Shock séptico de foco respiratorio por Pasteurella multocida en un paciente inmunocompetente. Caso Clínico / Septic shock originating from a pulmonary focus caused by Pasteurella multocida. Report of one case

Pasteurella multocida is a gram-negative coccobacillus bacterium found as a commensal in the oropharynx of domestic animals such as cats and dogs and some farm animals. Soft tissue infections and occasionally bacteremia in immunocompromised patients with direct contact with animals are described. We report a 61 year old male with a history of scratches and close contact with domestic cats, with a septic shock originating from a pulmonary focus, requiring mechanical ventilation and vasopressors. Blood cultures disclosed the presence of Pasteurella multocida. He responded successfully to antimicrobials.

Bacteriemia por Enterobacter cancerogenus en un paciente con trauma pélvico / Enterobacter cancerogenus bacteremia in a patient with pelvic trauma

Resumen Existen escasas comunicaciones de infecciones por Enterobacter cancerogenus. Aunque ha sido aislado en heridas contaminadas asociadas a traumas, también ha sido reportado como agente etiológico en una amplia variedad de otras infecciones, siendo infrecuente la presencia de bacteriemia. Presentamos el primer caso reportado en Chile de una bacteriemia causada por este microorganismo, en un varón de 28 años con una fractura de pelvis estable debido a un accidente de tránsito de alta energía. Tuvo una buena respuesta clínica al tratamiento con ertapenem.

Abstract There are few cases reports of Enterobacter cancerogenus infections. Although it has been isolated in contaminated wounds associated with trauma, it has also been reported as an etiological agent in a wide variety of other infections, with the presence of bacteremia being infrequent. We present the first case reported in Chile of a bacteremia caused by this agent, in a 28-year-old patient with a stable pelvic fracture due a high-energy traffic accident. He had a good clinical response to treatment with ertapenem.

Distribution and drug resistance profiles of pathogens causing bloodstream infection after chemotherapy in children with acute lymphoblastic leukemia / 中国当代儿科杂志

OBJECTIVES@#To study the changes in the distribution and drug resistance profiles of pathogens causing bloodstream infection after chemotherapy in children with acute lymphoblastic leukemia.@*METHODS@#The medical data were collected from the children with acute lymphoblastic leukemia who were admitted to the First Affiliated Hospital of Zhengzhou University between January 2015 and December 2020 and developed bloodstream infection after chemotherapy. The samples were divided into the first three years group and the next three years group according to the time of testing to investigate the differences in the distribution and drug resistance profiles of pathogens as time.@*RESULTS@#A total of 235 strains of pathogens were isolated, among which there were 159 Gram-negative strains (67.7%; mainly Escherichia coli and Klebsiella pneumoniae), 61 Gram-positive strains (26.0%; mainly Staphylococcus epidermidis), and 15 strains of fungi (6.4%; mainly Candida albicans). There were no significant differences between the first three years group and the next three years group in the detection rate of Gram-negative bacteria (68.8% vs 66.9%, P>0.05) or Gram-positive bacteria (29.2% vs 23.7%, P>0.05). Compared with the first three years group, the next three years group had significant increases in the detection rate of Streptococcus mitis (5.8% vs 0.0%, P<0.05) and fungi (9.4% vs 2.1%, P<0.05). There was no significant difference in the drug resistance rate of Gram-negative or Gram-positive bacteria between the two groups (P>0.05).@*CONCLUSIONS@#Enterobacteriaceae bacteria are the main pathogens of bloodstream infection after chemotherapy in children with acute lymphoblastic leukemia, while the detection rates of Streptococcus mitis and fungi tend to increase as time, which needs to be taken seriously in clinical practice.

Post-antibiotic era in hemodialysis? Two case reports of simultaneous colonization and bacteremia by multidrug-resistant bacteria / Era pós-antibiótica em hemodiálise? Relato de dois casos de colonização simultânea e bacteremia por bactérias multirresistentes

ABSTRACT The emergence of resistance mechanisms not only limits the therapeutic options for common bacterial infections but also worsens the prognosis in patients who have conditions that increase the risk of bacterial infections. Thus, the effectiveness of important medical advances that seek to improve the quality of life of patients with chronic diseases is threatened. We report the simultaneous colonization and bacteremia by multidrug-resistant bacteria in two hemodialysis patients. The first patient was colonized by carbapenem- and colistin-resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA). The patient had a bacteremia by MRSA, and molecular typing methods confirmed the colonizing isolate was the same strain that caused infection. The second case is of a patient colonized by extended-spectrum beta-lactamases (ESBL)-producing Escherichia coli and carbapenem-resistant Pseudomonas aeruginosa. During the follow-up period, the patient presented three episodes of bacteremia, one of these caused by ESBL-producing E. coli. Molecular methods confirmed colonization by the same clone of ESBL-producing E. coli at two time points, but with a different genetic pattern to the strain isolated from the blood culture. Colonization by multidrug-resistant bacteria allows not only the spread of these microorganisms, but also increases the subsequent risk of infections with limited treatments options. In addition to infection control measures, it is important to establish policies for the prudent use of antibiotics in dialysis units.

RESUMO O surgimento de mecanismos de resistência não apenas limita as opções terapêuticas para infecções bacterianas comuns, mas também piora o prognóstico em indivíduos com condições que aumentam o risco de infecções bacterianas. Assim, a eficácia de importantes avanços médicos que buscam melhorar a qualidade de vida de pacientes com doenças crônicas está ameaçada. Relatamos a colonização e bacteremia simultâneas por bactérias multirresistentes em dois pacientes em hemodiálise. O primeiro paciente foi colonizado por Klebsiella pneumoniae resistente a carbapenem e colistina, Pseudomonas aeruginosa resistente a carbapenem e Staphylococcus aureus resistente a meticilina (MRSA). O paciente apresentou bacteremia por MRSA, e os métodos de tipagem molecular confirmaram que o isolado colonizador era a mesma cepa que estava causando infecção. O segundo caso é de um paciente colonizado por Escherichia coli produtora de beta-lactamases de espectro estendido (ESBL) e Pseudomonas aeruginosa resistente ao carbapenem. Durante o período de seguimento, o paciente apresentou três episódios de bacteremia, um deles causado por E. coli produtora de ESBL. Os métodos moleculares confirmaram a colonização pelo mesmo clone de E. coli produtora de ESBL em dois momentos, mas com um padrão genético diferente da cepa isolada da hemocultura. A colonização por bactérias multirresistentes aumenta o potencial não apenas da disseminação desses microrganismos, mas também do risco subsequente de infecções com opções limitadas de tratamentos. Além das medidas de controle de infecção, é importante estabelecer políticas para o uso prudente de antibióticos nas unidades de diálise.

Bacteriemia por Streptococcus equi subespecie zooepidemicus en un binomio madre hijo / Streptococcus equi subspecies zooepidemicus bacteremia in a mother-child binomial

Resumen Streptococcus equi subespecie zooepidemicus es una cocácea grampositiva, p-hemolítica, considerada parte de la microbiota de los equinos y un patógeno oportunista en otros animales. La infección en humanos es poco frecuente, pero suele manifestarse como cuadros graves. Se ha asociado al contacto con animales, especialmente caballos, y al consumo de productos lácteos no pasteurizados. Presentamos el caso de una bacteriemia en un binomio madre-hijo por este agente, asociado al consumo de quesos artesanales. Pese a que la penicilina es el tratamiento de elección, la recién nacida fue tratada en forma exitosa con ampicilina y la madre con ceftriaxona. Ninguna de ellas presentó complicaciones asociadas a la bacteriemia. A nuestro conocimiento, este es el primer reporte de infección connatal por este agente.

Abstract Streptococcus equi subspecies zooepidemicus is a Gram-positive, P-hemolytic coccus considered part of the commensal flora in horses and an opportunistic pathogen in other animals. Infection in humans is rare, but it usually manifests as serious symptoms, it has been associated with contact with animals, especially horses, and the consumption of unpasteurized dairy products. In this report we describe a case of bacteremia of the mother-child binomial by this agent, associated with the consumption of artisan cheeses. Although penicillin is the treatment of choice, the newborn was successfully treated with ampicillin and the mother with ceftriaxone, none of them presented complications associated with bacteremia. To our knowledge, this is the first report of connatal infection by this agent.

Single Center Analysis of Bloodstream Infection Clinical Characteristics and Prognosis in Patients with Hematological Malignancies in the Tropics / 中国实验血液学杂志

OBJECTIVE@#To analyze the characteristics, prognosis and risk factors of bloodstream infection in patients with hematological malignancies in the tropics, so as to provide evidence for the prevention and treatment of bloodstream infection.@*METHODS@#The clinical features, blood culture results and prognosis of patients with bloodstream infection in patients with hematological malignancies admitted to Hainan Hospital of PLA General Hospital were retrospectively studied.@*RESULTS@#The most common primary infection site of the 81 patients with hematological malignancies was lung (46.91%), followed by PICC (11.11%). The detection rate of Gram-positive bacteria and Gram-negative bacteria in the blood culture was 60.98% and 30.02%, respectively. Coagulase-negative staphylococci was the most common Gram-positive bacteria resulting in bloodstream infection in our study. Of the Gram-negatives, Klebsiella pneumoniae (34.38%) was predominant, followed by Escherichia coli (18.75%) and Pseudomonas aeruginosa (18.75%). Gram-positive bacteria was highly sensitive (100%) to vancomycin, linezolid and tigecycline. Study showed that Gram-negative bacteria had low sensitive to quinolones, in particular, the resistance rate of Escherichia coli to quinolones was as high as 83.33%. In terms of overall survival (OS), the 30-days OS of patients with Gram-negative and Gram-positive septicemia was 77.42% and 92.00%, respectively. There was no statistically significant difference between the two groups. Multivariate analysis revealed that septic shock (P=0.001, RR=269.27) was an independent risk factor for 30-day mortality, and remission status (P=0.027, RR=0.114) was an independent predictor of a favourable outcome of bloodstream infection in patients with hematological malignancies.@*CONCLUSION@#Gram-positive bacteria are the main pathogens causing bloodstream infections in patients with hematological malignancies in the tropics. Improving the care of PICC is an important measure to reduce the incidence of bloodstream infection in patients with hematological malignancies in the tropics. A correct treatment relieving disease and effective prevention and treatment of septic shock can reduce mortality of patients with bloodstream infection in patients with hematological malignancies in the tropics.

Bacteremia and sepsis by Arcanobacterium haemolyticum in a young immunocompetent patient / Bacteriemia y sepsis por Arcanobacterium haemolyticum en un paciente joven inmunocompetente

Abstract We report the case of a twenty-year-old immunocompetent male patient presenting to the emergency room with pharyngitis and fever. Blood cultures were drawn and Arcanobacterium haemolyticum (rough biotype) was recovered. The presence of the arcanolysin gene was investigated at the molecular level and the upstream region was amplified and sequenced in order to correlate it with the smooth or rough biotype. Although the isolate was susceptible to penicillin, vancomycin and gentamicin, empirical treatments first with amoxicillin/clavulanic acid (1g/12h) and then with ceftriaxone (1g/12h) failed and the infection evolved to sepsis. Finally, treatment with vancomycin (1 g/12 h) plus piperacillin/tazobactam (4.5g/8h) was effective. Lemierre's syndrome was ruled out. To the best of our knowledge, this is the first case of bacteremia by A. haemolyticum reported in Argentina.

Resumen Se describe el caso de un paciente varón inmunocompetente de veinte anos de edad que se presentó en la sala de emergencias con faringitis y fiebre. Se extrajeron muestras para realizar hemocultivos y se recuperó Arcanobacterium haemolyticum (biotipo rugoso). Se investigó la presencia del gen de la arcanolisina por un método molecular, y se amplificó y Faringitis; secuenció la región upstream de dicho gen para determinar su correlación con los biotipos lisos Bacteriemia; o rugosos. Aunque el aislamiento fue sensible a la penicilina, la vancomicina y la gentamicina, Sepsis; los tratamientos empíricos primero con amoxicilina/ácido clavulánico (1 g/12 h) y luego con Síndrome de Lemierre ceftriaxona (1 g/12 h) no fueron efectivos, y la infección evolucionó a sepsis. Finalmente, el tratamiento con vancomicina (1 g/12 h) más piperacilina/tazobactam (4,5g/8h) fue efectivo. Se descartó la presencia del síndrome de Lemierre. Según nuestro conocimiento, este es el primer caso de bacteriemia por A. haemolyticum reportado en Argentina.

Factores relacionados con letalidad en pacientes con bacteriemia hospitalizados por patología médica en una institución de tercer nivel en Colombia, 2014-2016 / Case fatality rate-related factors in patients with bacteremia hospitalized due medical conditions in an institution of third level in Colombia, 2014-2016

Resumen Introducción: Las infecciones del torrente sanguíneo son un problema creciente y actualmente son una amenaza para la salud pública. La bacteriemia representa aproximadamente 15% de todas las infecciones nosocomiales y afecta a 1% de los pacientes hospitalizados. Objetivo: Describir las características clínicas, epidemiológicas y microbiológicas de episodios de bacteriemia nosocomial ocurridos en un hospital colombiano. Pacientes y Métodos: Estudio retrospectivo, observacional, de corte transversal, con inclusión de pacientes adultos, hospitalizados por el Servicio de Medicina Interna en el Hospital Universitario de Santander, Bucaramanga, Colombia, durante los años 2014 a 2016. El protocolo fue aprobado por el Comité de Ética en Investigación de la Universidad Industrial de Santander. Resultados: Se revisaron 450 historias clínicas, con 148 pacientes y 182 aislados microbianos. Los antecedentes más frecuentes fueron: hipertensión arterial (46,6%) e infección por VIH (29,7%). El sistema vascular y urinario ocuparon los sitios anatómicos más frecuentes (37,3 y 38,3%, respectivamente). La letalidad fue de 29%. Los patógenos más frecuentemente aislados fueron: Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa (en suma: 49,8%) y Staphylococcus aureus 12,1%. El análisis multivariado mostró relación de la anemia con mortalidad intrahospitalaria (OR = 17,3; IC95% 2,95-102,0). Conclusiones: La bacteriemia es una infección frecuente durante la atención hospitalaria que presenta gran mortalidad. Es destacable el predominio de aislados de enterobacterias multiresistentes. El antecedente de infección por VIH es uno de los más frecuentes el que amerita ser evaluado como grupo de riesgo.

Abstract Background: Bloodstream infections are an increasing problem and currently represent a threat to public health, overcoming diseases such as HIV. Bacteremia accounts for approximately 15% of all nosocomial infections and affects 1% of all hospitalized patients. Aim: To describe the clinical, epidemiological and microbiological characteristic of episodes of nosocomial bacteremia occurring in a Colombian hospital. Methods: Retrospective, observational, cross-sectional study including adult patients, hospitalized in the internal medicine unit at the University Hospital of Santander, Bucaramanga, Colombia, during years 2014 to 2016, who met the criteria of the CDC for bloodstream infection. The protocol was approved by the Hospital Ethics Committee and by the Research Ethics Committee of the Industrial University of Santander. Results: We reviewed 450 clinical records with 148 patients and 182 microbiological isolates. 53% were male. The most frequent comorbidities were: high blood pressure (46.6%), HIV infection (29.7%). The vascular and urinary systems were the most frequent anatomical sites as the source of the infection (respectively 37.3% and 38.3%). Case fatality rate was 29%. The pathogens most frequently isolated were: Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa (globally: 49.8%) and Staphylococcus aureus 12.1%. The multivariate analysis showed a relationship between anemia and in-hospital mortality (OR = 17.3, 95%CI 2.95-102.0). Conclusions: Bacteremia is a frequent infection during hospital care that presents high mortality. It is noteworthy the predominance of Enterobacteriaceae isolates with broad profiles of resistance. The history of HIV infection is one of the most frequent which deserves to be evaluated as a risk group.

Caracterización clínica, epidemiológica y microbiológica de bacteriemias producidas por enterobacterias resistentes a carbapenems en un hospital universitario de Córdoba, Argentina / Clinical, epidemiological and microbiological characterization of bacteremia produced by carbapenem-resistant enterobacteria in a university hospital in Córdoba, Argentina

Resumen Introducción: Las enterobacterias son una causa principal de infecciones del torrente sanguíneo y su resistencia antimicrobiana se encuentra en aumento. Esto lleva a un incremento de la morbilidad-mortalidad y de los costos en la salud pública. Las enterobacterias resistentes a carbapenems representan un grave desafío a nivel global ya que existen escasas opciones terapéuticas disponibles. Objetivo: Caracterización clínico/microbiológica de las bacteriemias resistentes a carbapenémicos observadas en un período de 4 años. Material y Método: Estudio retrospectivo, observacional y descriptivo, sobre las bacteriemias por enterobacterias resistentes y sensibles a carbapenems. Resultados: Se analizó un total de 84 pacientes con bacteriemia por enterobacterias resistentes y sensibles a carbapenems. Entre las resistentes, observamos una mayor proporción de: tratamiento antimicrobiano previo, hospitalización en unidad de terapia intensiva (UTI), inicio de la bacteriemia en UTI y antecedentes de β-lactamasas de espectro extendido. Además, se detectó un amplio predominio de Klebsiella pneumoniae productor de KPC y una mortalidad atribuible de 52,4%. Discusión: El estudio posibilitó profundizar el conocimiento de una enfermedad emergente de elevada mortalidad, en vistas al diseño y aplicación de estrategias de control de infecciones y de esquemas de tratamiento efectivos adaptados a la epidemiologia local.

Abstract Background: Enterobacteriaceae are a major cause of bloodstream infections and their antimicrobial resistance continues to increase. This leads to higher morbidity-mortality rates and public health costs. Carbapenem-resistant Enterobacteriaceae represent a serious challenge globally, since there are few therapeutic options available. Aim: Clinical/microbiological characterization of the carbapenem-resistant bacteremia observed over a period of 4 years. Methods: Retrospective, observational and descriptive study about bacteremia caused by carbapenem-resistant and susceptible Enterobacteriaceae. Results: A total of 84 patients with bacteremia including carbapenem-resistant and susceptible Enterobacteriaceae were analyzed. We found that patients infected with carbapenem-resistant strains presented a higher proportion of: previous antibiotic treatment, hospitalization in intensive care unit (ICU), onset of the bacteremia during hospitalization in ICU and previous infection with extended-spectrum-beta-lactamase producing Enterobacteriaceae. Additionally, we observed a predominance of KPC-producing Klebsiella pneumoniae and an attributable mortality rate of 52.4%. Discussion: This study allowed for a better understanding of an emerging problem with high mortality, which in turn is useful for the design and adoption of infection control strategies and effective treatment regimens adapted to our local epidemiology.

Caracterización clínica y microbiológica de episodios de bacteriemia por Streptococcus grupo viridans en niños con cáncer y neutropenia febril de alto riesgo / Clinical characteristics and microbiological profile of viridans group streptococci bacteremia in children with cancer and high-risk febrile neutropenia

Resumen Introducción: Streptococcus grupo viridans (SGV) ha adquirido relevancia como microorganismo causante de neutropenia febril, asociándose a morbilidad significativa. Objetivo: Caracterizar episodios de bacteriemia causados por SGV en niños con cáncer que desarrollaron neutropenia febril de alto riesgo (NFAR) desde abril de 2004 a junio de 2018 en seis hospitales pediátricos de Santiago, Chile. Pacientes y Métodos: Análisis retrospectivo de bases de datos de cuatro proyectos FONDECYT sucesivos, prospectivos y multicéntricos, registrando características clínicas y de laboratorio de los pacientes, además de patrón de resistencia antimicrobiana de las cepas aisladas. Resultados: Se registraron 95 episodios de bacteriemia asociada a SGV en 91 niños con NFAR. Destacan: leucemia mieloide aguda como enfermedad de base, neutropenia profunda, hospitalización prolongada (15 días), uso extendido de antimicrobianos (14 días), uso de citarabina en esquemas de quimioterapia (86% episodios). Las manifestaciones clínicas más frecuentes fueron respiratoria y gastrointestinal, asociándose en 26% a síndrome de shock por Streptococcus grupo viridans. Hubo elevada resistencia a β lactámicos, sin cepas no susceptibles a vancomicina. Discusión: SGV es un patógeno relevante en niños con cáncer, fiebre y neutropenia en nuestro medio, asociado a casos de sepsis. La resistencia a β lactámicos es un aspecto que requiere vigilancia epidemiológica estricta en esta población.

Abstract Background: Viridans group streptococci (VGS) has acquired relevance as a microorganism causing febrile neutropenia, associated with significant morbidity. Aim: To characterize episodes of bacteremia caused by VGS in children with cancer who developed high-risk febrile neutropenia (HRFN) during the period from April 2004 to June 2018 in six pediatric hospitals of Santiago, Chile. Method: Database analysis of 4 successive, prospective and multicentric studies recording clinical and laboratory characteristics of patients, as well as antimicrobial susceptibility pattern of isolated strains. Results: 95 episodes of VGS bacteremia in 91 children with HRFN were analyzed. It emphasizes acute myeloid leukemia as cancer type, deep neutropenia, prolonged hospitalization (15 days), with extended use of antimicrobials (14 days) and use of cytarabine in chemotherapy schemes (86% episodes). The most frequent clinical manifestations were respiratory and gastrointestinal, associating up to 26% viridans group shock syndrome. There was high resistance to β lactams. As expected, there were not non-susceptible strains to vancomycin. Discussion: VGS is a relevant microorganism in children with cancer, fever and neutropenia, with a high percentage of sepsis. Resistance to β lactams is an issue that requires strict epidemiological surveillance in this population.

Uso racional de antibióticos y tecnología FilmArray para identificación rápida de bacteriemias en unidad de cuidados intensivos pediátrica / Rational use of antibiotics and FilmArray technology for rapid identification of bacteremias in a pediatric intensive care unit

INTRODUCCIÓN: Las infecciones graves son la principal causa de ingreso a cuidados intensivos pediátricos. El panel FilmArray BCID permite identificar rápidamente a microorganismos causantes de bacteriemias. OBJETIVO: evaluar la eficacia de la identificación rápida de microorganismos asociado a un Programa de Uso Racional de Antibióticos (URA) en reducir los tiempos de terapias antibióticas, en un hospital pediátrico. PACIENTES Y MÉTODO: Estudio retrospectivo, que incluyó 100 pacientes, en su primer episo dio de bacteriemia, divididos en 2 grupos de 50 cada uno: Intervención (FilmArray BCID y programa URA) y Controles históricos pareados para la misma especie del microrganismo identificado (microbiología convencional). Las variables evaluadas fueron los tiempos de identificación microbiana, latencia de la terapia dirigida y de desescalar antibióticos. RESULTADOS: Los grupos fueron comparables en características demográficas, foco de infección y etiología de bacteriemia. El tiempo promedio de identificación de microorganismos fue de 23 h (IC 95% 12,4-26,7) en el grupo intervención, y 70,5 h (IC 95% 65,2-78,6) en el control (p < 0,05), mientras que la latencia de inicio de terapia dirigida fue de 27,9 h (IC 95% 22,3-32,8) y 71,9 h (IC 95% 63,2-77,8) respectivamente (p < 0,05). El tiempo de desescalar o suspender antibióticos fue de 6,4 h (IC 95% 2,76-9,49) y 22 h (IC 95% 6,74-35,6) en los grupos mencionados (p > 0,05). CONCLUSIÓN: El panel FilmArray BCID articulado a un programa URA, contribuye a la identificación de los microorganismos causantes de bacteriemias en menor tiempo que los métodos convencionales, siendo una herramienta que optimiza las terapias antibióti cas en niños críticamente enfermos.

INTRODUCTION: Severe infections are the leading cause of admission to pediatric intensive care. The FilmArray BCID panel quickly identifies microorganisms that cause bacteremia. OBJECTIVE: To evaluate if the rapid identification of the microorganisms that cause bacteremia, along with a Rational Use of Antibio tics (RUA) Program, allows optimizing the time of antibiotic therapy in a pediatric hospital. PATIENTS AND METHOD: Retrospective study which included 100 patients presenting their first episode of bacteremia, divided into 2 groups of 50 each. The first one was Intervention (FilmArray BCID and RUA program) and the second one was Historical Controls (conventional automated ID/AST). The variables evaluated were the time required for microbial identification, duration of appropriate therapy, and antibiotic de-escalation. RESULTS: The groups were comparable in terms of demographic characteristics, focus of infection, and etiology of bacteremia. The average time of microorganisms' identification of the control group was 70.5 hours (IC 95% 65.2-78.6) and 23.0 hours (IC 95% 12.4 -26.7) in the intervention one (p < 0.05). The average time of targeted therapy onset was shorter in the intervention group (27.9 h [IC 95% 22.3-32.8]) than that of the control one (71.9 h [IC 95% 63.2-77.8]) (p < 0.05). Finally, the time to de-escalate or discontinue antibiotics in the intervention group and the control one was 6.4 hours (IC 95% 2.76-9.49) hours and 22.0 hours (IC 95% 6.74-35.6 h) respectively (p > 0.05). CONCLUSION: The FilmArray panel along with the RUA Program allows the identification of the microorganisms causing bacteremia faster than conventional methods, which positions it as a tool that optimizes antibiotic therapy of critical patients.

Bacteriemia por Campylobacter jejuni en un paciente con infección por VIH en etapa SIDA / Campylobacter jejuni bacteremia in a patient with HIV infection in AIDS stage

Resumen La bacteriemia es una presentación atípica de la infección por Campylobacter jejuni, y es más frecuente en pacientes con inmunodepresión avanzada debido al VIH u otras enfermedades sistémicas. Debido a la terapia anti-retroviral, en las últimas décadas el número de casos ha disminuido. Presentamos el caso de una mujer en situación de calle, con VIH en etapa C3, que cursó con una bacteriemia por C. jejuni durante su hospitalización por una tuberculosis pulmonar. Realizamos una breve revisión de bacteriemia por C. jejuni en pacientes con VIH.

Bacteremia is an atypical presentation of Campylobacter jejuni infection and it is more frequent in patients with advanced inmunodepression due to HIV or other sistemic diseases. Because of the highly active antiretroviral therapy, in the last decades the number of cases had declined. We report a case of a homeless woman with HIV in C3 stage who was diagnosed with the bacteremia during her hospitalization for pulmonary tuberculosis, and a brief review of C. jejuni bacteremia in HIV patients.

Bacteriemia por Pasteurella multocida asociada al contacto con un animal doméstico / Pasteurella multocida bacteremia associated with contact with a domestic animal: case report

Resumen Pasteurella multocida es reconocida por ser una de las especies más frecuentemente aisladas en la microbiota oral de animales domésticos y salvajes; asociadas a infecciones de piel y tejidos blandos secundarias a mordeduras y rasguños. Las infecciones sistémicas son poco frecuentes, asociadas a la diseminación desde infecciones localizadas y a factores de riesgo asociados a inmunosupresión. Presentamos un caso de bacteriemia por Pasteurella multocida en un paciente de 88 años, relacionada con alimentos compartidos con su mascota; un mecanismo de producción de bacteriemia nunca antes descrito en la literatura médica.

Pasteurella species are known to be one of the most frequently isolated in oral microbiota of domestic and wild animals, because of that, they are associated with skin and soft tissues infections secondary to bites and scratches. Systemic infections are uncommon, but are associated with dissemination from localized infections and some risks factors related to immunosuppression. We report a case of Pasteurella multocida bacteremia in an 88 years old patient, associated with food sharing with his dog; a bacteremia mechanism never described before in the medical literature.

Piomiositis en niños: experiencia en un hospital pediátrico de referencia en Argentina / Pediatric pyomyositis: experience in a Pediatric Reference Center in Argentina

Resumen Introducción: La piomiositis es la infección del músculo esquelético, entidad poco frecuente en pediatría. Objetivo: Describir las características de 21 niños con piomiositis. Métodos: Estudio prospectivo-analítico de niños ingresados con diagnóstico de piomiositis entre mayo de 2016 y abril de 2017 en el Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina. Resultados: Tasa de hospitalización de 21,5/10.000 admisiones (IC 95% 4,65- 71,43). La mediana de edad fue de 5,4 años (rango 1,25-11,6). El 90,4% presentaba algún factor predisponente. La localización más frecuente fue en miembros inferiores. La proteína C reactiva (PCR) estuvo elevada en todos los pacientes, con una media de 124 mg/L (DS 96), siendo significativamente más elevada en los pacientes que tuvieron hemocultivos positivos 206 (DS 101) vs 98 (DS 81), (p = 0,02). Se obtuvo rescate microbiológico en 17 pacientes (80,9%): Staphylococcus aureus resistente a meticilina (SARM) (n: 15) y Streptococcus pyogenes (n: 2). Se presentó con bacteriemia 23,8% de los pacientes. El 81% requirió drenaje quirúrgico. Conclusión: Staphylococcus aureus RM adquirido en la comunidad (SARMAC) es el patógeno predominante. En la selección del tratamiento empírico adecuado debería tenerse en cuenta: el patrón de resistencia local y el valor de PCR.

Background: Pyomyositis is the infection of skeletal muscle, a rare pathology in children. Aim To describe the characteristics of pyomyositis in pediatric patients. Methods: Prospective analytical study of hospitalized children diagnosed with pyomyositis from May 2016 to April 2017 at the Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina. Results: Twenty-one patients with pyomyositis were identified. Annual rate: 21.5/10,000 admissions (95% CI 4.65-71.43). The median age was 5.4 years (range 1.25-11.6). The lower limbs were the most affected site. C-reactive protein (CRP) was elevated in all patients, with a mean of 124 mg/L (SD 96), being significantly higher in patients with bacteremia: 206 (DS 101) vs 98 (DS 81), p = 0.02. Bacterial cultures were positive in 17/21 (80.9%): 15 methicillin-resistant Staphylococcus aureus (MRSA), and 2 Streptococcus pyogenes. Blood cultures were positive in 5 (23.8%). Conclusion: MRSA-community acquired is the predominant pathogen in our setting. In the selection of the appropriate empirical treatment, the local resistance pattern and the CRP value should be taken into account.

Direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry and real-time PCR in a combined protocol for diagnosis of bloodstream infections: a turnaround time approach

ABSTRACT Bloodstream infections (BSIs) are serious infections associated with high rates of morbidity and mortality. Every hour delay in initiation of an effective antibiotic increases mortality due to sepsis by 7%. Turnaround time (TAT) for conventional blood cultures takes 48 h, forcing physicians to streamline therapy by exposing patients to broad-spectrum antimicrobials. Our objective was (1) to evaluate the accuracy and TAT of an optimized workflow combining direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) and in-house real-time polymerase chain reaction (PCR) for bacterial identification and antimicrobial resistance profiling directly from positive blood bottles for diagnosing bloodstream infections and (2) to verify the effect of reporting results to medical staff. A total of 103 BSI episodes from 91 patients admitted to three hospitals in São Paulo, Brazil were included. TAT from molecular versus conventional methods was measured and compared. Our protocol showed an overall agreement of 93.5% for genus and 78.5% for species identification; 74.2% for methicillin resistance detection, 89.2% for extended-spectrum β-lactamase profiling, 77.8% for metallo-β-lactamase profiling, and 100% for carbapenemase profile and vancomycin-resistance detection when compared with conventional testing. TAT of molecular sample processing according to our protocol was 38 h shorter than conventional methods. Antimicrobial interventions were possible in 27 BSI episodes. Antimicrobial discontinuation was achieved in 12 BSI episodes while escalation of therapy occurred in 15 episodes. Antimicrobial therapy was inadequate in three (12%) BSI episodes diagnosed using results of molecular testing. Our in-house rapid protocol for identifying both bacteria and antimicrobial resistance provided rapid and accurate results, having good agreement with conventional testing results. These results could contribute to faster antimicrobial therapy interventions in BSI episodes.

Infecciones asociadas a catéteres venosos centrales: Actualización y recomendaciones intersociedades / Central venous catheter related infections. Inter-Societies update and recommendations

Representantes de la Sociedad Argentina de Infectología (SADI) y la Sociedad Argentina de Terapia Intensiva (SATI) se reunieron para trabajar en la elaboración de recomendaciones concretas de diagnóstico, tratamiento y prevención de las infecciones asociadas a catéteres venosos centrales (IAC). La metodología utilizada fue el análisis de la bibliografía publicada en los últimos 10 años complementada con la opinión de expertos y datos locales. En este documento se pretende ofrecer herramientas básicas de optimización de diagnóstico sobre la base de criterios clínicos y microbiológicos, orientar acerca de los esquemas antibióticos empíricos y dirigidos, la posología y la administración de antibióticos en pacientes críticos, y promover las medidas efectivas para reducir el riesgo de IAC. Asimismo, se ofrece un algoritmo de diagnóstico y tratamiento para uso en la actividad asistencial y consideraciones sobre la dosificación de antibióticos. Este trabajo conjunto de infectólogos e intensivistas pone en evidencia la preocupación por el manejo de las IAC y la importancia de velar por la mejora en las prácticas cotidianas. A través de esta recomendación se establecen pautas locales para optimizar el diagnóstico, el tratamiento y la prevención de las IAC con el objeto de disminuir la morbimortalidad, los días de internación, los costos y la resistencia antimicrobiana.

Representatives of the Argentine Society of Infectious Diseases (SADI) and the Argentine Society of Intensive Therapy (SATI) joined together to issue specific recommendations for the diagnosis, treatment, and prevention of intravascular catheter related infections (CRI). The methodology used was the analysis of the literature published in the last 10 years, complemented with the opinion of experts and local data. This document aims to promote effective measures to reduce the risk of CRI and to offer basic tools for diagnosis optimization based on clinical and microbiological criteria, orientation on empirical and targeted antibiotic schemes, posology, and administration of antibiotics in critical patients. It also offers a diagnostic and treatment algorithm for use in the care activity, as well as considerations on the dosage of antibiotics. The joint work of both societies highlights the concern for the management of CRI and the importance of ensuring improvement in daily practices. Through this recommendation, local guidelines are established to optimize the diagnosis, treatment and prevention of CRI in order to reduce morbidity and mortality, days of hospitalization, costs, and antimicrobial resistance.

Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection

ABSTRACT Polymyxin B is one of the last resort option for carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection in China. Therefore, the timing of administration of polymyxin is frequently delayed. We collected 40 cases of CRKP bloodstream infections (BSIs) treated with combinations based on polymyxin B over 30 months. The primary outcome, 30-day mortality rate, was 52.5% (21/40). Early administration of polymyxin B is meant to administer the drug within 48 h of diagnosing bacteremia. Delayed administration was considered when polymyxin B was administered after 48 h of bacteremia onset. Polymyxin B duration and total dosages were similar in the two groups (11.57 days versus 11.76 days, p = 0.919; 1306.52 mg versus 1247.06 mg, p = 0.711). Compared with delayed administration, early use of polymyxin B-based combination therapy had a significant increase in the rate of bacterial clearance (65.22% versus 29.41%, p = 0.025; OR = 0.533) and decreased 30-day mortality (39.13% versus 70.59%, p = 0.045; OR = 0.461) and overall mortality (43.48% versus 82.35%, p = 0.022; OR = 0.321).

Neumonía neumocócica bacteriémica en adultos en hospital regional de Chile / Bacteremic pneumococcal pneumonia in adults admitted to a general hospital: experience in 60 cases

Background: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. Aim: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. Patients and Methods: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. Results: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. Conclusions: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.

Retrospective evaluation of the clinical characteristics associated with Corynebacterium species bacteremia

ABSTRACT Objectives: Corynebacterium spp. are becoming recognized as pathogens that potentially cause various infections. We aimed to evaluate the clinical characteristics associated with Corynebacterium spp. bacteremia. Patients and methods: We retrospectively reviewed the medical records of all adult patients who had positive blood cultures for Corynebacterium spp. in a single university hospital between January 2014 and December 2016. Patients were divided into a bacteremia group and a contamination group based on microbiological test results and clinical characteristics. Patients' characteristics, antimicrobial susceptibility of isolated species, antimicrobials administered, and patient outcomes were evaluated. Results: Corynebacterium spp. were isolated from blood samples of 63 patients; Corynebacterium striatum was the predominant isolate. Twenty-eight patients were determined to have bacteremia. Younger age (p = 0.023), shorter time to positivity (p = 0.006), longer hospital stay (p = 0.009), and presence of an indwelling vascular catheter (p = 0.002) were observed more often in the bacteremia group compared to the contamination group. The source of infection in most patients with bacteremia was an intravenous catheter. All tested strains were susceptible to vancomycin. Four of the 27 patients with bacteremia died, despite administration of appropriate antimicrobial therapy. Conclusions: We found that younger age, shorter time to positivity, and presence of an indwelling catheter were related to bacteremia caused by Corynebacterium spp. Appropriate antimicrobials should be administered once Corynebacterium spp. are isolated from the blood and bacteremia is suspected.

Bacteremia due to Moraxella osloensis: a case report and literature review

ABSTRACT Herein we report the case of a 10-year-old boy with an autosomal mosaic mutation who developed bacteremia. The causative agent was identified as Moraxella osloensis by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA gene sequencing. In the pediatric population, there have been 13 case reports of infection attributed to M. osloensis and this is the fifth reported case of pediatric bacteremia due to M. osloensis. After Moraxella species infection was confirmed, the patient recovered with appropriate antimicrobial therapy. It is important to consider that M. osloensis can cause serious infections, such as bacteremia, in otherwise healthy children.