Polymicrobial bacteremia due to Lactobacillus jensenii and Veillonella montpellierensis in a pregnant patient; case report and review of literature.

Prompt and accurate diagnosis of polymicrobial bacteremia, which causes the difficulty in anti-infective treatments, poor treatment outcome and high mortality, is essential for initiating effective antimicrobial therapy. Here we present a case of bacteremia caused by two types of uncommon bacteria, Lactobacillus jenseniand and Veillonella montpellierensis in a 29-year-old pregnant woman at 33 weeks of gestation with anemia due to iron deficiency. She had no comorbidity or other chronic illnesses and was successfully treated with appropriate antibiotic use.

Sepsis caused by Anaerococcus nagyae after transarterial-chemoembolization for hepatocellular carcinoma: Case report and literature review.

Hepatocellular carcinoma (HCC) is more common in patients with chronic viral hepatitis infection and cirrhosis. Transarterial chemoembolization (TACE) is an effective treatment method for unresectable HCC. A rare complication of TACE is the development of bloodstream infection. We present a fatal case of sepsis due to Anaerococcus nagyae after TACE.

Detection of beta-lactamase production in clinical Prevotella species by MALDI-TOF MS method.

Penicillins, can be used in treatment of infections due to Prevotella species if they are susceptible to penicillin. Early and accurate preliminary detection of ß-lactamase-producing isolates is crucial for treatment of infection. The aim of this study was to determine ß-lactamase-producing Prevotella species by MALDI-TOF MS and screen them for the presence of cfxA gene, responsible for ß-lactamase production. A total of 500 clinically relevant Prevotella isolates, collected from 13 countries for the previous European antibiotic resistance surveillance study, were tested. Susceptibility testing was performed against ampicillin and ampicillin/sulbactam by Etest methodology. EUCAST guidelines were used for susceptibility interpretations; the isolates with MIC value ≤ 0.5 for ampicillin were considered susceptible and >2 resistant. All Prevotella isolates, were tested for detection of ß-lactamase activity by MALDI-TOF MS (Vitek® MS Research Use Only) system and the presence of the cfxA gene by PCR method. The susceptibility levels of the isolates to ampicillin/sulbactam and ampicillin were 99.6% and 43.4%, respectively. A total 59% of isolates presented ß-lactamase activity and 60.8% were cfxA gene positive. Both these tests were positive for isolates in the resistant category. Additionally, >95% of the isolates (n = 65) which ampicillin MIC values ranged from >0.5 µg/mL to 2 µg/ml displayed ß-lactamase activity. We also found that the MALDI-TOF MS-based ß-lactamase assay delivers results in 2 h. We found a high concordance between the MALDI-TOF MS ß-lactamase results in terms of cfxA ß-lactamase gene presence. MALDI-TOF MS may serve as a simple and efficient alternative method of the existing phenotypic and PCR-based methods.

A Europe-wide assessment of antibiotic resistance rates in Bacteroides and Parabacteroides isolates from intestinal microbiota of healthy subjects.

Here, we sought to assess the levels of antibiotic resistance among intestinal Bacteroides and Parabacteroides strains collected between 2014 and 2016 in Europe and also attempted to compare resistance levels between clinical and commensal isolates. Bacteroides and Parabacteroides isolates were recovered from faecal samples via the novel Bacteroides Chromogenic Agar (BCA) method. Antibiotic susceptibilities were determined by agar dilution for ten antibiotics. The values obtained were then statistically evaluated. Altogether 202 Bacteroides/Parabacteroides isolates (of which 24, 11.9%, were B. fragilis) were isolated from the faecal specimens of individuals taken from five European countries. The percentage values of isolates resistant to ampicillin, amoxicillin/clavulanate, cefoxitin, imipenem, clindamycin, moxifloxacin, metronidazole, tetracycline, tigecycline and chloramphenicol were 96.6, 4.5, 14.9, 2.0, 47.3, 11.4, 0, 66.2, 1.5 and 0%, respectively. These values are close to those reported in the previous European clinical Bacteroides antibiotic susceptibility survey except for amoxicillin/clavulanate and clindamycin, where the former was lower and the latter was higher in normal microbiota isolates. To account for these latter findings and to assess temporal effects we compared the data specific for Hungary for the same period (2014-2016), and we found differences in the resistance rates for cefoxitin, moxifloxacin and tetracycline.

Comparing identification of clinically relevant Prevotella species by VITEK MS and MALDI biotyper.

In this multicenter study, we aimed to evaluate the performance of MALDI Biotyper and VITEK MS, for identification of Prevotella species. Three hundred and fourteen clinical isolates, collected in eight European countries between January 2014 and April 2016, were identified at the collecting sites by MALDI Biotyper (versions 3.0 and 3.1) and then reidentified by VITEK MS (version 3.0) in the central laboratory. 16S rRNA gene sequencing was used as a standard method. According to sequence analysis, the 314 Prevotella strains belonged to 19 species. MALDI Biotyper correctly identified 281 (89.5%) isolates to the species level and 33 (10.5%) only at the genus level. VITEK MS correctly identified 253 (80.6%) isolates at the species level and 276 (87.9%) isolates at the genus level. Thirty-three isolates belonging to P. bergensis, P. conceptionensis, P. corporis, P. histicola, and P. nanciensis, unavailable in the VITEK MS 3.0 database, were resulted in genus level or no identification. Six Prevotella strains, belonged to P. veroralis, P. timonensis, and P. conceptionensis not represented in the MALDI Biotyper system database, were misidentified at the genus level. In conclusion, both VITEK MS and MALDI Biotyper provided reliable and rapid identification. However, the permanent extension of the databases is needed.

Ventilator-associated pneumonia caused by Chryseobacterium indologenes: a rare infant case and review of the literature.

BACKGROUND: Chryseobacterium indologenes is an uncommon organism that has been documented to cause a variety of invasive infections mostly in hospitalized patients with severe underlying diseases. CASE PRESENTATION: A three-month-old female infant born at term by caesarean section with meningomyelocele and congenital diaphragmatic hernia had two surgeries for the repair of meningomyelocele and diaphragmatic hernia on her 3rd and 14th day, respectively. On the 3rd month of her life, she deteriorated clinically with fever, leukocytosis and increase of acute-phase reactants. Gas exchange condition became worse than it was before. Respiratory secretions, oxygen requirements and ventilator demand increased. Chest X-ray showed bilateral pulmonary infiltrates. Bacteriological blood, urine and cerebrospinal fluid culture test results were negative. C. indologenes was isolated from tracheobronchial secretion sample obtained by endotracheal aspiration. Although susceptible to ciprofloxacin (MIC:0.5 gr/L), levofloxacin and piperacillin-tazobactam, the isolate was resistant to meropenem, imipenem and colistin. She was treated with ciprofloxacin successfully. Her fever resolved and gas exchange condition improved after 72 h of the treatment. The antibiotic treatment was given for a course of 14 days. CONCLUSION: Chryseobacterium indologenes may emerge as a potential pathogen in infants with the factors such as invasive equipment, having underlying diseases and prolonged hospitalization.

Hospital acquired Clostridium difficile infection in pediatric wards: a retrospective case-control study.

BACKGROUND: Clostridium difficile is a major cause of antibiotic-associated diarrhea and frequently results in healthcare-associated infections. The aim of this study was to determine the incidence and potential risk factors for C. difficile infection (CDI) in hospitalized children who developed diarrhea. A retrospective study was performed at a university hospital in Istanbul over a three-year period (2012-2014). RESULTS: During the study period 12,196 children were hospitalized, among them 986 (8 %) children with diarrhea were investigated for CDI and 100 (0.8 %) children were diagnosed with CDI. The incidence of CDI in hospitalized children was 4/1000, 9/1000 and 9/1000 patients per year in year 2012, 2013 and 2014, respectively (p = 0.008, p < 0.01). The mean age of children with CDI (2.6 ± 2.6 months) was lower than children without CDI (57.5 ± 63.5 months) [p = 0.001]. In the multivariate analysis, the presence of underlying chronic diseases [presence of malnutrition (OR 7, 95 % CI 1.33-36.7, p = 0.021), presence of solid organ tumors (OR 6, 95 % CI 2.4-15.7, p < 0.00), presence of congenital heart diseases (OR 4.6, 95 % CI 1.13-18.7, p = 0.03), hospitalization in PICU (OR 15.6, 95 % CI 3.2-75.8, p = 0.001) and hospitalization in hematology and oncology ward (OR 7.8, 95 % CI 2-29.9, p = 0.002)] were found to be independent risk factors for CDI. CONCLUSION: This is the first description of the incidence and associated risk factors of CDI in Turkish children. One of the most important risk factor was prior antibiotic exposure which emphasizes the importance of antibiotic stewardship programs.

Susceptibility profiles and resistance genes for carbapenems (cfiA) and metronidazole (nim) among Bacteroides species in a Turkish University Hospital.

Sixty-six nonduplicate Bacteroides clinical isolates collected at Marmara University Hospital were tested to investigate carbapenem and metronidazole resistance profiles and to detect the resistance genes (cfiA and nim) and related insertion sequence (IS) elements. The study found that there were no strains resistant to metronidazole and nim genes were not detected in any of the strains. Five Bacteroides fragilis strains were resistant to meropenem, one of which was also resistant to imipenem. The cfiA gene was detected in 27% of strains, 32% of strains had the IS1187 element, and five strains harbored both gene cfiA and IS1187. These results indicate higher rates of carriage of the cfiA gene and IS1187 insertion elements than have been reported in other countries.

Do antimicrobial susceptibility patterns of colonic isolates of Bacteroides species change after antibiotic prophylaxis with cefoxitine during elective abdominal surgery?

The objectives of the study were to investigate and compare the susceptibility profiles of preoperative and postoperative intestinal Bacteroides fragilis and Bacteroides thetaiotaomicron strains against antimicrobials to evaluate their resistance development patterns due to prophylactic antibiotic administration. Preoperative and postoperative stool samples were obtained from patients undergoing elective abdominal surgery with a "clean-contaminated" wound categorization. All patients received cefoxitin 2 g as prophylaxis. Isolates of Bacteroides species were identified. Susceptibility tests against ampicillin, piperacillin, cefoxitin, clindamycin, chloramphenicol, metronidazole, imipenem, and amoxicillin-clavulanate were performed. Stool samples were collected from 40 patients at two settings: before and after the operation. Most of the patients (53%) were operated on because of colorectal carcinoma and underwent surgery that included colectomy or anterior resection. Bacteroides fragilis and Bacteroides thetaiotaomicron were isolated in both samples obtained from 22 and 34 patients, respectively. In the present study 95% to 100%, 50% to 74%, 46% to 64%, and 18% to 35% of preoperatively isolated Bacteroides species were resistant to ampicillin, cefoxitin, clindamycin, and piperacillin, respectively. Although there were no statistically significant difference, postoperative strains were more resistant than preoperative isolates, and the resistance rates were found to be 95% to 100%, 55% to 82%, 46% to 86%, and 37% to 41%, respectively. Both Bacteroides species isolated from all specimens before and after the surgery were uniformly susceptible to amoxicillin-clavulanate, imipenem, metronidazole, and chloramphenicol.Our data revealed that Bacteroides strains revealed high resistance to ampicillin, cefoxitin, piperacillin, and clindamycin. Metronidazole, imipenem, and amoxicillin-clavulanate seem highly effective against both Bacteroides species. Cefoxitin prophylaxis did not significantly increase the resistance patterns against antimicrobial agents.

[Comparison of antimicrobial resistance patterns of enterotoxin gene positive and negative Bacteroides fragilis isolates]. / Enterotoksin geni pozitif ve negatif Bacteroides fragilis izolatlarinin antibiyotiklere direnç durumlarinin karsilastirilmasi.

Some of the Bacteroides fragilis strains produce enterotoxin named fragilysin which is accepted as a virulence factor. In this study, the presence of enterotoxin genes (bft) in clinical B. fragilis strains has been investigated and the antimicrobial resistance patterns of bft positive and negative isolates have been compared. B. fragilis strains isolated from different clinical samples were identified by conventional methods and API 20A system, and the presence of bft genes were searched by using BF3/BF4 primers in polymerase chain reaction. A total of 100 B. fragilis strains of which 50 bft gene positive and 50 bft gene negative were included to the study, and their antimicrobial susceptibilities were determined by agar dilution method as recommended by NCCLS (M11-A4). Of 100 strains, 71 (34 bft negative, 37 bft positive) have been isolated from the stool, and 29 (16 bft negative, 13 bft positive) have been isolated from other specimens (blood, abscess, pleural and peritoneal fluids). beta-lactamase production was detected in 96% of enterotoxigenic B. fragilis (ETBF) and 95% of non-toxigenic strains, and all tested strains were found to be susceptible to amoxicillin/clavulanic acid, imipenem and metronidazole. The resistance rates (with MIC90 values) of bft positive isolates against the other antibiotics were as follows; 96% (256 microg/ml) for ampicillin, 16% (256 microg/ml) for piperacillin, 8% (32 microg/ml) for cefoxitin, 24% (> 256 microg/ml) for clindamycin, 74% (64 microg/ml) for tetracycline and 0% (8 microg/ml) for chloramphenicol. These rates were found as follows for bft negative strains; 95% (256 microg/ml) for ampicillin, 6% (64 microg/ml) for piperacillin, 6% (32 microg/ml) for cefoxitin, 38% (> 256 microg/ml) for clindamycin, 64% (64 microg/ml) for tetracycline and 4% (8 microg/ml) for chloramphenicol. Although the resistance rates and MIC90 values of bft positive strains against the antimicrobials seemed to be higher, there were no statistically significant differences between resistance rates of bft positive and negative strains (P > 0.05; 0.12 and 0.28, respectively).

[Enzyme activities of dermatophytes isolated from different clinical samples by ApiZYM method]. / Ce,itli klinik orneklerden izole edilen dermatofitlerin enzim aktivitelerinin ApiZYM yöntemiyle tayini.

Dermatophytes' enzymes may have a role in chronic superficial infections. In this study it was planned to investigate the possible relationship between the enzymatic activities of the dermatophytes and acute or chronic course of the infections. Dermatophytes were isolated from 58 (72%) out of 81 patients with superficial infections. The infections were divided into two groups as acute (< or = 6 weeks) or chronic (> 6 weeks). Isolated fungi were identified by the classical methods and ApiZYM method. ApiZYM exhibits 19 different enzymatic activities. From 11 acute cases; five Epidermophyton floccosum, three Trichophyton rubrum, two Microsporum canis and one Trichophyton mentagrophytes strains were isolated. Of the 47 chronic cases, 96% was due to T. rubrum and 4% due to T. mentagrophytes. Production of alkaline phosphatase, leucine arylamidase and beta-glucosidase enzymes were detected in all tested strains. There was no difference between the enzymatic activities of acute and chronic cases. Alpha-mannosidase activity was detected in all of the species isolated from acute cases whereas none of the chronic cases were positive (P < 0.001). The results of this study suggest that alpha-mannosidase activity may play a role in both cutaneous inflammatory response caused by dermatophytes and the chronicity of the lesions.