Frecuencia de Bacilos Gram Negativos en la cavidad bucal de estudiantes de una Universidad de Asunción

Introducción: La cavidad bucal hospeda una gran cantidad de microorganismos, como los bacilos Gram negativos, y entre ellas, bacterias de gran importancia médica debido a su capacidad de producir enfermedades graves para el ser humano, especialmente en pacientes inmunodeprimidos. El objetivo de este trabajo fue determinar la presencia de Bacilos Gram Negativos y sus patrones de resistencia a antibióticos, en una población estudiantil de la ciudad de Asunción, en los años 2019 y 2020. Materiales y métodos: Se realizó un estudio observacional, descriptivo de corte transversal, donde se realizaron hisopados de la cavidad bucal a 35 alumnos de entre 18 a 24 años, de una universidad privada en la ciudad de Asunción. Se requirió consentimiento informado firmado por los participantes y fueron excluidos quienes tuvieron tratamientos antibióticos. Las muestras fueron obtenidas con un hisopo de algodón, posteriormente se colocaron en un medio de transporte para luego ser cultivadas en Agar MacConkey. El cultivo se realizó por 48 horas a 37° centígrados, luego se procedió a la identificación bacteriana. Por último, se realizó el antibiograma. Resultados: De los 35 alumnos se encontró una frecuencia de 48,57% de bacilos Gram negativos. Cepas de Klebsiella pneumoniae fueron las más frecuentes (35,29%). Se observó que las bacterias eran altamente resistentes a la Amoxicilina/Ácido Clavulánico. Conclusiones: La presencia de estos tipos de microorganismos puede ser peligrosa para la salud general de las personas, específicamente de los pacientes con algún tipo de inmunodepresión, debido a la gran la resistencia a antibióticos presentadas por algunas cepas.

Introduction: The oral cavity hosts a large number of microorganisms, such as Gram negative bacilli, and among them, bacteria of great medical importance due to their capacity to cause serious diseases for humans, especially in immunosuppressed patients. The objective of this work was to determine the presence of Gram Negative Bacilli and their patterns of resistance to antibiotics, in a student population of the city of Asunción, in the years 2019 and 2020. Materials and methods: An observational, descriptive cross-sectional study was carried out, where oral cavity swabs were made from 35 students between 18 and 24 years of age, from a private university in the city of Asunción. Informed consent signed by the participants was required and those who had antibiotic treatments were excluded. The samples were obtained with a cotton swab, later they were placed in a transport medium to later be cultured in MacConkey Agar. The culture was carried out for 48 hours at 37° Celsius, then the bacterial identification was carried out. Finally, the antibiogram was performed. Results: Of the 35 students, a frequency of 48,57% of Gram negative bacilli was found. Klebsiella pneumoniae strains were the most frequent (35.29%). The bacteria were found to be highly resistant to Amoxicillin/Clavulanic Acid. Conclusions: The presence of these types of microorganisms can be dangerous for the general health of people, specifically of patients with some type of immunosuppression, due to the great resistance to antibiotics presented by some strains.

Infección urinaria de presentación atípica: caso clínico y revisión de literatura

Introducción: el síndrome de orina púrpura es una presentación clínica poco frecuente en el ámbito de urgencias, caracterizado por coloración anormal de la orina secundaria a una reacción química de algunos patógenos que producen infección de vías urinarias, siendo más frecuente en pacientes con múltiples comorbilidades y diferentes factores de riesgo. Objetivo: el objetivo de este manuscrito es presentar el caso de un paciente con síntomas atípicos de infección de vías urinarias. Presentación del caso: varón de 88 años de edad, con antecedente de diabetes mellitus no insulino-requiriente, con hiperplasia prostática benigna que ingresó al servicio de urgencias por síntomas irritativos urinarios asociados a uso de sonda vesical, con orina de coloración violeta en bolsa recolectora. El urocultivo reportó la presencia de Proteus vulgaris multisensible, por lo que se decidió dar manejo con cefepima de 1 gr cada ocho horas, con lo cual se obtuvo una adecuada evolución clínica. Discusión y conclusión: el síndrome de la bolsa de orina púrpura es una presentación clínica atípica, pero muy llamativa de la infección urinaria. Esta se genera como resultado de la conversión del triptófano en la dieta en indoxil sulfato que, una vez se elimina por la orina, se transforma en índigo (color violeta) e indirrubina (color rojo), dando este aspecto clínico.

Background: Purple urine syndrome is a rare clinical presentation in the emergency room, characterized by abnormal colouration of the urine secondary to a chemical reaction of some pathogens that cause urinary tract infection, being more frequent in patients with multiple comorbidities and different risk factor's. Purpose: The objective of the article is present the case of a patient with atypical symptoms of urinary tract infection. Clinical case: An 88-year-old male, with a history of non-insulin diabetes mellitus, benign prostatic hyperplasia, who was admitted to the emergency room due to irritative urinary symptoms associated with the use of a urinary catheter, with purple urine in a collection bag. Urine culture reported the presence of multisensitive Proteus vulgaris, for which it was decided to give treatment with Cefepime 1 g every 8 hours, with which it was obtained with adequate clinical evolution. Conclusions: Purple urine bag syndrome is an atypical but very striking clinical presentation of urinary tract infection. This is generated as a result of the conversion of tryptophan in the diet into indoxyl sulfate, which, once it is eliminated in the urine, transforms into indigo (purple color) and indirubin (red color), giving this clinical appearance.

Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli

ABSTRACT Background: There are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI. Methods: We searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software. Results: A total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate). Conclusions: There are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.

Factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de Cartagena-Colombia / Prognostic factors for mortality caused by an infectious agent in a high complexity hospital in Cartagena-Colombia

Introducción: La identificación de los principales factores clínico-epidemiológicos que determinan causas de mortalidad en pacientes hospitalizados es una necesidad apremiante, principalmente cuando los esfuerzos realizados en la actualidad no permiten asumir acciones fundamentadas en la identificación de las causas de dicho evento. Objetivo: Establecer cuáles son los factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de la ciudad de Cartagena- Colombia. Material y Métodos: Se realizó un estudio de casos y controles retrospectivo, con muestra proyectada de 86 casos y 258 controles, en una relación 1:3, que cumplieron con los criterios de elegibilidad respectivos y en los que realizaron análisis bivariados y posteriormente un análisis multivariado que incluyó métodos de regresión logística binaria. Resultados: El riesgo de mortalidad en el análisis multivariado está determinado por variables como sexo masculino (ORa 1,695 IC 95 por ciento: 1,005-2,856); Cáncer (ORa 2,389 IC 95 por ciento 1,230-4,642); inmunosupresión (ORa 3,211 IC 95 por ciento 1,004-10,26); Ventilación mecánica (ORa 2,541 IC 95 por ciento 1,128-5,722); Estancia en la UCI (ORa 2,331 IC 95 por ciento1,227-4,425) e Infección por bacterias productoras de carbapenemasas (ORa 4,778 IC95 por ciento 1,313-17,38). Conclusiones: En pacientes masculinos con cáncer o cualquier otra forma de inmunosupresión, en los que se requiera el uso del ventilador mecánico o estancia en la unidad de cuidado intensivo y que además desarrollen infecciones por bacterias productoras de carbapenemasas existe mayor riesgo de muerte por agente infeccioso(AU)

Introduction: The identification of the main epidemiological clinical factors that determine the causes of mortality in hospitalized patients is a pressing need, mainly when the efforts made at present do not allow us to take actions based on the identification of the causes of the aforementioned event. Objective: To identify the prognostic factors for mortality caused by infectious agents in a high complexity hospital in the city of Cartagena, Colombia. Material and Methods: A retrospective case-control study was conducted in 86 cases and 258 control samples that met the eligibility criteria, at the 1: 3 ratio. Bivariate analyses and a subsequent multivariate analysis that included binary logistic regression methods were also performed. Results: In the multivariate analysis, the risk of mortality is determined by variables such as male sex (ORa 1,695 95 percent CI: 1.005-2.856); cancer (ORa 2,389 95 percent CI 1,230-4,642); immunosuppression (ORa 3.211 95 percent CI 1.004-10.26); mechanical ventilation (ORa 2.541 95 percent CI 1.128-5.722); stay in the ICU (ORa 2,331 95 percent CI 1,227-4,425) and infection caused by carbapenemase-producing bacteria (ORa 4,778 95 percent CI 1,313-17.38). Conclusions: Male patients with cancer or any other form of immunosuppression who require the use of a mechanical ventilator or admission to the intensive care unit who also develop infections caused by carbapenemase-producing bacteria, are at greater risk of death from an infectious agent(AU)

Rrisk factors, pathogenic bacteria and drug resistance of postoperative surgical site infection in patients with Crohn's disease / 中华普通外科杂志

Objective:To analyze the risk factors for postoperative surgical site infections (SSIs) in patients with Crohn's disease (CD).Methods:This retrospective observational study included CD patients undergoing bowel resection between July 2015 and July 2018. The prevalence and risk factors of SSIs were evaluated. The microbiological evaluation from patients with SSIs was performed by bacterial culture and drug sensitivity test.Results:There were 66 patients suffering SSIs, with 41 incisional SSIs and 32 organ/space SSIs. Multivariate analysis identified the preoperative infliximab therapy ( OR 2.338,95% CI 1.192-4.587, P=0.013), laparoscopic surgery ( OR 0.460,95% CI 0.226-0.936, P=0.013), and preoperative white blood cell ( OR 2.008,95% CI 1.018-3.961, P=0.044) as independent factors for SSIs. Fifty-nine strains of pathogenic bacteria were detected in 66 cases of CD combined with SSIs, including 36 strains of gram-negative bacteria, 5 strains of gram-positive bacteria, and 2 strains of fungi. Escherichia coli and Klebsiella pneumoniae were main G - bacteria, with high resistance to common used antibiotics. Enterococcus faecalis and Enterococcus faecium were main G -. 62.1% of the SSIs grew extended-spectrum β-lactamase (ESBL)-producing pathogens in their bacteria cultures and 37.9% grew non-ESBL microbes. Conclusion:The incidence of SSIs was higher in CD patients. Preoperative infliximab therapy, preoperative white blood cell, and laparoscopic surgery were predictors of SSIs.

Delftia acidovorans pneumonia with lung cavities formation / Neumonia con formación de cavidades pulmonares causada por Delftia acidovorans

Abstract Case Description: A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years. Clinical Finding: Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm3 and Platelet counts were 29,000 mm3. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system. Treatment and outcomes: The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up. Clinical Relevance: This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.

Resumen Descripción del caso: Una mujer de 52 años llegó a la clínica con tos, esputo, fiebre y fatiga. El paciente estuvo recibiendo terapia inmunosupresora durante 5 años para el tratamiento de la púrpura trombocitopénica. Hallazgo clínico: se escucharon crepitaciones inspiratorias en ambos hemitórax. La saturación de oxígeno fue del 97%. La radiografía de tórax mostró opacidades reticulares difusas que eran más prominentes en las zonas superiores de ambos pulmones. Los recuentos de leucocitos fueron de 17,600 mm3 y los recuentos de plaquetas fueron de 29,000 mm3. La TC de tórax mostró muchas cavidades de pared delgada y nódulos milimétricos acompañados de infiltrados vitrales en los lóbulos superior y medio. La tinción de Gram del líquido bronquial reveló bacilos gramnegativos y leucocitos polimorfonucleares. Las bacterias fueron identificadas como Delftia acidovorans. Tratamiento y resultados: La paciente fue hospitalizado con una sospecha de infección oportunista pulmonar y enfermedad pulmonar cavitaria. Después del tratamiento empírico de piperacilina-tazobactam intravenosa y claritromicina oral, los síntomas y signos retrocedieron significativamente, y fue dada de alta con seguimiento ambulatorio. Relevancia clínica: este es el primer registro de neumonía cavitaria causado por Delftia acidovorans en una paciente inmunocomprometida. Enfatizamos que la neumonía por Delftia debe considerarse en el diagnóstico diferencial de la afectación de la cavidad pulmonar en tales pacientes.

Klebsiella variicola and Klebsiella quasipneumoniae with capacity to adapt to clinical and plant settings / Klebsiella variicola y Klebsiella quasipneumoniae con capacidad para adaptarse al ambiente clínico y a las plantas

Abstract: Objective: To compare the genetic determinants involved in plant colonization or virulence in the reported genomes of K. variicola, K. quasipneumoniae and K. pneumoniae. Materials and methods: In silico comparisons and Jaccard analysis of genomic data were used. Fimbrial genes were detected by PCR. Biological assays were performed with plant and clinical isolates. Results: Plant colonization genes such as cellulases, catalases and hemagglutinins were mainly present in K. variicola genomes. Chromosomal β-lactamases were characteristic of this species and had been previously misclassified. K. variicola and K. pneumoniae isolates produced plant hormones. Conclusions: A mosaic distribution of different virulence- and plant-associated genes was found in K. variicola and in K. quasipneumoniae genomes. Some plant colonizing genes were found mainly in K. variicola genomes. The term plantanosis is proposed for plant-borne human infections.

Resumen: Objetivo: Comparar genes de colonización de plantas o de virulencia en los genomas reportados de K. variicola, K. quasipneumoniae y K. pneumoniae. Material y métodos: Se utilizaron análisis in silico y de Jaccard. Por PCR se detectaron genes de fimbrias. Se realizaron ensayos biológicos con aislados de plantas y clínicos. Resultados: Los genes de colonización de plantas como celulasas, catalasas y hemaglutininas se encontraron principalmente en genomas de K. variicola. Las β-lactamasas cromosómicas son características de la especie y en algunos casos estaban mal clasificadas. K. variicola y K. pneumoniae producen hormonas vegetales. Conclusiones: Se encontró una distribución en mosaico de los genes de asociación con plantas y de virulencia en K. variicola y K. quasipneumoniae. Principalmente en K. variicola se encontraron algunos genes involucrados en la colonización de plantas. Se propone el término plantanosis para las infecciones humanas de origen vegetal.

Genome misclassification of Klebsiella variicola and Klebsiella quasipneumoniae isolated from plants, animals and humans / Clasificación errónea de aislados de Klebsiella variicola y Klebsiella quasipneumoniae obtenidos de plantas, animales y humanos

Abstract: Objective: Due to the fact that K. variicola, K. quasipneumoniae and K. pneumoniae are closely related bacterial species, misclassification can occur due to mistakes either in normal biochemical tests or during submission to public databases. The objective of this work was to identify K. variicola and K. quasipneumoniae genomes misclassified in GenBank database. Materials and methods: Both rpoB phylogenies and average nucleotide identity (ANI) were used to identify a significant number of misclassified Klebsiella spp. genomes. Results: Here we report an update of K. variicola and K. Quasipneumoniae genomes correctly classified and a list of isolated genomes obtained from humans, plants, animals and insects, described originally as K. pneumoniae or K. variicola, but known now to be misclassified. Conclusions: This work contributes to recognize the extensive presence of K. variicola and K. quasipneumoniae isolates in diverse sites and samples.

Resumen: Objetivo: Identificar genomas mal clasificados de K. variicola, y K. quasipneumoniae en la base de datos del GenBank. Material y métodos: En el presente estudio se usaron tanto análisis filogenéticos usando rpoB como la identidad media de nucleótidos (ANI, por sus siglas en ingles) para identificar un número significativo de genomas del género Klebsiella. Resultados: Se reportó una actualización de genomas de K. variicola y K. quasipneumoniae correctamente clasificados y una lista de aquellos aislamientos obtenidos de seres humanos, plantas, animales e insectos, descritos originalmente como K. pneumoniae o K. variicola pero ahora se conoce que están mal clasificados. Conclusiones: Este trabajo contribuye a la presencia extensiva de aislamientos de K. variicola y K. quasipneumoniae en diversos sitios y muestras.

Analysis of the characteristics of multi-drug resistant acinetobacter baumannii infection in elderly patients with severe respiratory / 中华老年医学杂志

Objective To investigate the clinical characteristics of multiple drug resistant Acinetobacter baumannii infection in respiratory elderly patients.Methods A total of 102 elderly patients infected with multidrug-resistant Acinetobacter baumannii were enrolled in our hospital from January 2014 to December 2015.At the same time,no multiple drug-resistant Acinetobacter baumannii infection elderly patients was selected as a control group.The gender,age,antimicrobial use,white blood cell count,mechanical ventilation time and other differences between the two groups of elderly patients were compared.Results There were significant differences in the days of hospitalization [(18.7±7.5) d vs.(10.0±2.7)d],the time of application of invasive ventilator[(24.6±10.3) d vs.(11.6±6.9)d] and the time of application of antimicrobial agents[(26.2±13.1) d vs.(8.0±2.6)d] (t=19.463、15.436、26.905,all P＜ 0.05).There was no significant difference in immunosuppressant use,white blood cell count,serum protein level and APACHEⅡ score (all P＞0.05).Conclusions Reasonable scientific application of antimicrobial agents,reducing invasive mechanical ventilation time and improving patient immunity can help to reduce the risk of respiratory infection in elderly patients with multiple drug resistance to Acinetobacter baumannii.

Results of high-risk neutropenia therapy of hematology-oncology patients in a university hospital in Uruguay

Background: Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia. Methods: A retrospective cohort study (2011-2012) was conducted of patients with high-risk neutropenia in a hematology-oncology service. Results: Forty-four episodes of 17 patients with a median age of 48 years (range: 18-78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia iso- lated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%. Conclusion: The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (frontline antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol. .

Acinetobacter spp. e Pseudomonas aeruginosa resistentes aos carbapenêmicos no Hospital Universitário de Santa Maria, Rio Grande do Sul / Carbapenem-resistant Acinetobacter spp. and Pseudomonas aeruginosa at the University Hospital of Santa Maria, Rio Grande do Sul state, Brazil

Objetivos: Avaliar as características de sensibilidade a antimicrobianos de Acinetobacter spp. e Pseudomonas aeruginosa resistentes aos carbapenêmicos, isolados entre agosto de 2011 a janeiro de 2012 de pacientes internados no Hospital Universitário de Santa Maria, na cidadede Santa Maria, Rio Grande do Sul, Brasil.Métodos: Foi realizado um estudo retrospectivo através da consulta ao banco de dados do Laboratório de Microbiologia, onde foram incluídos todos os isolados de Acinetobacter spp. e P. aeruginosa provenientes de diferentes espécimes clínicos coletados de pacientes internados que apresentaram resistência ou perfil intermediário aos antimicrobianos carbapenêmicos de uso neste nosocômio (imipenem, meropenem e ertapenem) verificados através de metodologia convencional pela técnica de difusão do disco (Kirby-Bauer) ou metodologia automatizada (MicroScan® ? Siemens) de acordo com as normas preconizadas pelo Clinical and Laboratory Standards Institute.Resultados: No período estudado foram encontradas 58 amostras de bacilos Gram-negativos não fermentadores resistentes aos carbapenêmicos, sendo 32 do gênero Acinetobacter e 26 P. aeruginosa. Acinetobacter spp. foi mais isolado na Unidade de Tratamento Intensivo, enquanto P. aeruginosa prevaleceu no Pronto Atendimento e no Ambulatório. Ambos os microrganismos provieram principalmente de secreções respiratórias.Conclusões: Neste estudo Acinetobacter spp. e P. aeruginosa apresentaram elevada resistência aos antimicrobianos. A polimixina B mostrou-se um bom antimicrobiano para o tratamento de infecções por microrganismos resistentes aos carbapenêmicos neste nosocômio.

Aims: To evaluate the characteristics of antimicrobial susceptibility of carbapenem-resistant Acinetobacter spp. and Pseudomonas aeruginosaisolated from August 2011 to January 2012 from inpatients at the University Hospital of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.Methods: A retrospective study was conducted by consulting the database of the Microbiology Laboratory, which included all isolates ofAcinetobacter spp. and P. aeruginosa from different clinical specimens collected from hospitalized patients who had resistant or intermediate profile to carbapenemic antimicrobials used in this hospital (imipenem, meropenem and ertapenem) verified through conventional methodologyby disc diffusion (Kirby-Bauer) or automated method (MicroScan® ? Siemens) according to the standards recommended by the Clinical andLaboratory Standards Institute.Results: In the studied period 58 samples of nonfermenters Gram-negative bacilli resistant to carbapenems were found, 32 of the genus Acinetobacter and 26 of P. aeruginosa. Acinetobacter spp. was more isolated in the intensive care unit, while P. aeruginosa prevailed in the emergency and outpatient departments. Both microorganisms came mainly from respiratory secretions.Conclusions: In this study, Acinetobacter spp. and P. aeruginosa showed high antimicrobial resistance. Polymyxin B was a good antimicrobial for the treatment of infections caused by microorganisms resistant to carbapenems in this hospital.

Delta Neutrophil Index as a Prognostic Marker of Early Mortality in Gram Negative Bacteremia / 감염과화학요법

BACKGROUND: Sepsis is a syndrome that results in high morbidity and mortality. We investigated the delta neutrophil index (DN) as a predictive marker of early mortality in patients with gram-negative bacteremia. MATERIALS AND METHODS: We conducted a retrospective study at a tertiary referral hospital in South Korea from November 2010 to March 2011. The DN was measured at onset of bacteremia and 24 hours and 72 hours later. The DN was calculated using an automatic hematology analyzer. Factors associated with 10-day mortality were assessed using logistic regression. RESULTS: A total of 172 patients with gram-negative bacteremia were included in the analysis; of these, 17 patients died within 10 days of bacteremia onset. In multivariate analysis, Sequental organ failure assessment scores (odds ratio [OR]: 2.24, 95% confidence interval [CI]: 1.31 to 3.84; P = 0.003), DN-day 1 > or = 7.6% (OR: 305.18, 95% CI: 1.73 to 53983.52; P = 0.030) and DN-day 3 > or = DN-day 1 (OR: 77.77, 95% CI: 1.90 to 3188.05; P = 0.022) were independent factors associated with early mortality in gram-negative bacteremia. Of four multivariate models developed and tested using various factors, the model using both DN-day 1 > or = 7.6% and DN-day 3 > or = DN-day 1 was most predictive early mortality. CONCLUSIONS: DN may be a useful marker of early mortality in patients with gram-negative bacteremia. We found both DN-day 1 and DN trend to be significantly associated with early mortality.

Clinical Features and Antibiotic Sensitivity of Gram-Negative Diabetic Foot Osteomyelitis / 天津医药

Objective To investigate the clinical features and antibiotic susceptibility of osteomyelitis infected by Gram-negative bacteria (G-) in patients suffered from diabetic foot ulcers (DFU). Methods The clinical data of 91 DFU pa-tients accompanied with osteomyelitis (DFO) were retrospective studied. These patients hospitalized in the Tianjin Metabolic Diseases Hospital were divided into two groups, Gram-negative bacteria (G-) group (n=44) and Gram-positive bacteria (G+) group (n=42), respectively. The clinical features were compared between two groups. Logistic regression analysis was used to determine the risk factors for Gram-negative bactreial infection. The Gram-negative antibiogram was summarized. Results A total of 112 pathogens were isolated from 91 patients. G-bacteria were the most frequent pathogens (48.2%), following by G+ bacteria (47.3%) and fungi (4.5%). Pseudomonas aeruginosa was the majority of the G-bacteria. Comparing the two groups, the rate of antibiotic use within the previous 6 months was significantly higher in G-group (75.0%) than that of G+group (52.4%, P<0.05). There were no significant differences in the other indicators between two groups. The Logistic re-gression analysis revealed that the history of antibiotic use was the independent risk factor of G-bacterial infections in DFO patients. Antibiotics susceptibilities reflected G- bacteria were more prevalent to resist to cephalosporins and quinolonem, but sensitive to imipenem, ceftazidine and cefperazone-sulbactam. Conclusion Gram negative bacteria were not only the main pathogens isolated from DFO patients, but also frequently resistant to several popular antibiotics in China. The proper bacteria culture and antibiotic sensitivity test are especially emphasized to patients with DFU.

Gram-negative osteomyelitis: clinical and microbiological profile

INTRODUCTION: Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature. OBJECTIVES AND METHODS: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo. RESULTS: Most patients were men (63 percent), with median age of 42 years, affected by chronic osteomyelitis (43 percent) or acute osteomyelitis associated to open fractures (32 percent), the majority on the lower limbs (71 percent). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60 percent, relapse 19 percent, amputation 7 percent, and death 5 percent. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25 percent), Acinetobacter baumannii (21 percent) e Pseudomonas aeruginosa (20 percent). Susceptibility to carbapenems was about 100 percent for Enterobacter sp., 75 percent for Pseudomonas aeruginosa and 60 percent for Acinetobacter baumannii. CONCLUSION: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

Therapeutic strategy for the management of multidrug-resistant gram-negative bacterial infections

Over the past decade, infections caused by antimicrobial-resistant bacteria have increased and continued to challenge physicians. Recent data show rapidly increasing rates of infection due to multidrug-resistant (MDR) gram-negative bacilli. Furthermore, pandrug-resistant infections now occur, especially due to gram-negative bacilli, and our therapeutic options for these pathogens are extremely limited. Infection caused by MDR bacteria was associated with a greater likelihood of inappropriate antimicrobial therapy, and inappropriate antimicrobial therapy has an adverse effect on survival in patients with serious infections. Consequently, it may be presumed that serious infections caused by MDR bacteria have a worse prognosis because of the delay in initiation of appropriate antimicrobial therapy. Empirical antibiotics for serious infections should be recommended on the basis of the distribution of pathogens and their susceptibility patterns in the institution where the regimen is administered. Therefore, physicians who are caring for patients with bacterial infection should be familiar with local antimicrobial susceptibility patterns and the epidemiology of MDR bacterial infections, in order to improve the treatment outcome of the patients. This comprehensive review aims to describe the epidemiology and clinical implications of MDR gram-negative bacterial infections in Korea, a country with a high prevalence of antimicrobial-resistant pathogens.

Resistance rate and epidemiology of gram-negative bacilli in bloodstream infection after liver transplantation / 中华器官移植杂志

ObjectiveTo define the resistance rate and epidemiology of Gram-negative bacilli (GNB) of bloodstream infections (BSI) after liver transplantation. MethodsFrom Jan. 1998 to Dec.2009,a retrospective analysis of GNB in liver transplants was conducted. Bacterial, CMV and fungal infections were prevented by piperacillin/tazobactam, ganciclovir, fluconazole postoperatively. Bacterial inoculation,isolation and culture were mandated by national test standard. Vitek 2 Compact was used to evaluate identification and antimicrobial susceptibility testing. ResultsEighty-eight BSI occurred in 83 patients of the 768 patients,in which a total of 88 GNB were isolated. The incidence was 10. 8 ％(83/768) ,and the most frequent pathogens were Escherichia coli (37 strains) and Klebsiella spp (18strains). The rate of infection (23. 9 ％) was high in the interval of 1998-2000, and then decreased to 12. 4 ％ or below. Carbapenems and Piperacillin/tazobactam were the most consistently active against the Escherichia coli and Klebsiella spp, while resistance rate of Escherichia coli to Ciprofloxacin,Gentamycin, Ampicillin-clavulanic acid or Klebsiella spp after 2005 to Ciprofloxacin, Ticarcillinclavulanic acid was over 60 ％. ConclusionGNB after liver transplantation were resistant to agents but active to Carbapenems and Piperacillin/tazobactam commonly, in which Escherichia coli and Klebsiella spp are common.

Microbiological analysis of bloodstream infections in Peking University Third Hospital from 2005 to 2007 / 中华传染病杂志

Objective To investigate the microbiological and epidemiological characteristics of bloodstream infections in Peking University Third Hospital Methods The clinical, microbiological and epidemiological data of bloodstream infections in Peking University Third Hospital from January lst,2005 to December 31st, 2007 were analyzed retrospectively. Differences in proportions were compared using X2 test. Results Six thousand four hundred and eighty-eight blood culture tests for 5 138 episode of bloodstream infections of 3 795 patients were performed. The positive rate was 9.9%. The average incidence rate of nosocomial infection was 40.8 cases per 10 000 hospital admissions. In the 593 pathogens, 483 (81.5%) were pathogens causing nosocomial. The ratio of Gram-positive microbs, Gram-negative ones and fungi (all were Candida spp.) were 38.5%, 54.7%, and 6.8%, respectively. The corresponding ratio of nosocomial pathogens were 42.0%, 49.9% and 8.1%, respectively. The most frequently isolated strain was Escherichia coli (25.3 %). The coagulase negative staphylococcus was the second one (18.8%). The corresponding ratio of Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus spp. , Pseudornonas aeruginosa , Acinetobacter baumannii and anaerobs were 7.1%, 7.4%, 8.3%, 3.2%, 2.2% and 0.7%, respectively. Ten patients (1.7%) had experienced polymicrobial infection. In hospital setting, Streptococcus spp. And Escherichia coli infections were more frequently in non-intensive care unit (ICU) than ICU (X2= 9.240, P= 0.002; X2= 23.609, P,<0.01; respectively). But the infection rate of Candida spp. Was significantly higher in the ICU (X2= 5.498, P= 0.019). The time interval between hospital admission and onset of infection for the most frequently isolated pathogens ranged from 15.1 days (Escherichia coli) to 29.7 days (Acinetobacter baumannii). The degree of resistance to the common antimicrobal agents had no change in the three years. Conclusions The average incidence rate of nosocomial bloodstream infection is 40.8 cases per 10 000 hospital admissions. The main pathogens are the Gram-negative microbs.

Clinical Identifiers and Pathogenic Significance of Pseudomonas aeruginosa Bacteremia, in Comparison with Klebsiella pneumoniae and Enterobacter species / 감염과화학요법

BACKGROUND: To identify specific risk factors for Pseudomonas aeruginosa and evaluate the relationship between the mortality rate and P. aeruginosa bacteraemia in bloodstream infections, we compared the clinical features and outcomes of patients with P. aeruginosa bacteremia with the patients with Klebsiella pneumoniae or Enterobacter bacteremia. MATERIALS AND METHODS: A total of 190 patients with P. aeruginosa bacteremia were identified from January 1998 to December 2002 and included in this retrospective analysis. During the same period, 377 patients with K. pneumoniae bacteremia and 183 patients with Enterobacter bacteremia were identified and compared with those with P. aeruginosa bacteremia. RESULTS: Factors associated with P. aeruginosa bacteremia in the multivariate analysis included pneumonia, soft tissue infection, nosocomial acquisition, neutropenia, and prior invasive procedure (All P<0.05). The 30-day mortality rate was 37.9% (72/190) in patients with P. aeruginosa bacteremia, 24.1% (91/377) in those with K. pneumoniae, and 25.7% (47/183) in those with Enterobacter bacteremia (P<0.001). However, in the analysis including patients who had received appropriate initial antimicrobial therapy (n=552), the mortality rate of P. aeruginosa bacteremia was not significantly higher than that of non-pseudomonas bacteremia (28.6% [18/63] vs. 22.5% [110/489]; P=0.282). Inappropriate initial antimicrobial therapy was found to be one of the significant independent predictors of mortality. P. aeruginosa bacteremia as a risk factor for mortality did not reach statistical significance (OR, 1.30; 95% CI, 0.73-2.32; P=0.371), after adjusting for underlying illness and adequacy of antimicrobial therapy. CONCLUSION: An initial empirical antimicrobial coverage of P. aeruginosa should be seriously considered in patients with pneumonia, soft tissue infection, neutropenia, and prior invasive procedure, when gram-negative sepsis was suspected in nosocomial infection.

Clinical Identifiers and Pathogenic Significance of Pseudomonas aeruginosa Bacteremia, in Comparison with Klebsiella pneumoniae and Enterobacter species / 감염과화학요법

BACKGROUND: To identify specific risk factors for Pseudomonas aeruginosa and evaluate the relationship between the mortality rate and P. aeruginosa bacteraemia in bloodstream infections, we compared the clinical features and outcomes of patients with P. aeruginosa bacteremia with the patients with Klebsiella pneumoniae or Enterobacter bacteremia. MATERIALS AND METHODS: A total of 190 patients with P. aeruginosa bacteremia were identified from January 1998 to December 2002 and included in this retrospective analysis. During the same period, 377 patients with K. pneumoniae bacteremia and 183 patients with Enterobacter bacteremia were identified and compared with those with P. aeruginosa bacteremia. RESULTS: Factors associated with P. aeruginosa bacteremia in the multivariate analysis included pneumonia, soft tissue infection, nosocomial acquisition, neutropenia, and prior invasive procedure (All P<0.05). The 30-day mortality rate was 37.9% (72/190) in patients with P. aeruginosa bacteremia, 24.1% (91/377) in those with K. pneumoniae, and 25.7% (47/183) in those with Enterobacter bacteremia (P<0.001). However, in the analysis including patients who had received appropriate initial antimicrobial therapy (n=552), the mortality rate of P. aeruginosa bacteremia was not significantly higher than that of non-pseudomonas bacteremia (28.6% [18/63] vs. 22.5% [110/489]; P=0.282). Inappropriate initial antimicrobial therapy was found to be one of the significant independent predictors of mortality. P. aeruginosa bacteremia as a risk factor for mortality did not reach statistical significance (OR, 1.30; 95% CI, 0.73-2.32; P=0.371), after adjusting for underlying illness and adequacy of antimicrobial therapy. CONCLUSION: An initial empirical antimicrobial coverage of P. aeruginosa should be seriously considered in patients with pneumonia, soft tissue infection, neutropenia, and prior invasive procedure, when gram-negative sepsis was suspected in nosocomial infection.

Risk factors for hospital acquired infections in patients with decompensated liver cirrhosis / 대한내과학회지

BACKGROUND: Infection is a frequent complication in patients with chronic liver disease, mainly during the advanced stages. This study was performed to investigate the risk factors for infections in hospitalized patients with decompensated liver cirrhosis. METHODS: We analyzed 108 decompensated hospitalized cirrhotic patients (34 cases with infection and 117 cases without infection) without clinical evidence of infection at the time of admission and during initial 72 hours after admission. RESULTS: Univariate and multivariate analysis revealed that patients who developed an infection were more likely to have a lower serum albumin levels. Gram-negative bacterial strains were detected most frequently, in 13 of the 18 strains isolated. There was no significant difference in etiology of disease, Child-Pugh classification, cirrhotic complications including upper G-I bleeding, hepatocelluar caricnoma, invasive procedure, diabetus mellitus, admission to ICU, duration of admission, survival rate and various parameters related to liver and renal function between patients with infection and without infection. CONCLUSION: The present study indicates that decompensated cirrhotic patient with low serum albumin levels have a higher risk of developing a hospital acquired infection, especially by gram negative bacteria.