Bloodstream Infections: Comparison of Diagnostic Methods and Therapeutic Consequences between a Hospital in a Resource-Limited Setting and Two French Hospitals.

In recent years, the diagnosis of bloodstream infections has been complemented by rapid microbiological methods, unattainable to most clinical laboratories in resource-limited settings. We evaluated the impact of their shortage on antibiotic therapy adequacy. We conducted a prospective multicenter cohort study including 150 adult Gram-negative bacilli bacteremia episodes, evenly distributed across three university hospitals: one in Lebanon, a resource-limited setting, and two in France, a resource-rich setting. Previous colonization by multidrug-resistant organisms (MDRO) was significantly more prevalent among the Lebanese than the French group of patients (16/50 vs. 5/100; p < 0.01). Bloodstream infections by carbapenemase-producing Enterobacterales and other MDRO were higher among the Lebanese than the French group of patients (25/50 vs. 12/100; p < 0.01). For the French group, rapid identification of species and mechanisms of resistance significantly shortened turnaround time for definitive laboratory diagnosis and increased antibiotic therapy adequacy. No statistically significant differences were noted in targeted antibiotic therapy between the two groups. This study suggests that, in settings where bacterial resistance is prevalent, rapid microbiological methods have not provided any additional value. The clinical and economic impact of rapid microbiological methods will likely depend on local CPE, VRE, and other MDRO epidemiology and are areas for future research.

First reported case of Cladosporium para-aortic abscess.

Cladosporium species are ubiquitous dematiaceous fungi, widely found in the indoor and outdoor environments. They are considered a frequent source of contamination in laboratory settings. In human pathology, Cladosporium is a main agent of phaeohyphomycosis, known to cause subcutaneous and brain abscess, especially in immunocompromised hosts. The route of disseminated infections is mainly hematogenous after inhalation of the spores. However, a direct inoculation could be possible. We report the first case of a para-aortic abscess with thrombus formation, caused by Cladosporium spp., after a valvular replacement surgery, in an immunocompetent patient. This raises the alarm about the rapid identification of the source of contamination in the operating room, in order to prevent the emergence of further fatal infections.