Clonal spread of CC17 vancomycin-resistant Enterococcus faecium with multilocus sequence type 78 (ST78) and a novel ST444 in Taiwan.

From May 2007 to January 2008, 30 isolates of vancomycin-resistant enterococci (VRE), including 29 Enterococcus faecium (96.7%) and 1 E. faecalis (3.3%) were obtained from various clinical specimens of 30 patients treated at a university hospital in Taiwan. Among these patients, 27 had VRE infections, including urinary tract infection (n = 16), bacteremia (n = 5), wound infection (n = 5), and central nervous system infection (n = 1). Three patients had VRE colonization. All of these isolates belonged to the vanA genotype with vancomycin minimum inhibitory concentrations of 64>or=128 microg/ml. The isolate of E. faecalis had VanB phenotype-vanA genotype. All these isolates were susceptible to linezolid and were inhibited by tigecycline at 0.25 microg/ml. Multilocus sequence typing (MLST) analysis of the E. faecium isolates showed that 82.8% were ST78, which belongs to lineage C1. Transposon typing classified the 30 isolates of VRE into three types and most of the Tn1546-like elements contained an IS1251-like insertion sequence. Mating experiments showed that the vanA gene clusters were transferable at a frequency of about 10(-6) to 10(-7). Our findings indicate that nosocomial spread of VRE resulted from dissemination of lineage C1 E. faecium clones, including a novel E. faecium MLST type (ST444), and the horizontal transfer of Tn1546 elements among enterococci.

Cerebral infarction in newborns: report of two cases.

Neonates with cerebral infarction do not present with specific symptoms and the condition is usually insidious, so many atypical cases are not diagnosed properly during the neonatal stage. Normal neurological examination results may be found in newborns who have actually had a cerebral infarction insidiously. We present two newborns with cerebral infarction. One had clinical symptoms of seizures. Brain computed tomography showed a low-attenuated area and magnetic resonance angiography showed a decreased caliber and number of cerebral artery branches. The other had normal neurological examination results. He was referred to our hospital due to cyanosis. Brain sonography revealed a focal hyperechoic area and T2 weighted magnetic resonance image showed an increased signal intensity area. The incidence, etiologies, clinical and radiographic findings are also reviewed.

Intravenous gamma-globulin therapy in myocarditis complicated with complete heart block: Report of one case.

Myocarditis complicated with complete heart block is rare in childhood. We report a case of 4-year-old child presented with complete heart block which may have been caused by Mycoplasma pneumoniae. Under emergent temporal pacing, patient experienced cardiogenic shock with pulmonary edema eventually. The cardiopulmonary function was improved with atrial rhythm at the 6th hour later after intravenous infusion with high-dose gamma-globulin (IVIG). The IVIG therapy may have immunomodulatory effects and serve as a potential adjunctive therapy for fulminant myocarditis.

Elizabethkingia meningoseptica: an important emerging pathogen causing healthcare-associated infections.

Elizabethkingia meningoseptica has been deemed a potentially important threat to patients in critical care areas because of its multidrug-resistant phenotype and its ability to adapt to various environments. This review considers the incidence, factors which predispose to, and clinical features of, E. meningoseptica sepsis, along with antimicrobial susceptibility patterns of clinical E. meningoseptica isolates and reportedly successful measures for the prevention and control of infections caused by this bacterium. The English-language literature from the PubMed database was reviewed. The incidence of E. meningoseptica bacteraemia has increased over the last decade. Patients at high risk of E. meningoseptica infection include preterm children, the immunocompromised and those exposed to antibiotics in critical care units. Vancomycin, rifampicin, newer fluoroquinolones, piperacillin-tazobactam, minocycline and possibly tigecycline are preferred empirical choices for E. meningoseptica infection according to in-vitro susceptibility data. Combination therapy has been used for infections not responding to single agents. Saline, lipid, and chlorhexidine gluconate solutions as well as contaminated sinks have been implicated as sources of infection following outbreak investigations. In addition to reinforcement of standard infection control measures, actions that have successfully terminated E. meningoseptica outbreaks include pre-emptive contact isolation, systematic investigations to identify the source of the bacterium and thorough cleaning of equipment and environmental surfaces. As the clinical complexity and incidence of E. meningoseptica infections increase, there is a need for heightened awareness of the potential for this bacterium to cause outbreaks. This will permit timely initiation of active surveillance for infected/colonized patients as well as investigations to identify the likely source of the bacterium, which will, in turn, allow implementation of appropriate infection control measures.

Smooth muscle antibody in children with acute rheumatic fever and rheumatic heart disease.

Smooth muscle antibody (SMA) was positive in 66.7% of children with acute rheumatic fever, in 46.1% of children with chronic rheumatic heart disease, and in only 11.9% of normal Chinese children. These findings indicate that the SMA is one of the bioproducts of acute rheumatic fever and rheumatic heart disease, but the immunopathogenetic role of SMA in these particular disease still needs further investigation.