RESUMO
This is the first case report of decubitus infection and bacteremia due to Veillonella parvula (V. parvula). A patient in his 70s with pre-existing diabetes mellitus was admitted with decubitus infection, and tazobactam/piperacillin treatment was initiated. Tazobactam/piperacillin-resistant V. parvula was detected in the blood and decubitus site cultures. The antimicrobial treatment was changed to clindamycin and cefmetazole. Antimicrobial therapy was administered for 28 days. The patient was transferred to a convalescent hospital. V. parvula occasionally causes infection in immunocompromised patients with underlying diseases, such as diabetes. An appropriate evaluation by culture test is important for diagnosis, treatment, and recurrence prevention. Tazobactam/piperacillin is often used in the treatment of multi-bacterial infections such as decubitus infections. V. parvula may be resistant to tazobactam/piperacillin, and this possibility should be taken into account when administering treatment.
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Antibacterianos , Bacteriemia , Ácido Penicilânico , Combinação Piperacilina e Tazobactam , Piperacilina , Úlcera por Pressão , Veillonella , Humanos , Masculino , Piperacilina/uso terapêutico , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Idoso , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Úlcera por Pressão/microbiologia , Úlcera por Pressão/tratamento farmacológico , Veillonella/efeitos dos fármacos , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Tazobactam/uso terapêutico , Testes de Sensibilidade MicrobianaRESUMO
INTRODUCTION: Community acquired bloodstream infection (CA-BSI) is positive blood culture obtained within 48 hours of hospital admission. Bloodstream infections need to be treated with antibiotics. Inappropriate choice of antibiotics will lead to antimicrobial resistance. This is an observational retrospective study to look at the antimicrobial resistance of organisms causing bloodstream infections in patients admitted to the medical wards in our centre. The aim of the study is to determine the appropriate choice of empirical antibiotics for suspected CA-BSI in our hospital. MATERIALS AND METHODS: All patients admitted to medical wards with blood stream infection during the period January 2021 to June 2021 were enrolled. Identification of organisms and antimicrobial susceptibility testing were obtained. Information regarding the severity of the bacteremia was collected by assessing if the patient needed inotropes, mechanical ventilation or renal replacement therapy. Data on comorbidities which were the presence of end-stage renal failure, diabetic mellitus and immunosuppression were collected. RESULTS: Total of 269 cases were screened. Out of these 104 communities acquired cases were included. The pathogens frequently isolated were gram negative organisms most commonly Escherichia coli (43%) and Klebsiella species (30%). Staphylococcus aureus accounts for the majority of gram-positive organisms. Only two out of 20 Staphylococcus aureus were methicillin resistant. Bulkholderia pseudomallei accounts for 7.8% cases. All Burkholderia pseudomallei isolates were sensitive to cotrimoxazole. Escherichia coli (46%) isolates demonstrated a higher resistance pattern to Augmentin compared to klebsiella species (17.4%). The overall mortality rate was 22%, with higher rates for those critically ill (39%). Patients with Enterobacteriaceae infection showed no difference in outcome between the groups of patients according to sensitivity to Augmentin and cefotaxime. These groups of patients who were critically ill did not demonstrate any significant difference in terms of resistance pattern to Augmentin (p = 0.3) and cefotaxime (p = 0.7). Patients who are aged 65 or older have a significantly more resistant pattern to Augmentin and cefotaxime. CONCLUSION: Antibiogram serves as a guide for clinicians to choose appropriate choices of antibiotics based on local data. Empirical antibiotics of choice for patients with sepsis should be narrow-spectrum beta lactam/beta lactamase inhibitors. Broad spectrum beta lactam/beta lactamase inhibitors such as piperacillin tazobactam should be reserved for patients who are critically ill and elderly patients over 65 years. The antibiotics should be deescalated once the organisms and sensitivity of the antibiotics are known.
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Antibacterianos , Bacteriemia , Infecções Comunitárias Adquiridas , Humanos , Estudos Retrospectivos , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Antibacterianos/uso terapêutico , Adulto , Idoso de 80 Anos ou mais , Testes de Sensibilidade Microbiana , Farmacorresistência BacterianaRESUMO
PURPOSE: Invasive Listeria monocytogenes infection is rare, but can lead to life-threatening complications among high-risk patients. Our aim was to assess characteristics and follow-up of adults hospitalized with invasive L. monocytogenes infection. METHODS: A retrospective observational cohort study was conducted at a national referral center between 2004 and 2019. Patients with proven invasive listeriosis, defined by the European Centre for Disease Prevention and Control criteria, were included. Data collection and follow-up were performed using the hospital electronic system, up until the last documented visit. The primary outcome was in-hospital all-cause mortality, secondary outcomes included residual neurological symptoms, brain abscess occurrence, and requirement for intensive care unit (ICU) admission. RESULTS: Altogether, 63 cases were identified (57.1% male, median age 58.8 ± 21.7 years), and 28/63 developed a complicated disease course (44.4%). At diagnosis, 38/63 (60.3%) presented with sepsis, 54/63 (85.7%) had central nervous system involvement, while 9/63 (14.3%) presented with isolated bacteremia. Frequent clinical symptoms included fever (53/63, 84.1%), altered mental state (49/63, 77.8%), with immunocompromised conditions apparent in 56/63 (88.9%). L. monocytogenes was isolated from blood (37/54, 68.5%) and cerebrospinal fluid (48/55, 87.3%), showing in vitro full susceptibility to ampicillin and meropenem (100% each), gentamicin (86.0%) and trimethoprim/sulfamethoxazole (97.7%). In-hospital all-cause mortality was 17/63 (27.0%), and ICU admission was required in 28/63 (44.4%). At discharge, residual neurological deficits (11/46, 23.9%) and brain abscess formation (6/46, 13.0%) were common. CONCLUSION: Among hospitalized adult patients with comorbidities, invasive L. monocytogenes infections are associated with high mortality and neurological complications during follow-up.
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Hospitalização , Listeria monocytogenes , Listeriose , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Listeriose/mortalidade , Listeriose/microbiologia , Listeriose/epidemiologia , Listeriose/tratamento farmacológico , Listeria monocytogenes/patogenicidade , Listeria monocytogenes/isolamento & purificação , Listeria monocytogenes/efeitos dos fármacos , Estudos Retrospectivos , Idoso , Hungria/epidemiologia , Adulto , Hospitalização/estatística & dados numéricos , Seguimentos , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/epidemiologia , Bacteriemia/tratamento farmacológico , Idoso de 80 Anos ou mais , Sepse/microbiologia , Sepse/mortalidade , Sepse/epidemiologia , Sepse/tratamento farmacológico , Mortalidade HospitalarRESUMO
BACKGROUND: Bloodstream infections are linked to heightened morbidity and mortality rates. The consequences of delayed antibiotic treatment can be detrimental. Effective management of bacteraemia hinges on rapid antimicrobial susceptibility testing. OBJECTIVES: This retrospective study examined the influence of the VITEK® REVEAL™ Rapid AST system on positive blood culture (PBC) management in a French tertiary hospital. MATERIALS AND METHODS: Between November 2021 and March 2022, 79 Gram-negative monomicrobial PBC cases underwent testing with both VITEK®REVEAL™ and VITEK®2 systems. RESULTS: The study found that VITEK®REVEAL™ yielded better results than the standard of care, significantly shortening the time to result (7.0â h compared to 9.6â h) as well as the turnaround time (15â h compared to 31.1â h) when applied for all isolates. CONCLUSIONS: This study implies that the use of VITEK®REVEAL™ enables swift adaptations of antibiotic treatment strategies. By considerably minimizing the turnaround time, healthcare professionals can promptly make necessary adjustments to therapeutic regimens. Notably, these findings underscore the potential of VITEK®REVEAL™ in expediting appropriate antibiotic interventions, even in less ideal conditions. Further studies in varied laboratory contexts are required to validate these encouraging outcomes.
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Antibacterianos , Bacteriemia , Hemocultura , Testes de Sensibilidade Microbiana , Humanos , Estudos Retrospectivos , Hemocultura/métodos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/diagnóstico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/genética , Bactérias Gram-Negativas/isolamento & purificação , Fatores de Tempo , Genótipo , Fenótipo , Centros de Atenção Terciária , FrançaRESUMO
OBJECTIVES: To outline the procedural implementation and optimization of rapid diagnostic test (RDT) results for bloodstream infections (BSIs) and to evaluate the combination of RDTs with real-time antimicrobial stewardship team (AST) support plus clinical surveillance platform (CSP) software on time to appropriate therapy in BSIs at a single health system. METHODS: Blood culture reporting and communication were reported for four time periods: (i) a pre-BCID [BioFire® FilmArray® Blood Culture Identification (BCID) Panel] implementation period that consisted of literature review and blood culture notification procedure revision; (ii) a BCID implementation period that consisted of BCID implementation, real-time results notification via CSP, and creation of a treatment algorithm; (iii) a post-BCID implementation period; and (iv) a BCID2 implementation period. Time to appropriate therapy metrics was reported for the BCID2 time period. RESULTS: The mean time from BCID2 result to administration of effective antibiotics was 1.2 h (range 0-7.9 h) and time to optimal therapy was 7.6 h (range 0-113.8 h) during the BCID2 Panel implementation period. When comparing time to optimal antibiotic administration among patients growing ceftriaxone-resistant Enterobacterales, the BCID2 Panel group (mean 2.8 h) was significantly faster than the post-BCID Panel group (17.7 h; Pâ=â0.0041). CONCLUSIONS: Challenges exist in communicating results to the appropriate personnel on the healthcare team who have the knowledge to act on these data and prescribe targeted therapy against the pathogen(s) identified. In this report, we outline the procedures for telephonic communication and CSP support that were implemented at our health system to distribute RDT data to individuals capable of assessing results, enabling timely optimization of antimicrobial therapy.
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Gestão de Antimicrobianos , Hospitais Comunitários , Humanos , Gestão de Antimicrobianos/métodos , Antibacterianos/uso terapêutico , Testes Diagnósticos de Rotina/métodos , Estados Unidos , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Hemocultura/métodos , Fatores de Tempo , Monitoramento Epidemiológico , Farmacêuticos , Masculino , Testes de Diagnóstico RápidoRESUMO
Antimicrobial susceptibility testing (AST) is a core function of the clinical microbiology laboratory and is critical to the management of patients with bloodstream infections (BSIs) to facilitate optimal antibiotic therapy selection. Recent technological advances have resulted in several rapid methods for determining susceptibility direct from positive blood culture that can provide turnaround times in under 8 h, which is considerably shorter than conventional culture-based methods. As diagnostic results do not directly produce a medical intervention, actionability is a primary determinant of the effect these technologies have on antibiotic use and ultimately patient outcomes. Randomized controlled trials and observational studies consistently show that rapid AST significantly reduces time to results and improves antimicrobial therapy for patients with BSI across various methods, patient populations and organisms. To date, the clinical impact of rapid AST has been demonstrated in some observational studies, but randomized controlled trials have not been sufficiently powered to validate many of these findings. This article reviews various metrics that have been described in the literature to measure the impact of rapid AST on actionability, antibiotic exposure and patient outcomes, as well as highlighting how implementation and workflow processes can affect these metrics.
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Antibacterianos , Bacteriemia , Testes de Sensibilidade Microbiana , Humanos , Testes de Sensibilidade Microbiana/métodos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/diagnóstico , Resultado do Tratamento , Gestão de Antimicrobianos/métodos , Fatores de Tempo , Hemocultura/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Bactérias/efeitos dos fármacosRESUMO
BACKGROUND Clostridium ramosum is an anaerobic, spore-producing, gram-positive rod, enteric pathogen that is difficult to identify and is rarely pathogenic. We present a case of Clostridium ramosum bacteremia secondary to aspiration pneumonia in a 65-year-old immunocompromised man on chemotherapy for follicular lymphoma. CASE REPORT We report the case of a 65-year-old man, on active chemotherapy for follicular lymphoma, presenting with a fever of 38.3°C, nonproductive cough, fatigue, and confusion. Physical examination was unremarkable except for +2 lower-extremity pitting edema. CT abdomen pelvis showed left lower-lung consolidation and CT chest angiogram showed that the consolidation was concerning for infarct verses abscess and segmental/subsegmental pulmonary emboli despite anticoagulation use. Blood cultures later grew Clostridium ramosum, which was successfully treated with IV piperacillin-tazobactam. Subsequent outpatient imaging demonstrated resolution of the lung consolidation. CONCLUSIONS Our case highlights the rare diagnosis of Clostridium ramosum bacteremia secondary to aspiration pneumonia in an immunocompromised patient and our approach to management. We highlight the difficulties in identification of Clostridium ramosum, rare pathogenicity, risk factors, and potential sources.
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Bacteriemia , Infecções por Clostridium , Hospedeiro Imunocomprometido , Pneumonia Aspirativa , Humanos , Masculino , Idoso , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Infecções por Clostridium/complicações , Infecções por Clostridium/diagnóstico , Pneumonia Aspirativa/microbiologia , Clostridium/isolamento & purificação , Antibacterianos/uso terapêutico , Neutropenia/complicações , Linfoma Folicular/complicações , Combinação Piperacilina e Tazobactam/uso terapêuticoRESUMO
Current data on fosfomycin usage in children are limited. We present data on the clinical use of intravenous (IV) fosfomycin in children. Hospitalized patients who received ≥3 days of IV fosfomycin between April 2021 and March 2023 were analyzed retrospectively. Forty-three episodes of infection in 39 patients were evaluated. The mean age of the patients was 5.35 (10 days to 17.5 years) years, and 54% were male. Infections were hospital-acquired in 79% of the episodes. Indications for fosfomycin were urinary tract infection (35%), bacteremia (32.6%), catheter-related bloodstream infection (16.3%), soft tissue infection (4.7%), sepsis (4.7%), surgical site infection (2.3%), burn infection (2.3%), and pneumonia (2.3%). Klebsiella pneumoniae was identified in 46.5% of the episodes, and a pan-drug or extensive drug resistance was detected in 75% of them. Carbapenem was used before fosfomycin at significantly higher rates in K. pneumoniae episodes (P = .006). Most (88.5%) patients received fosfomycin as a combination therapy. Culture negativity was achieved in 80% of episodes within a median treatment period of 3 (2-22) days, which was significantly shorter in K. pneumoniae episodes (P < .001). Treatment-related side effects were seen in 9.3% of the episodes. Side effects were significant after 3 weeks of treatment (P = .013). The unresponsivity rate to fosfomycin was 23.3%. Nine (21%) of the patients who were followed up in the intensive care units mainly died because of sepsis (56%). IV fosfomycin is an effective agent in treating severe pediatric infections caused by resistant microorganisms. Fosfomycin can be used in various indications and is generally safe for children.
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Administração Intravenosa , Antibacterianos , Bacteriemia , Fosfomicina , Humanos , Fosfomicina/administração & dosagem , Fosfomicina/uso terapêutico , Masculino , Feminino , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Criança , Estudos Retrospectivos , Turquia , Lactente , Adolescente , Pré-Escolar , Resultado do Tratamento , Bacteriemia/tratamento farmacológico , Recém-Nascido , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Infecção Hospitalar/tratamento farmacológico , Sepse/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Infecções por Klebsiella/tratamento farmacológicoRESUMO
BACKGROUND: Corynebacterium striatum (C. striatum), a common skin and mucosal colonizer, is increasingly considered as an opportunistic pathogen causing bloodstream infections (BSIs). This study aims to investigate the clinical features and outcomes of C. striatum-BSI. METHODS: We included hospitalized cases with C. striatum-positive blood cultures from January 2014 to June 2022 and classified them into C. striatum-BSI group and contamination group; Clinical characteristics, treatments, and outcomes were compared between the C. striatum-BSI group and contamination group, Methicillin-resistant Staphylococcus aureus (MRSA)-BSI and Methicillin-resistant Staphylococcus epidermidis (MRSE)-BSI. RESULTS: Fifty-three patients with positive C. striatum blood cultures were identified. Among them, 25 patients were classified as C. striatum-BSI, with 21 as contamination cases. And 62 cases of MRSA-BSI and 44 cases of MRSE-BSI were identified. Compared to the contaminated group, the C. striatum-BSI group had a shorter time to positivity of blood cultures (27.0 h vs. 42.5 h, P = 0.011). C. striatum-BSI group had a longer time to positivity (27 h) when compared to both the MRSA (20 h) and MRSE groups (19 h) (p < 0.05). Appropriate therapy within 24 h of BSI onset was significantly lower in the C. striatum group (28%) compared to the MRSA (64.5%) and MRSE (65.9%) groups (p < 0.005). The 28-day mortality was higher in the C. striatum group (52.0%) compared to the MRSA (25.8%) and MRSE (18.2%) groups. CONCLUSIONS: Given the distinct characteristics of C. striatum-BSI, including a longer time to positivity than other Gram-positive bacteria and higher mortality rates, we suggest prescribing early appropriate antibiotics if C. striatum-BSI is suspected.
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Bacteriemia , Infecções por Corynebacterium , Corynebacterium , Staphylococcus aureus Resistente à Meticilina , Humanos , Corynebacterium/isolamento & purificação , Corynebacterium/classificação , Corynebacterium/genética , Masculino , Feminino , Pessoa de Meia-Idade , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções por Corynebacterium/microbiologia , Infecções por Corynebacterium/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Idoso , Staphylococcus epidermidis/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Estudos Retrospectivos , Idoso de 80 Anos ou maisRESUMO
INTRODUCTION: Within the context of the coronavirus disease 2019 (COVID-19) pandemic, this study investigated the multifaceted challenges of bacterial infections in cancer patients with COVID-19. It focuses on clinical predictors, resistance patterns, and microbiological characteristics. METHODOLOGY: Over 18 months, 112 adult cancer patients with coronavirus infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) were enrolled. Bloodstream and respiratory samples were evaluated for bacterial infection using the Phoenix automation system for definitive species identification. In vitro susceptibility testing followed the Clinical Laboratory Standards Institute (CLSI) M100-Ed30 guidelines. RESULTS: Bacterial infections affected 25.0% of patients, encompassing bacteremia (21.4%) and respiratory tract infections (8.0%). Multivariable analysis identified hypertension, age < 60, and critical COVID-19 as significant predictors for bacterial infections (p-values = 0.024, 0.029, and 0.039, respectively). Most patients received antimicrobial therapy (93.8%), including last-resort carbapenems (52.7%) and colistin (8.9%). Thirty-three bacterial isolates were identified, with secondary infections doubling co-infection rates. Escherichia coli, Klebsiella species, and Staphylococcus aureus were the most common co-infecting species, while Klebsiella, Acinetobacter, and Pseudomonas species were more frequently associated with secondary infections. Alarmingly, 84.8% of isolates displayed high resistance patterns. All isolated S. aureus species were methicillin-resistant, and 62.5% of Gram-negative bacteria were exclusively sensitive to colistin. CONCLUSIONS: The dominance of highly transmissible hospital-acquired bacterial species, with increased resistance and extensive antibiotic use in COVID-19 patients, necessitates strict infection control and antimicrobial stewardship. Developing customized antimicrobial strategies for cancer patients with COVID-19 is crucial to managing bacterial infections effectively and improving patient outcomes.
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Antibacterianos , Infecções Bacterianas , COVID-19 , Coinfecção , Neoplasias , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Masculino , Coinfecção/microbiologia , Coinfecção/epidemiologia , Coinfecção/tratamento farmacológico , Pessoa de Meia-Idade , Neoplasias/complicações , Feminino , Idoso , Infecções Bacterianas/microbiologia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/tratamento farmacológico , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Adulto , SARS-CoV-2 , Farmacorresistência Bacteriana , Testes de Sensibilidade Microbiana , Bacteriemia/microbiologia , Bacteriemia/epidemiologia , Bacteriemia/tratamento farmacológico , Idoso de 80 Anos ou mais , Infecções Respiratórias/microbiologia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/virologia , Infecções Respiratórias/epidemiologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Bactérias/classificaçãoRESUMO
Bacteremia caused by Lactobacillus is rare, data on its clinical significance are based only on case reports and a limited number of studies, often difficult to interpret. Lactobacillus species is a commensal colonizer of the mouth, gastrointestinal and genitourinary tract. Its significance as a pathogen is overlooked frequently. The diagnosis of these infections requires a mutual relationship between the physician and the microbiologist to rule out contamination risk. Most patients with Lactobacillus bacteremia are immunosuppressed or patients at increased risk of symptomatic bacteremia with comorbidities, treated with broad-spectrum antibiotics and have indwelling venous catheters. Risk factors related to Lactobacillus bacteremia include impaired host defenses and severe underlying diseases, as well as prior surgery and prolonged antibiotic therapy ineffective for lactobacilli. We describe an unusual case of a woman, on chronic hemodialysis treatment, with a sepsis due to Lactobacillus casei and review the literature.
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Bacteriemia , Hospedeiro Imunocomprometido , Humanos , Feminino , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Lacticaseibacillus casei , Pessoa de Meia-IdadeRESUMO
Introduction. Staphylococcus aureus is a leading agent in community-acquired bacteraemia (CAB) and has been linked to elevated mortality rates and methicillin resistance in Costa Rica.Gap statement and aim. To update and enhance previous data obtained in this country, we analysed the clinical manifestations of 54 S. aureus CAB cases in a tertiary hospital and delineated the sequence types (STs), virulome, and resistome of the implicated isolates.Methodology. Clinical information was retrieved from patient files. Antibiotic susceptibility profiles were obtained with disc diffusion and automated phenotypic tests. Genomic data were exploited to type the isolates and for detection of resistance and virulence genes.Results. Primary infections predominantly manifested as bone and joint infections, followed by skin and soft tissue infections. Alarmingly, 70% of patients continued to exhibit positive haemocultures beyond 48 h of treatment modification, with nearly a quarter requiring mechanical ventilation or developing septic shock. The 30-day mortality rate reached an alarming 40%. More than 60% of the patients were found to have received suboptimal or inappropriate antibiotic treatment, and there was an alarming tendency towards the overuse of third-generation cephalosporins as empirical treatment. Laboratory tests indicated elevated creatinine levels, leukocytosis, and bandaemia within the first 24 h of hospitalization. However, most showed improvement after 48 h. The isolates were categorized into 13 STs, with a predominance of representatives from the clonal complexes CC72 (ST72), CC8 (ST8), CC5 (ST5, ST6), and CC1 (ST188). Twenty-four isolates tested positive for mecA, with ST72 strains accounting for 20. In addition, we detected genes conferring acquired resistance to aminoglycosides, MLSB antibiotics, trimethoprim/sulfamethoxazole, and mutations for fluoroquinolone resistance in the isolate collection. Genes associated with biofilm formation, capsule synthesis, and exotoxin production were prevalent, in contrast to the infrequent detection of enterotoxins or exfoliative toxin genes.Conclusions. Our findings broaden our understanding of S. aureus infections in a largely understudied region and can enhance patient management and treatment strategies.
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Antibacterianos , Bacteriemia , Infecções Comunitárias Adquiridas , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas , Staphylococcus aureus , Centros de Atenção Terciária , Humanos , Costa Rica/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/mortalidade , Bacteriemia/microbiologia , Bacteriemia/epidemiologia , Bacteriemia/mortalidade , Bacteriemia/tratamento farmacológico , Masculino , Staphylococcus aureus/genética , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Pessoa de Meia-Idade , Feminino , Idoso , Adulto , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Idoso de 80 Anos ou mais , Adulto Jovem , Adolescente , Fatores de Virulência/genética , CriançaRESUMO
BACKGROUND: Glycopeptides for ampicillin-susceptible Enterococcus faecalis/faecium bacteremia are readily prescribed depending on the severity of the condition. However, there is limited data on the outcomes of glycopeptide use compared to ampicillin-containing regimens for ampicillin-susceptible E. faecalis/faecium bacteremia. From an antibiotic stewardship perspective, it is important to determine whether the use of glycopeptides is associated with improved clinical outcomes in patients with ampicillin-susceptible E. faecalis/faecium bacteremia. METHODS: This retrospective cohort study was conducted at a university-affiliated hospital between January 2010 and September 2019. We collected data from patients with positive blood cultures for Enterococcus species isolates. The clinical data of patients who received ampicillin-containing regimens or glycopeptides as definitive therapy for ampicillin-susceptible E. faecalis/faecium bacteremia were reviewed. Multivariate logistic regression analysis was performed to identify risk factors for 28-day mortality. RESULTS: Ampicillin-susceptible E. faecalis/faecium accounted for 41.2% (557/1,353) of enterococcal bacteremia cases during the study period. A total of 127 patients who received ampicillin-containing regimens (N = 56) or glycopeptides (N = 71) as definitive therapy were included in the analysis. The 28-day mortality rate was higher in patients treated with glycopeptides (19.7%) than in those treated with ampicillin-containing regimens (3.6%) (p = 0.006). However, in the multivariate model, antibiotic choice was not an independent predictor of 28-day mortality (adjusted OR, 3.7; 95% CI, 0.6-23.6). CONCLUSIONS: Glycopeptide use was not associated with improved mortality in patients with ampicillin-susceptible E. faecalis/faecium bacteremia. This study provides insights to reduce the inappropriate use of glycopeptides in ampicillin-susceptible E. faecalis/faecium bacteremia treatment and promote antimicrobial stewardship.
Assuntos
Ampicilina , Antibacterianos , Bacteriemia , Enterococcus faecalis , Glicopeptídeos , Infecções por Bactérias Gram-Positivas , Sulbactam , Humanos , Estudos Retrospectivos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Ampicilina/uso terapêutico , Ampicilina/farmacologia , Masculino , Feminino , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Enterococcus faecalis/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Idoso , Pessoa de Meia-Idade , Glicopeptídeos/uso terapêutico , Glicopeptídeos/farmacologia , Sulbactam/uso terapêutico , Sulbactam/farmacologia , Resultado do Tratamento , Testes de Sensibilidade Microbiana , Idoso de 80 Anos ou maisRESUMO
OBJECTIVES: To investigate whether using the BioFire® FilmArray® Blood Culture Identification 2 panel (BCID2) leads to timely antimicrobial therapy and improves patient outcomes in critically ill patients with bloodstream infections (BSIs). METHODS: This retrospective observational study included patients with BSIs admitted to the intensive care unit from July 1, 2021, to August 31, 2023. Patients were divided into groups receiving appropriate or inappropriate antimicrobial therapy. Those receiving inappropriate therapy underwent adjustments using standard-of-care (SOC) testing or BCID2. Propensity score matching (PSM) was performed on the original cohort (Model 1) and a time-window bias-adjusted cohort (Model 2). Clinical impact of BCID2-guided antimicrobial adjustment was analysed in both models. RESULTS: A total of 181 patients received inappropriate antimicrobial therapy, with 33 undergoing BCID2 testing and 148 undergoing SOC testing. Following PSM and time-window bias adjustment, 66 patients were analysed in Model 1 and 46 patients in Model 2. BCID2 significantly reduced the median time to appropriate antimicrobial therapy (40.8 vs. 74.0 h in Model 1; 42.8 vs. 68.9 h in Model 2) and the day-28 mortality rate (27.8% vs. 77.1%, P < 0.001 in Model 1; 23.5% vs. 58.6%, P = 0.021 in Model 2). In multivariate regression analysis, BCID2-guided antimicrobial adjustment was an independent prognostic factor for day-28 mortality (adjusted odds ratio [aOR] 0.07 in Model 1 and aOR 0.12 in Model 2). CONCLUSION: BCID2-guided antimicrobial stewardship was associated with a shorter time to appropriate antimicrobial therapy and reduced day-28 mortality in critically ill patients with BSIs receiving inappropriate antimicrobial therapy.
Assuntos
Antibacterianos , Gestão de Antimicrobianos , Hemocultura , Estado Terminal , Unidades de Terapia Intensiva , Pontuação de Propensão , Humanos , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Hemocultura/métodos , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Bacteriemia/microbiologia , Sepse/tratamento farmacológico , Sepse/mortalidade , Sepse/microbiologiaRESUMO
Globally, Campylobacter spp. are responsible for most cases of bacterial gastrointestinal infections in humans and although rare, extraintestinal Campylobacter infections have been described. A 2-yearold neutropenic girl with underlying precursor B-cell acute lymphoblastic leukemia presented with a 3-day history of diarrhea. Her stool culture yielded no enteric bacterial pathogens. However, when her blood culture was flagged as positive for bacterial growth, no colonies could be observed on routine bacteriological isolation media. Nonetheless, gram-negative bacilli with seagull and spiral morphologies were seen when the surface of the isolation media used to subculture her blood was Gram-stained. Bacterial colonies were only visible when a subculture was attempted on a Campylobacter blood-free selective agar medium. The organism was identified as Campylobacter jejuni by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Since the organism was erythromycin-resistant and the patient's age precluded the use of tetracycline and ciprofloxacin, an antibiotic regimen consisting of piperacillin-tazobactam and gentamicin was commenced. Her C. jejuni bacteremia resolved following eight days of antibiotic therapy.
Assuntos
Antibacterianos , Bacteriemia , Infecções por Campylobacter , Campylobacter jejuni , Humanos , Feminino , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/diagnóstico , Campylobacter jejuni/isolamento & purificação , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/microbiologia , Infecções por Campylobacter/diagnóstico , Antibacterianos/uso terapêutico , Pré-Escolar , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológicoRESUMO
Erythroderma is characterized by diffuse erythema and scale covering over 90% body surface area that can affect individuals with inflammatory dermatoses such as psoriasis. Complications of erythrodermic psoriasis include infection and cardiovascular compromise. Here we present a case of a 68 year-old man who was hospitalized for erythrodermic psoriasis refractory to multiple immunosuppressive and immunomodulatory therapies, ultimately developing sepsis due to bacteremia and fungemia complicated by infective endocarditis and a mycotic aneurysm. Although the widespread loss of epidermal function in erythroderma increases the risk of infection by opportunistic pathogens, water loss, and electrolyte imbalances, there are very few reported cases of psoriatic erythroderma complicated by fungemia and mycotic aneurysm. Given the high mortality associated with widespread epidermal dysfunction, there is a great need for evidence-based treatment guidelines for psoriatic erythroderma. J Drugs Dermatol. 2024;23(8): doi:10.36849/JDD.7751.
Assuntos
Aneurisma Infectado , Dermatite Esfoliativa , Psoríase , Choque Séptico , Humanos , Masculino , Psoríase/complicações , Psoríase/tratamento farmacológico , Psoríase/diagnóstico , Idoso , Dermatite Esfoliativa/diagnóstico , Dermatite Esfoliativa/etiologia , Dermatite Esfoliativa/terapia , Dermatite Esfoliativa/tratamento farmacológico , Choque Séptico/diagnóstico , Choque Séptico/microbiologia , Choque Séptico/terapia , Choque Séptico/etiologia , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/terapia , Aneurisma Infectado/microbiologia , Evolução Fatal , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Fungemia/complicações , Guias de Prática Clínica como Assunto , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/complicações , Bacteriemia/microbiologiaRESUMO
BACKGROUND Fermenting bacilli producing lactic acid, including Bifidobacterium spp., are supposed to have low pathogenicity and no virulence for humans. Probiotics consisting of those fermenting bacilli can prevent and treat symptomatic gastrointestinal conditions, such as diarrhea. We use probiotics even in cancer patients, those who are immunocompromised, because a preferable effect to the intestinal commensal microbiome has been shown in a recent report. Some case reports warn of a rare risk of bloodstream infection caused by probiotics. However, complete prohibition of probiotic use in cancer patients abandons the benefits. CASE REPORT A 75-year-old Japanese woman with malignant lymphoma was treated with immune-chemotherapy regimen consisting of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The patient had onset of febrile neutropenia during chemotherapy and had Bifidobacterium breve bloodstream infection on day 8 after the eighth R-CHOP treatment. She had usually eaten commercial yogurt every morning. This yogurt was produced from only Lactobacillus bulgaricus and Streptococcus thermophilus. It did not contain Bifidobacterium breve. The bloodstream infection in this case looked like it derived from her food; however, it was not associated with her habitual foods. The patient was treated with meropenem for 8 days and experienced complete remission of the bloodstream infection. CONCLUSIONS We speculate that fermenting bacilli can also be a source of bloodstream infection, not necessarily associated with probiotic strains, in cancer patients treated with chemotherapy. Additionally, we recommend that probiotics can alleviate alimentary tract symptoms in immunocompromised patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Probióticos , Humanos , Feminino , Idoso , Probióticos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Doxorrubicina/efeitos adversos , Vincristina/uso terapêutico , Infecções por Bifidobacteriales/microbiologia , Rituximab/uso terapêutico , Rituximab/efeitos adversos , Prednisona/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bifidobacterium breve , Linfoma/tratamento farmacológicoRESUMO
A man in his 70s was admitted to an intensive care unit with severe COVID-19 and treated with dexamethasone and tocilizumab. After recovery from COVID-19, he developed Clostridium butyricum bacteraemia and non-occlusive mesenteric ischaemia, with fatal outcome. He had been prescribed C. butyricum MIYAIRI 588 fine granules as probiotics for a month. The genome sequences of the C. butyricum isolate from the blood culture and C. butyricum MIYAIRI 588 fine granules were identical by single nucleotide polymorphism analysis. This is the first case of definitive probiotics-related C. butyricum bacteraemia after treatment of severe COVID-19.
Assuntos
Bacteriemia , COVID-19 , Clostridium butyricum , Probióticos , Sequenciamento Completo do Genoma , Humanos , Masculino , Clostridium butyricum/genética , Probióticos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , COVID-19/complicações , Idoso , Infecções por Clostridium , Evolução Fatal , SARS-CoV-2 , Isquemia MesentéricaRESUMO
BACKGROUND: Non-tuberculous mycobacteria (NTM) are present widely in the natural environment and can invade the human body through the respiratory tract, gastrointestinal tract, and skin. Immunocompromised patients are particularly prone to infection, which primarily affects multiple organs, including the lungs, lymph nodes, and skin. However, cases of NTM bloodstream infections are rare. Here, we report a rare case of Mycobacterium marseillense bloodstream infection with concurrent skin fungal infection in a patient after kidney transplantation. Related literature was reviewed to enhance the understanding of this rare condition. CASE PRESENTATION: A 58-year-old male with a history of long-term steroid and immunosuppressant use after kidney transplantation presented with limb swelling that worsened over the past two months. Physical examination revealed redness and swelling of the skin in all four limbs, with a non-healing wound on the lower left limb. Skin tissue analysis by metagenomic next-generation sequencing (mNGS) and fungal culture indicated infection with Trichophyton rubrum. Blood culture results suggested infection with Mycobacterium marseillense. After receiving anti-NTM treatment, the patient's symptoms significantly improved, and he is currently undergoing treatment. CONCLUSION: Mycobacterium marseillense is a NTM. Gram staining suffered from misdetection, and the acid-fast staining result was positive. This bacterium was identified by mass spectrometry and mNGS analyses. Antimicrobial susceptibility tests for NTM were performed using the broth microdilution method. The results of the susceptibility test showed that Mycobacterium marseillense was sensitive to clarithromycin, an intermediary between moxifloxacin and linezolid. Bacterial clearance requires a combination of drugs and an adequate course of treatment. NTM bloodstream infections are relatively rare, and early identification and proactive intervention are key to their successful management.
Assuntos
Infecções por Mycobacterium não Tuberculosas , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Dermatomicoses/microbiologia , Dermatomicoses/tratamento farmacológico , Transplante de Rim/efeitos adversos , Hospedeiro Imunocomprometido , Antibacterianos/uso terapêutico , Micobactérias não Tuberculosas/isolamento & purificação , Micobactérias não Tuberculosas/efeitos dos fármacos , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Mycobacterium/isolamento & purificação , Mycobacterium/efeitos dos fármacos , Pele/microbiologia , Pele/patologiaRESUMO
BACKGROUND: Klebsiella pneumoniae (KP) is the second most prevalent Gram-negative bacterium causing bloodstream infections (BSIs). In recent years, the management of BSIs caused by KP has become increasingly complex due to the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP). Although numerous studies have explored the risk factors for the development of CRKP-BSIs, the mortality of patients with KP-BSIs, and the molecular epidemiological characteristics of CRKP, the variability in data across different populations, countries, and hospitals has led to inconsistent conclusions. In this single-center retrospective observational study, we utilized logistic regression analyses to identify independent risk factors for CRKP-BSIs and factors associated with mortality in KP-BSI patients. Furthermore, a risk factor-based prediction model was developed. CRKP isolates underwent whole-genome sequencing (WGS), followed by an evaluation of microbiological characteristics, including antimicrobial resistance and virulence genes, as well as epidemiological characteristics and phylogenetic analysis. RESULTS: Our study included a total of 134 patients with KP-BSIs, comprising 50 individuals infected with CRKP and 84 with carbapenem-susceptible Klebsiella pneumoniae (CSKP). The independent risk factors for CRKP-BSIs were identified as gastric catheterization (OR = 9.143; CI = 1.357-61.618; P = 0.023), prior ICU hospitalization (OR = 4.642; CI = 1.312-16.422; P = 0.017), and detection of CRKP in non-blood sites (OR = 8.112; CI = 2.130-30.894; P = 0.002). Multivariate analysis revealed that microbiologic eradication after 6 days (OR = 3.569; CI = 1.119-11.387; P = 0.032), high Pitt bacteremia score (OR = 1.609; CI = 1.226-2.111; P = 0.001), and inappropriate empirical treatment after BSIs (OR = 6.756; CI = 1.922-23.753; P = 0.003) were independent risk factors for the 28-day mortality in KP-BSIs. The prediction model confirmed that microbiologic eradication after 6.5 days and a Pitt bacteremia score of 4.5 or higher were significant predictors of the 28-day mortality. Bioinformatics analysis identified ST11 as the predominant CRKP sequence type, with blaKPC-2 as the most prevalent gene variant. CRKP stains carried multiple plasmid-mediated resistance genes along with some virulence genes. Phylogenetic analysis indicated the presence of nosocomial transmission of ST11 CRKP within the ICU. CONCLUSIONS: The analysis of risk factors for developing CRKP-BSIs and the association between KP-BSIs and 28-day mortality, along with the development of a risk factor-based prediction model and the characterization of CRKP strains, enhances clinicians' understanding of the pathogens responsible for BSIs. This understanding may help in the timely administration of antibiotic therapy for patients with suspected KP-BSIs, potentially improving outcomes.