Prevalence and impact of extended-spectrum beta-lactamase production on clinical outcomes in cancer patients with Enterobacter species bacteremia

BACKGROUND/AIMS: We examined the prevalence of extended-spectrum beta-lactamase (ESBL) production and the impact of ESBL on clinical outcomes in cancer patients with Enterobacter spp. bacteremia. METHODS: Using prospective cohort data on Enterobacter bacteremia obtained between January 2005 and November 2008 from a tertiary care center, the prevalence and clinical impact of ESBL production were evaluated. RESULTS: Two-hundred and three episodes of Enterobacter spp. bacteremia were identified. Thirty-one blood isolates (15.3%, 31/203) scored positive by the double-disk synergy test. Among 17 isolates in which ESBL genes were detected by polymerase chain reaction and sequencing, CTX-M (n = 12), SHV-12 (n = 11), and TEM (n = 4) were the most prevalent ESBL types. Prior usage of antimicrobial agents (77.4% vs. 54.0%, p = 0.02) and inappropriate empirical antimicrobial therapy (22.6% vs. 3.0%, p < 0.001) were more commonly encountered in the ESBL-positive group than in the extended-spectrum cephalosporin-susceptible ESBL-negative group, respectively. Clinical outcomes did not differ significantly between the two groups (30-day mortality rate, 19.4% vs. 17.0%, p = 0.76; median length of hospital stay, 24.0 days vs. 30.5 days, p = 0.97). Initial presentation of severe sepsis/septic shock, pneumonia, and intra-abdominal infection were independently associated with 30-day mortality. CONCLUSIONS: The prevalence of ESBL-producing isolates was 15.3% in cancer patients with Enterobacter bacteremia. Although inappropriate empirical therapy was more common in the ESBL-positive group, ESBL production was not associated with poorer outcomes.

Caracterización fenotípica de enterobacterias aisladas en pacientes con el virus de la inmunodeficiencia humana/sida / Phenotypic characterization of enterobacteria isolated from patients with human immunodeficiency virus infection/AIDS

Introducción: en pacientes con el virus de la inmunodeficiencia humana/sida se incrementa el riesgo de padecer infecciones por enterobacterias. Objetivo: caracterizar fenotípicamente las enterobacterias causantes de infecciones en estos pacientes. Métodos: se realizó un estudio descriptivo prospectivo, en el Instituto Pedro Kourí, de marzo de 2010 a marzo de 2011. Se procesaron muestras de esputo, lavado bronquial, secreciones faríngeas, óticas y vaginales, orina, fecales, lesiones de piel, sangre y catéteres, en 65 pacientes (ambulatorios y hospitalizados). La identificación bacteriológica y la susceptibilidad antimicrobiana de los 73 aislamientos, se determinaron mediante sistema VITEK 2 Compact (bioMérieux, Francia). Resultados: se identificaron Escherichia coli (30), Klebsiella spp. (19), Enterobacter spp. (15), Proteus spp. (7) y Serratia spp. (2). Prevalecieron las sepsis en pacientes hospitalizados (87,7 porciento). Menos de 50 porciento de las enterobacterias resultaron resistentes a las cefalosporinas, excepto Klebsiella spp. y Enterobacter spp. (68,4 porciento y 93,3 porciento de resistencia a cefepima y cefoxitina, respectivamente), y más del 80 porciento se mostró sensible a la amikacina. Se observó resistencia a piperazilina/tazobactam y ciprofloxacina en 27,3 porciento y 15 porciento, respectivamente. Se detectó 34,2 porciento de cepas productoras de betalactamasas de espectro extendido. Conclusiones: Escherichia coli y Klebsiella spp. causan frecuentemente infecciones en pacientes VIH/sida. El estudio de la sensibilidad antimicrobiana por VITEK 2 Compact, sugiere que las cefalosporinas, aminoglucósidos, quinolonas y piperacilina/tazobactam, pudieran constituir una alternativa terapéutica en estos casos

Introduction: the risk of infections caused by enterobacteria increases in HIV patients. Objective: to phenotypically characterize the enterobacteria responsible for infections in these patients. Methods: a prospective and descriptive study was conducted in Pedro Kourí Institute from March 2010 to March 2011. Samples of sputum, bronchial lavage, pharyngeal, ear and vaginal secretions, urine, stool, skin lesions, blood and catheters taken from 65 patients (ambulatory and hospital) were processed. Bacterial identification and antimicrobial susceptibility of 73 isolates were determined by automated system VITEK 2 Compact (bioMérieux, France). Results: Escherichia coli (30), Klebsiella spp. (19), Enterobacter spp. (15), Proteus spp. (7) and Serratia spp. (2) were identified. Sepsis in hospitalized patients (87.7 percent) was prevalent. Less than 50 percent of Enterobacteriaceae were resistant to cephalosporins, except Klebsiella spp. and Enterobacter spp. (68.4 percent and 93.3 percent resistance to cefepime and cefoxitin, respectively) and over 80 percent were sensitive to amykacin. Resistance to piperacillin/tazobactam and ciprofloxacin was observed in 27.3 percent and 15 percent of cases, respectively. In the study, 34.2 percent of extended-spectrum beta-lactamases- producing strains was detected. Conclusions: Escherichia coli and Klebsiella spp. often cause infections in HIV patients. The study of antimicrobial susceptibility by using VITEK 2 Compact system, suggests that cephalosporins, aminoglycosides, quinolones and piperacillin/tazobactam, could be effective therapeutic alternatives in these cases

A Case of Bilateral Endogenous Pantoea Agglomerans Endophthalmitis with Interstitial Lung Disease

We here in report a case of bilateral endogenous endophthalmitis caused by Pantoea agglomerans (P. agglomerans) in a patient who had interstitial lung disease and was treated with oral corticosteroids. A 72-year-old man presented with decreased visual acuity in both eyes nine days after he received oral corticosteroids. He had marked uveitis, cataracts, and vitreous opacities. Cultures were taken of blood, aqueous humor, and vitreous. We initially suspected a fungal etiology and treated him with antifungal drugs; however, the intraocular disease progressed without improvement. Vitreous culture was positive for P. agglomerans. The patient underwent pars plana vitrectomy with cataract surgery bilaterally, followed by a 2-week course of antibiotics. The final visual acuity was 20/25 in the right eye and 20/200 in the left eye. This is the first report of bilateral endogenous endophthalmitis caused by P. agglomerans in Korea; it is also the first case reported outside of the United States.

Changing profile of prostatic abscess

PURPOSE: To compare the clinical presentation of prostatic abscess and treatment outcome in two different time frames with regards to etiologies, co-morbid factors and the impact of multidrug resistant organism. MATERIALS AND METHODS: We retrospectively assessed the charts of 48 patients with the diagnosis of prostatic abscess from 1991 to 2005. The period was divided arbitrarily into two different time frames; phase I (1991-1997) and phase II (1998-2005). Factors analyzed included presenting features, predisposing factors, imaging, bacteriological and antibiotic susceptibility profile, treatment and its outcome. RESULTS: The mean patient age in phase I (n = 18) and phase II (n = 30) were 59.22 ± 11.02 yrs and 49.14 ± 15.67 respectively (p = 0.013). Diabetes mellitus was most common predisposing factor in both phases. Eleven patients in phase II had no co-morbid factor, of which nine were in the younger age group (22 - 44 years). Of these eleven patients, five presented with pyrexia of unknown origin and had no lower urinary tract symptoms LUTS Two patients with HIV had tuberculous prostatic abscess along with cryptococcal abscess in one in phase II. Two patients had melioidotic prostatic abscess in phase II. The organisms cultured were predominantly susceptible to first line antibiotics in phase I whereas second or third line in phase II. CONCLUSION: The incidence of prostatic abscess is increasing in younger patients without co-morbid factors. The bacteriological profile remained generally unchanged, but recently multi drug resistant organisms have emerged. A worrying trend of HIV infection with tuberculous prostatic abscess and other rare organism is also emerging.

Citrobacter freundii infection in glutaric aciduria type 1: adding insult to injury.

Glutaric aciduria type 1 (GA1) is an inborn error of organic acid metabolism, where the brain is the principal organ affected with exposure to toxic metabolic product, 3-hydroxyglutaric acid (3-OHGA). A 2-year-old boy with GA1 and delayed developmental milestones had an acute neurological crisis leading to massive brain abscess with Citrobacter freundi infection, a rare cause of neonatal meningitis and often associated with brain abscess. Both 3-OHGA and C. freundii can damage the blood-brain barrier and can cause significant trauma which demands immediate and appropriate management. Encephalopathic manifestations of GA1 may consequently increase the risk of meningeal infection and it has not been previously documented.

Role of enteric fever in ileal perforations: an overstated problem in tropics?

PURPOSE: To determine the role of enteric fever in ileal perforations. METHODS: A prospective cohort of 47 patients of ileal perforation was subjected to clinical examination and investigations for APACHE II scoring. Blood, ulcer edge biopsy, mesenteric lymph node and peritoneal aspirate were subjected to culture to determine the predominant aerobic bacterial isolate and its antibiogram. RESULTS: Seven patients (14.9%) required intensive care and seven (14.9%) developed septicaemia. Mortality was 17%. Highest isolation rate was seen in ulcer edge (70.2%) followed by lymph node (66%) culture. The bacterial spectrum was Escherichia coli (23.4%), Enterococcus faecalis (21.3%), Salmonella enterica serovar Typhi (6.3%), Salmonella enterica serovar Paratyphi A (4.2%), etc. CONCLUSIONS: Enteric fever organisms are not the predominant causative agents of ileal perforations. Culture of ulcer edge biopsy, lymph node is crucial for aetiological diagnosis. The use of APACHE II triaging and prescription of antimicrobials based on the local pattern of susceptibility profile of the aetiological agent is recommended.

Morganella Morganii Sepsis with Massive Hemolysis

Morganella morganii is a facultative gram-negative and anaerobic rod. It may be a cause of devastating infections in neonates and immunocompromised hosts. Some bacterial infections such as Clostridium and Vibrio are associated with hemolysis. However, massive hemolysis caused by M. morganii sepsis has not yet been reported. We observed a 59-yr-old man who had chemotherapy-induced neutropenia and was found to have massive hemolysis and metabolic acidosis due to sepsis. He died 6 hr after admission in spite of aggressive treatment. Two sets of blood cultures revealed the growth of M. morganii. We report here that M. morganii sepsis can cause fatal massive hemolysis leading to death.

A Case of Pneumonia Caused by Ewingella americana in a Patient with Chronic Renal Failure

Though the pathogenic significance and the reservoir of Ewingella americana have not been clarified, this organism has caused several pathogenic infections, especially in immunocompromised patients. We report a pneumonia in a patient with chronic renal failure, who had chronic rejection of transplanted kidney. E. americana was identified to be the pathogen of pneumonia with clinical symptoms and signs and radiological examination. As soon as he was treated with ceftriaxone and isepamicin, clinical improvement was followed with no further growth of E. americana or other pathogenic isolates from sputum culture. This suggests to be the case of pneumonia caused by E. americana for the first time in the Korean literature.

Early onset neonatal sepsis due to Morganella morganii.

Two neonates, both 32-weekers, developed Morganella morganii sepsis on the first day of life. They presented within a day of each other, primarily with respiratory signs. In both cases there was a history of spontaneous premature rupture of membranes, exposure to a single dose of ampicillin ante-partum, and similar antibiograms. No common source could be identified.

Empiema pleural causado por Edwardsiella tarda / Pleural empyema caused by Edwardsiella tarda

Os autores descrevem o primeiro caso registrado de empiema pleural causado por Edwardsiella tarda, uma bactéria Gram negativa, e fazem uma revisão da literatura das infecções causadas por este patógeno

Meningite por Enterobacter sakazakii em recem-nascido: relato de caso / Enterobacter sakazakii meningitis in a newborn infant: case report

Descrever as particularidades de um caso de meningite por Enterobacter sakazakii. Descricao: foi diagnosticada meningite em uma menina de 14 dias de vida...

Brain abscess by citrobacter diversus in infancy: case report

Citrobacter diversus is closely related to brain abscess in newborn infants. We describe a case of brain abscess by this bacteria in a newborn infant and his clinical and cranial computed tomographic evaluation until the fourth month of life and discuss therapeutic management of this patient

Niveles sericos de vitamina A y su relacion con diarrea aguda y persistente / Seric levels of vitamin A and their relation with acute and persistent diarrhea

Se estudiaron 75 pacientes menores de un año en el período entre enero 1991-abril 1992, los que fueron divididos en tres gurpos: grupo 1: 25 pacientes controles; grupo 2: 25 pacientes con enfermedad diarreica aguda y grupo 3: 25 pacientes con diarrea persistente. A todos se les realizó dosificación sérica de vitamina A, clasificádolos según el resultado en normal niveles mayores de 0,75 Mmol/l, deficiencia no severa entre 0,75 y 0,35 Mmol/I y deficiencia menor de 0,35 Mmol/l. Demonstrandose que la deficiencia de vitamina A constituye un factor de riesgo para la diarrea persistente en nuestro medio

Stool electrolytes in acute dehydrating gastroenteritis.

Stool electrolytes were studied in 100 cases of gastroenteritis. The duration of illness was 24-48 hours in 32% and 72-96 hours in 28% of the cases. On stool culture, 43% children had no growth, 23% had Enteropathogenic E. coli and 10% had cholera and rotavirus each. The stool sodium loss was more in cholera and shigella cases, diarrhea of shorter duration and in children between 24-30 months of age. Potassium loss in the stool was more in shiegella cases, diarrhea of short duration and in children between 30-36 months of age. In cases of gastroenteritis with severe malnutrition, stool sodium loss was less; stool potassium loss was not affected by the nutritional status. Total electrolytes lost in stools can be estimated by knowing purging rate and rehydration therapy can be planned accordingly.

Infección de vias urinarias en niños / Urinary tract infectious in children

Se estudiaron 109 niños con proceso febril agudo y/o síntomas sugestivos de infección de vías urinarias (IVU). De los 109 casos, 41 (44.6 por ciento ) tuvieron crecimiento de gérmenes en el urocultivo, conciderándose como portadores de IVU. En los 41 casos con IVU el agente etiológico predominante fue la E. Coli (48.7 por ciento ), siguiéndole el enterobacter (34.1 por ciento ). Se destaca la correlación existente entre leucocituria y la presencia de urocultivo positivo. Por otro lado, se evidenció que la presencia de fiebre asociada a manifestaciones clínicas de disuria, polaquiria, etc., estuvo asociada a crecimiento de bacterias en el urocultivo, en el 50 por ciento de los casos

Artritis reactiva / Reactive arthritis

Se evaluó retrospectivamente a 22 pacientes (21 varones y una mujer) con el diagnóstico de Artritis reactiva en el Centro Médico Naval de Lima entre julio de 1987 y junio de 1991. La edad promedio fue de 28 años. Tiempo de enfermedad, 45 días, en 55 por ciento de los casos. Disarcos precedieron la artritis en el 45.5 por ciento. Los síntomas iniciales fueron: artralgias 100 por ciento, lumalgias: inflamatoria 23 por ciento, disuria 27 por ciento, `ojo rojo': 14 por ciento. Al exámen físico: fiebre, 55 por ciento. La artritis fue adimétrica y oligoarticular, en 91 por ciento (rodillas, tobillos e IFP fueron las más afectadas). Sacroilitis en 23 por ciento. El test de Shober y la expansión torácica, normales. Conjuntivitis, 13.7 por ciento uveítis anterior aguda, 13.7, dactilitis, 27.2 por ciento. Síndrome de Reiter completo, 2 pacientes, `incompleto', 4 pacientes. Exámenes auxiliares: VSG elevada en 77 por ciento. Todos los cultivos de líquido articular fueron negativos. Radiografías: cuadratura vertebral, 2/10; 2/10 sacrilitis unilateral, 1/6. Gamagrafía ósea Tc99: hipercaptación periférica 7/8. Todos recibieron AINEs y sólo 2 recibieron methotrexate. El seguimiento fue de 1 a 44 meses. Once pacientes fueron seguidos por más de año (autolimitado, 4; ondulante, 5 y crónico, 2). Se concluye que son más frecuentes las enfermedades entéricas como causa de las artritis reactivas y que éstas suelen ser de curso prolongado

Bacteremia nosocomial por enterobacter: hospital Guillermo Almenara Irigoyen 1988 / Nosocomial septicemia by enterobacter: Guillermo Almenara Irigoyen Hospital (1988)

En el servicio de microbiología del H.N.G.A.I. durante 1988, el germen más aislado de hemocultivos exceptuando a Salmonella sp. fue Enterobacter sp. por eso con la finalidad de conocer algunas características de la Bacteremia Nosocomial por Enterobacter y su sensibilidad in vitro se realizó el presente estudio. Se encontró 33 casos de Bacteremia significativa por Enterobacter, más del 80 por ciento de los casos fueron nosocomiales, la puerta de entrada fue en orden decreciente de frecuencia: indeterminado, tracto respiratorio, cateter endovenoso y herida operatoria, la enfermedad de fondo fue Diabetes Mellitus, Neoplasias y problemas cardiovasculares, la mayoría de pacientes procedían de servicios de Medicina. La mortalidad fue aproximadamente 50 por ciento. La resistencia in vitro fue muy alta para Ampicilina, Mezlocilina, Cloranfenicol, Gentamicina en cambio la sensibilidad fue excelente para quinolonas y Ceftriacxone