RESUMEN
Leuconostoc lactis is a glycopeptide-resistant, gram-positive, facultative anaerobic coccus isolated from dairy products, whereas Staphylococcus nepalensis is coagulase-negative coccus that has not been identified as human pathogen. We report an instructive case of L. lactis and S. nepalensis bacteremia in a 71-year-old man who experienced Boerhaave syndrome after a meal.
Asunto(s)
Bacteriemia , Infecciones por Bacterias Grampositivas , Anciano , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Japón/epidemiología , Leuconostoc , Masculino , StaphylococcusRESUMEN
OBJECTIVE: We implemented a stepwise antimicrobial stewardship program (ASP). This study evaluated the effect of each intervention and the overall economic impact on carbapenem (CAR) use. METHOD: Carbapenem days of therapy (CAR-DOT) were calculated to assess the effect of each intervention, and antipseudomonal DOT were calculated to assess changes in use of broad-spectrum antibiotics. We carried out segmented regression analysis of studies with interrupted time series for 3 periods: Phase 1 (infectious disease [ID] consultation service only), Phase 2 (adding monitoring and e-mail feedback), and Phase 3 (adding postprescription review and feedback [PPRF] led by ID specialist doctors and pharmacists). We also estimated cost savings over the study period due to decreased CAR use. RESULTS: The median monthly CAR-DOT, per month per 100 patient-days, during Phase 1, Phase 2, and Phase 3 was 5.46, 3.69, and 2.78, respectively. The CAR-DOT decreased significantly immediately after the start of Phase 2, but a major decrease was not observed during this period. Although the immediate change was not apparent after Phase 3 started, CAR-DOT decreased significantly over this period. Furthermore, the monthly DOT of 3 alternative antipseudomonal agents also decreased significantly over the study period, but the incidence of antimicrobial resistance did not decrease. Cost savings over the study period, due to decreased CAR use, was estimated to be US $150 000. CONCLUSIONS: Adding PPRF on the conventional ASP may accelerate antimicrobial stewardship. Our CAR stewardship program has had positive results, and implementation is ongoing.
Asunto(s)
Proteínas Bacterianas/genética , Proteínas de Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Klebsiella pneumoniae/aislamiento & purificación , Enfermedad Relacionada con los Viajes , beta-Lactamasas/genética , Adulto , Antibacterianos/farmacología , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/microbiología , Heces/microbiología , Femenino , Humanos , India , Japón , Infecciones por Klebsiella/diagnóstico , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/enzimología , Pruebas de Sensibilidad Microbiana , EmbarazoRESUMEN
An 87-year-old man with poorly controlled diabetic mellitus presented with fever, bedsores, and elevated hepatobiliary enzyme levels. He was diagnosed with bacteremia with acute cholangitis due to Arthrobacter species, which are Gram-positive, aerobic, catalase-positive, coryneform bacteria belonging to the family Microbacteriaceae. Doripenem and subsequencial sulbactam/ampicillin treatment were used for the acute cholangitis, and the bacteremia was treated with a 2-week course of vancomycin. The bacteremia was misidentified by the phenotyping assay (API Coryne test), but was identified as Arthrobacter creatinolyticus by 16S rRNA and matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry. To our knowledge, this is the first report of a human case of A. creatinolyticus bacteremia.
Asunto(s)
Arthrobacter/aislamiento & purificación , Bacteriemia/diagnóstico , Colangitis/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/patología , Infecciones por Bacterias Grampositivas/diagnóstico , Aerobiosis , Anciano de 80 o más Años , Ampicilina/administración & dosificación , Antibacterianos/administración & dosificación , Arthrobacter/clasificación , Arthrobacter/genética , Arthrobacter/fisiología , Bacteriemia/microbiología , Bacteriemia/patología , Carbapenémicos/administración & dosificación , Colangitis/complicaciones , Colangitis/microbiología , Colangitis/patología , ADN Bacteriano/química , ADN Bacteriano/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Doripenem , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/patología , Humanos , Masculino , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Sulbactam/administración & dosificación , Inhibidores de beta-Lactamasas/administración & dosificaciónRESUMEN
Spondylodiscitis caused by Parvimonas micra, a rarely reported infection, might be under-detected using conventional methods. This report of the detection and treatment of two cases of spondylodiscitis due to P. micra and review of the literature indicates that the use of gene sequencing methods might improve the accuracy of diagnosing this infection.