ABSTRACT
The European Society for Clinical Microbiology and Infectious Diseases recommends 3rd generation cephalosporins and metronidazole for empirical treatment of community-acquired brain abscesses. In 53 retrospectively analyzed pediatric patients with community-acquired brain abscesses at a German University Hospital Staphylococcus aureus was identified as a relevant pathogen (21%). Therefore, it may be reasonable to cover S. aureus when selecting empirical therapy.
Subject(s)
Anti-Bacterial Agents , Brain Abscess , Community-Acquired Infections , Staphylococcal Infections , Staphylococcus aureus , Humans , Retrospective Studies , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Brain Abscess/microbiology , Brain Abscess/drug therapy , Child , Male , Female , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Adolescent , Staphylococcus aureus/drug effects , Infant , Germany/epidemiology , Metronidazole/therapeutic useABSTRACT
PURPOSE: In late 2022, a surge of severe S. pyogenes infections was reported in several European countries. This study assessed hospitalizations and disease severity of community-acquired bacterial infections with S. pyogenes, S. pneumoniae, N. meningitidis, and H. influenzae among children in North Rhine-Westphalia (NRW), Germany, during the last quarter of 2022 compared to long-term incidences. METHODS: Hospital cases due to bacterial infections between October and December 2022 were collected in a multicenter study (MC) from 59/62 (95%) children's hospitals in NRW and combined with surveillance data (2016-2023) from the national reference laboratories for streptococci, N. meningitidis, and H. influenzae. Overall and pathogen-specific incidence rates (IR) from January 2016 to March 2023 were estimated via capture-recapture analyses. Expected annual deaths from the studied pathogens were calculated from national death cause statistics. RESULTS: In the MC study, 153 cases with high overall disease severity were reported with pneumonia being most common (59%, n = 91). IRs of bacterial infections declined at the beginning of the COVID-19 pandemic and massively surged to unprecedented levels in late 2022 and early 2023 (overall hospitalizations 3.5-fold), with S. pyogenes and S. pneumoniae as main drivers (18-fold and threefold). Observed deaths during the study period exceeded the expected number for the entire year in NRW by far (7 vs. 0.9). DISCUSSION: The unprecedented peak of bacterial infections and deaths in late 2022 and early 2023 was caused mainly by S. pyogenes and S. pneumoniae. Improved precautionary measures are needed to attenuate future outbreaks.
Subject(s)
Community-Acquired Infections , Disease Outbreaks , Humans , Germany/epidemiology , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Child , Child, Preschool , Infant , Disease Outbreaks/statistics & numerical data , Adolescent , Female , Male , Hospitalization/statistics & numerical data , Bacterial Infections/epidemiology , Incidence , Infant, Newborn , Streptococcus pyogenesABSTRACT
BACKGROUND: Peritoneal dialysis (PD)-related peritonitis is a rare but serious complication and is associated with increased morbidity and mortality rates. It is most commonly caused by Staphylococcus aureus or Staphylococcus epidermidis, but infection with Listeria monocytogenes may also occur. Recommendations for antibiotic treatment of a Listeria infection are currently based on a small number of case reports and suggest the administration of ampicillin. But unlike vancomycin or gentamicin, for ampicillin the route of application, the dosage, and the duration of treatment have not yet been established. We report a case in which PD-associated peritonitis due to Listeria infection was treated with ampicillin administered intravenously and intraperitoneally, separately and in combination. CASE PRESENTATION: A 72-year-old man with chronic kidney disease stage 5 dialysis (CKDG5D) secondary to hypertension and diabetes was hospitalised in April 2020 because of PD-related peritonitis caused by a Listeria infection. In accordance with the results of resistance tests, the patient was treated with intravenous ampicillin at a dosage of 6 g twice daily. After initial treatment the leukocyte count in the PD effluent had decreased substantially, but it was permanently reduced only with the addition of intraperitoneal ampicillin (4 g daily). Efficient serum concentrations of ampicillin were determined for both routes of administration, intravenous and intraperitoneal. CONCLUSION: This is the first case report demonstrating that PD-related peritonitis due to Listeria monocytogenes infection can be treated with intraperitoneal ampicillin and monitored by the determination of peripheral serum concentrations of ampicillin.
Subject(s)
Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Listeriosis/drug therapy , Peritoneal Dialysis/adverse effects , Peritonitis/drug therapy , Aged , Humans , Leukocyte Count , Listeria monocytogenes , Listeriosis/etiology , Male , Peritonitis/etiologyABSTRACT
BACKGROUND: The number of invasive Candida infections has significantly increased in recent decades. For the successful treatment of fungal infections, rapid identification at the species level, particularly in polyfungal infections, is a key factor. In this study, four commercially available chromogenic media, CandiSelect™ 4 (CS4), chromID™ Candida Agar (CCA), BBL™ CHROMagar™ Candida Medium (BBL) and Brilliance™ Candida Agar (BCA) were evaluated for Candida identification. MATERIAL/METHODS: Overall, 181 bronchial secretion samples from intensive care patients were analysed prospectively. In addition, 18 primarily sterile materials, previously tested positive for Candida, were investigated retrospectively. All samples were cultured as recommended by the manufacturer and visually inspected after 24 and 48 hours by three independent investigators. As a control, colonies were identified by MALDI-TOF MS. Specificity and sensitivity were determined for C albicans identification prospectively. RESULTS: CS4 and BCA showed the best overall consensus with the identification results reached by MALDI-TOF MS for Candida albicans and species. A clear differentiation between the species could be ascertained via easily identifiable, species-specific coloration in contrast to BBL and CCA. Sensitivity for C albicans (n = 73) identification varied between 32% (BCA) and 69% (CS4 and CCA) after 24 hours and 68% (BBL) and 82% (BCA) after 48 hours incubation, while specificity ranged between 62% (BBL) and 81% (CCA) after 24 hours and 82% (BBL) and 85% (CS4) after 48 hours. CONCLUSION: CS4 and BCA are recommended for routine identification of Candida species in human samples.
Subject(s)
Candida , Candidiasis/diagnosis , Mycological Typing Techniques/methods , Candida/growth & development , Candida/isolation & purification , Candida albicans/growth & development , Candida albicans/isolation & purification , Humans , Retrospective Studies , Sensitivity and Specificity , Species SpecificityABSTRACT
Postpneumonectomy empyema (PPE) with methicillin-resistant Staphylococcus aureus (MRSA) is a challenging problem because these germs have extensive virulence factors and mechanisms to escape from the host's immune system. The present case was successfully treated with accelerated repeated surgical debridement, vancomycin gauze packing and final obliteration of the postpneumonectomy space with latissimus myoplasty and vancomycin solution.
