GERMS最新文献

{"title":"The emergence of multidrug-resistant Gram-positive bloodstream infections in India - a single center prospective cohort study.","authors":"Nakka Vihari, Gopal Krishana Bohra, Ram Ratan Yadev, Deepak Kumar, Durga Shankar Meena, Vibhor Tak, Ankur Sharma, Vijaylaxmi Nag, Mahendra Kumar Garg","doi":"10.18683/germs.2023.1389","DOIUrl":"10.18683/germs.2023.1389","url":null,"abstract":"<p><strong>Introduction: </strong>Gram-positive bloodstream infections (BSIs) are an emerging health concern, especially in resource-limited settings. There is a paucity of data regarding the antimicrobial resistance (AMR) pattern of Gram-positive BSIs. The rise in multidrug-resistant infections further convoluted antibiotic selection. We aimed to assess the incidence, clinical and microbiological profile, antimicrobial resistance (AMR) and outcome in Gram-positive BSIs.</p><p><strong>Methods: </strong>This was a single-center prospective study conducted at a tertiary care hospital in Western India. All patients (age ≥18 years) with culture-proven Gram-positive BSIs were included. Data were collected on all patients' demography, risk factors, AMR and clinical outcome.</p><p><strong>Results: </strong>A total of 210 clinically significant isolates were grown from July 2020 to December 2021. The incidence of Gram-positive BSIs was 29% (n=61); 55.9% of cases were healthcare-associated, while 44.1% were community-acquired. Coagulase-negative staphylococci (CoNS) were the major isolates (36.1%), followed by <i>Enterococcus</i> spp. (27.9%), methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA) (18%) and methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) (14.7%). The proportion of vancomycin and teicoplanin-resistant CoNS isolates was 13.6% and 19%. Among <i>Enterococcus</i> isolates, the proportion of vancomycin-resistant enterococci (VRE) and linezolid-resistant enterococci (LRE) were 11.8% and 5.9%. The overall mortality in Gram-positive BSIs was 42.6%. Older age, MRSA infection, septic shock, and high NLR were significantly associated with mortality. On the Cox regression model, age ≥65 years (HR: 2.5; 95%CI: 1.1-5.8; p=0.024) and MRSA infection (HR: 3.6; 95%CI: 1.5-8.5; p=0.021) were found as independent predictors of 30-day mortality.</p><p><strong>Conclusions: </strong>This study found substantial mortality with Gram-positive BSIs, especially MRSA infections. Moreover, the emergence of VRE and LRE is also alarming. Active surveillance of AMR and evaluation of mortality predictors may help overcome the therapeutic challenges in managing BSIs.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 3","pages":"229-237"},"PeriodicalIF":2.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of antibiotic de-escalation on clinical outcomes in patients with carbapenem-resistant Enterobacteriaceae bacteremia (CRE) in the hematology-oncology setting.","authors":"Nitin Bansal, Neelam Sachdeva, Dinesh Bhurani, Narendra Agarwal, Rayaz Ahmed, Pallavi Mehta, Rohan Halder","doi":"10.18683/germs.2023.1388","DOIUrl":"10.18683/germs.2023.1388","url":null,"abstract":"<p><strong>Introduction: </strong>Carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with poor outcomes, particularly among hematology-oncology patients. Appropriate use (selection and de-escalation) of antibiotics is a key component of management of febrile neutropenia particularly in high CRE prevalence regions like India.</p><p><strong>Methods: </strong>This was a retrospective study done (April 2019-December 2021) in a dedicated oncology center in North India, which assessed the case records of the patients undergoing therapy for hematological malignancies who were diagnosed with CRE bacteremia. Demographic, clinical and microbiological data, as well as antibiotic prescription patterns were studied. Inter-group analysis was done between an antibiotic stewardship cohort (avoiding CRE therapy empirically or stopping CRE therapy if cultures negative; as per suggestions of the AMS team) and a non-antibiotic stewardship cohort (continuation of empirical CRE therapy; de-escalation advice was not followed).</p><p><strong>Results: </strong>A total of 139 patients were identified, with median age of 41 years (range 13-74) out of which 82 (58.9%) were males. Acute myeloid leukemia (66.2%) was the most common malignancy, followed by lymphoma (8.6%) and myeloma (8.6%). Nearly 30% of patients were post allogenic stem cell transplant. <i>Klebsiella pneumoniae</i> was the predominant organism (78.4%) and combination of NDM+OXA-48 (46.3%) was the most common carbapenemase gene detected followed by OXA-48 alone (34.7%). Overall, 28-day mortality was 26.6%. On binary logistic regression analysis, lack of compliance with antibiotic stewardship intervention was an independent predictor of mortality (p=0.005).</p><p><strong>Conclusions: </strong>Prior exposure to empirical CRE therapy or failure to de-escalate was associated with poor outcomes in patients with CRE bacteremia, which gives us a window of antibiotic stewardship in febrile neutropenia.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 3","pages":"221-228"},"PeriodicalIF":2.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 5Ds of optimized antimicrobial prescription in dental medicine.","authors":"Oana Săndulescu, Mihai Săndulescu","doi":"10.18683/germs.2023.1386","DOIUrl":"10.18683/germs.2023.1386","url":null,"abstract":"","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 3","pages":"207-209"},"PeriodicalIF":2.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally-invasive definitive treatment of recurrent sialadenitis due to obstructive sialolithiasis - a case report.","authors":"Iulian Filipov, Corina Marilena Cristache, Mihai Săndulescu","doi":"10.18683/germs.2023.1397","DOIUrl":"10.18683/germs.2023.1397","url":null,"abstract":"<p><strong>Introduction: </strong>Salivary gland lithiasis is one of the most frequent causes of sialadenitis. We report the case of a patient who presented multiple episodes of subangulomandibular tumefaction, until salivary lithiasis was finally identified as the underlying condition and resolved through a minimally invasive approach.</p><p><strong>Case report: </strong>A 43-year-old male patient presented with a history of 12 episodes of recurring one-sided subangulomandibular tumefaction over the course of the past 3 years. A computed tomography of the head and neck revealed a large calculus on Wharton's duct and right lithiasic submaxillitis. Non-steroidal anti-inflammatory treatment and antibiotic treatment was administered, and after the complete resolution of the acute process, we performed a sialendoscopically-assisted sialolithotomy with complete removal of the calculus. Following the procedure, the patient was discharged on the same day, clinically well, and displayed no further recurrences over a follow-up duration of 12 months.</p><p><strong>Conclusions: </strong>The case we have reported highlights the importance of performing a correct differential diagnosis and of determining the underlying cause of recurrent sialadenitis, in order to ensure the most adequate therapeutic and, when warranted, minimally-invasive surgical management for definitive treatment.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 3","pages":"288-291"},"PeriodicalIF":2.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolation of <i>Hafnia alvei</i> from bronchoalveolar lavage of an immunocompetent host presenting with cavitating pneumonia: Contaminant or Causative?","authors":"Jayleigh Lim, Kenneth Bolger, Brian Canavan","doi":"10.18683/germs.2023.1398","DOIUrl":"10.18683/germs.2023.1398","url":null,"abstract":"<p><strong>Introduction: </strong><i>Hafnia alvei</i> is a Gram-negative, facultative anaerobic bacillus that is most often found as an enteric commensal. It is seldom considered to be pathogenic in immunocompetent individuals.</p><p><strong>Case report: </strong>We describe a case of a 23-year-old, previously healthy male, who presented to the emergency department with a two-day history of hemoptysis, mild dyspnea, pleuritic chest pain, fevers, and chills. Bloods revealed leukocytosis and elevated C-reactive protein. Chest X-ray and CT of the thorax revealed a cavitating lesion in the right upper lobe. He was commenced on empiric antibiotic treatment with amoxicillin/clavulanate and clarithromycin for community-acquired pneumonia in accordance with local guidelines. He subsequently underwent a bronchoscopy, and the bronchoalveolar lavage sample revealed a heavy growth of <i>H. alvei</i>. Despite the widely documented natural resistance of <i>H. alvei</i> to penicillin, the patient demonstrated complete resolution of his symptoms and initial raised inflammatory markers.</p><p><strong>Conclusions: </strong>We present a case of community-acquired cavitary pneumonia in a previously healthy young adult with <i>H. alvei</i> isolated from bronchoalveolar lavage samples. Parallels are drawn between our case and other cases of <i>H. alvei</i> respiratory isolates in our discussion of its clinical significance.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 3","pages":"292-296"},"PeriodicalIF":2.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acquired thrombotic thrombocytopenic purpura as a clinical manifestation of pulmonary tuberculosis: a case report.","authors":"Kateir Contreras, Oscar Miguel Contreras Amorocho, Julian Serrano Giraldo","doi":"10.18683/germs.2023.1392","DOIUrl":"10.18683/germs.2023.1392","url":null,"abstract":"<p><strong>Introduction: </strong>Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy associated with severe ADAMTS13 deficiency that can be potentially fatal if not treated in a timely manner.</p><p><strong>Case report: </strong>A 49-year-old previously healthy woman was admitted with a 3-month history of thoracoabdominal pain and headache associated with loss of appetite, emesis, nocturnal diaphoresis, and unintentional loss of 10 kg. On admission she presented anemia, thrombocytopenia, schistocytes in peripheral blood smear, and ADAMTS13 in 1.4%. Due to laboratory findings a diagnosis of TTP was established, and plasma exchange therapy and steroid pulses were started, with resolution of hematological alterations. Within the studies to determine etiology of TTP, pulmonary tuberculosis (TB) was found, neoplastic and autoimmune pathologies were excluded. The tetraconjugated treatment was initiated with optimal tolerance.</p><p><strong>Conclusions: </strong>Upon clinical suspicion of TTP, plasma exchange therapy should be initiated urgently; infectious, neoplastic, or autoimmune pathologies can be triggers; in this case, pulmonary TB was confirmed.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 3","pages":"259-265"},"PeriodicalIF":2.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminated Bacillus Calmette-Guérin (BCG) infection presenting as severe respiratory failure and septic shock.","authors":"Diamantina Marouli, Charalampos Pappas, Maria Raissaki, Athanasia Proklou, Eleftherios Papadakis, Eumorfia Kondili","doi":"10.18683/germs.2023.1395","DOIUrl":"10.18683/germs.2023.1395","url":null,"abstract":"<p><strong>Introduction: </strong>Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective adjuvant therapy for superficial urinary bladder carcinoma, prolonging disease-free survival. Although it is usually well tolerated, moderate to severe local or systemic infectious complications, including sepsis involving multiple organs, may occur.</p><p><strong>Case report: </strong>We report the unusual case of a man in his mid '70s who presented with septic shock and severe acute respiratory failure requiring intubation. Lack of response to antibiotics, history of intravesical BCG instillation and consistent imaging findings led to further investigations, with bronchoalveolar lavage (BAL) fluid polymerase chain reaction (PCR) results indicating pneumonitis due to <i>Mycobacterium bovis</i> dissemination. Prompt anti-tuberculosis treatment combined with corticosteroids resulted in significant clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection.</p><p><strong>Conclusions: </strong>Due to its non-specific clinical presentation and the relatively low diagnostic yield of conventional microbiological tests, a high index of suspicion is required for prompt diagnosis and treatment of systemic BCG infection. PCR-based assays for mycobacterial DNA identification may represent a valuable tool facilitating timely diagnosis of this uncommon, yet potentially life-threatening infection.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 3","pages":"277-281"},"PeriodicalIF":2.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finding of <i>Anaerococcus hydrogenalis</i> in blood using cell-free DNA technique in a patient with infective endocarditis.","authors":"Tulika Chatterjee, Moni Roy, Yeshaswini Panathur Sreenivasa Reddy, Sharjeel Ahmad","doi":"10.18683/germs.2023.1396","DOIUrl":"10.18683/germs.2023.1396","url":null,"abstract":"<p><strong>Introduction: </strong>The annual incidence of infective endocarditis (IE) is 3-9 cases per 100000 in developed countries and most cases are due to staphylococci and streptococci. IE due to Gram-positive anaerobic cocci (GPAC) is very rare.</p><p><strong>Case report: </strong>We present a case of a 38-year-old female with <i>Anaerococcus hydrogenalis</i> bacteremia and infective endocarditis of the native mitral valve. She presented with fever, chills, and abdominal pain. A computed tomographic scan of the abdomen showed splenic abscesses. Blood cultures and broad-range PCR from the splenic abscess sample were negative. Transthoracic echocardiography showed a mobile filamentous structure on the atrial side of the anterior mitral leaflet which was suggestive for infective endocarditis. Karius test (cell-free microbial DNA testing) showed Gram-positive anaerobic cocci <i>Anaerococcus hydrogenalis.</i> She was successfully treated with antibiotics.</p><p><strong>Conclusions: </strong>In cases of infection with fastidious organisms like GPACs, the use of next-generation sequencing (NGS) can allow the correct identification of culprit pathogens and streamlined treatment.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 3","pages":"282-287"},"PeriodicalIF":2.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Medical students' attitudes and perceptions of influenza and SARS-CoV-2 vaccination in Cyprus\".","authors":"Rujittika Mungmunpuntipantip, Viroj Wiwanitkit","doi":"10.18683/germs.2023.1385","DOIUrl":"https://doi.org/10.18683/germs.2023.1385","url":null,"abstract":"","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 2","pages":"192-193"},"PeriodicalIF":2.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10746334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal hemorrhagic bronchopneumonia caused by <i>Bordetella bronchiseptica</i> in an immunocompetent patient.","authors":"Steven Tessier, Santo Longo, Mohamed Turki, Malek Numeir, Thong Le, Firas Ido","doi":"10.18683/germs.2023.1381","DOIUrl":"https://doi.org/10.18683/germs.2023.1381","url":null,"abstract":"<p><strong>Introduction: </strong><i>Bordetella bronchiseptica</i> is a rare cause of hemorrhagic bronchopneumonia. Important to the clinician is a clear understanding that the treatment of this rare organism differs greatly from the successful antibiotic treatment of the more common <i>Bordetella</i> species, <i>pertussis</i> and <i>parapertussis</i>.</p><p><strong>Case report: </strong>A 64-year-old female presented to the emergency department after experiencing one week of worsening hemoptysis. Upon admission, she was afebrile and all initial laboratory test results were normal. Bronchoalveolar hemorrhage suggested by radiographic imaging was confirmed by bronchoscopy. Bronchoalveolar lavage (BAL) cultures contained unspeciated <i>Bordetella</i>. Rapid worsening of the hemoptysis led to intubation and the decision to perform bronchial artery embolization. However, the intensity of the hemoptysis persisted. Septic shock ensued despite treatment with broad spectrum antibiotics including azithromycin, vancomycin, and cefepime. The microbiological speciation results finalized shortly after the patient's death. The identified organism was <i>B. bronchiseptica</i>.</p><p><strong>Conclusions: </strong>Although macrolide antibiotics are first line treatment for <i>B. pertussis</i> and <i>parapertussis</i>, macrolide antibiotics are generally not effective against <i>B. bronchiseptica</i>. Clinical suspicion of <i>B. bronchiseptica</i> infection should prompt consideration of alternative antibiotics known to be effective against this rare species, including carbapenems and fluoroquinolones. The use of these latter antibiotics may advisably be considered as an empirical treatment during the delay of microbiological speciation.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":"13 2","pages":"172-176"},"PeriodicalIF":2.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10746337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}