Post-surgical mediastinitis due to carbapenem-resistantEnterobacteriaceae: Clinical, epidemiological and survivalcharacteristics

Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE),including polymyxin-resistant(PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE,including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE(PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carriedblaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received atleast one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higherin patients infected with PR-CRE (17% vs. 53%; P = 0.06). In conclusion, mediastinitis due to CRE, includingPR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a highmortality, particularly those infected with PR-CRE...

Identification of ochrobactrum oryzae in primary bloodstream infection in a dialysis patient: can it be an emerging pathogen?

Ochrobactrum spp is a gram-negative bacillus currently considered an emerging and opportunistic infection, rare inhumans, and generally associated with indwelling foreign bodies. We report a case of primary bloodstream infectionrelated to a dialysis catheter, caused by Ochrobactrum oryzae misidentified...

Carbapenem-resistant Enterobacteriaceae on a cardiacsurgery intensive care unit: successful measures for infection control

Carbapenem-resistant Enterobacteriaceae (CRE) cause surgical site infections(SSIs) in intensive care units (ICUs). This study aimed to evaluate the impact of intervention and control measures to reduce CRE colonization and infection rates among patients in the ICU of a cardiac surgery hospital following a CRE outbreak...

A space–time model for carbapenemase-producing Klebsiellapneumoniae (KPC) cluster quantification in a high-complexityhospital

A retrospective space–time permutation model with non-Euclidean distance criteria was appliedwithin a high-complexity hospital setting to quantitatively explore cluster patterns of 273 patientsinfected with or colonized by carbapenemase-producing Klebsiella pneumoniae during 4 years.Results were compared to standard nosocomial active-surveillance methods. Two clusters wereidentified in the period, suggesting that space–time strategies for cluster quantification withinconfined environments may be useful.

Infection with Klebsiella pneumonia carbapenemase (KPC)-producing K. pneumonia in solid organ transplantation

Abstract: Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae is spreading globally and represents achallenge in infection control and treatment. Solid organtransplant (SOT) recipients are especially at risk for infection bymultidrug-resistant bacteria, and little is known about infectionwith KPC-producing organisms in this setting. The aim of thisstudy was to describe the clinical and microbiologic aspects ofKPC-producing K. pneumoniae infections in SOT recipients. AKPC-2-producing K. pneumoniae outbreak was identified in apublic teaching tertiary care hospital in Sa˜o Paulo, Brazil, in June2009. During the outbreak, cases of KPC-2-producing K.pneumoniae infection in SOT recipients occurred between July2009 and February 2010; these cases were retrospectivelyreviewed. Overall, 12 episodes of infection with KPC-producingK. pneumoniae occurred in 2 heart, 4 liver, and 6 kidneytransplant recipients with incidence rates of 16.7%, 12.9%, and26.3% in heart, liver, and kidney transplantation, respectively.Infection occurred at a median time of 20 days aftertransplantation. Primary infection sites were as follows: 4 urinarytract infections, 4 bloodstream infections, 2 pneumonias, and 2surgical site infections. All patients except one had receivedantibiotics in the last 30 days, mostly piperacillin-tazobactam orglycopeptides. All strains exhibited susceptibility to amikacin andgentamicin. Patients were treated with tigecycline plus polymyxinB (3 cases), polymyxin B plus carbapenem (3 cases), polymyxin Balone (3 cases), or tigecycline plus imipenem (1 case). In 2 cases,patients received only carbapenem, and death occurred before thefinal culture result. The overall 30-day mortality rate was 42%. Inthis series of KPC-producing K. pneumoniae infection in SOTrecipients, the infection occurrence was high during aninstitutional outbreak and was potentially life threatening.

Case report of hepatic mucormycosis after liver transplantation: successful treatment with liposomal amphotericin B followed by posaconazole sequential therapy

Mucormycosis is a rare but emerging fungal infection complicating solid organ transplantation(SOT), with a cumulative incidence of around 2% during the first year after SOT.The associated mortality rate is high, and surgical debridement is frequently required aspart of the treatment along with antifungal therapy based mostly on amphotericin Bformulations, We describe here an unusual case of hepatic mucormycosis in a livertransplant recipient that was successfully treated with clinical therapy based on liposomalamphotericin B followed by posaconazole, without surgical resection.