Pasteurella canis soft tissue infection after a cat bite - A case report

Pasteurella canis is a Gram-negative facultative anaerobic bacterium that is a typical commensal of the oral cavity and enteric tract of domestic animals. Human infections caused by this species are most often associated with dog bites and rarely with other animal bites. In this report, we present a case of a 34-year-old man who developed P. canis soft tissue infection of the left hand after a cat bite. The patient was successfully treated by a surgical intervention and antibiotics. The species identification of the isolate was performed by a conventional automatic system and nucleic acid-based methods. The nucleic acid-based methods provide a powerful alternative to the conventional microbiological diagnostic of these bacteria.

Risk factors for gut colonization with vancomycin-resistant enterococci among Bulgarian critically ill patients

Vancomycin-resistant enterococci (VRЕ) are recognized as important hospital pathogens which have become common in patients admitted to the intensive care units (ICUs). The purpose of this study was to evaluate the incidence of and the risk factors for colonization with VRE among ICU patients. A total of 91 patients who had duration of hospitalization more than 48 h and without infection caused by VRE or/and other microorganisms in the ICU at University Hospital, Pleven were screened for colonization with VRE. The following data were collected: demographic characteristics, clinical information and antimicrobials use. The statistical analysis was performed using SPSS version 27.0. Colonization with VRE was established in 22 patients and one was carrying two enterococcal species. A total of 23 VRE were isolated. The univariate analysis showed that the postoperative critical cares (p < 0.001), cardiovascular diseases (p = 0.009) and the presence of an endotracheal tube (p = 0.003) were risk factors for colonization with VRE. Also, the postoperative critical cares (p = 0.021) and cardiovascular diseases (p = 0.018) were confirmed as independent risk factor for VRE acquisition by multivariate analysis. The prevalence of VRE colonization among the ICU patients was relatively high (24.2%). Risk factors for acquisition of intestinal VRE were the postoperative cares, cardiovascular diseases and the presence of an endotracheal tube.

Pediatric case of septic arthritis due to Streptococcus pneumoniae serotype 19A

In recent years, the incidence of pediatric septic arthritis caused by Streptococcus pneumoniae has been quite low. The pneumococcal conjugate vaccine PCV10 is the available vaccine included in the Bulgarian national immunization program. PCV10 reduces the incidence of invasive diseases, but non-vaccinal serotypes like 19A, the etiologic agent of the case of septic arthritis reported herein in a 3-year-old boy. The synovial fluid was positive for S. pneumoniae. The patient was treated with vancomycin during hospitalization and trimethoprim/sulfamethoxazole was recommended for at-home treatment. The isolate was subjected to latex agglutination, antimicrobial susceptibility testing, PCR detection for macrolide-resistance genes, and MLST. The strain revealed ST695 and a genotype previously associated with vaccine serotype 4. The incidence of pneumococcal infections caused by capsule-switching events and non-PCV10 serotypes is expected to increase.

Catheter-Related Bloodstream Infection in Hemodialysis Patient due to Atlantibacter hermannii

Atlantibacter hermannii, previously known as Escherichia hermannii, is a rare causative agent of human infections. Several reports testify that the most frequently infected patients are immunosuppressed, especially those undergoing hemodialysis. A 34-year-old man with an end-stage renal disease complained of chills, fever, and general fatigue at the end of a regular hemodialysis session. The echocardiographic examination showed vegetation located on the dialysis catheter in the right atrium. Empirical therapy was initiated with intravenous gentamicin, and after the isolation of the agent, the treatment was continued with intravenous imipenem/cilastatin. The blood cultures and the tip of the replaced catheter were positive for A. hermannii, identified by Vitek 2 Compact. Verification of the automated identification was performed using 16S sequencing. The 16S sequence product was used to query the NCBI bacterial database and revealed 99.75% identity to that of A. hermannii strain CIP 103176 16S ribosomal RNA in the NCBI GenBank database. The antimicrobial susceptibility results revealed resistance to aminopenicillins and susceptibility to all other tested antimicrobials. To our knowledge, this is the first report of catheter-related vegetation with echocardiographic confirmation and the successful eradication of A. hermannii infection in a patient undergoing hemodialysis with imipenem/cilastatin.

INCIDENCE OF THE INFECTIVE ENDOCARDITIS IN PATIENTS WITH TUNNELED CATHETERS IN ONE BULGARIAN DIALYSIS CENTER PER YEAR

Background: Infections are common complications among patients on chronic hemodialysis. Catheter-related bloodstream infections (CRBSIs) are estimated to be 0.15 to 3.5 cases per 1000 catheter-days (CD) in case of tunneled catheters, and the frequency of bacterial endocarditis is estimated at 3.5 to 10% of these. Materials and methods: We retrospectively present data from the study, which was conducted in our clinic for a one-year period from January 1 to December 31, 2018. The average number of patients undergoing hemodialysis was 104, and 33 (32%) of them had tunneled catheters. There was 12 045 total CD. We took chemocultures of all patients with clinical signs dubious about CRBSIs. All patients with positive chemocultures were examined by echocardiography. Results: We have found 19 episodes of CRBSIs in 15 patients (1.5/1000 CD). We found a total of 21 causative microbial agents in positive chemocultures, two of which were polymicrobial. Thirteen of the bacteria (62%) were Gram-positive [G (+)] and eight Gram-negative [G (-)] (38%). The most common G (+) bacterium was Staphylococcus aureus 9 and G (-) – Citrobacter coseri. In six patients (32%) with CRBSIs, we found bacterial endocarditis. Four of them (67%) were infected with G (-) negative agent, and two (33%) – with G (+). Conclusions: We conclude that our high incidence of bacterial endocarditis is probably due to the fact that we have examined all of the patients for this complication and that gram-negative bacteria are more often the cause of bacterial endocarditis in patients undergoing hemodialysis with a tunnel catheter.

Tunnelled hemodialysis catheter-related bloodstream infection with Ochrobactrum anthropi: a report of the first two cases from Bulgaria and a brief overview

The use of central venous catheters for hemodialysis continues to grow worldwide, despite the efforts of many specialists. Patients with end-stage renal disease have impaired immunity, which is why infections are the most common complication seen in them. It worsens their quality of life and is a major cause of high morbidity and mortality, especially in hemodialysis patients.We report two cases of catheter-related bloodstream infection in hemodialysis patients caused by Ochrobactrum anthropi, which are the first reported cases in Bulgaria and present a brief literature review of the known facts.