Carbapenem-resistant Enterobacteriaceae: A retrospective review of treatment and outcomes in a long-term acute care hospital.

BACKGROUND: Long-term acute care hospitals (LTACHs) have a unique patient population, with multiple risk factors for carbapenem-resistant Enterobacteriaceae (CRE) colonization and infection. METHODS: We performed a retrospective analysis of patients in LTACHs who were diagnosed with and treated for CRE infections. Baseline data, antimicrobial treatment, and outcomes were collected in patients with bacteremia, health care-associated pneumonia, and complicated urinary tract infection/acute pyelonephritis due to CRE diagnosed between January 2017 and December 2017. RESULTS: A total of 57 cases of CRE infection were identified over the study period, including 12 cases of bacteremia, 20 cases of health care-associated pneumonia, and 25 cases of complicated urinary tract infection/acute pyelonephritis. Patient had significant comorbidities: 31.5% with diabetes, 40.4% with heart failure, 29.8% with kidney disease, and 10% with solid tumors. The majority (56) of 57 patients received empiric antibiotics known to have activity against gram-negative bacteria, but only 38.6% had in vitro activity against the CRE organism in cultured specimens. A total of 78.9% of patients received monotherapy. Overall outcome was poor, with 28-day mortality across all infection sites of 17.5% in patients but up to 25% in patients with bacteremia. CONCLUSIONS: In this retrospective analysis of our clinical experience treating CRE infections in an LTACH setting, we documented that CRE infections occur in patients with substantial comorbidities. Although clinical outcome remains of great concern, the 28-day mortality and rate of eradication of CRE in this study were comparatively better than other national estimates. Inappropriate empiric treatment may be one of many factors leading to overall poor treatment outcomes.

Aerococcus Viridans: Case Report, Microbiology, and Literature Review.

BACKGROUND Aerococcus viridans are Gram-positive, catalase and oxidase-negative, microaerophilic, and non-motile bacteria species that are rarely associated with human infections such as arthritis, bacteremia, endocarditis, and meningitis. The bacteria are also fastidious (i.e., have complex nutritional requirements) and often confused with Streptococci species or treated as a contaminant. CASE REPORT We report a case of Aerococcus septicemia in an 85-year-old female patient, who transferred from a nursing home to an acute care hospital in Washington DC, USA. She had a 2-day history of worsening mental status, fever of 38.9°C (102°F), and tachycardia. Urinalysis revealed numerous white blood cells and bacteria. Laboratory tests revealed a white blood cell count of 14 000 cells/mL (85% neutrophils, 8% lymphocytes, 5% bands, and 2% monocytes), hemoglobin of 12.6 g/dL, and serum creatinine of 0.8 mg/dL. Blood and urine cultures obtained during admission grew penicillin-resistant A. viridans, identified via matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) on day 3 of admission. The patient received empiric vancomycin with piperacillin-tazobactam, and we deescalated to vancomycin monotherapy to complete a 14-day treatment course. CONCLUSIONS This case report highlights the role of MALDI-TOF for identifying fastidious organisms, and we were able to form a better clinical correlation between patient symptoms and causative organisms. We believe that antimicrobial therapy (in accordance with susceptibility results) should be initiated in symptomatic patients who have A. viridans isolated in significant amounts in urine or from a sterile site.

Case series of Bartonella quintana blood culture-negative endocarditis in Washington, DC.

INTRODUCTION: Prior studies (predominantly from Europe) have demonstrated blood culture-negative endocarditis due to Bartonella. Our objective was to describe three cases of Bartonella quintana endocarditis identified within one year at a large hospital in Washington, DC, USA. CASE PRESENTATION: We constructed a descriptive case series from a retrospective review of medical records from April to December 2013 at an 800-bed urban hospital. All three patients (ages: 52, 55 and 57 years) were undomiciled/homeless men with a history of alcoholism. Although they had negative blood cultures, echocardiography demonstrated aortic/mitral valve perforation and regurgitation in one patient, aortic/mitral valve vegetation with mitral regurgitation in the second patient, and aortic valve vegetation with regurgitation in the third patient. The patients had positive Bartonella quintana serum immunoglobulin G (IgG) with negative immunoglobulin M (IgM). PCR on DNA extracted from cardiac valves was positive for Bartonella, and DNA sequencing of PCR amplicons identified Bartonella quintana. Patients received treatment with doxycycline/rifampin or doxycycline/gentamicin. CONCLUSION: Clinicians should consider Bartonella endocarditis as a differential diagnosis in patients who fit elements of the Duke Criteria, as well as having a history of homelessness and alcoholism.

Effects of biochemical alteration in animal model after short-term exposure of Jatropha curcas (Linn) leaf extract.

This study aims to evaluate potential toxic effect of Jatropha curcas leaves methanol extract on laboratory rats as well as determine its LD50. A total of 80 male Wistar rats were used as the experimental animals, 40 for LD50 determination and the other 40 for toxicity study. Based on the pretest that was done in order to establish a range of toxicity, 4 dosages (86.00, 58.00, 46.00, and 34.0 kg/body weight) were chosen. The rats were randomly assigned into four groups with 10 rats in each group. Rats in groups 1, 2, 3, and 4 were given 0 mg/kg, 500 mg/kg, 1000 mg/kg, and 2000 mg/kg body weight of Jatropha curcas extract, respectively, by oral intubation for 21 days. Thereafter, clinical signs, change in body weight, toxicity symptoms, and biochemical parameters were obtained. The LD50 at 95% confidence limits for rats was 46.0 mg/kg body weight (44.95-52.69 mg/kg body mass). There was no clinical and biochemical signs of toxicity when the extract was administered at 500, 1000, and 2000 mg/kg body weight, respectively (P > 0.05). Results obtained from this study suggest that liver, kidney, and haematological system of rats tolerated methanolic leave extract of Jatropha curcas at a certain concentration.

Pregnancy associated pancreatitis revisited.

OBJECTIVES: To evaluate the demographics, risk factors and outcomes of pregnancy associated pancreatitis (PAP). STUDY DESIGN: A retrospective chart review was done using ICD-9 Code 577.0 (acute pancreatitis) from January 2005 through December 2009. Women aged 18 to 45 years, who were pregnant and 6 months after delivery were considered for the study. For each case, two women of the same age (± 4 years) with no history of pancreatitis were matched as control. Demographics, etiology, diagnostic modality and intervention were obtained. RESULTS: During the 5 years of study, 29 cases of PAP occurred among 25,600 total hospital deliveries, yielding prevalence of 0.001%: Hispanics 48%, Caucasians 24%, African Americans 17.2%, and Asian/Pacific Islanders 13% (P<0.05). Sixty-five percent of those with pre-pregnancy body mass index (BMI) more than 30 kg/m(2) had PAP, versus 24% with BMI between 25 and 30 kg/m(2) and 10% with BMI less than 25 kg/m(2) (P<0.05). An increasing trend of PAP was seen with gestational age and number of pregnancy. CONCLUSION: Gallstone disease is the most frequent etiology for PAP and tends to occur more often in Hispanics in New Jersey.

Polyphenolic contents and antioxidant potential of stem bark extracts from Jatropha curcas (Linn).

We assessed the polyphenolic contents and antioxidant potential of the aqueous, ethanol and methanol stem bark extracts of Jatropha curcas. The total phenol, flavonoids, flavonols and proanthocyanidin contents of the extracts were evaluated to determine their effect on the antioxidant property of this plant, using standard phytochemical methods. The antioxidant and free radical scavenging activity of ethanol, methanol and aqueous extracts of the plant were also assessed against 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS), ferric reducing, nitric oxide (NO), superoxide anion, (O(2) (-)) and hydrogen peroxide (H(2)O(2)) using spectroscopic methods and results were compared with that of butylated hydroxyl toluene (BHT) and ascorbic acid as standards. The concentrations of different classes of phenolic compounds were higher in methanol and ethanol extracts compared to aqueous extracts. There was correlation between total phenol, total flavonoids, total flavonol and total proanthocyanidins (r = 0.996, 0.978, 0.908, and 0.985) respectively. There was correlations between the amount of phenolic compounds and percentage inhibition of DPPH radicals scavenging activity of the extract (r = 0.98). Findings from the present study indicated that J. curcas is a potential source of natural antioxidants and may be a good candidate for pharmaceutical plant based products.

Pseudopapillary tumor of the pancreas. An algorithmic approach.

CONTEXT: Solid-cystic pseudopapillary tumor of the pancreas is a rare tumor, but has favorable prognosis even in the presence of distant metastases. It is often associated with diagnostic and therapeutic challenges. CASE REPORTS: Described are two cases of solid-cystic pseudopapillary tumor of the pancreas managed in our hospital between January 2000 and January 2010. One female and one male with mean age of 42 years (range: 33 to 51 years). Data collected were: presenting symptoms, signs, imaging and management. Literature review was obtained from computer generated MEDLINE and Google Scholar search for solid-cystic pseudopapillary tumor of the pancreas between 1980 and 2010. Articles relevant to the scope of this paper were selected. The incidence of solid-cystic pseudopapillary tumors of the pancreas in our institution is 2 cases in 10 years; i.e., 0.2 cases/year. Clinical presentation include; palpable abdominal mass, vague abdominal discomfort, increasing abdominal girth, significant weight loss, nausea and vomiting in both patients. The mean diameter of the tumors was 7.0 cm (range: 5.9 to 8.0 cm). Pancreaticoduodenectomy was performed on both patients. None received adjuvant therapy and no cancer recurrence was detected on follow-up. CONCLUSION: Solid-cystic pseudopapillary tumor of the pancreas is a rare tumor with a favorable prognosis even with distant metastases; therefore, attempts must be made to differentiate it from other pancreatic neoplasms. Clinical and radiological studies alone are insufficient to establish the diagnosis of a pancreatic mass and tissue biopsy should be sought. Surgery is generally curative and should be pursued independent of size and distant metastases.