The prevalence of bacteremia caused by Gram negative non-fermentative (GNNF) bacteria has been increasing globally over the past decade. Many studies have investigated their epidemiology but focus on the common GNNF including Pseudomonas aeruginosa and Acinetobacter baumannii. Knowledge of the uncommon GNNF bacteremias is very limited. This study explores invasive bloodstream infection GNNF isolates that were initially unidentified after testing with standard microbiological techniques. All isolations were made during laboratory-based surveillance activities in two rural provinces of Thailand between 2006 and 2014. METHODS: A subset of GNNF clinical isolates (204/947), not identified by standard manual biochemical methodologies were run on the BD Phoenix automated identification and susceptibility testing system. If an organism was not identified (12/204) DNA was extracted for whole genome sequencing (WGS) on a MiSeq platform and data analysis performed using 3 web-based platforms: Taxonomer, CGE KmerFinder and One Codex. RESULTS: The BD Phoenix automated identification system recognized 92% (187/204) of the GNNF isolates, and because of their taxonomic complexity and high phenotypic similarity 37% (69/187) were only identified to the genus level. Five isolates grew too slowly for identification. Antimicrobial sensitivity (AST) data was not obtained for 93/187 (50%) identified isolates either because of their slow growth or their taxa were not in the AST database associated with the instrument. WGS identified the 12 remaining unknowns, four to genus level only. CONCLUSION: The GNNF bacteria are of increasing concern in the clinical setting, and our inability to identify these organisms and determine their AST profiles will impede treatment. Databases for automated identification systems and sequencing annotation need to be improved so that opportunistic organisms are better covered.


Assuntos
Bacteriemia/microbiologia , Técnicas de Tipagem Bacteriana/métodos , Bactérias Gram-Negativas/isolamento & purificação , DNA Bacteriano/genética , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/genética , Humanos , Testes de Sensibilidade Microbiana/métodos , Tailândia , Sequenciamento Completo do Genoma/métodos
18.
Hosp Pract (1995) ; 47(4): 192-195, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31545676

RESUMO

Pylephlebitis is a rare condition that is characterized by an infected thrombus of the portal vein system and was traditionally associated with a high mortality rate prior to the introduction of antibiotics. This report details a 77-year-old Chinese male found to have a splenic vein thrombosis, Parvimonas micra bacteremia, and a polymicrobial splenic abscess. The patient was treated with abscess drainage and a 6 week course of intravenous antibiotics, and a direct oral anticoagulant, apixaban 2.5 mg twice daily. To our knowledge, this is the second documented case of pylephlebitis treated with apixaban. Here, we summarize our experience treating this case of pylephlebitis and briefly report on the existing body of literature.


Assuntos
Bacteriemia/tratamento farmacológico , Inibidores do Fator Xa/uso terapêutico , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Tromboflebite/tratamento farmacológico , Idoso , Bacteriemia/microbiologia , Drenagem , Firmicutes , Humanos , Masculino , Veia Esplênica , Tromboflebite/microbiologia
19.
Rev Inst Med Trop Sao Paulo ; 61: e50, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531628

RESUMO

This study involves a 49-year-old male, who for three years suffered with a myelodysplastic syndrome and who needed frequent blood transfusions. One day following a transfusion, he presented fever and abdominal pain. The fever became persistent and only improved temporarily with two cycles of intravenous ciprofloxacin. Nearly 120 days after beginning the second cycle of treatment, he had experienced a weight loss of 16 kg and recurring fever. Screening for fever of unknown origin was conducted, including Bartonella infection. No etiology could be found. The patient improved with an antimicrobial regimen composed of oral doxycycline and intravenous ciprofloxacin. After 15 days afebrile, the patient was discharged with a four-month oral prescription of doxycycline and ciprofloxacin. Eight months following the antibiotic treatment, the patient received an allogeneic bone marrow transplant. Five days following the transplant, the patient initiated a febrile neutropenia and died. From a blood sample collected and stored at the time of hospitalization, a microbiological and molecular study was performed again. Blood- and liquid culture-PCRs from the same blood sample were all negative, but an isolate from solid subculture was found. The molecular reactions from this isolate were all positive and the sequence was 100% homologous to Bartonella henselae . The present report points to the limitations of laboratory techniques currently available for investigation of possible cases of bartonellosis in clinical practice, and the potential risk of Bartonella spp. transmission through blood transfusions.


Assuntos
Bacteriemia/microbiologia , Infecções por Bartonella/diagnóstico , Bartonella henselae , Síndromes Mielodisplásicas/microbiologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade
20.
Artigo em Inglês | MEDLINE | ID: mdl-31522664

RESUMO

From 1 January to 31 December 2017, 36 institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2017 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the E. faecium isolates. Of the 1,137 unique episodes of bacteraemia investigated, 95.2% were caused by either E. faecalis (52.9%) or E. faecium (42.3%). Ampicillin resistance was not detected in E. faecalis but in 89.6% of E. faecium. Vancomycin non-susceptibility was reported in 0.3% and 47.0% of E. faecalis and E. faecium respectively. Overall 50.9% of E. faecium harboured vanA or vanB genes. For the vanA/B positive E. faecium isolates, 49.6% harboured vanB genes and 49.2% vanA genes; 1.2% harboured vanA and vanB genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is significantly higher than that seen in most European countries. E. faecium consisted of 76 multilocus sequence types (STs) of which 77% of isolates were classified into nine major STs containing ten or more isolates. All major STs belong to clonal cluster (CC) 17, a major hospital-adapted polyclonal E. faecium cluster. Seven of the nine predominant STs (ST80, ST1421, ST17, ST296, ST555, ST203 and ST18) were found across most regions of Australia. The most predominant clone was ST17 which was identified in all regions except the Australian Capital Territory, the Northern Territory and Tasmania. Overall 60.7% of isolates belonging to the nine predominant STs harboured vanA or vanB genes. The AESOP 2017 has shown enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin resistant vanA or vanB E. faecium which have limited treatment options.


Assuntos
Anti-Infecciosos/farmacologia , Bacteriemia/epidemiologia , Farmacorresistência Bacteriana Múltipla , Enterococcus/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Enterococcus/classificação , Enterococcus/genética , Enterococcus faecalis/classificação , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/genética , Enterococcus faecium/classificação , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecium/genética , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Adulto Jovem
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