Body Sites Of Patients Research Articles

Trends in coagulase-negative staphylococci (CoNS), England, 2010-2021.

To review the epidemiology of coagulase-negative staphylococci (CoNS) in England over the recent 12 year period. Laboratory-confirmed CoNS reported from sterile sites in patients in England to the UK Health Security Agency (UKHSA) between 2010 and 2021 were extracted from the national laboratory database and analysed. Overall, 668 857 episodes of CoNS were reported. Unspeciated CoNS accounted for 56 % (374 228) of episodes, followed by Staphylococcus epidermidis (26 %; 174 050), S. hominis (6.5 %; 43 501) and S. capitis (3.9 %; 25 773). Unspeciated CoNS increased by 8.2 % (95 % CI, 7.1-9.3) annually between 2010 and 2016, then decreased annually by 6.4 % (95 % CI: -4.8 to -7.9) until 2021. Speciated CoNS increased by 47.6 % (95 % CI, 44.5-50.9) annually between 2010 and 2016 and increased annually by 8.9 % (95 % CI: 5.1 to 12.8) until 2021. Antimicrobial susceptibility profiles differed by species. Reports of CoNS from normally sterile body sites in patients in England increased between 2010 and 2016 and remained stable between 2017 and 2021. There has been a striking improvement in species-level identification of CoNS in recent years. Monitoring trends in CoNS epidemiology is crucial for development of observational and clinical intervention studies on individual species.

Epidemiology and molecular identification of mixed yeast isolates in Malaysia: A way forward.

Invasive candidiasis is one of the most common systemic mycoses, and studies have shown mixed yeast infections. Malaysia lacks mixed yeast culture data. Yeast isolates were collected in Sultan Abdul Halim Hospital, North Malaysia, from October 2020 to October 2021. Chromogenic Candida differential agar media and PCR-RFLP were used to identify yeast species. A total of 206 yeast isolates were collected from different body sites of patients. The majority of the yeast isolates (n=104) were obtained from the urine. Other isolates were extracted from blood (n=52), vaginal swabs (n=45), ear discharge (n=2), tracheal aspirate (n=2), tissue (n=2), skin (n=1), nail (n=1), sputum (n=1), and cerebrospinal fluid (n=1). In total, 200 yeast samples were identified as single species, and six isolates were a mixture of Candida species. Malaysia lacks accurate epidemiological data on mixed yeast infections. We identified all samples to the species level, including mixed yeast cultures, using the MspI enzyme and PCR-RFLP.

Multiple spatial scale mapping of time-resolved brain network reconfiguration during evoked pain in patients with rheumatoid arthritis.

Functional brain networks and the perception of pain can fluctuate over time. However, how the time-dependent reconfiguration of functional brain networks contributes to chronic pain remains largely unexplained. Here, we explored time-varying changes in brain network integration and segregation during pain over a disease-affected area (joint) compared to a neutral site (thumbnail) in 28 patients with rheumatoid arthritis (RA) in comparison with 22 healthy controls (HC). During functional magnetic resonance imaging, all subjects received individually calibrated pain pressures corresponding to visual analog scale 50 mm at joint and thumbnail. We implemented a novel approach to track changes of task-based network connectivity over time. Within this framework, we quantified measures of integration (participation coefficient, PC) and segregation (within-module degree z-score). Using these network measures at multiple spatial scales, both at the level of single nodes (brain regions) and communities (clusters of nodes), we found that PC at the community level was generally higher in RA patients compared to HC during and after painful pressure over the inflamed joint and corresponding site in HC. This shows that all brain communities integrate more in RA patients than in HC for time points following painful stimulation to a disease-relevant body site. However, the elevated community-related integration seen in patients appeared to not pertain uniquely to painful stimulation at the inflamed joint, but also at the neutral thumbnail, as integration and segregation at the community level did not differ across body sites in patients. Moreover, there was no specific nodal contribution to brain network integration or segregation. Altogether, our findings indicate widespread and persistent changes in network interaction in RA patients compared to HC in response to painful stimulation.

Identification and Characterization of Aerobic Bacteria Isolated from Normally Sterile Body Sites of Patients Attending a Tertiary Care Hospital in Ajmer, India

Identification and Characterization of Aerobic Bacteria Isolated from Normally Sterile Body Sites of Patients Attending a Tertiary Care Hospital in Ajmer, India

Colonisation and Transmission Dynamics of Candida auris among Chronic Respiratory Diseases Patients Hospitalised in a Chest Hospital, Delhi, India: A Comparative Analysis of Whole Genome Sequencing and Microsatellite Typing

Candida auris is a nosocomial pathogen responsible for an expanding global public health threat. This ascomycete yeast has been frequently isolated from hospital environments, representing a significant reservoir for transmission in healthcare settings. Here, we investigated the relationships among C. auris isolates from patients with chronic respiratory diseases admitted in a chest hospital and from their fomites, using whole-genome sequencing (WGS) and multilocus microsatellite genotyping. Overall, 37.5% (n = 12/32) patients developed colonisation by C. auris including 9.3% of the screened patients that were colonised at the time of admission and 75% remained colonised till discharge. Furthermore, 10% of fomite samples contained C. auris in rooms about 8.5 days after C. auris colonised patients were admitted. WGS and microsatellite typing revealed that multiple strains contaminated the fomites and colonised different body sites of patients. Notably, 37% of C. auris isolates were resistant to amphotericin B but with no amino acid substitution in ERG2, ERG3, ERG5, and ERG6 as compared to the reference strain B8441 in any of our strains. In addition, 55% of C. auris isolates likely had two copies of the MDR1 gene. Our results suggest significant genetic and ecological diversities of C. auris in healthcare setting. The WGS and microsatellite genotyping methods provided complementary results in genotype identification.

Stratum corneum lipidomics analysis reveals altered ceramide profile in atopic dermatitis patients across body sites with correlated changes in skin microbiome.

Atopic dermatitis (AD) is driven by the interplay between a dysfunctional epidermal barrier and a skewed cutaneous immune dysregulation. As part of the complex skin barrier dysfunction, abnormalities in lipid organization and microbiome composition have been described. We set out to systematically investigate the composition of the stratum corneum lipidome, skin microbiome and skin physiology parameters at three different body sites in patients with AD and healthy volunteers. We analysed tape strips from different body areas obtained from 10 adults with AD and 10 healthy volunteers matched for FLG mutation status for 361 skin lipid species using the Metabolon mass spectrometry platform. 16S rRNA data were available from all probands. Our study showed that the lipid composition differs significantly between body sites and between AD patients and healthy individuals. Ceramide species NS was significantly higher in AD patients compared to healthy volunteers and was also higher in AD patients with a FLG mutation compared to AD patients without a FLG mutation. The correlation analysis of skin lipid alterations with the microbiome showed that Staphylococcus colonization in AD is positively correlated with ceramide subspecies AS, ADS, NS and NDS. This is the first study to reveal site-specific lipid alterations and correlations with the skin microbiome in AD.

383 Distinguishable bacterial and fungal dysbiosis in skin of patients with Atopic Dermatitis or Netherton Syndrome

Atopic dermatitis (AD) is an inflammatory skin disease, in which epidermal barrier impairment, often owing to FLG null mutations, precedes immune hyper-responsiveness. Ichthyosis vulgaris (IV) is characterized by FLG null mutations and non-inflammatory dry skin. SPINK5 null mutations in Netherton syndrome (NS) lead to erythroderma and atopic manifestations. Thus, AD, IV and NS share clinical, genetic or immunological similarities. We sought to evaluate effects of specific skin disease features i.e. ichthyotic and/or atopic manifestations on bacterial and fungal microbiota. The bacterial and fungal skin microbiota was determined by using 16S rRNA (V4) and ITS gene sequencing and the Illumina MiSeq platform at two body sites in patients with AD with or without FLG null mutations or skin lesions, IV or NS and in healthy donors. We found that bacterial richness and evenness were suggested to greater variations than those of fungi in response to skin diseases. Severity of epidermal barrier impairment controlled bacterial but not fungal skin composition. Proportions of Firmicutes (Staphylococcaceae) and Actinobacteria (Corynebacteriaceae) were augmented in ichthyoses and lesional AD, whereas proportions of Proteobacteria and Bacteroidetes were reduced, regardless of body sites. Ascomycota were increased in AD and NS but owing to the expansion of different fungal species. Potentially pathogenic bacteria (Staphylococci and Corynebacteria) were particularly abundant in IV and NS. Severity of epidermal barrier impairment superseded physicochemical properties of body sites to alter skin bacterial communities but had no effects on fungal microbiota. Thus, distinguishable bacterial and fungal dysbiosis in AD, NS, and IV emphasizes disease-specific pathomechanisms.

European Surveillance System on Contact Allergies (ESSCA): Contact allergies in relation to body sites in patients with allergic contact dermatitis.

BackgroundAnalyses of the European Surveillance System on Contact Allergies (ESSCA) database have focused primarily on the prevalence of contact allergies to the European baseline series, both overall and in subgroups of patients. However, affected body sites have hitherto not been addressed.ObjectiveTo determine the prevalence of contact allergies for distinct body sites in patients with allergic contact dermatitis (ACD).MethodsAnalysis of data collected by the ESSCA (www.essca‐dc.org) in consecutively patch tested patients, from 2009 to 2014, in eight European countries was performed. Cases were selected on the basis of the presence of minimally one positive patch test reaction to the baseline series, and a final diagnosis of ACD attributed to only one body site.ResultsSix thousand two hundred and fifty‐five cases were analysed. The head and hand were the most common single sites that ACD was attributed to. Differences between countries were seen for several body sites. Nickel, fragrance mix I, cobalt and methylchloroisothiazolinone/methylisothiazolinone were the most frequent allergens reported for various body sites.ConclusionsDistinct allergen patterns per body site were observed. However, contact allergies were probably not always relevant for the dermatitis that patients presented with. The possibility of linking positive patch test reactions to relevance, along with affected body sites, should be a useful addition to patch test documentation systems.

Correlation analysis between the expression of cathepsin D and the accumulation of advanced glycation end products in skin tissues

Objective To determine the expression of cathepsin D and advanced glycation end products (AGEs) in skin tissues from patients of different ages or skin tissues with different degrees of sun exposure, to evaluate their correlation, and to preliminarily investigate the role of cathepsin D in the degradation and accumulation of AGEs in photoaged skin. Methods Skin tissues were collected from sun-exposed and sun-protected body sites in patients aged 15 - 20 years, 35 - 40 years, 55 - 60 years or 75 - 80 years. These skin tissues were divided into 8 groups according to age of patients and degrees of sun exposure, and there were 6 specimens in each group. Immunohistochemical and immunofluorescent methods were used to measure the expression of cathepsin D and AGEs in the skin tissues. Statistical analysis was carried out by factorial design analysis of variance, Wilcoxon rank sum test and Kruskal-Wallis rank sum test for analyzing associations of the expression of cathepsin D and AGEs with age and sun exposure, as well as by Pearson correlation analysis for assessing the correlation between cathepsin D expression and AGEs expression. Results Immunohistochemical study showed that the expression of cathepsin D markedly decreased along with the increase of age, but the accumulation of AGEs gradually increased along with the increase of age. In the same age group, the cathepsin D expression was lower in the sun-exposed skin tissues than in the sun-protected skin tissues, while the accumulation of AGEs was more in the sun-exposed skin tissues than in the sun-protected skin tissues. Factorial design analysis of variance showed that sun exposure could decrease the expression of cathepsin D (F = 58.70, P < 0.001) , but increase the accumulation of AGEs (F = 158.18, P < 0.001) . Moreover, the increase of age could lead to decreased expression of cathepsin D (F = 79.49, P < 0.001) , and increased expression of AGEs (F = 106.06, P < 0.001) . Compared with the sun-protected skin tissues, the sun-exposed skin tissues in all the age groups showed significantly lower absorbance value of cathepsin D (35 - 40 years: 0.020 ± 0.005 vs. 0.032 ± 0.005; 55 - 60 years: 0.012 ± 0.004 vs. 0.026 ± 0.002; 75 - 80 years: 0.002 ± 0.001 vs. 0.013 ± 0.004; all P < 0.001) , but higher absorbance value of AGEs (35 - 40 years: 0.030 ± 0.008 vs. 0.010 ± 0.003; 55 - 60 years: 0.066 ± 0.010 vs. 0.021 ± 0.004; 75 - 80 years: 0.085 ± 0.015 vs. 0.035 ± 0.009; all P < 0.001) except the age group of 15 - 20 years. No matter whether the skin tissues were sun-exposed or sun-protected, there were significant differences in the expression of cathepsin D and AGEs among different age groups (all P < 0.001) . The results of double immunofluorescence staining were similar to those of immunohistochemical study. Pearson correlation analysis showed that the expression of cathepsin D in the sun-exposed skin tissues was highly negatively correlated with the accumulation of AGEs (r = -0.915, P < 0.05) , while they were moderately negatively correlated in the sun-protected skin tissues (r = -0.730, P < 0.05) . Conclusions Along with the increase of age, the expression of cathepsin D in skin tissues decreased, but the expression of AGEs increased. In the sun-protected skin tissues, the expression of cathepsin D was moderately negatively correlated with the expression of AGEs, while they were highly negatively correlated in the sun-exposed skin tissues, suggesting that cathepsin D may play an important role in the degradation and accumulation of AGEs in photoaged skin. Key words: Skin aging; Cathepsin D; Glycosylation end products, advanced; Age factors; Sunlight

Molecular detection of methicillin resistant Staphylococcus aureus harbouring β- lactamase resistance genes isolated from different sources of infections

Background and objective: The detection and investigation of methicillin resistance staphylococci specifically S. aureus in clinical microbiology setting is very helpful both for informing the appropriate treatment of individual patients and also for the surveillance of these organisms. This study aimed at the rapid molecular detection of methicillin resistant staphylococci harbouring β-lactamase gene and determination of the efficiency of m-PCR through comparison with uniplex PCR. Methods: Standard microbiological techniques were applied for the determination of the presence of methicillin resistant S. aureus in samples recovered from different body sites of patients who attended Al-Kadhumyhia Teaching and Baghdad Teaching Hospitals. The resulting methicillin resistant S. aureus (MRSA) isolates were subjected to uni and multiplex PCR amplifications for detecting the existence of mec A gene and β-lactamase (TEM) resistance gene. Results: Half of the cases involved were found to be caused by MRSA. All the tested isolates showed positive amplification bands for the presence of mec A gene and only 48.8% of these harbored TEM gene. The obtained results revealed high sensitivity of universal bacterial and TEM primers expressed as 97.6% and 100% respectively, while the sensitivity of mec A primer was limited to 60%. Conclusion: The phenotypic identification of MRSA revealed a higher incidence rate and that different molecular techniques can yield conflicting results and it can also be concluded that resistant due to beta- lactamase production can be a crucial factor added to the previously settled methicillin resistant due to mec A gene.

The effects of systemic isotretinoin and antibiotic therapy on the microbial floras in patients with acne vulgaris

Although there are several studies about the alteration in skin flora, limited number of reports about changes in the microbial contents and their resistance profile of other body sites in patients treated with isotretinoin for acne vulgaris. The aim of this study was to investigate the effects of systemic isotretinoin and antibiotic therapy on the microbial floras of oropharynx, nose and feces in acne patients. Treatment groups of isotretinoin and antibiotics consisting of 20 and 15 patients, respectively were included. Microbiological culture samples were taken at baseline and once a month during 4-6 months of treatment period. Difference in microbial flora throughout the treatment period was detected at least among one of all culture samples of 15 (75%) and 5 (33%) patients in isotretinoin and antibiotic groups. There was statistically significant difference between two groups in means of alteration of the microbial flora (P = 0.013). The difference was definitely observed among nasal cultures (65%) in isotretinoin group and fecal cultures (20%) in the other. Staphylococcus aureus colonization was prominent in the microbial floras of nose and oropharynx and 2 of 14 nasal isolates were detected to be methicilline resistant while Escherichia coli with extended spectrum beta lactamase activity was detected in fecal floras of patients in isotretinoin group. Systemic isotretinoin and antibiotic treatments in acne patients precisely caused variations in the microbial floras of several sites of the body, while isotretinoin was commonly more responsible than antibiotics. Knowing that alterations in the microbial colonization of the flora regions may preceede infectious disease and bacterial resistance, treatment options and follow-up procedures in acne vulgaris should be carefully determined to reduce the risk of destruction of the microbial flora.

DNA sequence homology analysis of Trichophyton rubrum isolates from multiple body sites of patients with onychomycosis

Objective To profile genotypes of Trichophyton rubrum isolates from different body sites in patients with onychomycosis. Methods DNA was extracted from 30 T. nibium isolates from 10 patients with onychomycosis, and subjected to PCR with tandemly repetitive subelement 1 (TRS1 )-specific primer to analyze the number of repetitive elements in the non-transcribed spacer (NTS) region of ribosomal DNA gene, and to random primer amplification with the random primer OPAA11. The genotype variety was evaluated for T. rubrum isolates from different body sites of patients with onychomycosis. Results All the strains were classified into 5 genotypes based on the copy number of TRS1, and into 11 genotypes by RAPD analysis. The genotypes of T. rubrum seemed unrelated to sites of infection. Genotype diversity was observed among T. rubrum strains from different body sites of the same host in 7 out of the 10 cases as shown by amplification of TRS1 region, in 8 out of the 10 cases as demonstrated by RAPD analysis. Conclusion A single host with onychomycosis could harbor multiple genotypes of T. rubrum at different body sites, suggesting external sources of infection rather than infection from a different site in the same individual. Key words: Trichophyton; Mycological typing techniques; Random amplified polymorphic DNA technique; Tinea

SU‐FF‐J‐14: An Optimized Protocol for Using Small Field MV Cone‐Beam CT Imaging in Image‐Guided Radiotherapy (IGRT)

Purpose: The aim of this study was to develop an optimal protocol for imaging different body sites in patients during MV Cone Beam CT (MVCBCT) based IGRT for small field of view (FOV) imaging for Stereotactic Radiosurgery and other applications. Methods and Materials: Clinically delivered MVCBCT imaging systems have built‐in protocols that are optimized for large FOV imaging. For our protocol optimization study, we chose a field size of 12cm × 10cm to acquire CBCT images. Our study was conducted using our Siemens Oncor Impression Linac, an image quality phantom, an offline reconstruction tool prototype software, a prototype visualization tool, a dicom image extractor tool, and the ImageJ open source software from NIH. Five regions of the image quality phantom were imaged and the raw data was processed using the offline reconstruction tool by changing various reconstruction parameters. Our study was focused on two specific regions of the phantom, corresponding to electron densities of 9% and 17%. A useful projection image size of 448 × 373 pixels on the flat panel detector was used for the filtered backprojection. The dicom images were extracted with the dicom extractor from the reconstructed images for post processing and quantitative image analysis using the ImageJ software. Results: Our efforts in optimizing the image reconstruction and processing chain resulted in the development of protocols that result in superior images. We have developed quantitative methods to analyze the results and determine the optimal protocol. We are currently repeating the imaging process with the Image Quality phantom to check for reproducibility of our methods and protocols. Conclusions: Our preliminary result provides a valuable reference to setup an optimal protocol for using small field MVCBCT for IGRT. Once we confirm the reproducibility of our protocol, we plan on imaging a series of patients to clinically test the protocol.

Susceptibility testing and resistance phenotype detection inStaphylococcus aureusstrains isolated from patients with atopic dermatitis, with apparent and recurrent skin colonization

Staphylococcus aureus colonization is accepted to be an important triggering factor in patients with atopic dermatitis (AD) and antibiotic resistance has been recognized to be a serious problem as a consequence and for the management of AD treatment. To investigate the antibiotic resistance pattern of S. aureus strains isolated from patients with AD with apparent (lesional and nonlesional skin areas) and recurrent skin colonization and strains obtained from healthy nasal carriers. Eighty-seven patients (age 23+/-11.5 years) with mild to severe AD (SCORAD 46.9+/-16.6), 21 patients (age 19.8+/-6.7 years) before antistaphylococcal treatment and 177 healthy nasal carriers (age 27.5+/-8.4 years) were microbiologically assessed for carriage of S. aureus. Colonization of lesional and nonlesional skin areas was quantified by counting the number of colony forming units on the skin surface (log(10) CFU cm(-2)). Antimicrobial susceptibility and resistance phenotypes of 179 S. aureus strains were assessed with the agar disc-diffusion method. Staphylococcus aureus was isolated from 87% of lesional and 44% of nonlesional skin samples from patients with AD. The colonization density of S. aureus was markedly higher in lesional than in nonlesional skin (P<0.001), and was positively correlated with AD severity (P<0.001) and total serum IgE (P<0.05). Patients with AD had a significantly higher prevalence of chloramphenicol-resistant S. aureus than nasal carriers (P<0.01). Similar rates of resistance were expressed to tetracycline, erythromycin, mupirocin, clindamycin and penicillin. Nearly 35% of S. aureus strains from the lesional skin demonstrated different antimicrobial sensitivity pattern compared with strains from nonlesional skin of the same patients with AD. The trend of increasing resistance to chloramphenicol, erythromycin and fusidic acid was observed among S. aureus strains recovered from patients after approximately 75 days of antibiotic treatment. Methicillin-resistant S. aureus isolates were cultured from two patients, one during exacerbation and the other after subsequent bacterial recolonization. Discrepancies in antibiotic sensitivity pattern were observed among S. aureus strains colonizing different sites of AD skin (lesional and nonlesional areas), and also in AD patients with prior antibiotic treatment. Therefore, clinicians should consider repeat microbial susceptibility testing on different body sites of patients with AD when clinically indicated.

Clobetasol propionate emollient formulation foam in the treatment of corticosteroid-responsive dermatoses

Background: Topical corticosteroids are the most common treatment modality for patients with psoriasis and atopic dermatitis; however, the efficacy of topical corticosteroids is often hampered by barriers to patient adherence, such as lack of efficacy, side effects and inconvenience. Recently published studies have investigated the safety and efficacy of a novel emollient foam (EF) formulation of clobetasol propionate (CP), a class I topical corticosteroid in psoriasis and atopic dermatitis. Objectives: To summarize recent literature on CP EF foam, and to evaluate recent Phase II and III clinical trials of CP EF foam in psoriasis and atopic dermatitis. Methods: The MEDLINE (1950 – January 2008) database was searched using the following terms: ‘clobetasol propionate foam’, ‘topical corticosteroids’, ‘topical glucocorticoids’, ‘psoriasis’ and ‘atopic dermatitis’. Results were evaluated for relevance and quality, and additional references were obtained from bibliographies of selected articles. Conclusion: CP EF foam appears to be safe and effective for corticosteroid-responsive dermatoses in adults and children ≥ 12 years of age. As compared to its hydroethanolic foam predecessor, CP EF presents a potential advance for patients who are less likely to tolerate alcohol-based foam. As alcohol-based foams can be irritating and cause stinging in non-hair-bearing areas, this new emollient formulation has the potential to widen the use of CP foam to more patients with atopic dermatitis and to more non-scalp body sites in patients with psoriasis.

International Surveillance of Candida spp. and Aspergillus spp.: Report from the SENTRY Antimicrobial Surveillance Program (2003)

During 2003, a total of 1,397 Candida isolates, 73 Aspergillus isolates, 53 Cryptococcus neoformans isolates, and 25 other fungal isolates from infected, normally sterile, body sites in patients hospitalized in North America, Europe, and Latin America were studied as a component of the longitudinal SENTRY Antimicrobial Surveillance Program. The MICs for seven antifungal agents were determined in a central laboratory (JMI Laboratories, North Liberty, IA) using testing methods promulgated by the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards). The rank order of Candida spp. occurrence was as follows: C. albicans (48.7%), C. parapsilosis (17.3%), C. glabrata (17.2%), C. tropicalis (10.9%), C. krusei (1.9%), and other Candida spp. (4.0%). C. albicans accounted for 51.5, 47.8, and 36.5% of candidal infections in North America, Europe, and Latin America, respectively. Ravuconazole, voriconazole, and fluconazole were highly active against C. albicans, C. parapsilosis, and C. tropicalis, with both former agents being more potent (MIC at which 90% of the isolates tested are inhibited [MIC90] of < or =0.008 to 0.12 microg/ml) than fluconazole (MIC90 of 0.5 to 2 microg/ml). C. glabrata isolates were less susceptible to these agents, with MIC90s of 1, 1, and 64 microg/ml, respectively. Ravuconazole and voriconazole were the most active agents tested against C. krusei (MIC90 of 0.5 microg/ml). Among Aspergillus spp., A. fumigatus was the most commonly (71.2% of isolates) recovered species; 96.2, 96.2, 84.6, and 11.5% of strains were inhibited by < or =1 microg/ml of ravuconazole, voriconazole, itraconazole, and amphotericin B, respectively. Of the antifungal agents tested, ravuconazole and voriconazole displayed the greatest spectrum of activity against pathogenic Candida and Aspergillus spp., regardless of geographic origin. These results extend upon previous findings from SENTRY Program reports (1997 to 2000), further characterizing species composition as seen in local clinical practice and demonstrating the potent activity of selected, newer triazole antifungal agents.

Molecular diversity and routes of colonization of Candida albicans in a surgical intensive care unit, as studied using microsatellite markers.

To evaluate the colonization of Candida species and the importance of cross-contamination with Candida albicans, we prospectively screened clinical specimens obtained from surgical patients in the intensive care unit (ICU) who had a high risk of yeast colonization. Genotyping of C. albicans was performed using microsatellite markers. Thirty-six of 94 patients acquired nosocomial yeast colonization and/or infection. A total of 1126 specimens were cultured, 167 (15%) of which yielded yeasts. All 122 isolates of C. albicans recovered from the 30 C. albicans-positive patients were genotyped. Twenty-four different genotypes were identified. No genotype was systematically associated with a specific room or time. Isolates recovered from different body sites of patients at different times had identical genotypes. Acquisition of C. albicans in the surgical ICU seems to be mainly endogenous. Microsatellite markers should also be developed for typing non-albicans Candida species to learn whether their epidemiology differs from that of C. albicans.

Epidemiological significance of cutaneous, pharyngeal, and digestive tract colonization by multiresistant Acinetobacter baumannii in ICU patients

The aim of this prospective study was to assess the relative epidemiological role of digestive tract colonization by Acinetobacter baumannii, in comparison with other body site colonizations, in patients admitted to intensive care units (ICUs). From January to May 1995, axillary, pharyngeal and rectal swabs were taken together within the first 48 h of admission, and then weekly during ICU stay. Seventy-three patients were included, 48 of them (66%) had axillary, pharyngeal, or rectal colonization with A. baumannii, nine (19%) of these 48 during the first 48 h and the remaining 28 (77%) during the first week. Twenty-one (29%) had clinical samples positive for A. baumannii and axillary, pharyngeal, or rectal colonization. In 15 of these 21 (71%), colonization on body sites occurred prior to isolation from clinical samples (mean seven days, range 1–20). Throughout admission, rates of detection of A. baumannii were 75% ( 36 48 ) for axillary or pharyngeal swabs and 77% ( 37 48 ) for rectal swabs. Combination of two body site swabs yielded culture positive rates of 90% ( 43 48 ) for axillary-pharyngeal or axillary-rectal sites, and 96% ( 46 48 ) for pharyngeal-rectal. Two epidemic clones were defined by antibiotype and pulsed-field gel electrophoresis (PFGE) of SmaI DNA digests in 43 isolates from 11 patients. We conclude that body sites of patients were a major reservoir for A. baumannii infections in the outbreak. This finding casts doubt on the value of selective decontamination of the digestive tract as an additional infection control measure in this kind of outbreak. The weekly performance of pharyngeal and rectal swabs appears to detect A. baumannii colonization early among ICU patients and enables barrier methods to be applied rapidly.

Species Distribution in Human Immunodeficiency Virus-Related Mycobacterial Infections: Implications for Selection of Initial Treatment

Management of mycobacterial infection is species specific; however, treatment is prompted by positive smears or cultures, often several weeks before species identification. The objective of this study was to determine the species distribution of mycobacterial isolates from various body sites in patients infected with human immunodeficiency virus (HIV). All mycobacterial isolates recovered at St. Paul's Hospital (Vancouver, British Columbia, Canada) from April 1989 to March 1993 were reviewed. Among 357 HIV-positive patients with mycobacterial infections, 64% (96) of the sputum isolates were Mycobacterium avium complex (MAC), 18% were Mycobacterium tuberculosis, and 17% were Mycobacterium kansasii. Lymph node involvement (25 patients) was due to either MAC (72%) or M. tuberculosis (24%). Two hundred ninety-eight episodes of mycobacteremia were due to MAC (98%), M. tuberculosis (1%), and M. kansasii (1%). Similarly, cultures of 84 bone marrow biopsy specimens (99%), 19 intestinal biopsy specimens (100%), and 30 stool specimens (97%) yielded predominantly MAC. These results have implications for initial therapy, particularly in areas where rapid methods for species identification are not readily available. Because of considerable geographic variation, development of guidelines for selection of initial therapy depends on regional determination of species distribution in HIV-related mycobacterial infections.

Detection of human herpesvirus 6 DNAs in samples from several body sites of patients with exanthem subitum and their mothers by polymerase chain reaction assay.

Polymerase chain reaction amplification was used to detect human herpesvirus 6 (HHV-6) DNAs in peripheral blood mononuclear cells (MNCs), plasma, saliva, stool, and urine from three patients with exanthem subitum and in peripheral blood MNCs, plasma, and saliva from their mothers. HHV-6 DNAs were detected in MNCs during and after the disease and were found in plasma only in the acute phase. The virus DNAs were also detected in saliva after recovery from the illness and were found persistently or intermittently in stool but not in urine samples after the onset of the disease. In contrast, one of the three mothers excreted HHV-6 DNAs persistently in saliva. None of the mothers had the virus DNAs in peripheral blood MNCs and plasma nor a significant increase in antibody titers to HHV-6 after possible exposure from their children. These findings suggest systemic replication of HHV-6 during the acute phase in patients with exanthem subitum and persistent infection of the virus in several organs after recovery from the disease.