Serological evidence of exposure to some zoonotic microorganisms in cattle and humans with occupational exposure to livestock in Antioquia, Colombia / Evidencia serológica de exposición a algunos microorganismos zoonóticos en bovinos y humanos con exposición ocupacional a ganadería en Antioquia, Colombia / Evidências sorológicas de exposição a alguns microrganismos zoonóticos em bovinos e em humanos com exposição ocupacional ao gado na Antióquia, Colômbia

Bacteria belonging to Anaplasma, Ehrlichia, Rickettsia and Coxiella genera are considered emerging pathogens and livestock is one of the contexts where the transmission of these microorganisms can occur. The goal of this study was to determine serological evidence for the exposure to these bacteria in cattle and humans with occupational exposure to livestock in the subregions North and Magdalena Medio, Antioquia, Colombia, and to explore related factors. A cross-sectional study was conducted in 48 livestock farms distributed in six municipalities from both subregions: Belmira, Entrerríos and San Pedro de los Milagros (North), and Puerto Berrío, Puerto Nare and Puerto Triunfo (Magdalena Medio). Blood samples from 332 people and 384 bovines were evaluated by serology (IgM and IgG) screening for bacteria from the Anaplasma, Ehrlichia, Rickettsia, and Coxiella genera. Seropositivity in humans from both regions was 42.4% (95%CI: 31.2-55.1) for Anaplasma, 74.2% (95%CI: 66.0-84.4) for Ehrlichia, 72.5% (95%CI: 62.1-82.0) for Rickettsia, and 60.7% (95%CI: 59.7-69.1) for Coxiella burnetii. In cattle, seropositivity was 31.6% (95%CI: 19.9-44.2), 66.8% (95%CI: 55.2-78.1), 64.6% (95%CI: 53.8-74.5), and 61.6% (95%CI: 51.9-69.2), respectively. History of biting by ticks, milking, vaccination, having dogs and hens in the residence, as well as the consumption of raw milk derivatives were some factors associated with the infection by the bacteria studied. The results suggest a previous and recent exposure to these zoonotic bacteria genera in people with occupational exposure to livestock, as well as in cattle in the two studied subregions.

Las bacterias pertenecientes a los géneros Anaplasma, Ehrlichia, Rickettsia y Coxiella son consideradas patógenos emergentes y la ganadería es uno de los contextos donde se puede producir la transmisión de este tipo de microorganismos. El objetivo de este estudio fue determinar la evidencia serológica, debida a la exposición a estas bacterias en bovinos y humanos con exposición ocupacional a ganadería en las subregiones Norte y Magdalena Medio, Antioquia, Colombia, además de estudiar los factores relacionados. Se realizó un estudio transversal en 48 fincas ganaderas, distribuidas en seis municipios de ambas subregiones: Belmira, Entrerríos y San Pedro de los Milagros (Norte), y Puerto Berrío, Puerto Nare y Puerto Triunfo (Magdalena Medio). Las muestras de sangre de 332 personas y 384 bovinos fueron evaluadas mediante tamización serológica (IgM e IgG) para la detección de bacterias de los géneros Anaplasma, Ehrlichia, Rickettsia, y Coxiella. La seropositividad en humanos de ambas regiones fue 42,4% (IC95%: 31,2-55,1) en el caso de Anaplasma, un 74,2% (IC95%: 66,0-84,4) en Ehrlichia, un 72,5% (IC95%: 62,1-82,0) en Rickettsia, y un 60,7% (IC95%: 59,7-69,1) en Coxiella burnetii. En los bovinos, la seropositividad fue 31,6% (IC95%: 19,9-44,2), 66,8% (IC95%: 55,2-78,1), 64,6% (IC95%: 53,8-74,5), y 61,6% (IC95%: 51,9-69,2), respectivamente. El antecedente de haber sido mordido por garrapatas, ordeñar, vacunación, tener perros y gallinas en la residencia, así como el consumo de derivados de leche cruda fueron algunos de los factores asociados con la infección por las bacterias estudiadas. Los resultados sugieren la exposición previa y reciente a estas bacterias en personas con una exposición ocupacional a la ganadería, así como a los bovinos en las dos subregiones estudiadas.

As bactérias dos gêneros Anaplasma, Ehrlichia, Rickettsia e Coxiella são considerados patógenos emergentes, e a transmissão desses microrganismos pode ocorrer no contexto da pecuária. O estudo teve como objetivos determinar as evidências sorológicas de exposição a essas bactérias em bovinos e em humanos com exposição ocupacional ao gado nas sub-regiões Norte e Magdalena Médio, Antióquia, Colômbia, e explorar fatores associados. Foi realizado um estudo transversal em 48 fazendas de gado bovino distribuídas em seis municípios nas duas sub-regiões: Belmira, Entrerríos e San Pedro de los Milagros (Norte) e Puerto Berrío, Puerto Nare e Puerto Triunfo (Magdalena Médio). Amostras de sangue de 332 humanos e 384 bovinos foram analisadas com sorologia (IgM e IgG) para bactérias dos gêneros Anaplasma, Ehrlichia, Rickettsia e Coxiella. Os níveis de sorologia positiva em humanos das duas regiões foram de 42,4% (IC95%: 31,2-55,1) para Anaplasma, 74,2% (IC95%: 66,0-84,4) para Ehrlichia, 72,5% (IC95%: 62,1-82,0) para Rickettsia e 60,7% (IC95%: 59,7-69,1) para Coxiella burnetii. Nos bovinos, os níveis foram 31,6% (IC95%: 19,9-44,2), 66,8% (IC95%: 55,2-78,1), 64,6% (IC95%: 53,8-74,5) e 61,6% (IC95%: 51,9-69,2), respectivamente. Os fatores associados às bactérias estudadas foram: história de picada de carrapato, ordenha, vacinação, presença de cães e galinhas no domicílio e consumo de laticínios feitos com leite cru, entre outros. Os resultados sugerem exposição prévia e recente a esses gêneros bacterianos zoonóticos em pessoas com contato ocupacional com gado, assim como nos próprios animais, nas duas sub-regiões estudadas.

Can procalcitonin be a diagnostic marker for catheter-related blood stream infection in children? / A procalcitonina pode ser um marcador de diagnóstico de infecções de corrente sanguínea relacionadas a cateter em crianças?

Abstract Objective The potential role of procalcitonin (PCT) in the diagnosis of catheter-related bloodstream infection (CRBSIs) is still unclear and requires further research. The diagnostic value of serum PCT for the diagnosis of CRBSI in children is evaluated here. Method This study was conducted between October 2013 and November 2014, and included patients with suspected CRBSI from 1 month to 18 years of age who were febrile, with no focus of infection, and had a central venous catheter. Levels of PCT and other serum markers were measured, and their utility as CRBSI markers was assessed. Additionally, the clinical performance of a new, automated, rapid, and quantitative assay for the detection of PCT was tested. Results Among the 49 patients, 24 were diagnosed with CRBSI. The PCT-Kryptor and PCT-RTA values were significantly higher in proven CRBSI compared to those in unproven CRBSI (p = 0.03 and p = 0.03, respectively). There were no differences in white blood cell count and C-reactive protein (CRP) levels between proven CRBSI and unproven CRBSI. Among the 24 patients with CRBSI, CRP was significantly higher among those with Gram-negative bacterial infection than in those with Gram-positive bacterial infections. PCT-Kryptor was also significantly higher among patients with Gram-negative bacterial infection than in those with Gram-positive bacterial infections (p = 0.01 and p = 0.02, respectively). Conclusions The authors suggest that PCT could be a helpful rapid diagnostic marker in children with suspected CRBSIs.

Resumo Objetivo O possível papel da procalcitonina (PCT) no diagnóstico de infecções de corrente sanguínea relacionadas a cateter (ICSRCs) ainda não está claro e precisa ser mais pesquisado. O valor diagnóstico da PCT sérica para o diagnóstico de ICSRC em crianças é avaliado neste estudo. Método Este estudo foi feito entre outubro de 2013 e novembro de 2014 e incluiu pacientes com suspeita de ICSRC de um mês a 18 anos que estavam febris, não tinham foco de infecção e tinham cateter venoso central. Foram medidos os níveis de PCT e de outros marcadores séricos, cuja utilidade como marcadores de ICSRC foi avaliada. Adicionalmente, foi testado o desempenho clínico de um novo ensaio quantitativo automatizado e rápido para a detecção de PCT. Resultados Dentre 49 pacientes, 24 foram diagnosticados com ICSRC. Os valores de PCT-Kryptor e PCT-RTA foram significativamente maiores em ICSRCs comprovadas do que em ICSRCs não comprovadas (p = 0,03 e p = 0,03, respectivamente). Não houve diferença na contagem de glóbulos brancos e nos níveis de proteína C reativa (PCR) entre ICSRCs comprovadas e ICSRCs não comprovadas. Dentre os 24 pacientes com ICSRC, a PCR era significativamente maior entre aqueles com infecção bacteriana gram-negativa do que naqueles com infecção bacteriana gram-positiva. O PCT-Kryptor também foi significativamente maior entre pacientes com infecção por bactérias gram-negativas do que naqueles com infecção por bactérias gram-positivas (p = 0,01 e p = 0,02, respectivamente). Conclusões Sugerimos que a PCT pode ser um marcador de diagnóstico rápido útil em crianças com suspeita de ICSRCs.

Rhizobium radiobacter recovered from blood of a pediatric patient with stem cell transplantation: a case report and characterization of antimicrobial susceptibility profile

Rhizobium radiobacter is an uncommon agent of infection and has been associated with indwelling intravascular devices such as catheter in immunocompromised patients. Here, we report a case of R. radiobacter recovered from blood cultures in stem cell transplantation in a pediatric patient and present an extensive characterization of its antimicrobial susceptibility profile. The isolate presented low MICs to many antimicrobial agents, but high MICs to ceftazidime, piperacillin-tazobactam, aztreonam, and fosfomycin.

Neonatal Septicemia Predominant Bacterial Species and Antibiotic Resistance.

A prospective study was undertaken over a period of one year to determine various organisms responsible for neonatal septicemia and their antibiotic sensitivity pattern in a rural area. 1-2 ml of blood from the clinically suspected cases of neonatal septicemia was cultured in Brain Heart Infusion Agar- Brain Heart Infusion Broth (BHIA-BHIB). Out of 54 cases, blood culture was positive in 38 (70.37%) cases. Gram negative septicemia was encountered in 32 (84.21%) of these neonates. E. coli (31.57%) was the commonest followed by Pseudomonas (21.05%). Most gram negative isolates were sensitive to Amikacin and Ciprofloxacin. Majority of the isolates were resistant to Ampicillin and Gentamicin.

Oligella urethralis isolada em hemocultura de paciente internada no complexo HSP/UNIFESP / Oligella urethralis isolated in hemoculture from patient interned in HSP-UNIFESP complex

Primeiro isolado de Oligella urethralis em duas amostras de sangue periférico detectado por metodologia de monitoração contínua de metabolismo (sistema Bactec®) e identificado pelo sistema automatizado Phoenix® (BD System) em paciente com linfoma retroperitoneal com metástase em sistema nervoso central (SNC) no Hospital São Paulo da Universidade Federal de São Paulo (HSP/UNIFESP).

First time isolation of Oligella urethralis in two samples of peripheral blood detected by continuous metabolism monitoring methodology (Bactec 61650 system) and identified by the automatized Phoenix 61650 system (BD System) in patient with retro-peritoneal lymphoma with metastasis in the central nervous system at São Paulo hospital of Federal University of São Paulo (HSP/UNIFESP).

Evaluation of MicroScan and Phoenix System for Rapid Identification and Susceptibility Testing Using Direct Inoculation from Positive BACTEC Blood Culture Bottles / 대한진단검사의학회지

BACKGROUND: Procedures for rapid identification and susceptibility testing by direct inoculation (DI) from positive blood culture bottles into an automated system have not been standardized. This study was purposed to evaluate DI from BACTEC 9240 blood culture system (BD, USA) into MicroScan (Dade Behring, USA) or Phoenix (BD, USA). METHODS: From May to June 2006, bacterial pellets from positive aerobic bottles showing gram-positive cocci (GPC) or gram-negative rods (GNR) of single morphology were directly inoculated to MicroScan PosCombo1A and NegCombo32 and to Phoenix PMIC/ID-107 and NMIC/ID-53. In addition, the automated instruments were also inoculated from subcultures (standard inoculations, SI). Species identification and susceptibilities were compared between DI and SI and between MicroScan and Phoenix. RESULTS: A total of 108, 104, and 78 specimens were tested with MicroScan, Phoenix, and both, respectively. When DI and SI were matched, 94.8% of GPC were correctly identified with MicroScan, compared to 80.7% with Phoenix, and 93.9% of GNR were correctly identified with MicroScan, compared to 95.7% with Phoenix. DI with MicroScan and Phoenix showed correct susceptibilities in 94.6% of 1,150 and 96.5% of 660 tests (with very major error [VME] of 1.1% and 1.1%), respectively, among GPC and in 94.4% of 942 and 96.3% of 781 tests (with VME of 0.6% and 0%), respectively, of GNR. Correlation of identification/susceptibilities between MicroScan and Phoenix using DI were 81.8%/98.0% for Staphylococcus aureus and 100.0%/95.6% for Escherichia coli. CONCLUSIONS: DI warrants a reliable method for identification and susceptibility testing of both GPC and GNR in MicroScan, and those of only GNR in Phoenix.

Evaluation of target concentration intervention strategy of gentamicin therapy in a malnourished patient population of south India.

BACKGROUND & OBJECTIVE: Aminoglycoside antibiotics, especially gentamicin, are widely used in suspected Gram-negative infections in India. Therapeutic drug monitoring is not commonly used for this drug in our population. We evaluated the target concentration intervention (TCI) strategy of gentamicin therapy in a predominantly malnourished patient population with lower respiratory tract infection in south India. METHODS: Patients who were prescribed gentamicin for suspected lower respiratory tract infection were randomized to any of the three groups, viz., control (CG), once daily dosing (ODD), and pharmacokinetic dosing (TCI) groups. Diagnosis was initially done by clinical evaluation and confirmed radiologically. Patients in CG received 80 mg gentamycin twice daily, ODD group received 160 mg once daily, and TCI groups received 160 mg once daily initially followed by dose revision based on serum drug levels. Blood samples were collected at peak and trough levels and assayed for gentamicin concentration. Dose adjustment was done in TCI group whereas the other groups received standard doses. Efficacy and safety were evaluated as outcome measures. RESULTS: Of the 52 patients included initially in the study, 43 (CG 20, ODD 12, TCI 11) completed the study. The doses administered to the study subjects were less than those prescribed in standard textbooks and guidelines. Patients in TCI group had their gentamicin doses revised upwardly to a dose of 4.3+/-0.6 mg/kg to achieve a peak gentamicin concentration of 12 to 15 microg/ml. Both ODD and TCI groups showed significant improvements in outcomes studied over the control group. INTERPRETATION & CONCLUSION: The results of our study indicated that once daily dosing of gentamycin was superior to multiple daily dosing in treating the lower respiratory tract infection in the study population. All patients in the ODD and TCI groups achieved satisfactory serum drug concentrations at administered doses (160 mg/day for ODD and <or= 200 mg/day for TCI group). In our study, target concentration intervention did not significantly improve the therapy outcomes. Since the study sample is small further research may be needed.

Stenotrophomonas Maltophilia Infection in Patients Receiving Continuous Ambulatory Peritoneal Dialysis

BACKGROUND: Stenotrophomonas maltophilia is a gram-negative bacillus that has become increasingly recognized as an important nosocomial pathogen, particularly in individuals with severe debilitation or immunosuppression. S. maltophilia is also characterized by its resistance to multiple antibiotics. S. maltophilia peritonitis in CAPD (continuous ambulatory peritoneal dialysis) patients is associated with a poor prognosis and loss of CAPD catheter. No report concerning this entity has been presented in Korea. Therefore, we describe and discuss five cases of the S. maltophilia infection associated with CAPD in three patients with peritonitis and two with exit-site infections. METHODS: We performed a retrospective search for episodes of S. maltophilia infections related to CAPD in our renal unit. The baseline levels of hemoglobin, albumin, cholesterol, BUN and creatinine were compared with age, sex and, if possible, the underlying disease-matched controls. RESULTS: All the patients with S. maltophilia peritonitis had diabetes mellitus as the underlying disease. The individual patients also had other significant combined morbidities, such as panhypopituitarism, COPD chronic obstructive pulmonary disease, cerebrovascular accident and myocardial infarction. The level of hemoglobin in these patients was significantly lower than in the controls, and the mean values of serum albumin, creatinine and BUN were also low. CONCLUSION: Immune dysfunction due to uremia, anemia, malnutrition, other comorbidities (e.g. diabetes mellitus), and also, an indwelling peritoneal catheter may be predisposing factors for the S. maltophilia infection in CAPD patients. Once the S. maltophilia infection is diagnosed in CAPD patient, the patient should be treated based on the understanding of this particular organism.

Serum potassium levels following suxamethonium administration in septic peritonitis patients.

Serum potassium and sodium changes following suxamethonium (1.5 mg/kg) administration were studied in 25 patients with septic peritonitis and 25 with no signs of peritonitis. A highly significant rise (P less than 0.001) in serum potassium (0.1-2.5 mEq/l) above the pre-induction levels was observed following suxamethonium administration in patients with septic peritonitis with maximum rise at 5 min following suxamethonium. This rise in potassium was significantly higher (P less than 0.001) in peritonitis patients at 3,5, and 10 min interval. A positive correlation was found between rise of potassium and duration of illness (P less than 0.01). No statistically significant changes were observed in serum sodium levels in both groups.