Invasive Infections In Patients Research Articles

Oligella spp.: A systematic review on an uncommon urinary pathogen.

Oligella is an uncommon Gram-negative coccobacillus that was first thought to belong to the urogenital tract. The genus Oligella comprises two species that were recovered from various samples worldwide. We perform a systematic review focusing on Oligella microbiological characteristics, habitat, role in Human microbiome and infection, and antimicrobial susceptibility. In humans, Oligella is mainly found as part of the microbiome of individuals with predisposing conditions. Oligella were also associated with invasive infections in patients with underlying diseases. Nevertheless, their prevalence remains to determine. Oligella culture requires up to 48h on agar media in vitro, while urinary samples are usually incubated for 24h. Consequently, microbiologists should be prompt to prolong the incubation of agar media when the direct examination showed Gram-negative coccobacilli. Oligella is accurately identified using MALDI-TOF mass spectrometry, but biochemical methods often provided inconsistent results. Specific guidelines for antimicrobial susceptibility testing of Oligella lack but the incubation could require up to 48h of incubation. In contrast to O. urethralis, which is susceptible to third-generation cephalosporin, O. ureolytica is likely resistant to numerous antimicrobials. Genectic determinants of resistance were identified for beta-lactams and aminoglycosides. Oligella is an uncommon pathogen that can be underrecognized. Microbiologists should be prompt to prolong the incubation of agar media plated with urines when the direct examination showed Gram-negative coccobacilli. Carbapenems should probably be given for the empirical treatment.

Magnusiomyces Capitatus Lung Nodule in a Patient with Nasopharyngeal and Hepatocellular Carcinoma.

Magnusiomyces capitatus is a dimorphic yeast commonly isolated from the environment and was uncommonly reported as a disease in Asia. It may cause invasive infection in patients with hematological malignancies, especially those with neutropenia, and resulting in high mortality. Herein, we reported a man with nasopharyngeal carcinoma and hepatocellular carcinoma suffered from intermittent fever after pulmonary nodules resection. The histopathology showed yeast-like fungal elements. For further identification, we extracted the tissue DNA from formalin-fixed paraffin-embedded tissue and M. capitatus was confirmed using polymerase chain reaction amplification and sequencing of the ITS region of ribosomal DNA. After a 4-week amphotericin B and flucytosine treatment, his condition recovered well and then was followed by a 3-month oral fluconazole treatment. There was no evidence of recurrence within one year. Our case highlights that nucleic acids obtained from formalin-fixed tissue could be a feasible identification method, especially in those whose culture results are unavailable.

Genome Analysis of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus ST398 Strains Isolated from Patients with Invasive Infection.

Using genomic data, we determined the origin of MRSA ST398 isolates responsible for invasive infection in patients with no known livestock contact. We sequenced the genome of seven MSSA and four MRSA ST398 isolates from patients with invasive infections between 2013 and 2017, using the Illumina technique. Prophage-associated virulence genes and resistance genes were identified. To determine the origin of the isolates, their genome sequences were included in phylogenetic analysis also encompassing the ST398 genomes available on NCBI. All isolates carried the φSa3 prophage, but with variations in the immune evasion cluster: type C in MRSA isolates, and type B in MSSA isolates. All MSSA belonged to the spa type t1451. MRSA strains had the same SCCmec type IVa (2B) cassette and belonged to spa types t899, t4132, t1939 and t2922. All MRSA harbored the tetracycline resistance gene, tet(M). Phylogenetic analysis revealed that MSSA isolates belonged to a cluster of human-associated isolates, while MRSA isolates belonged to a cluster containing livestock-associated MRSA. We showed that the clinical isolates MRSA and MSSA ST398 have different origins. An acquisition of virulence genes by livestock-associated MRSA isolates allows them to induce an invasive infection in human.

347. Azole Activity against Filamentous Fungi Causing Invasive Infections in Patients from ICU and Non-ICU Units (2017-2021)

Abstract Background Invasive fungal infection (IFI) is associated with high mortality rates in critically ill patients. Appropriate antifungal treatment is crucial for managing IFI. We evaluated the in vitro activity of isavuconazole (ISC), itraconazole (ITC), posaconazole (PSC), and voriconazole (VRC) against contemporary moulds from ICU and non-ICU patients. Methods 1,226 moulds causing IFI (386/840 from ICU/non-ICU patients, respectively) were consecutively collected (1/patient) in 43 worldwide hospitals from 2017-2021 and susceptibility tested by CLSI broth microdilution. CLSI interpretation criteria were applied. Pneumonia was the predominant infection type among ICU (81.6%) and non-ICU (71.8%) patients. Results Aspergillus spp. was the most common mould (87.6%/80.5%). A. fumigatus (AFM; 76.0%/65.4% of Aspergillus), A. section Flavi (ASF; 9.2%/10.9%), and A. section Nigri (ASN; 7.4%/13.6%) were the top 3 Aspergillus groups. ISC inhibited 94.2%/91.2%, 100.0%/98.6%, and 96.0%/96.7% of AFM, ASF, and ASN from ICU/non-ICU, respectively, at the epidemiological cut-off values. Similar activities were noted for ISC, PSC, ITC, and VRC against AFM from ICU (MIC50/90 range, 0.25-1/0.5-1 mg/L) and non-ICU (MIC50/90 range, 0.5-1/0.5-2 mg/L) isolates. No difference in the azole activities was noted against ASF from ICU (MIC50/90 range, 0.5/0.5-1 mg/L) and non-ICU (MIC50/90, 0.5/0.5-1 mg/L) or ASN from ICU (MIC50/90 range, 0.5-2/1-4 mg/L) and non-ICU (MIC50/90 range, 0.5-2/1-4 mg/L) isolates. VRC-non-susceptible (NS) AFM isolates were detected in 9.3% of ICU and 9.0% of non-ICU isolates. Among VRC-NS AFM from ICU/non-ICU, 58.3%/27.5% were wildtype (WT) to ISC, 50.0%/25.0% were ITC-WT, and 75.0%/50.0% remained VRC-WT, respectively. VRC was the most active azole against Scedosporium spp. (SCE) but was less active against Mucorales (MUC) than the other azoles. All azoles showed limited activity against Fusarium spp. (FUS). No difference on azole activities against SCE, MUC, and FUS were noted from ICU and non-ICU isolates. Conclusion ISC was active against Aspergillus isolates from ICU and non-ICU, including against VRC-NS AFM from ICU. Azoles displayed similar activity against moulds from ICU and non-ICU units. Disclosures Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Paul Rhomberg, BS, MT(ASCP), Cidara: Grant/Research Support|Pfizer: Grant/Research Support Paul Rhomberg, BS, MT(ASCP), Cidara: Grant/Research Support|Pfizer: Grant/Research Support Beth A. Schaefer, BA, MT(ASCP), Pfizer: Grant/Research Support Michael A. Pfaller, MD, Pfizer: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.

Phenotypic and Genotypic Identification of Yeast Species Isolated from Diabetic Foot Patients in Al-Najaf Province, Iraq.

Opportunistic yeasts, such as <i>Trichosporon</i> and <i>Candida</i> species (spp.), are reported to cause high rates of morbidity and mortality in immunocompromised and underlying patients. This study was conducted to investigate the phenotypic and genotypic identification of yeast spp. isolated from diabetic patients in Al-Najaf province, Iraq. Samples were collected from the depth of diabetic foot patients' wounds. They were then cultured on Sabouraud Dextrose Agar (SDA) and incubated at 30°C to 35°C for 5 to 7 days for the growth of yeast spp. The colonies were identified based on their microscopic features. Afterward, these yeast samples were cultured in CHROMagar for the isolation and identification of yeast spp. All collected samples were cultured on the SDA through the use of CHROMagar, which is considered a differential agar since the colonies obtained from <i>Candida intermedia</i> and <i>Trichosporon asahii</i> appear in different colors on this media. The Polymerase Chain Reaction assay was performed to amplify the internal transcribed spacer 1 (ITS1) and Internal transcribed spacer 4 (ITS4) sequences for the identification of the yeast spp. Furthermore, the products were sequenced by the Sanger method and compared to the reference global sequences in the national center for biotechnology information Gene Bank. The results showed different molecular sizes of the ITS regions of yeast spp. The primer pair was used for the same sample (i.e., ITS1-ITS4) and targeted the ITS regions. Yeast spp. can be considered the most common fungal agent of life-threatening invasive infections in patients with severe immunodeficiency or underlying diseases, and the treatment of these infections requires long stays in the intensive care units.

Antibiotic susceptibility patterns of gram-negative bacteria in the pediatric hematology-oncology ward of RSUD Dr. Soetomo, Surabaya

Infection is one of the causes of death in children with malignancy. Gram-negative bacteria with broad resistance to antibiotics are the cause of invasive infections in patients with malignancy. This prospective observational study was conducted by collecting medical record data, including the identity of patients, their diagnosis results, and the antibiotic susceptibility test results, from January to December 2020 in the pediatric hematology-oncology ward of Dr. Soetomo Regional General Hospital (hereinafter referred to as RSUD Dr. Soetomo), Surabaya. Positive cultures were obtained in 20.9% of the 196 samples. The growth of gram-negative bacteria was found in 48.8% of the positive culture test results, with a percentage of 50% in blood cultures, 30% in pus cultures, and 15% in urine cultures. The most common gram-negative bacteria isolates obtained in general were E. coli (40%) and K. pneumoniae (30%). The most commonly found non-fermenting gram-negative bacteria was P. aeruginosa (15%). The lowest antibiotic susceptibility was obtained to ampicillin (0%) and ampicillin-sulbactam 10%. The lowest antibiotic susceptibility was obtained to amikacin (85%) and cefepime (80%). The MDR resistance pattern was found in 80% of samples, 40% of which was found in ESBL-producing bacteria.

Risk factors for isolation of carbapenem-resistant Enterobacterales from normally sterile sites and urine

Invasive infections caused by carbapenem-resistant Enterobacterales (CRE) are of significant concern in health care settings. We assessed risk factors for a positive CRE culture from a sterile site (invasive infection) compared to isolation from urine in a large patient cohort in Atlanta from August 2011 to December 2015. CRE cases required isolation, from urine or a normally-sterile site, of E. coli, Klebsiella spp., or Enterobacter spp. that were carbapenem-nonsusceptible (excluding ertapenem) and resistant to all third-generation cephalosporins tested. Risk factors were compared between patients with invasive and urinary infections using multivariable logistic regression. A total of 576 patients had at least 1 incident case of CRE, with 91 (16%) having an invasive infection. In multivariable analysis, the presence of a central venous catheter (OR 3.58; 95% CI: 2.06-6.23) or other indwelling device (OR 2.34; 95% CI: 1.35-4.06), and recent surgery within the last year (OR 1.81; 95% CI: 1.08-3.05) were associated with invasive infection when compared to urinary infection. Health care exposures and devices were associated with invasive infections in patients with CRE, suggesting that targeting indwelling catheters, including preventing unwarranted insertion or encouraging rapid removal, may be a potential infection control intervention. Future infection prevention efforts to decrease CRE cases in health care settings should focus on minimizing unnecessary devices.

Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infections

Staphylococcus capitis is a coagulase-negative staphylococcus that has been described primarily as causing bloodstream infections in neonatal intensive care units (NICUs), but has also recently been described in prosthetic joint infections (PJIs). The multidrug-resistant S. capitis subsp. urealyticus clone NRCS-A, comprising three sublineages, is prevalent in NICUs across the world, but its impact on other patient groups such as those suffering from PJIs or among adults planned for arthroplasty is unknown. Genome sequencing and subsequent analysis were performed on a Swedish collection of PJI isolates (n = 21), nasal commensals from patients planned to undergo arthroplasty (n = 20), NICU blood isolates (n = 9), operating theatre air isolates (n = 4), and reference strains (n = 2), in conjunction with an international strain collection (n = 248). The NRCS-A Outbreak sublineage containing the composite type V SCCmec-SCCcad/ars/cop element was present in PJIs across three Swedish hospitals. However, it was not found among nasal carrier strains, where the less virulent S. capitis subsp. capitis was most prevalent. The presence of the NRCS-A Outbreak clone in adult patients with PJIs demonstrates that dissemination occurs beyond NICUs. As this clone has several properties which facilitate invasive infections in patients with medical implants or immunosuppression, such as biofilm forming ability and multidrug resistance including heterogeneous glycopeptide-intermediate susceptibility, further research is needed to understand the reservoirs and distribution of this hospital-associated pathogen.

Asplenia congenita

The paper presents a case of congenital asplenia diagnosed occasionally in a child who previously presented with a pneumococcal sepsis. The case offers the opportunity to discuss about the elevated risk of severe invasive infections in patients with congenital asplenia and the importance of early diagnosis so to prevent infections by starting an antibiotic prophylaxis, adequate vaccinations and prompt antibiotic therapy with immediate medical consult in case of fever. First degree relatives should be concerned about the high frequency of autosomal dominant transmission of this condition and should be submitted to early follow-up.

506. Urinary Catheters Are Associated with Progression from Bacteriuria to Invasive Infections in Patients with Carbapenem-Resistant Enterobacteriaceae, Metropolitan Atlanta, 2011–2017

BackgroundPatients with carbapenem-resistant Enterobacteriaceae (CRE) bacteriuria have better outcomes than patients with an invasive CRE infection, but patients with bacteriuria may subsequently develop an invasive infection (“progression”). We sought to evaluate risk factors, particularly urinary catheters, for progression from CRE bacteriuria to an invasive CRE infection within one year.MethodsWe used population-based active surveillance data from the Georgia Emerging Infections Program to identify patients in metropolitan Atlanta with CRE in urine, but not in a concomitant or previous sterile site between August 1, 2011 and July 31, 2017. CRE was defined as an isolate resistant to tested third-generation cephalosporins and a minimum inhibitory concentration of ≥4 µg/mL for meropenem, doripenem or imipenem. We then assessed if these patients developed an invasive CRE infection (positive sterile site culture) with the same organism between one day and one year later. Demographics, culture site, comorbidities, and risk factors were obtained by chart review. Univariable analyses and multivariable logistic regression with progression as the outcome were performed in SAS 9.4.ResultsWe identified 551 patients with CRE bacteriuria in 6 years, with an annual incidence of 1.1 cases/100,000 population. Many patients previously resided in long-term care facilities (48%), had a Charlson comorbidity index (CCI) >3 (38%), a central venous catheter (CVC, 34%) or a decubitus ulcer (27%, Table 1). Twenty-five patients (5%) progressed from CRE bacteriuria to an invasive CRE infection within one year (median 34 days). Predictors of progression in univariable analyses included the presence of a urinary catheter (OR 6.4 [95% CI: 1.9–21.6]), decubitus ulcer, CVC or other indwelling device, Klebsiella pneumoniae, black race, CCI >3, and ICU stay after urine culture was obtained (Table 2). In a multivariable analysis, urinary catheter (OR 4.6 [95% CI: 1.3–16.1]) predicted progression as well as K. pneumoniae, CCI >3 and CVC.ConclusionProgression from CRE bacteriuria to an invasive CRE infection is rare but clinically significant and is associated with urinary catheters. Future interventions should target urinary catheter removal, where possible, in patients with CRE bacteriuria. Disclosures All authors: No reported disclosures.

Breast abscess caused by Staphylococcus aureus in 2 adolescent girls with atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease in children. Patients with AD experience a high rate of colonization of the skin surface by Staphylococcus aureus. Because of a skin barrier defect, there is a potential risk of staphylococcal invasive infection in patients with AD. Here, we present 2 cases of breast abscess caused by S. aureus in 2 adolescent girls with severe AD. Methicillin-sensitive S. aureus was identified from the breast abscess material. They were treated with appropriate antibiotics, however surgical drainage of the abscess was needed in case 1. Identical strains were found from the breast abscess material as well as the lesional and the nonlesional skin of the patients through matrixassisted laser desorption/ionization time-of-flight analysis. We characterized the differential abundance of Firmicutes phylum in patients' skin in microbiota analysis. In particular, S. aureus, a member of Firmicutes, differed significantly between the lesional and the normal-appearing skin. Our cases demonstrate the potential severity of bacterial deep tissue infection in AD and the dysbiosis of skin microbiota may be involved in inflammation in AD.

Functional antibodies to Haemophilus influenzae type B, Neisseria meningitidis, and Streptococcus pneumoniae contained in intravenous immunoglobulin products

Intravenous immunoglobulin G (IVIG) replacement therapy is used to prevent invasive infections in patients with primary antibody deficiency (PAD). However, few studies have functionally evaluated specific antibodies against encapsulated bacteria that cause invasive infection in patients with PAD. In this study, functional antibodies against Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococci), and Neisseria meningitidis (meningococci) in IVIG therapy were evaluated. Sixteen lots of IVIG products prepared by two Korean manufacturers (Products A and B) were evaluated. The functional antibodies were measured by serum bactericidal assay for Hib and four meningococcal serogroups and by multiplexed opsonophagocytic assay for 26 pneumococcal serotypes. The estimated trough levels of antibodies against Hib, pneumococcus, and meningococcus were calculated to determine whether the usual IVIG dose is appropriate for protecting patients with PAD. The functional antibody levels for Hib were similar in all of the IVIG products. In contrast, serum bacterial indices of meningococcal serogroups A and Y showed significant differences between products A and B. Opsonic indices to pneumococci varied depending on the serotype in each IVIG product. The estimated trough levels of antibodies against Hib, pneumococcus, and meningococcus exceeded the protective levels in most of the IVIG products except for the antibodies against two pneumococcal serotypes. Most of the tested commercial IVIG products had sufficient functional antibodies against Hib, pneumococcus, and meningococcus to protect patients with PAD receiving IVIG treatment. Regular and continuous evaluation of IVIG products is necessary to maintain an optimal therapeutic effect.

Matrix-assisted laser desorption ionization-time of flight Mass spectrometry can detect Staphylococcus aureus clonal complex 398

Within the last decade methicillin-resistant Staphylococcus aureus belonging to CC398 has become a worldwide threat associated with livestock. More recently, methicillin-susceptible S. aureus (MSSA) belonging to CC398 have been increasingly reported as a cause of invasive infections in patients without livestock contact. It appears therefore necessary to implement a convenient tool for the surveillance this emerging pathogen. We evaluated the MALDI-TOF MS as a tool for rapid detection of S. aureus CC398.We used 626 S. aureus isolates characterized by a CC398-specific PCR, to constitute independent training (300 isolates including 60 isolates CC398) and validation sets (326 isolates including 82 isolates CC398). Fifteen peak biomarkers of CC398 were identified from the mass spectra of the training set. Ninety four % (307 of 326) of strains of the validation set were well assigned with an overall sensitivity of 93% and a specificity of 95%. Six CC398 and 13 non-CC398 isolates were misclassified.With MALDI-TOF MS, clinical laboratories could rapidly detect S. aureus CC398 associated with a higher mortality in hospitalized patients.

Clonal complex 398 methicillin-susceptible Staphylococcus aureus bloodstream infections are associated with high mortality

Within the last decade, methicillin-resistant Staphylococcus aureus belonging to clonal complex 398 (CC398) has become a worldwide threat associated with livestock. More recently, methicillin-susceptible S. aureus (MSSA) belonging to CC398 have been increasingly reported as a cause of invasive infections in patients without livestock contact. We investigated risk factors associated with CC398 bloodstream infections (BSIs) compared with non-CC398 BSIs with a case–control study in a French university Hospital. From January 2010 to December 2014, nonduplicate Staphylococcus aureus (SA) isolates responsible for BSIs in adult patient were typed to identify those belonging to CC398. Each adult patient with a CC398 SA BSI (cases) was matched with 2 non-CC398 SA BSI controls randomly selected on the basis of the time at risk, the unit of hospitalization and susceptibility to methicillin. We retrospectively extracted the clinical information from electronic medical records and used conditional logistic regression for univariate and multivariate analyses. We identified 67 CC398 isolates among the 770 SA responsible for BSI in adult patients. All CC398 isolates were susceptible to methicillin. The proportion of CC398 among MSSA increased steadily from 4.6% in 2010 to 15.1% in 2013 and then stabilized at 13.8% in 2014. Factors significantly associated with CC398 MSSA BSIs were healthcare-associated infection (odds ratio (OR) 3.02, 95% confidence interval (CI) 1.19–7.63), history of neurologic disease (OR 2.51, 95% CI 1.13–5.65) and 30-day mortality (OR 2.44, 95% CI 1.23–4.85).

Actividad in vitro de ampicilina-ceftriaxona frente a aislamientos de Enterococcus faecalis recuperados de infecciones invasivas

In vitro activity of the combination of ampicillin- ceftriaxone against 30 Enterococcus faecalis isolates recovered from invasive infections in patients admitted to Hospital de Clínicas José de San Martin in the city of Buenos Aires was assessed. Ampicillin- ceftriaxone synergies were determined by microdilution in Müeller-Hinton (MH) broth with and without subinhibitory concentrations of ceftriaxone. Synergy was detected in 22/30 isolates. A decrease in both minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) was observed in 14/30 isolates, whereas in 6/30 isolates the decrease was observed in the MIC value and only in the MBC value in the 2 remaining isolates. The bactericidal activity of the combination showed to be higher at low concentrations of ampicillin (< 1μg/ml). We detected in vitro synergy using the ampicillin-ceftriaxone combination and thus, its efficacy was confirmed in the treatment of severe infections by E. faecalis.

Perianal Abscess and Proctitis by Klebsiella pneumoniae.

Klebsiella pneumoniae (K. pneumoniae) can at times cause invasive infections, especially in patients with diabetes mellitus and a history of alcohol abuse. A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks. After admission, he underwent sigmoidoscopy, which revealed multiple ulcerations with yellowish exudate in the rectum and sigmoid colon. The patient was treated with ciprofloxacin and metronidazole. After one week, follow up sigmoidoscopy was performed owing to sustained fever and diarrhea. The lesions were aggravated and seemed webbed in appearance because of damage to the rectal mucosa. Abdominal computed tomography and rectal magnetic resonance imaging were performed, and showed a perianal and perirectal abscess. The patient underwent laparoscopic sigmoid colostomy and perirectal abscess incision and drainage. Extended-spectrum beta-lactamase-producing K. pneumoniae was identified in pus culture. The antibiotics were switched to ertapenem. He improved after surgery and was discharged. K. pneumoniae can cause rapid invasive infection in patients with diabetes and a history of alcohol abuse. We report the first rare case of proctitis and perianal abscess caused by invasive K. pneumoniae infection.

Interference of Aspergillus fumigatus with the immune response.

Aspergillus fumigatus is a saprotrophic filamentous fungus and also the most prevalent airborne fungal pathogen of humans. Depending on the host’s immune status, the variety of diseases caused by A. fumigatus ranges from allergies in immunocompetent hosts to life-threatening invasive infections in patients with impaired immunity. In contrast to the majority of other Aspergillus species, which are in most cases nonpathogenic, A. fumigatus features an armory of virulence determinants to establish an infection. For example, A. fumigatus is able to evade the human complement system by binding or degrading complement regulators. Furthermore, the fungus interferes with lung epithelial cells, alveolar macrophages, and neutrophil granulocytes to prevent killing by these immune cells. This chapter summarizes the different strategies of A. fumigatus to manipulate the immune response. We also discuss the potential impact of recent advances in immunoproteomics to improve diagnosis and therapy of an A. fumigatus infection.

Characterisation of invasive group B streptococci from adults in Denmark 1999 to 2004

The aim of this study was to characterise the group B streptococci (GBS) isolates causing severe invasive infections in patients >15 years of age in Denmark from 1999 to 2004. A total of 411 invasive GBS isolates were phenotypically characterised by the capsular polysaccharide (CPS) serotype and protein Calpha, Cbeta and R4. The incidence of invasive GBS disease ranged from 2.2 to 3.2 per 100,000 adults in the study period, being highest among adults over 65 years of age. Diabetes was observed in 15% of the cases, 12% had alcohol abuse and 7% had cancer. Of all isolates, 77% were CPS serotypes Ia, Ib, III or V. The surface proteins Calpha or R4 were detected as the only protein in 57% of the GBS isolates. Cbeta was detected in 12% of the isolates, but always in combination with either Calpha or both Calpha and R4. The incidence of invasive GBS infections continued to increase in Denmark from 1999 to 2004. In that period, the overall case fatality was 14%. The most prevalent CPS serotypes were serotypes III, Ia, V and Ib. The most prevalent surface protein was R4 when testing for R4, Calpha and Cbeta. There was no clear relation between the GBS phenotype and infections with fatal outcome.

Bacteriological monitoring of invasive infection in patients with burns

Objective To investigate the bacteriological monitoring and antibiotic use of invasive infection in patients with burns. Method The index of burn wound、 eschar distribution、 strains of bacteria, bacterial classification、sensitivity and drug resistance were determinated in 100 cases with burns. Results The wound and eschar 382 strain were isolated from the wound and eschar;The wound bacteria 250 strain(65.4%) were significantly higher than that eschar 132 strain (34.6%) (x~2 = 3. 987,P ＜ 0.05); Gram-negative (G -) 227 strain (59. 4%) were significantly higher than that Gram-positive(G +) 155 strain(40. 6%) (x~2 = 3. 887, P ＜ 0.05); Pseudomonas aeruginosa and Enterobacteriaceae in Gram-negative is major strains,while Staphylococcus aureus in Gram-positive is major strains;The Pseudomonas aeruginosa resistance rate(10.38%) was significantly lower than gentamicin(70. 12%) (x~2 =7. 451 ,P＜ 0.01) ;The rate of methicillin-resistant(82. 14%) for Staphylococcus aureus was significantly higher than that of vancomycin(5.35%) (x~2 =7.548 ,P ＜0.01). Conclusion The Gram-negative infection could treat with imipenem,Gram-positive infections could treat with vancomycin for patients with burns. Key words: Burns; Bacterial infections; Cross infecion

Monitoring of adenovirus load in stool by real-time PCR permits early detection of impending invasive infection in patients after allogeneic stem cell transplantation

Invasive adenovirus (AdV) infections are associated with high morbidity and mortality in allogeneic stem cell transplant recipients. We observed that molecular detection of the virus in stool specimens commonly precedes AdV viremia, suggesting that intestinal infections may represent a common source of virus dissemination. To address this notion, we have investigated 153 consecutive allogeneic transplantations in 138 pediatric patients by quantitative monitoring of AdV in stool specimens and peripheral blood by a pan-adenovirus real-time (RQ)-PCR approach. AdV was detectable in serial stool specimens in all cases of AdV viremia during the post-transplant course (P<0.0001). The incidence of AdV viremia in individuals with peak virus levels in stool specimens above 1 x 10E6 copies per gram (n=22) was 73% vs 0% in patients with AdV levels in stool specimens below this threshold (n=29; P<0.0001). Serial measurement of AdV levels in stool specimens by RQ-PCR permitted early diagnosis of impending invasive infection with a sensitivity and specificity of 100% (95% confidence interval (CI) 96-100%) and 83% (95% CI 67-92%), respectively. The median time span between detection of AdV loads in stool specimens above 1 x 10E6 copies per gram and first observation of viremia was 11 days (range 0-192). Quantitative monitoring of the AdV load in stool specimens therefore provides a rationale for early initiation of antiviral treatment with the aim of preventing progression to life-threatening invasive infection.