Positive Stool Culture Research Articles

What Have We Learnt from Bacterial Stool Culture Results? a Retrospective Study of Hospitalised Gastroenteritis Cases in a Regional Hospital in Hong Kong

BackgroundStool culture is one of the common investigations done for patients with gastroenteritis, and fluoroquinolones have been used frequently for suspected bacterial gastroenteritis.ObjectiveTo study the yield of bacterial pathogens in stool culture in a local regional hospital for in‐patients with gastroenteritis and the individual pathogens identified. Also, the value of stool culture and the prescription of fluoroquinolones as empirical antibiotics were reviewed.MethodsThis was a retrospective study. All in‐patients with the principal diagnosis of “gastroenteritis” in the year 2007 were reviewed. We excluded pregnant patients and patients under 18 years of age. Patients were divided into two age groups and data were analysed including demographics, clinical findings, admission time and culture results. Antibiotics prescription behaviour was also analysed.ResultsA total of 837 adult patients fulfilled the criteria. Among them, 562 cases had their stool saved and sent for bacterial culture. Eighty‐nine cases were found to have their stool cultures positive for bacteria. The identified pathogens were namely Vibrio parahaemolyticus (38.2%), Salmonella species (34.8%), Campylobacter species (11.2%), Plesiomonas species (10.1%) and Aeromonas species (3.4%) respectively. The yield of positive stool culture was 15.8%.ConclusionVibrio parahaemolyticus and Salmonella species were still the most common pathogens for bacterial gastroenteritis among hospitalized patients in Hong Kong, especially in the young and middle aged. Their occurrence followed a seasonal pattern. Physicians had a tendency to prescribe fluoroquinolones for cases with fever and travel history. Also, the problem of antibiotic resistance did exist. It is important for practitioners to follow local guidelines before ordering microbiological investigations on stool and prescribing empirical antibiotic treatment.

Efficacy of high-dose oral erythromycin on enhancement of feeding tolerance in premature neonates

Objective: Most neonates admitted to neonatal wards do not tolerate sufficient milk. Recently the effect of erythromycin on increasing feeding tolerance in neonates has been studied. In this study the effectiveness of oral, high dose Erythromycin a prokinetic agent was used to enhance feeding tolerance in these neonates. Methods: This prospective randomized controlled clinical trial was conducted on 60 premature neonates with birth weight< 1800 g at Hafez and Namazi hospitals in Shiraz during a 13- month period. Those neonates who did not tolerate milk more than 75 cc/kg/day five days after starting feeding, were chosen for the study. A total of 60 neonates were studied who were divided randomly into two equal groups (control and study), and were similar in sex, birth weight, gestational age, apgar score, route of delivery, oxygen need, type of milk and corticosteroid therapy in the antepartum period. Oral erythromycin (ethyl succinate suspension) was given in a dose of 12.5mg/kg/dose every 6 hours for a maximum of 10 days, or until they tolerated full enteral feeding (150 cc/kg/day). One neonate in the erythromycin group and two neonates in the control group expired during the study. Results: Oral erythromycin was effective on enhancement of feeding tolerance in premature neonates with gestational age equal to or more than 32 weeks (p= 0.031) and lead to earlier discharge of these neonates from hospital (p= 0.003). Also oral erythromycin was relatively effective in enhancement of feeding and early discharge of neonates with birth weight equal to or greater than 1500 g. Erythromycin was not effective for neonates less than 32 weeks of age (very preterm). In this study, no adverse effects (necrotizing enterocolitis, sepsis, O2 dependency, patent ductus arteriosus, high-dose positive stool culture or prolonged QT interval) were observed following erythromycin usage. Conclusion: High-dose oral erythromycin in premature neonates of gestational age equal to or greater than 32 weeks with feeding intolerance is effective for increasing feeding tolerance and earlier hospital discharge. However, routine use is not suggested.

Early Diagnosis of Neutropenic Enterocolitis by Ultrasound Sonography.

Abstract 4742 IntroductionNeutropenic enterocolitis (NEC) is a life threatening complication of chemotherapy in leukemic and solid tumor patients with an incidence ranging from 2.6% to 33%. It is a necrotizing inflammatory disease that most commonly involves the ileo-cecal region. The cecum is almost invariably affected likely due to its distensibility and limited blood supply. Macroscopically the involved bowel segments show oedematous and thickened walls, with varying degrees of ulceration and haemorrhage. Perforation occurs in 5%-10% of cases. Early diagnosis is crucial to start conservative medical treatment which appears the optimal strategy. Criteria for prompt surgical treatment have also been proposed (Shamberger RC et al, 1986) so that a careful clinical evaluation by both the physician and the surgeon is mandatory (Davila ML et al, 2004). NEC should be always suspected in neutropenic patients with abdominal pain, fever and diarrhea. Ultrasound (US) has been used to evaluate bowel-wall thickening (BWT). One study correlated BWT with clinical outcome: 60% of patients with BWT > 10 mm died from NEC as compared with 4.2% of those with BWT < 10 mm (Cartoni C. et al, 2001). Overall, despite aggressive treatment, mortality rate is up to 21-48% and patients may die within hours from the onset of acute symptoms. Because of the risk of early death, a swift diagnosis is imperative. We investigated if US could detect early signs of NEC and lead to prompt treatment. We analyzed two patients cohorts (A and B). In cohort A US was performed later in the course of the disease whereas, in cohort B US was immediately performed at the onset of a single symptom (diarrhea and/or abdominal pain whichever occurred first with/without fever). Underlying haematological diagnoses were Hodgkin Disease (N=10), acute leukemias (N=9), multiple myeloma (N=3) and non-Hodgkin lymphomas (N=10). Treatments consisted of standard chemotherapy (N=10), myeloablative allografting after busulfan/cytoxan (N=1) and cytoxan/total body irradiation (N=1); autografting after busulfan/cytoxan (N=1), BEAM (N=16) and melphalan (N=3). ResultsAll 32 patients showed grade 4 neutropenia at the onset of symptoms. Thirty-one/32 (97%) complained of abdominal pain whereas diarrhea was present in 30/32 (94%). Positive stool (for Clostridium Difficilis and Escherichia Coli) and blood cultures (62% Gram negative and 38% Gram positive bacteria) were found in 4/32 (12.5%) and 8/32 (25%) respectively. Trans-abdominal real-time US scanning of the bowel was performed using a 3.5-5 MHz convex probe and a 7 MHz linear transducer. A portable sonographer (Esaote model My Lab 25) was used for bed-side US. Both trans-abdominal axial and transverse US scans were performed on the colon. US signs of NEC were defined as thickening or dilation of small and/or large intestine. The intestinal involved areas were ileum, 21%, last terminal ileum, 21%, cecum 7%, ascending colon, 16%, transverse colon, 16%, descending colon, 14% and jejunum, 4%. US revealed signs of NEC in 8/14 in cohort A and 18/18 in cohort B. In cohort B, early US detected signs of NEC in 7 patients with abdominal pain and diarrhea without fever. Complete response to prompt medical treatment occurred in 6. Three/7 patients developed fever 48 hours after the US-guided diagnosis of NEC. Two patients, at risk of wall rupture by US imaging (confirmed by CT scans), underwent successful colon surgery within 12 hours from diagnosis. Except for these 2, all patients received medical treatment (broad spectrum antibiotics for gram-negative, gram-positive and anaerobic coverage, and antifungal drugs, granulocyte transfusions, bowel rest and granulocyte colony stimulating factor as per internal protocol). Overall 3/32 patients died. ConclusionsEarly bed-side intestinal US in neutropenic patients performed at the onset of a single symptom suggestive of NEC led to timely and successful treatment of this life threatening complication even before the development of fever. Disclosures:No relevant conflicts of interest to declare.

Evaluation of ELISA in the diagnosis of Yersinia enterocolitica diarrhoea in children.

In a series of acute gastroenteritis in children, including 2 bacteriologically confirmed cases of Yersinia enterocolitica infection, paired sera from 286 patients were studied for the presence of Y. enterocolitica 0:3 and 0:9 antibodies, using an enzyme-linked immunosorbent assay (ELISA). In the 2 cases with positive stool culture of Y. enterocolitica 0:3 significant rise was seen in each IgM, IgG and IgA class Y. enterocolitica 0:3 antibodies. There were 6 further cases with elevated anti-Yersinia IgM: these possibly false-positive reactions were distinguished from the confirmed cases of Y. enterocolitica infection by the absence of IgG and IgA antibodies.

Diarrhea in children less than two years of age with known HIV status in Kisumu, Kenya

Objective To compare the frequency and etiology of diarrhea in children aged less than 2 years with known HIV status. Methods This was a nested cohort study, whereby children were followed during monthly routine and unscheduled visits. The HIV status of children was determined with PCR. A stool culture was obtained from children with diarrhea. A subset of stool samples was examined for parasites and tested for rotavirus. Results Between 1997 and 2001, 682 children (51.0% male) contributed observation periods with a mean of 47 weeks. Overall there were 198 episodes of diarrhea per 100 child-years of observation (CYO); diarrhea was more common among HIV-positive children than among HIV-negative children (321 vs. 183 episodes/100 CYO, respectively, p < 0.01) and was not statistically different for HIV-negative children born to HIV-positive compared with HIV-negative mothers (182 vs. 187 episodes/100 CYO, respectively, p = 0.36). For 66.5% of the acute episodes a stool culture was obtained; 27.8% of stool cultures yielded a bacterial pathogen. A positive stool culture was less likely among HIV-positive children compared to children of HIV-negative mothers (20.5% vs. 34.3%, p = 0.01). Susceptibility of Salmonella and Shigella to commonly used antibiotics was low. Rotavirus was detected in 13.9% of 202 examined stool samples, and a stool parasite in 3.8% of 394 samples. Diarrhea was associated with 37.8% of child deaths. Conclusions Diarrhea was more common among HIV-infected children, but was not associated with specific bacterial pathogens. Measures that reduce diarrhea will benefit all children, but may benefit HIV-infected children in particular.

Meningitis with subdural empyema due to non-typhoid Salmonella in a 9-month-old girl

We report a case of a 9-month-old baby admitted to the hospital because of low-grade fever, focal seizures in a context of watery diarrhea for 14 days' duration. The patient workup revealed a mild neutrophilic pleocytosis on cerebrospinal fluid (46 cells/microl), a positive stool culture for Salmonella pomona sensitive to ceftriaxone and ciprofloxacin, and a subdural empyema (SDE) on the cerebral MRI. The child received an intravenous third-generation cephalosporin for 4 weeks which resulted in cure. This case highlights an unusual extra-intestinal complication of non-typhoid salmonella infection. Involvement of the central nervous system with non-typhoidal salmonellosis is an important complication that can result in significant morbidity if not recognized and treated promptly. A focal intra-cranial infection must be considered in the differential diagnosis of any child presenting with focal seizures and gastroenteritis due to Salmonella. Appropriate diagnostic imaging of the head (cerebral CT scan with contrast and/or MRI) is mandatory to exclude the presence of an intra-cranial complication, even in the presence of negative CSF culture for Salmonella. Subfrontal and subtemporal SDE are sometimes missed on axial CT scans and better appreciated on MRI. Non-surgical treatment of small subdural empyemas with prolonged intravenous antibiotic therapy is a therapeutic option.

Questioning the Role of A Neutropenic Diet in Hematopoietic Stem Cell Transplantation

Neutropenic diets (ND) were developed to decrease gut-derived infections and are widely used. After finding that there were no clinical trials supporting their use, we discontinued ND in HSCT in late 2006. Our ND excluded fresh fruits and vegetables as well as black pepper, sushi, deli meats, raw milk products, soft cheeses, raw honey, miso, and yeast. It was replaced by a modified general diet (Non-ND) that permits black pepper, fresh fruits and vegetables, and homemade freshly squeezed juice - but excludes raw tomatoes. The other restrictions remain. 648 consecutive hospitalized patients were studied; 314 on ND and 314 after ND discontinuation (non-ND). All infections occurring during the first hospital stay were analyzed. All patients received ciprofloxacin 500 mg twice a day, fluconazole 200 mg daily (autograft) or voriconazole 200 mg twice daily (allograft), and acyclovir/valacyclovir. The documented infections included in the analysis comprised positive blood, urine (>100,000 organisms), BAL, stool, or wound cultures, and clostridium difficile. As the table shows, there were no differences between the ND and non-ND groups with regards to age, sex, diagnosis and conditioning regimen, or the number of days to resolution of neutropenia. There were no significant differences in the number of positive cultures between the groups during the neutropenic period. However, after the resolution of neutropenia, there was a significantly higher number of non-enteric gram-positive coccal infections in the ND group compared to non-ND. There was also a trend towards a higher incidence of C difficile, and a significantly higher incidence of new positive surveillance cultures of VRE on rectal swabs in the ND group.Tabled 1Neutropenic dietNon-neutropenic dietPAge (years)57 (18-76)56 (18-78)0.89Male:Female186:128190:1240.97Allogeneic:Autologous77:23772:2420.64Diagnosis0.91 Myeloma163165 NHL5764 AML5450 Other4039Conditioning regimen0.97 High-dose Melphalan163165 BEAM4542 Busulfan-fludarabine3233 Reduced-intensity3336 Median days to neutrophil recovery12120.91 Positive cultures during neutropenia97890.49 CoNS/MSSA/MRSA + miscellaneous gram-positive32331 C difficile24220.88 E faecium (VRE)991 Non-VRE Enterococci331 Gram-negative bacilli1590.21 S viridans11101 Fungus431 Positive cultures after resolution of neutropenia4820<0.001 CoNS/MSSA/MRSA + miscellaneous gram-positive2190.028 C difficile920.069 E faecium (VRE)730.34 Gram-negative bacilli840.38 S viridans211 Fungus111 VRE surveillance culture positivity acquired during hospitalization5631<0.004 Open table in a new tab Our findings show that there is no apparent benefit associated with ND. However, more surprising is the finding that some infections were more common with ND. It could be speculated that the microbial content of the non-ND is higher and, in the setting of broad-spectrum antimicrobial prophylaxis and therapy, such a diet could contribute to reduced colonization with virulent microorganisms. These findings suggest that additional studies are needed to investigate the role of dietary restrictions. If our findings are confirmed, a major change in an established but non-evidence-based practice will be needed. An added benefit of the more liberal diet would be greater palatability - which may contribute to reduction in the use of TPN and better nutrition.

Predictive factors for severe infection among febrile infants younger than three months of age

Purpose : This study investigated the predictive factors for identifying infection-prone febrile infants younger than three months. Methods : We conducted a retrospective study of 167 infants younger than three months with an axillary temperature >38℃ who were hospitalized between 2006 and 2008. If they met any of the following criteria, positive blood culture, CSF WBC 11/mm3 or positive CSF culture, urinalysis WBC 6/HPF and positive urine culture, WBC 6/HPF on microscopic stool examination or positive stool culture, they were considered at high risk for severe infection. Infants with focal infection, respiratory infection or antibiotic administration prior to admission to the hospital were excluded. We evaluated the symptoms, physical examination findings, laboratory data, and the clinical course between the high risk and low risk groups for severe infection. Results : The high-risk group included 77(46.1%) infants, and the most common diagnosis was urinary tract infection (51.9%). Factors, such as male sex, ESR and CRP were statistically different between the two groups. But, a multilinear regression analysis for severe infection showed that male and ESR factors are significant. Conclusion : We did not find the distinguishing symptoms and laboratory findings for identifying severe infection-prone febrile infants younger than three months. However, the high-risk group was male and ESR-dominated, and these can possibly be used as predictive factors for severe infection.

Specimens and culture media for the laboratory diagnosis of typhoid fever

Culture of S. Typhi is necessary for the definitive diagnosis of typhoid fever and provides isolates for antibiotic susceptibility testing and epidemiological studies. However, current methods are not fully optimised and sourcing culture media and bottles for culture media may be problematic. In two hospital laboratories in Viet Nam, comparisons of media for blood and stool culture were conducted. The effect of the volume of blood or stool on culture positivity rate was examined and direct plating of the blood buffy coat was trialed. For 148 suspected typhoid fever cases, ox bile broth (58 positive) and brain-heart infusion broth containing saponin (63 positive), performed equally well. For 69 confirmed adult typhoid fever cases, large-volume (15 ml) blood culture gave the same sensitivity as 1 ml of bone marrow culture. For 44 confirmed typhoid fever cases, the direct plating of the buffy coat was positive in 28 cases. For 263 positive stool cultures, selenite F and selenite mannitol performed equally well and culturing 2 g rather than 1g increased the isolation rate by 10.5%. For the diagnosis of typhoid fever by blood culture the medium should be a rich nutrient broth containing a lysing agent. In adults 1 ml bone marrow or 15 ml blood culture gave similar results. Where isolates are needed for susceptibility testing or epidemiological studies, but resources for culture are scarce, direct plating of the blood buffy coat can be used with a 50% fall in sensitivity compared to standard blood culture.

Rotavirus infection increases the risk of bacteremia in children with nontyphoid Salmonella gastroenteritis

To evaluate whether there is any impact of rotavirus infection on nontyphoid Salmonella (NTS) gastroenteritis, a total of 207 diarrheal children who had positive stool culture for NTS and also a stool examination for the rotavirus antigen were retrospectively analyzed. According to the positivity of the stool rotavirus antigen, patients were divided into two groups and compared with regard to demographic data, clinical features, laboratory findings, and complications. The results showed that there were no significant differences between the two groups of patients with regard to demographic data, clinical features, and laboratory findings, except that vomiting was more common in patients with a coinfection of rotavirus (70.4% vs 40.0%, P = 0.003). Complication by bacteremia occurred more frequently in patients with coinfection of rotavirus (32% vs 9.3%, P = 0.004), but none of them developed extraintestinal focal infections, which were observed only in patients with isolated NTS infection. Our study indicated that concomitant rotavirus infection increased the risk of bacteremia in children with NTS gastroenteritis, although the prognosis remained favorable.

Abdominal pain in a young man — a rare condition to consider

A 27-year-old previously fit and healthy non-smoking man presented with a 6-week history of abdominal pain, nausea, vomiting, weight loss and recent onset of a fever, which he attributed to the consumption of a chicken kebab. There was no other relevant history of familial conditions or trauma. Initial clinical examination was unremarkable. He had leukocytosis and raised inflammatory markers. Despite no positive blood or stool culture diagnosis, he was given intravenous antibiotic and rehydration treatment. However, no significant clinical improvement was observed and, on abdominal examination, a pulsatile mass was felt. A CT scan of the abdomen was performed after intravenous and oral contrast (Figures 1–3). What is your diagnosis?

Clostridium Difficile in Urology

The objective was to determine the incidence of Clostridium difficile infection in a UK urology ward from 2000 to 2005, and correlate and compare the data with other specialty wards and national figures. Urology patients with a positive stool culture for C. difficile between 2000 and 2005 were identified from a hospital database. The medical records of these patients were reviewed and data such as antibiotic use, urological diagnosis and elective/emergency status of the patient were recorded and analysed. The number of C. difficile cases on an elderly care ward, an acute medical ward and an acute surgical ward were also recorded for this period. Data on the number of admissions and occupied bed-days on all 4 wards were compared. There were 33 cases of C. difficile on the urology ward between 2000 and 2005. The incidence of this infection varied between 10.2 and 48.4 cases per 10,000 patient episodes (mean 21.0). There was a significant difference between the number of C. difficile cases per 1000 patient days between the urology ward and the acute medical ward (P = 0.002) and the elderly care ward (P = 0.03). There is no evidence to suggest that there has been an increase in the incidence of C. difficile in a UK urology ward. The rates on the urology ward were lower than the national average, and significantly lower than those rates on an acute medical ward and an elderly care ward. There is a 0.21% chance of a patient testing positive for C. difficile during their stay on a urology ward.

Use of Acid-Suppressing Drugs and the Risk of Bacterial Gastroenteritis

Gastric acid is a defense mechanism against gastrointestinal infections caused by ingested bacteria. Studies have suggested that the use of acid-suppressing drugs may increase the risk of gastroenteritis (GE). Patients aged 20-74 years with an episode of acute bacterial GE (n = 6414) were identified. A control group from the same study population without a diagnosis of GE (n = 50,000) was frequency-matched by age, sex, and calendar year to the case group. Unconditional logistic regression was used to calculate the adjusted relative risk (RR) of GE in patients using proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs). Current use of PPIs was associated with an increased risk of bacterial GE compared with nonuse, regardless of the treatment duration (RR, 2.9; 95% confidence interval [CI], 2.5-3.5), whereas no association was observed with H2RA use (RR, 1.1; 95% CI, 0.9-1.4). Doubling the PPI dose further increased the risk of developing bacterial GE (RR, 5.0; 95% CI, 2.7-9.3). The effect of PPI use did not vary significantly with regard to treatment indication. The increased risk associated with PPI use was similar for both omeprazole (RR, 3.0; 95% CI, 2.5-3.7) and lansoprazole (RR, 2.1; 95% CI, 1.4-3.0), whereas neither cimetidine nor ranitidine showed any increased risk. Campylobacter (n = 4124) and Salmonella (n = 1885) were the 2 species most frequently responsible for GE episodes in the case group. When analyzed separately, both species reproduced the increased risk associated with PPI use and not H2RA use. Clostridium GE cases were rare (n = 31). This study suggests that gastric acid suppression induced by PPIs but not H2RAs is associated with an increased risk of Campylobacter and Salmonella GE.

Patterns of Guillain-Barré syndrome in children

Guillain-Barré syndrome (GBS) is an acute, immune-mediated flaccid paralysis frequently associated with Campylobacter infection. Of two predominant GBS subtypes, a demyelinating subtype (acute inflammatory demyelinative polyneuropathy [AIDP]) predominates in the United States and Europe, and axonal subtype (acute motor axonal neuropathy [AMAN]) is the predominant form in China. Previous clinical studies suggested that AMAN also occurs in Mexican children. The purpose of this study was to describe the subtypes of GBS in children from Mexico City. We prospectively studied 121 children admitted to two pediatric hospitals in Mexico City from 1996 to 2002. Clinical histories were obtained, electrophysiologic studies were performed to determine GBS subtype, and microbiologic studies were performed. Of the 121 children, 46 had AMAN and 32 had AIDP. The male to female ratio was 1.3 for AMAN cases (mean age = 6.3) and 3.0 for AIDP cases (mean age = 7.0). There was a strong seasonal distribution of AMAN cases in July to September. Children with AMAN, but not AIDP, had worsening of illness during hospitalization as judged by peak severity scores. Vomiting was more likely in AIDP (28.1%) vs AMAN (6.5%) (p = 0.012) and diarrhea was more common in AMAN (32.6%) than AIDP (12.5%) (p = 0.06). IgG anti-GM1 antibody titers were higher in patients with AMAN vs AIDP (p = 0.067). Anti-GD1a antibodies were equally present in both groups. Anti GQ1b titers were higher in AMAN vs AIDP (p = 0.009). Campylobacter antibody responses were positive in 44.1% of patients with AMAN and 37.0% of patients with AIDP. Twenty patients (14 = AMAN, 6 = AIDP) had positive stool cultures for C jejuni. Two serotypes, HS:19 and HS:41, accounted for 6 of 10 Campylobacter isolates available for serotyping from these cases. This study confirms that acute motor axonal neuropathy is an important Guillain-Barré syndrome subtype in Mexican children, is associated with diarrhea, and occurs seasonally.

Epidemiologic attributes of invasive non-typhoidal Salmonella infections in Michigan, 1995–2001

To determine: (1) the incidence of invasive salmonellosis, (2) the distribution of specific Salmonella serotypes associated with invasive disease, and (3) the role of demographic characteristics in invasive salmonellosis in Michigan. We conducted a cross-sectional study using laboratory-confirmed cases of salmonellosis reported to the Michigan Department of Community Health between 1995 and 2001. Average annual incidences (AAIs) for invasive salmonellosis were computed, and Poisson regression analysis was used to model the association between demographic attributes and invasive salmonellosis. Of 6797 cases of salmonellosis, 347 (5.1%) were characterized as invasive having an AAI of 0.5/100000. A covariate-adjusted Poisson model showed children aged <1 year to be at higher risk for invasive salmonellosis compared to adults aged 40-49 years (rate ratio (RR) 8.98, 95% confidence interval (CI) 5.69-14.17). No significant differences were found between males and females (RR 1.02, 95% CI 0.83-1.26), African-Americans and Caucasians (RR 0.95, 95% CI 0.64-1.42), and urban and rural residents (RR 0.98, 95% CI 0.76-1.26). Among the most common serotypes associated with invasive salmonellosis (Heidelberg, Typhimurium, and Enteritidis), Salmonella serotype Heidelberg had the highest blood invasiveness ratio (15.79/100). Children aged <1 year, especially of minority groups, are at higher risk for invasive Salmonella infections. Invasive salmonellosis may be included in the differential diagnosis of acute bacterial infections in young children with positive stool cultures for Salmonella.

Staphylococcus aureus intestinal colonization is associated with increased frequency of S. aureuson skin of hospitalized patients

BackgroundIntestinal colonization by Staphylococcus aureus among hospitalized patients has been associated with increased risk of staphylococcal infection and could potentially contribute to transmission. We hypothesized that S. aureus intestinal colonization is associated with increased frequency of S. aureus on patients' skin and nearby environmental surfaces.MethodsSelected inpatients were cultured weekly for S. aureus from stool, nares, skin (groin and axilla), and environmental surfaces (bed rail and bedside table). Investigator's hands were cultured after contacting the patients' skin and the environmental surfaces.ResultsOf 71 subjects, 32 (45.1%) had negative nares and stool cultures, 23 (32.4%) had positive nares and stool cultures, 13 (18.3%) were nares carriers only, and 3 (4.2%) were stool carriers only. Of the 39 patients with S. aureus carriage, 30 (76.9%) had methicillin-resistant isolates. In comparison to nares colonization only, nares and intestinal colonization was associated with increased frequency of positive skin cultures (41% versus 77%; p = 0.001) and trends toward increased environmental contamination (45% versus 62%; p = 0.188) and acquisition on investigator's hands (36% versus 60%; p = 0.057). Patients with negative nares and stool cultures had low frequency of S. aureus on skin and the environment (4.8% and 11.3%, respectively).ConclusionWe found that hospitalized patients with S. aureus nares and/or stool carriage frequently had S. aureus on their skin and on nearby environmental surfaces. S. aureus intestinal colonization was associated with increased frequency of positive skin cultures, which could potentially facilitate staphylococcal infections and nosocomial transmission.

Analysis of Kawasaki disease showing elevated antibody titres of Yersinia pseudotuberculosis

To elucidate a clinical difference between patients with Kawasaki disease documented with Yersinia pseudotuberculosis infection and patients with Kawasaki disease without Yersinia pseudotuberculosis infection. From January 1985 to July 2004, 452 patients were diagnosed with Kawasaki disease. Forty-two patients had elevated antibody titres of Yersinia pseudotuberculosis and/or positive stool culture (Yersinia-positive group). Three hundred and thirty patients had no elevated antibody titres (Yersinia-negative group). We compared the clinical characteristics retrospectively. The age of onset in the Yersinia-positive group (3.05+/-2.20 y) was significantly higher than that in the Yersinia-negative group (2.31+/-2.05 y) (p=0.03). The age-adjusted statistical analysis demonstrated that the incidence of coronary artery lesions (dilatations plus aneurysms) in the Yersinia-positive group (22/42, 52.4%) was significantly higher than in the Yersinia-negative group (105/330, 31.8%) (p=0.001), and the incidence of additional administration of immunoglobulin in the Yersinia-positive group (13/36, 36.1%) was significantly higher than in the Yersinia-negative group (41/256, 16.0%) (p=0.004). Our data suggest that Yersinia pseudotuberculosis infection might play a role in the developing mechanism of poor response to therapy and the tendency to develop coronary artery lesions in Kawasaki disease patients.

Acute Renal Dysfunction in Salmonella Gastroenteritis

To determine the incidence of renal function deterioration in adult patients with Salmonella infection. Renal impairment has been described during severe Salmonella infection and is mainly due to shock, dehydration, or rhabdomyolysis. However, it is unclear whether less severe Salmonella infection also has an impact on kidney function. We retrospectively reviewed over a 2-year period the data of all hospitalized adult patients with microbiologically proven gastrointestinal infection. Different biologic parameters were compared between patients infected with Salmonella and patients with other gastrointestinal infections. One hundred and seven patients with positive stool cultures were identified; 44 of them had proven Salmonella infection. Renal dysfunction, defined as an increase in serum creatinine above 1.5 mg/dL in men and above 1.3 mg/dL in women, was observed in 16 (36%) patients infected by Salmonella but only in 3 (5%) comparators (P<0.0001). Hydration status and creatine kinase levels were not different in patients affected by Salmonella as compared with other pathogens. Kidney function recovered in all but 1 patient. Salmonella gastroenteritis in adults is frequently accompanied by renal dysfunction that is caused by mechanisms other than dehydration or rhabdomyolysis.

Once-Daily, High-Concentration MMX Mesalamine in Active Ulcerative Colitis

SPD476 (LIALDA in the US; MEZAVANT in the EU; otherwise known as MMX mesalamine; Shire Pharmaceuticals Inc., Wayne, PA, under license from Giuliani SpA, Milan, Italy) is a novel, once-daily, high-strength (1.2 g/tablet) formulation of mesalamine, utilizing MMX Multi Matrix System (MMX) technology designed to deliver the active drug throughout the colon. We performed a double-blind, multicenter study, comparing MMX mesalamine vs placebo for the treatment of active ulcerative colitis. A delayed-release oral mesalamine (ASACOL; Procter & Gamble, Cincinnati, OH) reference arm was included. Three hundred forty-three patients with active, mild-to-moderate ulcerative colitis received MMX mesalamine 2.4 g/day or 4.8 g/day given once daily, ASACOL 2.4 g/day given in 3 divided doses, or placebo for 8 weeks. The primary end point was the proportion of patients in clinical and endoscopic remission (modified ulcerative colitis disease activity index of < or =1 with rectal bleeding and stool frequency scores of 0, no mucosal friability, and a > or =1-point reduction in sigmoidoscopy score from baseline). A significantly greater proportion of patients receiving MMX mesalamine 2.4 g/day given once daily (40.5%; P = .01) and 4.8 g/day given once daily (41.2%; P = .007) achieved clinical and endoscopic remission at week 8, vs placebo (22.1%). The clinical and endoscopic remission rate for ASACOL (32.6%; P = .124) was not significantly superior to placebo. All active treatments were well-tolerated. Once-daily MMX mesalamine was efficacious and well-tolerated for the induction of clinical and endoscopic remission. MMX mesalamine offers effective and convenient mesalamine therapy, potentially improving treatment compliance.

Probable Intrafamilial Transmission of Coxsackievirus B3 With Vertical Transmission, Severe Early-Onset Neonatal Hepatitis, and Prolonged Viral RNA Shedding

Here we report a familial cluster of 3 cases of coxsackievirus B3 infection: a recent history of illness in a woman's 3-year-old son with a coxsackievirus B3-positive stool culture indicated that he probably infected his mother at home during her last week of pregnancy. Consequently, she delivered an infected neonate who developed severe hepatitis, disseminated intravascular coagulation, and bilateral intracranial hemorrhage. The neonate remained well for the first 2 days of life. On the third day, he developed fever (39 degrees C) and poor peripheral circulation. On the fourth day, he developed petechiae and bruises over his chest wall and extremities, and prolonged bleeding was observed over venipuncture sites. Investigations revealed severe thrombocytopenia (platelets: 41 x 10(9)/L) and a markedly deranged coagulation profile (prothrombin time: 19 seconds [reference: < 10 seconds]; activated partial thromboplastin time: > 120 seconds [reference: 24.2-37.0 seconds], serum D-dimers: 6722 ng/mL [reference: < 500 ng/mL]), suggestive of disseminated intravascular coagulopathy. Clinical examination revealed yellow sclera, hepatomegaly (5 cm), and splenomegaly (2 cm), consistent with hepatitis. Serial chest radiographs showed bilateral pleural effusions, and an ultrasound of the abdomen demonstrated ascites. An echocardiogram showed normal cardiac structure and good contractility of both ventricles. However, a cranial ultrasound revealed bilateral grade 2 intraventricular hemorrhages. Serum C-reactive protein increased to 33.9 mg/L. Liver-function tests were also markedly deranged at this time, with maximum values for serum alanine transferase, bilirubin, alkaline phosphatase, and ammonia concentration of 1354 IU/L, 258 micromol/L, 189 IU/L, and 147 micromol/L, respectively. Serum glucose levels were normal. Over the next 3 days, his fever subsided, and his liver function and clotting profile normalized by day 13 after onset of illness. A stool sample from the older brother, collected 14 days after his onset of illness at home, was positive for coxsackievirus B3 by both virus culture and enterovirus reverse-transcription polymerase chain reaction. He had neutralizing coxsackievirus B3 antibody titers of 1:2560 and 1:1280 on days 14 and 28 after his onset of illness, respectively. No virus was cultured from the mother's stool sample, collected 5 days after her onset of illness, but the enterovirus polymerase chain reaction was positive and maternal sera neutralized the coxsackievirus B3 isolated from the neonate. The maternal sera also showed a more than fourfold rise in antibody titer from 1:80 to 1:640 on days 5 and 16 after her onset of illness, respectively. Neonatal antibody titers also showed a more than fourfold rise from < 1:80 to 1:2560 on days 1 and 21 after his onset of illness, respectively. This demonstrates that both the mother and the neonate had had recent coxsackievirus B3 infections. Serially collected neonatal throat swab and stool samples were culture negative for enterovirus by 4 and 8 days after his onset of illness, respectively. However, enterovirus RNA remained detectable by reverse-transcription polymerase chain reaction in these samples for considerably longer, only becoming undetectable by 16, 23, and 41 days after his onset of illness. We show that even mild household infections may have potentially serious consequences for pregnant women and their infants.