Previous Antibiotic Treatment Research Articles

MR and CT Imaging to Optimize CT-Guided Biopsies in Suspected Spondylodiscitis

The diagnostic value of computed tomography (CT)-guided spinal biopsy in patients with suspected spondylodiscitis is reported inconsistently in the literature. Our aim was to evaluate associations between procedural, clinical, and imaging parameters and the diagnostic yield of CT-guided spinal biopsy. One hundred and two procedures performed in 87 patients with clinically suggested spondylodiscitis were analyzed retrospectively. Preprocedural magnetic resonance (MR) and CT images were evaluated regarding signal alterations, vertebral destruction, and soft-tissue involvement. The position of the biopsy needle in correlation with MR imaging findings was assessed. Patient characteristics and clinical details were noted. Parameters were compared in patients with positive and negative microbiological and histologic results. Following microbiologic and histologic analysis, infectious spondylodiscitis was diagnosed in 29 and 23 biopsies, respectively. Microbiology results were significantly higher in biopsy specimens with central needle positioning within contrast enhancing tissue in correlation with the MR images (36% vs. 7%; P= 0.005). Biopsy specimens positioned in fluid-equivalent hyperintense discs in T2-weighted sequences yielded significantly lower microbiology results (6% vs. 33%; P= 0.036). Purely lytic endplate destruction and mixed vertebral density as shown by CT increased microbiology results (60% vs. 24%; P= 0.028). Previous antibiotic treatment for any cause did not influence microbiology yields significantly (P= 0.232). MR imaging is mandatory to determine the optimal biopsy position. No clinical or imaging parameter could rule out a positive biopsy result and thus omit an unnecessary procedure. Biopsy should not be avoided if antibiotic treatment has previously been administered.

Mint Extract Present Antioxidant Action on the Erythrocytes of Dairy Cows Suffering from Mastitis?

<p>Bovine Mastitis is an infection of the mammary glands that represents important economic losses in milk production. As in other pathologies, medicinal plants emerged as an important alternative for treatment of this condition. In this sense, the aim of this study was to investigate the antioxidant activity of the extract of <em>Mentha arvensis</em> L. on the erythrocytes of healthy dairy cows (P1); of dairy cows with mastitis without previous treatment (P2); and of dairy cows with mastitis and previously treated with antibiotics (P3). The levels of Thiobarbituric Acid Reactive Substances (TBARS), of the protein carbonylation (PC) and reduced glutathione (GSH) were analyzed in the cows’ erythrocytes before and after treatment with the extract of Mentha. This study demonstrated an occurrence of oxidative stress in the cows with mastitis. The mint extract promoted an increase in GSH levels combined with a decrease in the levels of oxidative markers, especially in cows with mastitis without previous antibiotic treatment.</p>

Extended-spectrum β-lactamase-producing bacteria caused less than 5% of urinary tract infections in a paediatric emergency centre.

The last decade has seen a significant increase in extended-spectrum β-lactamase (ESBL) secreting organisms responsible for paediatric urinary tract infections (UTIs), particularly in community-acquired infections. These expose patients to the risks of antibiotic treatment failure and renal scarring. This prospective study examined the prevalence and risk factors of febrile ESBL UTIs and their treatment in the paediatric emergency department of a university hospital. In this prospective observational study, all children from 0 to 16 years of age with febrile UTIs were included from May 2012 to April 2013. Cases with and without ESBL involvement were compared. Of the 474 diagnosed febrile UTIs, 22 (4.6%) with a 95% confidence interval (95% CI) of 2.9-6.9 were due to an ESBL-producing organism. Escherichia coli was found in 85% of cases. Significant odds ratios (OR) for ESBL urinary tract infections were prior hospitalisation (OR 4.1, 95% CI 1.6-10.8), urinary tract abnormalities (OR 3.9, 95% CI 1.5-10.2) and previous antibiotic treatment (OR 3.1, 95% CI 1.2-8.8). All ESBL urinary tract infections had positive outcomes. The prevalence of febrile ESBL urinary tract infections was less than 5% in a paediatric emergency department. This low rate was not high enough to justify changing our guidelines.

A Compelling New Diagnostic Option for Identification of Orthopaedic Infections: Commentary on an article by M.C. Wyatt, BSc(Hons), MBChB, MRCS(Ed), FRACS(Tr&Orth), et al.: "The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection: A Systematic Review and Meta-Analysis".

Accurate diagnosis of periprosthetic joint infection (PJI) remains a clinical challenge, particularly in subacute or chronic infections, in patients with previous antibiotic treatment, and in the setting of a microbial species that does not easily or rapidly grow when cultured. Wyatt et al. have provided a welcome and balanced assessment of the diagnostic accuracy of 2 tests that may improve our ability to detect joint infection: enzyme-linked immunosorbent assay (ELISA) for alpha-defensins and leukocyte esterase colorimetric test strips. The authors quantitatively pooled data on sensitivities, specificities, and areas under the curves (AUCs) from 6 studies on alpha-defensins and 5 studies on leukocyte esterase colorimetric test strips. Only high-quality studies that used the Musculoskeletal Infection Society definition of PJI were included. The authors provide thorough background information on these tests. In brief, alpha-defensins, otherwise known as human neutrophil peptides, are small proteins found primarily within neutrophils and macrophages. They are released in the presence of pathogens and have antimicrobial function against bacteria, …

Bloodstream Infections in Hematological Cancer Patients Colonized By Multiresistant Bacteria: Results of a Multicentric Prospective Observational Seifem Study

▪Introduction. Incidence and mortality due to multiresistant (MR) bloodstream infections (BSI) are increasing in the last years among hematological patients (pts). Also rate of MR colonization seems to be relevant, but few data are available on the actual incidence of MR colonization and the probability of developing a BSI in hematological pts. In order to evaluate the incidence of MR bacterial colonization and the probability of developing MR BSI in hematological pts, we carried out a multicentric prospective observational study within the SEIFEM group.Patients and Methods. Since March 1st 2015, all cancer patients were screened at least for rectal swab at admission in 11 Hematology Centres participating to SEIFEM; culture of other sites were performed if clinically indicated. Patients showing MR bacterial colonization were recorded in a database where the occurrence of any BSI was correlated with age, gender, type and phase of haematological disease, stem cell transplantation (SCT), presence of invasive devices, type of colonizing bacteria.Results. During a 3-month period (March 1st -May 31st 2015), 75 pts with MR colonization were observed. Incidence was 9.8% among all admitted pts (75/764). Median age was 61y (range 20-81) and M/F ratio 46/29. Thirty-three pts were affected by acute leukemia (AL), 30 by lymphoma (Ly), 10 by myeloma (MM), 1 by myelofibrosis and 1 by aplastic anemia. Nineteen pts underwent SCT during the period of observation (11 autologous and 8 allogeneic, respectively). Vancomycin resistant enterococci (VRE) were responsible for colonization in 6 (8%) pts, extended spectrum β-lactamases producing (ESBL) enterobacteria in 29 (38.8%) and carbapenemase producing (CP) Gram-Negative Rods (GNR) in 49 (65.3%). Seven pts showed multiple colonizations. In 8 cases colonizing enterobacteria (6 E. coli, 1 E. cloacae, 1 P. mirabilis) were both ESBL and carbapenemase producers. Rectum was the most frequent site of colonization (70.7%). No risk factor for type of colonizing bacteria emerged except for previous intensive care unit stay for CP GNR colonization (p=0.02, chi-square test). Overall, 15 (20%) pts colonized with MR bacteria developed BSI by the same pathogen (MR related BSI) (1 VRE, 5 ESBL producing E. coli, 5 CP K. pneumoniae, 2 CP P. aeruginosa and 2 CP Acinetobacter spp). Therefore, rate of related BSI according to type of antibiotic resistance was 16.7% for VRE colonization, 17.2% for ESBL producing enterobacteria and 18.4% for CP GNR, respectively. Among CP enterobacteria, K. pneumoniae, but not other enterobacteria, was predictive of related BSI (25%). All but 2 related BSI occurred during neutropenia. At multivariate analysis, previous cephalosporin treatment was associated to related BSI (OR 0.25 [CI 0.07-0.91], p=0.03). Unrelated BSI were also observed in 15 pts (20%), including 3 MR BSI (2 CP P. aeruginosa and 1 CP K. pneumoniae). After a median follow-up of 61 days (range 30-116), 9 pts died (12%). Death was attributable to CP GNR related BSI in 3 pts. Multivariate analysis showed that CP GNR related BSI (OR 6.1, CI 1-36.2, p=0.04), together with a relapsed/refractory hematological disease (OR 10, CI 1.5-66.4, p=0.02) and presence of urinary catheter (OR 9.1, CI 1.3-62.1, p=0.02), was an independent predictor variable for death.Conclusions. Incidence of MR colonizing bacteria, particularly CP GNR, is quite high among hematological cancer pts and is associated with related BSI in a considerable proportion of them. Unrelated MR BSI may also occur. Previous antibiotic treatment with cephalosporins is a risk factor for MR related BSI and CP related BSI are predictive of death. Empiric antibiotic treatment should be planned taking into account these results. DisclosuresNo relevant conflicts of interest to declare.

Lyme disease in Poland – A serious problem?

PurposeWe evaluated the clinical picture of patients hospitalized with Lyme disease (LD). Additionally, we analyzed the possible cause of sudden rise in LD incidence in Poland. Materials and methodsWe retrospectively analyzed medical documentation of patients admitted to the Department of Infectious Diseases and Neuroinfections, Medical University in Bialystok in 2013 with suspicion of LD.The collected data featured patients’ age, gender, occupation, symptoms, clinical form of LD and final diagnosis. Additionally 38 patients with diagnosed LD and chronic joint pain, with no improvement after previous antibiotic treatment, completed the survey. ResultsIn 2013 overall 378 patients were admitted to our Department with suspicion of LD. Neuroborreliosis (NB) was confirmed in 10 out of 42 patients. Acrodermatitis chronica atrophicans (ACA) was confirmed in 5 cases. As far as patients with joint pains are concerned – in 4 cases Lyme arthritis (LA) was diagnosed, in 174 the serology and clinical symptoms indicated possibility of active infection, in 153 patients no features of active infection were found.The majority of surveyed patients had BMI over 25, they suffered from many chronic diseases, e.g. osteoarthrosis, hypertension, diabetes. ConclusionsThe reported incidence of LD in Poland, in our opinion, may be biased by overreporting and overdiagnosis. Nonspecific musculoskeletal and joint pain are the most frequent cause of LD suspicion and hospitalization. There is a necessity of better tests for active LD confirmation (especially in patients with musculoskeletal pain) as seroprevalence of anti Borrelia burgdorferi antibodies is high in endemic regions.

Leaking seroma following breast augmentation: technical fault or new complication?

Sir, Breast augmentation (BA) remains the most common aesthetical operation performedworldwide [1, 2]. It is considered as a simple, reliable procedure with a low complications rate. Early complications such as hematoma, seroma and infection are well known and were referenced in the scientific literature [3]. However, we have not found any published studies regarding early seroma, leaking through the surgical wound (leaking seroma). The goal of this letter is to describe leaking seroma (LS) as an early complication following breast augmentation, to present our thoughts regarding the etiology of LS, patients’ risk group, potential treatment and ways to prevent it. We reviewed 350 consecutive patients that underwent breast augmentation by the same surgeon (ABB) in a private medical center during the years 2007–2012. Breast fascial closure was performed with interrupted stitches in 172 patients (49.1 %) and with running interlocking stitches in 178 (50.9 %). Drainage was not used in any of the patients operated in this series. Medical files and operating records were extracted, and all data were statistically analyzed. We defined leaking seroma as a serous exudate discharging from surgical wound, ranging from spots on the dressing to massive fluid leak. Empirically, chosen regimen for treatment of LS, including oral antibiotic, iodine ointment dressing, non-steroidal anti-inflammatory drugs (NSAID), and complete patient rest, was employed. Seventeen patients (4.86 %) showed signs of leaking seroma, in 16 cases unilateral and in one case bilateral. Among 350 patients, two identical female twins were operated and both of them developed LS symptoms. The incidence of LS during the study period gradually decreased as shown in Table 1. Lag time between the operation date and first LS symptoms appearance varied from 5 to 50 days with mean value 15.9±11.6 days. In five patients with massive leak, the fluid from the wound was obtained for bacteriologic examination; in this group all bacterial cultures were sterile. LS treatment regimen included oral antibiotics (usually Ceftin 500 mg×2/day), iodine ointment dressings, nonsteroidal anti-inflammatory drugs (NSAID), and rest until the symptoms’ cessation. This treatment was successful in 13 out of 17 patients (76.5 %) and duration of their symptoms ranged from 3 to 20 days with mean value 8.6±4.8 days. Patients’ postoperative course was uneventful thereafter. The lack of data regarding LS in the plastic surgery literature can be explained by problematic definition of the subject. Usually, breast implant exposure and extrusion are the result of infection. It is very difficult to differentiate leaking seroma from sub-clinical infection. In our cases, the fluid discharge from the wound was serous and pellucid; all wound cultures obtained from patients with massive leak were sterile. Previous antibiotic treatment may have prevented bacterial growth and as a result, may lead to a negative bacterial culture. The lack of data can also be explained by under-reporting of postoperative complications in aesthetical plastic surgery due to the competitive character of the private plastic surgery sector. LS development can be explained by early tissue edema and exudate fluid accumulation around breast implant as a result of foreign body reaction. In some cases, excessive fluid production and non-infectious inflammatory reaction took place and caused partial wound dehiscence and subsequent LS. * Vasileios A. Pagkalos pagkalos_v@yahoo.gr

Outcomes and Risk Factors Associated with Clostridium difficile Diarrhea in Hospitalized Adult Patients.

Background. The epidemiology of Clostridium difficile infection has changed over time. Therefore, it is essential to monitor the characteristics of patients at risk of infection and factors associated with poor prognosis. Objective. To evaluate factors associated with C. difficile infection and with poor prognosis in those with documented C. difficile colitis. Methods. A retrospective case-control study of 75 patients with documented C. difficile colitis and 75 controls with hospital-acquired diarrhea of other causes. Stepwise multiple logistic regression was used to identify factors associated with C. difficile infection among patients with hospital-acquired diarrhea. Results. Previous antibiotic treatment (odds ratio (OR), 13.3; 95% confidence interval (CI), 1.40–126.90), abdominal distension (OR, 3.85; 95% CI, 1.35–10.98), and fecal leukocytes (OR, 8.79; 95% CI, 1.41–54.61) are considered as predictors of C. difficile colitis; anorexia was negatively associated with C. difficile infection (OR, 0.15; 95% CI, 0.03–0.66). Enteral tube feeding was independently associated with a composite outcome that included in-hospital mortality, intensive care unit admission, and treatment failure (OR, 3.75; 95%CI, 1.24–11.29). Conclusions. Previous antibiotic use and presence of fecal leukocytes in patients with hospital-acquired diarrhea are associated with C. difficile colitis and enteral tube support with complications associated with C. difficile colitis.

Staphylococcus aureus resistente a meticilina en un servicio de urgencias hospitalarias de un departamento de salud de la Comunidad Valenciana

ObjectiveTo determine the percentage of methicillin-resistant Staphylococcus aureus (MRSA) among patients admitted from an emergency department of the Hospital Lluís Alcanyís de Xàtiva (Valencia), Spain, from January to June 2012. MethodThe data were collected using a questionnaire with the following items: age, sex, personal history, previous antibiotic treatment, previous hospital admission, and origin. The emergency department doctors used swabs moistened with physiological saline (TranSystems® COPAN) to collect the material from the nasal cavity of the cited patients. ResultsA total of 120 patients with a high risk of MRSA colonisation were studied. Positive isolation of MRSA was detected in 19 (15.83%) patients, of whom 52.63% were women, with a median age of 66.6 years. Only 5 (26.31%) patients had taken antibiotics previously, 4 (21.05%) had a previous admission, 7 (36.84%) were from homes for the elderly, 12 (63.15%) were from home, 4 (21.05%) had morbid obesity, 9 (47.36%) suffered from diabetes mellitus, 6 (31.57%) with chronic obstructive pulmonary disease, and none of them were allergic to beta-lactams. ConclusionsThe proportion of infections due to MRSA was 16%. Active surveillance cultures must be considered in patients with a high risk of MRSA colonisation and admitted from emergency departments.

Comment on "A Case of Healthcare Associated Pneumonia Caused by Chryseobacterium indologenes in an Immunocompetent Patient".

I am writing regarding the publication of S. A. Nemil et al., “A Case of Healthcare Associated Pneumonia Caused by Chryseobacterium indologenes in an Immunocompetent Patient” [1]. In the published case report, the authors state that the patient acquired a Healthcare Associated Pneumonia (HAP) caused by Chryseobacterium indologenes. Notwithstanding that the patient had a HAP, the evidence that the infection was caused by C. indologenes is insufficient and could possibly be questionable. (a) According to the authors both E. coli and C. indologenes were isolated from a transtracheal aspirate (TTA) sample; however it is suggested that the infection was caused only by C. indologenes. (b) The transtracheal aspirate (TTA) samples are ideal for bacteriology investigation; however an organism growth on a single TTA sample is not proof of the pathogen that causes the infection. The interpretation of the relevance of bacterial growth depends on the pathogen and it is high if the isolate is a typical pathogenic organism that causes respiratory tract infection/chest infection and significantly low if the isolated organism is an uncommon bacterium (Chryseobacterium indologenes). Chryseobacterium indologenes is an opportunistic pathogen, not normally present in the human microflora, although it is widely distributed in nature. The patient was not immunocompromised and therefore is more susceptible to an organism with low pathogenicity. Important information regarding the microbiology culture growth (quantitative or semiquantitative) and presence of inflammation were not reported in the document in order to estimate the significance of the culture. The presence of two organisms on the same culture reduces further the clinical significance of the culture result. In addition the diagnostic utility of TTA is likely decreased in a patient with a chronic airway disease, such as bronchiectasis, in which case a false-positive culture result should be expected due to common colonization below the level of the larynx [2]. (c) According to the authors the antimicrobial susceptibility test revealed that the “C. indologenes was resistant to carbapenems and sensitive to levofloxacin. Levofloxacin was added to antimicrobial therapy on the 6th day of admission. On follow-up, after the second day of therapy modification, improvement on blood gas parameters was observed and the patient was extubated.” The authors speculate that the patient had an infection caused by C. indologenes due to the patient not responding to the previous antibiotic treatment. The patient's antimicrobial therapy was modified to ertapenem on the 3rd day of admission (when urine culture yielded ESBL and after 3 days treatment with piperacillin-tazobactam), possibly indicating that the patient was possibly close to or less than 72 hours on ertapenem treatment when levofloxacin was added. It would be interesting to know if the 82-year-old patient had hypoalbuminaemia. Hypoalbuminaemia is rarely considered in clinical decisions but ertapenem is highly albumin bound (85–95%) and data from multiple studies showed that hypoalbuminaemia may have a profound effect on pharmacokinetics (failure to attain pharmacodynamic targets) and therefore could possibly lead to treatment failure or a delayed clinical response [3, 4]. In addition a large proportion of C. indologenes isolates are susceptible to piperacillin-tazobactam (the patient was initially treated with piperacillin-tazobactam) [5, 6]; however the C. indologenes susceptibility to piperacillin-tazobactam is not documented. On conclusion, the interpretation of the relevance of bacterial growth of uncommon bacterium with low pathogenicity (C. indologenes) in transtracheal aspirates needs to be carefully interpreted, including clinical cases when there is a clear clinical improvement after targeted antimicrobial therapy to the uncommon bacterium has been applied.

Multiplex PCR performed of bronchoalveolar lavage fluid increases pathogen identification rate in critically ill patients with pneumonia: a pilot study.

BackgroundIn critically ill patients with pneumonia, accurate microorganism identification allows appropriate antibiotic treatment. In patients undergoing bronchoalveolar lavage (BAL), direct examination of the fluid using Gram staining provides prompt information but pathogen identification accuracy is low. Culture of BAL fluid is actually the reference, but it is not available before 24 to 48 h. In addition, pathogen identification rate observed with direct examination and culture is decreased when antibiotic therapy has been given prior to sampling. We therefore assessed, in critically ill patients with suspected pneumonia, the performance of a multiplex PCR (MPCR) to identify pathogens in BAL fluid. This study is a prospective pilot observation.MethodsWe used a MPCR detecting 20 types of microorganisms. Direct examination, culture, and MPCR were performed on BAL fluid of critically ill patients with pneumonia suspicion. The final diagnosis of infective pneumonia was retained after the medical chart was reviewed by two experts. Pathogen identification rate of direct examination, culture, and MPCR in patients with confirmed pneumonia was compared.ResultsAmong the 65 patients with pneumonia suspicion, the diagnosis of pneumonia was finally retained in 53 cases. Twenty nine (55%) were community-acquired pneumonia and 24 (45%) were hospital acquired. Pathogen identification rate with MPCR (66%) was greater than with culture (40%) and direct examination (23%) (p =0.01 and p <0.001, respectively). When considering only the microorganisms included in the MPCR panel, the pathogen identification rate provided by MPCR reached 82% and was still higher than with culture (35%, p <0.001) and direct examination (21%, p <0.001). Pathogen identification rate provided by MPCR was not modified in the case of previous antibiotic treatment (66% vs. 64%, NS) and was still better than with culture (23%, p <0.001).ConclusionsThe results of this pilot study suggest that in critically ill patients, MPCR performed on BAL fluid could provide higher identification rate of pathogens involved in pneumonia than direct examination and culture, especially in patients having received antimicrobial treatment.

Prevalence of risk factors for Clostridium difficile associated disease in Galați

Methods Retrospective study based on medical records of patients with CDAD admitted in our hospital between June 2013 June 2014. Diagnosis was based on clinical signs of gastroenteritis, fever and presence of C. difficile toxins A/B in stool (Vidas bioMerieux). Previous antibiotic treatment and duration, previous hospital exposure, abdominal surgery and PPI treatment, age and gender were considered. Statistical analysis: MedCalc.

Acute mastoiditis in children under 15 years of age in Southern Israel following the introduction of pneumococcal conjugate vaccines: A 4-year retrospective study (2009–2012)

ObjectivesTo describe the epidemiologic, microbiologic, clinical and therapeutic aspects of acute mastoiditis (AM) in children <15 years of age during the 4-year period (2009–2012) following the introduction of pneumococcal conjugate vaccines in Israel. Patients and methodsThe medical records of all children with a discharge diagnosis of AM were reviewed. ResultsA total of 66 AM episodes occurred in 61 patients. Forty-four (66.6%) cases occurred among patients <4 years, recent acute otitis media (AOM) history was reported in 27.1% and 28.8% patients received previous antibiotics for AOM. Postauricular swelling, postauricular sensitivity, protrusion of auricle and postauricular edema (93.8%, 90.6%, 85.9% and 95.7%, respectively) were the most common signs of AM. Leukocytosis >15000WBC/mm3 was found in 39 (59.1%) cases. Cultures were performed in 52/66 episodes (positive in 27, 51.92% episodes), with recovery of 32 pathogens. The most frequently isolated pathogens were Streptococcus pneumoniae (15/52, 28.85%), Streptococcus pyogenes (9, 17.3%) and nontypeable Haemophilus influenzae (5, 9.62%). Eight (53.3%) S. pneumoniae isolates were susceptible to penicillin. Mean incidence of overall and pneumococcal AM were 11.1 and 2.58 cases/100000, with no significant changes during the study years. Surgical intervention was required in 19 (28.8%) patients. Conclusions(1) AM occurs frequently in patients without previous AOM history and with no previous antibiotic treatment; (2) S. pneumoniae and S. pyogenes continued to be the main etiologic agents of AM during the postvaccination period; (3) No changes were recorded in overall AM incidence and in pneumococcal AM incidence during the postvaccination period.

Beta- lactam antibiotics stimulate biofilm formation in non-typeable haemophilus influenzae by up-regulating carbohydrate metabolism.

Non-typeable Haemophilus influenzae (NTHi) is a common acute otitis media pathogen, with an incidence that is increased by previous antibiotic treatment. NTHi is also an emerging causative agent of other chronic infections in humans, some linked to morbidity, and all of which impose substantial treatment costs. In this study we explore the possibility that antibiotic exposure may stimulate biofilm formation by NTHi bacteria. We discovered that sub-inhibitory concentrations of beta-lactam antibiotic (i.e., amounts that partially inhibit bacterial growth) stimulated the biofilm-forming ability of NTHi strains, an effect that was strain and antibiotic dependent. When exposed to sub-inhibitory concentrations of beta-lactam antibiotics NTHi strains produced tightly packed biofilms with decreased numbers of culturable bacteria but increased biomass. The ratio of protein per unit weight of biofilm decreased as a result of antibiotic exposure. Antibiotic-stimulated biofilms had altered ultrastructure, and genes involved in glycogen production and transporter function were up regulated in response to antibiotic exposure. Down-regulated genes were linked to multiple metabolic processes but not those involved in stress response. Antibiotic-stimulated biofilm bacteria were more resistant to a lethal dose (10 µg/mL) of cefuroxime. Our results suggest that beta-lactam antibiotic exposure may act as a signaling molecule that promotes transformation into the biofilm phenotype. Loss of viable bacteria, increase in biofilm biomass and decreased protein production coupled with a concomitant up-regulation of genes involved with glycogen production might result in a biofilm of sessile, metabolically inactive bacteria sustained by stored glycogen. These biofilms may protect surviving bacteria from subsequent antibiotic challenges, and act as a reservoir of viable bacteria once antibiotic exposure has ended.

Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: Systematic review and metaanalysis

ObjectiveTo determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia. DesignA systematic review of publications prospectively assessing the diagnostic role of PCT in ventilator-associated pneumonia was carried out. The search was performed using Medline, Embase, the Cochrane Collaboration and MEDION, with reviewing of the references of retrieved articles. We extracted data that allowed the calculation of sensitivity, specificity, likelihood ratios and diagnostic odds ratio. InterventionMetaregression was performed to determine whether exposure to previous antibiotic treatment, the time to occurrence of ventilator-associated pneumonia and the type of patients had an impact upon the diagnostic performance of procalcitonin. ResultsSeven studies were considered (373 patients, 434 episodes). We found no publication bias or threshold effect. High plasma PCT levels were associated to an increased risk of suffering ventilator-associated pneumonia (OR: 8.39; 95% CI: 5.4–12.6). The pooled data on sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio found were 76% (69–82), 79% (74–84), 4.35 (2.48–7.62), 0.26 (0.15–0.46) and 17.9 (10.1–31.7), respectively. Diagnostic yield was modified by prior exposure to antibiotics (rDOR 0.11, 0.02–0.069), but not by the type of critically ill patient or the time to occurrence of ventilator-associated pneumonia. ConclusionsOur results suggest that PCT provides additional information on the risk of VAP. Inclusion of PCT in diagnostic algorithms could improve their effectiveness.

Classification of healthcare-associated infection: a systematic review 10 years after the first proposal

BackgroundTen years after the first proposal, a consensus definition of healthcare-associated infection (HCAI) has not been reached, preventing the development of specific treatment recommendations. A systematic review of all definitions of HCAI used in clinical studies is made.MethodsThe search strategy focused on an HCAI definition. MEDLINE, SCOPUS and ISI Web of Knowledge were searched for articles published from earliest achievable data until November 2012. s from scientific meetings were searched for relevant abstracts along with a manual search of references from reports, earlier reviews and retrieved studies.ResultsThe search retrieved 49,405 references: 15,311 were duplicates and 33,828 were excluded based on title and abstract. Of the remaining 266, 43 met the inclusion criteria. The definition more frequently used was the initial proposed in 2002 - an infection present at hospital admission or within 48 hours of admission in patients that fulfilled any of the following criteria: received intravenous therapy at home, wound care or specialized nursing care in the previous 30 days; attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the previous 30 days; were hospitalized in an acute care hospital for ≥2 days in the previous 90 days, resided in a nursing home or long-term care facility. Additional criteria founded in other studies were: immunosuppression, active or metastatic cancer, previous radiation therapy, transfer from another care facility, elderly or physically disabled persons who need healthcare, previous submission to invasive procedures, surgery performed in the last 180 days, family member with a multi-drug resistant microorganism and recent treatment with antibiotics.ConclusionsBased on the evidence gathered we conclude that the definition initially proposed is widely accepted. In a future revision, recent invasive procedures, hospitalization in the last year or previous antibiotic treatment should be considered for inclusion in the definition. The role of immunosuppression in the definition of HCAI still requires ongoing discussion.

The use of antibiotics and their influence on course and outcome of bacterial meningitis in children before diagnosing it

Bacterial meningitis is a severe infective disease caused by different bacteria during which purulent pyorrhea is created in a subarachnoid space. In clinical terms, it is represented with the appearance of meningeal symptoms and signs. Neither recent years' success accomplished in treatment of bacterial meningitis nor the best organized treatment provide an optimistic prognosis in sick children. Our research was conducted in 91 children with bacterial meningitis. Before diagnosing bacterial meningitis, 50 patients ( 54.9% ) were treated with antibiotic therapy. In this group, 21 patients ( 42% ) showed complications in disease manifested with convulsions in 13 patients (26 % ). In the same group, 29 patients ( 58 % ) had a complete recovery after the treatment while 8 patients ( 16 % ) had sequele. In 41 patients ( 45 % ) without previous antibiotic treatment, complications are registered in 25 patients ( 60.9 % ) as follows: 18 patients ( 43.9 % ) had early complications while 7 patients ( 17.1 % ) had sequele. 16 patients ( 39 % ) had a complete recovery in this group. Complications and sequele are more common in the group of sick children without antibiotic therapy before diagnosing bacterial meningitis. However, the presence of sequele in the group of children which were treated with antibiotics before completed diagnostics showed that treatment of bacterial meningitis must be done in a more effective way as well as an early antibiotics treatment.

Impact of enterococcal colonization and infection in solid organ transplantation recipients from the Swiss Transplant Cohort Study

The burden of enterococcal infections has increased over the last decades with vancomycin-resistant enterococci (VRE) being a major health problem. Solid organ transplantation is considered as a risk factor. However, little is known about the relevance of enterococci in solid organ transplantation recipients in areas with a low VRE prevalence. We examined the epidemiology of enterococcal events in patients followed in the Swiss Transplant Cohort Study between May 2008 and September 2011 and analyzed risk factors for infection, aminopenicillin resistance, treatment, and outcome. Of the 1234 patients, 255 (20.7%) suffered from 392 enterococcal events (185 [47.2%] infections, 205 [52.3%] colonizations, and 2 events with missing clinical information). Only 2 isolates were VRE. The highest infection rates were found early after liver transplantation (0.24/person-year) consisting in 58.6% of Enterococcus faecium. The highest colonization rates were documented in lung transplant recipients (0.33/person-year), with 46.5% E. faecium. Age, prophylaxis with a betalactam antibiotic, and liver transplantation were significantly associated with infection. Previous antibiotic treatment, intensive care unit stay, and lung transplantation were associated with aminopenicillin resistance. Only 4/205 (2%) colonization events led to an infection. Adequate treatment did not affect microbiological clearance rates. Overall mortality was 8%; no deaths were attributable to enterococcal events. Enterococcal colonizations and infections are frequent in transplant recipients. Progression from colonization to infection is rare. Therefore, antibiotic treatment should be used restrictively in colonization. No increased mortality because of enterococcal infection was noted.

Group A Streptococcus pharyngitis outbreak among university students in a judo club

We report on an outbreak of Group A Streptococcus (GAS) pharyngitis among university students in a judo club. Eventually, 14 of total 23 club members developed acute pharyngitis clinically. In a span of 15 days in April 2013, 12 students visited our hospital complaining of sore throat and high fever. All were men with a median age of 19.5 years (interquartile range, 18-21). The rapid streptococcal antigen test was positive in 3 of 4 patients (75%) without previous antibiotic treatment, and in 2 of 8 patients (25%) with previous antibiotic treatment. The definitive diagnosis of GAS pharyngitis was made by either a positive RADT or positive throat culture of GAS when patients had more than 2 findings from the Centor scoring system in this study. 5 students received the definitive diagnosis. The throat culture results showed that 1 out of 9 asymptomatic students was GAS-positive. The outbreak might have occurred by person-to-person contact while living in a dormitory and during judo training, which is a highly close-contact sport. However, there was also the possibility of oral transmission by the shared use of water bottles, although the culture from 1 bottle was negative. Some students continued to participate in the judo club activities after the onset of sore throat or fever. Healthcare professionals, teachers, and coaches should be aware of the potential outbreaks of infectious diseases among university students engaged in athletic activities. Furthermore, it is important to educate athletes about infectious diseases.

Invasive device-related infections after heart surgery

Abstract Objective To analyze postoperative infections in critically ill patients undergoing heart surgery. Setting Intensive care units (ICUs). Design An observational, prospective, multicenter study was carried out. Patients Patients in the postoperative period of heart surgery admitted to the ICU and included in the ENVIN-HELICS registry between 2005 and 2011. Main outcome variables Mechanical ventilation associated pneumonia (MVP), urinary catheter-related infection (UCI), primary bacteremia (PB), PB related to vascular catheters (PB-VC) and secondary bacteremia. Results Of a total of 97,692 patients included in the study, 9089 (9.3%) had undergone heart surgery. In 440 patients (4.8%), one or more infections were recorded. Infection rates were 9.94 episodes of MVP per 1000 days of mechanical ventilation, 3.4 episodes of UCI per 1000 days of urinary catheterization, 3.10 episodes of BP-VC per 1000 days of central venous catheter, and 1.84 episodes of secondary bacteremia per 1000 days of ICU stay. Statistically significant risk factors for infection were ICU stay (odds ratio [OR] 1.18, 95%CI 1.16–1.20), APACHE II upon admission to the ICU (OR 1.05, 95%CI 1.03–1.07), emergency surgery (OR 1.67, 95%CI 1.13–2.47), previous antibiotic treatment (OR 1.38, 95%CI 1.04–1.83), and previous colonization by Pseudomonas aeruginosa (OR 18.25, 95%CI 3.74–89.06) or extended spectrum beta-lactamase producing enterobacteria (OR 16.97, 95%CI 5.4–53.2). The overall ICU mortality rate was 4.1% (32.2% in patients who developed one or more infections and 2.9% in uninfected patients) (p Conclusions Of the patients included in the ENVIN-HELICS registry, 9.3% were postoperative heart surgery patients. The overall mortality was low but increased significantly in patients who developed one or more infection episodes.