ABSTRACT
OBJECTIVE: We report an outbreak of Elizabethkingia anophelis infections in France. To the best of our knowledge, this is the first outbreak described in Europe. METHODS: Each E. anophelis-positive microbiological sample was considered a case. All patients were hospitalized in an infectious diseases unit. Clinical, environmental, and microbiological investigations (MALDI-TOF mass spectrometry, PCR, E-test) were performed for each case. RESULTS: Twenty cases were reported from September 2020 to September 2021, mainly community-acquired infections, responsible for nine deaths. The phylogenetic analysis showed a clonal origin and excluded nosocomial transmission. Despite the analysis of multiple environmental specimens, no source of contamination was identified. All strains were highly resistant to cefotaxime, ceftazidime, and imipenem. CONCLUSIONS: Clinicians and microbiologists should be aware of this multidrug-resistant bacterium, capable of causing severe infections. Most strains showed the lowest minimum inhibitory concentration values for cotrimoxazole and ciprofloxacin, making them the best choice for empirical antibiotic therapy.
Subject(s)
Flavobacteriaceae Infections , Flavobacteriaceae , Disease Outbreaks , Flavobacteriaceae Infections/drug therapy , Flavobacteriaceae Infections/epidemiology , Flavobacteriaceae Infections/microbiology , Humans , PhylogenyABSTRACT
OBJECTIVES: To assess the meningeal penetration of cefazolin and cloxacillin in individuals treated for methicillin-susceptible staphylococcal meningitis. METHODS: We retrospectively identified individuals treated for Staphylococcus meningitis with measurements of cefazolin or cloxacillin concentrations in cerebrospinal fluid (CSF) using a validated assay of liquid chromatography coupled with mass spectrometry at the Nantes University Hospital between January 2009 and October 2019. Staphylococcus meningitis was defined by a compatible clinical presentation and a microbiological confirmation (positive CSF culture or positive specific PCR). Medical charts were retrospectively reviewed to collect microbiological and clinical data, and to assess therapeutic success. RESULTS: Among the 17 included individuals, eight (47%) were treated with cefazolin and nine (53%) with cloxacillin. Median daily dosages of cefazolin and cloxacillin were 8 g (range 6-12 g) and 12 g (range 10-13 g), respectively. Cefazolin and cloxacillin were mainly administered by continuous infusion. Eleven individuals (65%) were men, median (interquartile range (IQR)) age was 54 years (50; 70), 14 (82%) had postoperative meningitis and 3 (18%) had haematogenous meningitis. Median (IQR) antibiotic CSF concentrations were 2.8 mg/L (2.1; 5.2) and 0.66 mg/L (0.5; 0.9) for cefazolin and cloxacillin groups, respectively. Cloxacillin was discontinued in two individuals for therapeutic failure. CONCLUSIONS: Patients with staphylococcal meningitis treated with high-dose continuous intravenous infusion of cefazolin achieved therapeutic concentrations in CSF. Cefazolin appears to be a therapeutic candidate that should be properly evaluated in this indication.
Subject(s)
Anti-Bacterial Agents/cerebrospinal fluid , Cefazolin/cerebrospinal fluid , Cloxacillin/cerebrospinal fluid , Meningitis, Bacterial/drug therapy , Staphylococcal Infections/drug therapy , Aged , Anti-Bacterial Agents/therapeutic use , Cefazolin/therapeutic use , Chromatography, Liquid , Cloxacillin/therapeutic use , Female , Humans , Male , Mass Spectrometry , Middle Aged , Retrospective Studies , Staphylococcus aureus/drug effectsSubject(s)
Brain Diseases/chemically induced , Brain Diseases/microbiology , Neuroaspergillosis/chemically induced , Opportunistic Infections/chemically induced , Pyrazoles/adverse effects , Pyrimidines/adverse effects , Adenine/analogs & derivatives , Aged , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Male , Piperidines , Pyrazoles/therapeutic use , Pyrimidines/therapeutic useABSTRACT
Enterococcus hirae, a gram-positive bacterium, is a rare isolate in clinical specimens. We report an unusual case of a relapse of prosthetic valve endocarditis due to E. hirae 6 months after the initial episode. Clonal relationship was proven by genomic analysis.
Subject(s)
Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Enterococcus/isolation & purification , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Aged , Bacterial Typing Techniques , Electrophoresis, Gel, Pulsed-Field , Endocarditis, Bacterial/pathology , Enterococcus/classification , Enterococcus/genetics , Female , Genotype , Gram-Positive Bacterial Infections/pathology , Humans , Molecular Typing , Prosthesis-Related Infections/pathology , RecurrenceABSTRACT
We report a case of a pulmonary histoplasmosis in an HIV-positive patient usually living in Cambodia, with a positive Aspergillus galactomannan antigenemia resulting from a cross-reaction, that decreased after antifungal therapy. We discuss the potential interest of the detection of fungal DNA by PCR and Aspergillus galactomannan antigenemia for the diagnosis of histoplasmosis, especially in countries where Histoplasma capsulatum antigen testing is not available.
Subject(s)
Antigens, Fungal/blood , Aspergillus/immunology , Histoplasmosis/blood , Histoplasmosis/diagnosis , Lung Diseases, Fungal/blood , Lung Diseases, Fungal/diagnosis , Mannans/immunology , Galactose/analogs & derivatives , Humans , Male , Middle Aged , Molecular BiologyABSTRACT
OBJECTIVE: A one-year prospective, observational study was conducted in the west of France, to evaluate the epidemiology of candidemia. METHOD: During the year 2004, each patient with at least one blood culture yielding Candida sp. was included. For each episode of candidemia, mycological, demographical, clinical, and therapeutic data, as well as outcome, were collected. RESULTS: One hundred and ninety-three strains of Candida sp. were isolated in 186 patients, Candida albicans accounting for 54.9%, Candida glabrata for 18.7%, Candida parapsilosis for 12.9%, Candida tropicalis for 4.7% and Candida krusei for 4.1% of these isolates. A percentage of 84% of the Candida isolates were fully susceptible to fluconazole in vitro. Dose-dependent susceptibility or resistance to fluconazole was detected in more than one third of the Candida glabrata strains, of which 36% were also resistant to voriconazole. Two-thirds of the patients were males, and the mean age was 61.5 years. A percentage of 37% of patients were hospitalized in intensive care units. The main predisposing factors for candidemia were broad-spectrum antibiotics (75.8%), central venous catheter (72.6%), cancer or hematologic malignancy (47.3%), recent surgery (42.5%), total parenteral nutrition (37.6%). One hundred and fifty-four patients were treated with antifungal therapy, two-thirds of whom received fluconazole as first-line agent. Mortality was 49% overall, and was significantly higher in case of septic shock, advanced age, and absence of catheter removal.
Subject(s)
Candidiasis/epidemiology , Fungemia/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Candida/classification , Candida/drug effects , Candida/isolation & purification , Candidiasis/drug therapy , Candidiasis/microbiology , Catheter-Related Infections/epidemiology , Catheter-Related Infections/microbiology , Catheterization, Central Venous/adverse effects , Child , Child, Preschool , Comorbidity , Cross Infection/epidemiology , Cross Infection/microbiology , Drug Resistance, Multiple, Fungal , France/epidemiology , Fungemia/drug therapy , Fungemia/microbiology , Humans , Infant , Infant, Newborn , Middle Aged , Neoplasms/epidemiology , Parenteral Nutrition , Postoperative Complications/epidemiology , Postoperative Complications/microbiology , Prospective Studies , Risk Factors , Superinfection/epidemiology , Superinfection/microbiology , Young AdultABSTRACT
Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report seven cases, which occurred during a period of 1 year in western France. Six cases were because of Candida albicans, and one pacemaker endocarditis was because of Candida parapsilosis. All patients were men and presented risk factors for candidaemia. Of the six patients with valvular involvement, five received caspofungin and two had surgical valve replacement. Three patients treated with caspofungin antifungal therapy without valve replacement were cured from endocarditis. Antifungal and surgical strategies are discussed, in particular, the possible role of new antifungal therapies and long-term suppression therapy without surgery. One patient died in the acute phase of endocarditis, three patients died of causes unrelated to infective endocarditis and three patients had a favourable outcome.
Subject(s)
Antifungal Agents/therapeutic use , Candida/isolation & purification , Candidiasis/diagnosis , Candidiasis/drug therapy , Endocarditis/drug therapy , Endocarditis/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Candida/classification , Candidiasis/microbiology , Candidiasis/surgery , Caspofungin , Child , Child, Preschool , Echinocandins/therapeutic use , Endocarditis/surgery , Fatal Outcome , Female , France , Heart Valve Diseases/drug therapy , Heart Valve Diseases/microbiology , Heart Valve Diseases/surgery , Humans , Infant , Infant, Newborn , Lipopeptides , Male , Middle Aged , Young AdultSubject(s)
Acetamides/therapeutic use , Anti-Bacterial Agents/therapeutic use , Daptomycin/therapeutic use , Hip Prosthesis/adverse effects , Methicillin-Resistant Staphylococcus aureus/drug effects , Oxazolidinones/therapeutic use , Prosthesis-Related Infections/drug therapy , Staphylococcal Infections/drug therapy , Acetamides/administration & dosage , Acetamides/adverse effects , Acetamides/pharmacology , Aged, 80 and over , Anesthesia , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacology , Bacteremia/drug therapy , Bacteremia/microbiology , Bone Marrow Diseases/chemically induced , Comorbidity , Contraindications , Daptomycin/administration & dosage , Daptomycin/pharmacology , Drug Administration Schedule , Drug Therapy, Combination , Gentamicins/administration & dosage , Gentamicins/therapeutic use , Humans , Linezolid , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Oxazolidinones/administration & dosage , Oxazolidinones/adverse effects , Oxazolidinones/pharmacology , Prosthesis-Related Infections/microbiology , Rifampin/administration & dosage , Rifampin/therapeutic use , Staphylococcal Infections/microbiology , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/etiology , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
We report the case of a 70-year-old diabetic man with spontaneous vertebral osteomyelitis due to Bacteroides fragilis. Diagnosis was obtained on positive blood cultures. The port of entry remained unknown despite extensive investigation. A combination of metronidazole and clindamycin led to a clinical cure with no need for surgical débridement and no relapse after 9 months of follow-up.