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El Mekes A, Zahlane K, Ait Said L, Tadlaoui Ouafi A, Barakate M. The clinical and epidemiological risk factors of infections due to multi-drug resistant bacteria in an adult intensive care unit of University Hospital Center in Marrakesh-Morocco. J Infect Public Health 2019; 13:637-643. [PMID: 31537511 DOI: 10.1016/j.jiph.2019.08.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 08/05/2019] [Accepted: 08/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intensive care units (ICUs) are considered epicenters of antibiotic resistance. The aim of this study is to determine clinical risk factors, epidemiology and the causative agents of multi-drug resistant bacteria in the ICU of the University Hospital in Marrakesh-Morocco. METHODS A one year case control study was carried out in our 10-bed clinical and surgical ICU from March 2015 to March 2016. The epidemiological surveillance was done by collecting data in the medical records with the help of a questionnaire. The antibiotic susceptibility testing was used following the recommendations of the Antibiogram Committee of the French Society of Microbiology and the European Committee for Antimicrobial Susceptibility Testing, 2015. RESULTS Among the 479 admitted patients, 305 bacteria were isolated and identified as Acinetobacter baumannii (31%), Enterobactereacae species (30%), and Staphylococcus (24%), P. aeruginosa (10%) and other bacterial strains (5%). The rate of MDR bacteria acquisition was 41% (124/305) with domination of A. baumannii resistant to imipenem (70%) and followed by Extended Spectrum β-lactamases producing Enterobacteriaceae, P. aeruginosa resistant to Ceftazidime, and Methicillin-resistant S. aureus (18%, 7%, and 5% respectively). The distribution of the common nosocomial infections were dominated by pneumonia, bacteremia, and catheter-related blood stream infections (39%, 29%, and 17%) respectively. Multivariate analysis identified lack of patient isolation precautions (OR: 7.500), use of quadri or triple therapy (OR: 5.596; OR: 5.175), and mechanical ventilation (OR: 4.926), as the most significant clinical and epidemiological factors associated with acquisition of MDR bacteria. The attributable mortality, in this ICU, of patients with MDR bacteria, is about 12%. CONCLUSIONS The incidence of MDR was higher compared with that of developed countries. The implementation of standard infection control protocols, active surveillance of MDR and generation of data on etiological agents and their antimicrobial susceptibility patterns are urgently needed in our hospital.
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Affiliation(s)
- Adel El Mekes
- Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital Center-Mohammed VI, Marrakesh, Morocco; Laboratory of Biology and Biotechnology of Microorganisms, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco
| | - Kawtar Zahlane
- Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital Center-Mohammed VI, Marrakesh, Morocco
| | - Loubna Ait Said
- Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital Center-Mohammed VI, Marrakesh, Morocco
| | - Ahmed Tadlaoui Ouafi
- Laboratory of Biotechnology and Molecular Bioengineering, Faculty of Science and Technology Gueliz, Cadi Ayyad University, Marrakesh, Morocco
| | - Mustapha Barakate
- Laboratory of Biology and Biotechnology of Microorganisms, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco.
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Goret NE, Goret CC, Ozkan OF. Necrotizing fasciitis after intramuscular self-injection A case report. Ann Ital Chir 2019; 8:S2239253X19028421. [PMID: 31112521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Necrotizing fasciitis (NF) is a rare, life-threatening soft tissue infection that affects the skin, subcutaneous tissue, fascia, and muscle, and is characterized by rapid spread and invasion of pathogens. Treatment is possible with early diagnosis, appropriate antibiotic therapy, and quick surgical intervention. Nevertheless, despite all interventions, it is sometimes difficult to manage NF. The Authors present the case of a patient with extensive NF caused by multidrug-resistant Acinetobacter baumannii (A. baumannii) that developed following an intramuscular injection of diclofenac sodium administered at home by someone who was not a healthcare professional. Wound sample culture revealed multidrug-resistant A. baumannii. The patient was treated using negative-pressure wound therapy along with antibiotic treatment and extensive surgical debridement. KEY WORDS: Multidrug-resistant acinetobacter baumannii, Necrotizing fasciitis, Negative-pressurelf-injection, Wound therapy.
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Perier F, Couffin S, Martin M, Bardon J, Cook F, Mounier R. Multidrug-Resistant Acinetobacter baumannii Ventriculostomy-Related Infection, Treated by a Colistin, Tigecycline, and Intraventricular Fibrinolysis. World Neurosurg 2018; 121:111-116. [PMID: 30312816 DOI: 10.1016/j.wneu.2018.09.218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/28/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acinetobacter baumannii meningitis and ventriculitis are difficult issues, because of the low diffusion of antibiotics in the cerebrospinal fluid and bacterial multidrug resistance. The presence of an infected intraventricular hematoma, constituting an equivalent of undrained abscess, may promote biofilm formation and failure of medical treatment. CASE DESCRIPTION In this case of ventriculostomy-related infection after ventricular hemorrhage, Acinetobacter baumannii was sensitive only to colistin and tigecycline. Despite a combination therapy involving intraventricular injections of colistin, we observed clinical and bacteriologic failure. Therefore, at day 4 of antibiotic therapy, we performed intraventricular fibrinolysis, which dissolved the clot, enabling sterilization of the cerebrospinal fluid after 48 hours. CONCLUSION This clinical case suggests the usefulness of intraventricular fibrinolysis to lyse the clot and optimize the action of antibiotics.
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Affiliation(s)
- François Perier
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Creteil, France.
| | - Severine Couffin
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Creteil, France
| | - Mathieu Martin
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Creteil, France
| | - Jean Bardon
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Creteil, France
| | - Fabrice Cook
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Creteil, France
| | - Roman Mounier
- Department of Anesthesia and Surgical Intensive Care, Henri Mondor University Hospital of Paris, Paris XII School of Medicine, Creteil, France
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Chew KL, Chew KL. Acinetobacter ursingii masquerading as Gram-positive cocci. Clin Microbiol Infect 2018; 24:856-857. [PMID: 29698818 DOI: 10.1016/j.cmi.2018.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore.
| | - Kean Lee Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
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Hogan NS, Thorpe KL, van den Heuvel MR. Opportunistic disease in yellow perch in response to decadal changes in the chemistry of oil sands-affected waters. Environ Pollut 2018; 234:769-778. [PMID: 29247939 DOI: 10.1016/j.envpol.2017.11.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
Oil sands-affected water from mining must eventually be incorporated into the reclaimed landscape or treated and released. However, this material contains petrogenic organic compounds, such as naphthenic acids and traces of polycyclic aromatic hydrocarbons. This has raised concerns for impacts of oil sands process-affected waters on the heath of wildlife and humans downstream of receiving environments. The objective of this study was to evaluate the temporal association of disease states in fish with water chemistry of oil sands-affected waters over more than a decade and determine the pathogens associated with disease pathologies. Yellow perch (Perca flavescens) captured from nearby lakes were stocked into two experimental ponds during 1995-1997 and 2008-2010. South Bison Pond is a drainage basin that has received unextracted oil sands-contaminated material. Demonstration Pond is a constructed pond containing mature fine tailings capped with fresh water. Two disease pathologies, fin erosion for which a suspected bacterial pathogen (Acinetobacter Iwoffi) is identified, and lymphocystis (confirmed using a real-time PCR) were associated with oil sands-affected water exposure. From 1995 to 1997 pathologies were most prevalent in the South Bison Pond; however, from 2008 to 2009, disease was more frequently observed in the Demonstration Pond. CYP1A activity was 3-16 fold higher in fish from experimental ponds as compared to reference populations and this pattern was consistent across all sampling years. Bile fluorescence displayed a gradient of exposure with experimental ponds being elevated over local perch populations. Naphthenic acids decreased in the Bison Pond from approximately 12 mg/L to <4 mg/L while naphthenic acids increased in the Demonstration Pond from 6 mg/L to 12 mg/L due to tailings densification. Temporal changes in naphthenic acid levels, CYP1A activity and bile fluorescent metabolites correlate positively with incidence of disease pathologies whereas all inorganic water quality changes (major ions, pH, metals) were not associated with disease responses.
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Affiliation(s)
- Natacha S Hogan
- Toxicology Centre, University of Saskatchewan, 44 Campus Drive, Saskatoon, Saskatchewan, S7N 5B3, Canada; Department of Animal and Poultry Science, University of Saskatchewan, 51 Campus Drive, Saskatoon, Saskatchewan, S7N 5A8, Canada.
| | - Karen L Thorpe
- Environmental Department, Wentworth Way, University of York, Heslington, York, YO10 5NG, United Kingdom
| | - Michael R van den Heuvel
- Canadian Rivers Institute, University of Prince Edward Island, 550 University Ave, Charlottetown, Prince Edward Island, C1A 4P3, Canada
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Carrera-Sanchez I, Jara-Montero C, Garcia-Lopez C, Fernandez-Moreno MC. [Familial brain abscesses secondary to hereditary familial telangiectasia]. Rev Neurol 2018; 66:173-174. [PMID: 29480514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - C Jara-Montero
- Hospital Universitario Virgen de Valme, 41014 Sevilla, Espana
| | - C Garcia-Lopez
- Hospital Universitario Virgen de Valme, 41014 Sevilla, Espana
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Kanwar A, Domitrovic TN, Koganti S, Fuldauer P, Cadnum JL, Bonomo RA, Donskey CJ. A cold hard menace: A contaminated ice machine as a potential source for transmission of carbapenem-resistant Acinetobacter baumannii. Am J Infect Control 2017. [PMID: 28625698 DOI: 10.1016/j.ajic.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
During an investigation of potential sources of transmission of multidrug-resistant gram-negative bacilli on a spinal cord injury unit, we recovered genetically related carbapenem-resistant Acinetobacter baumannii isolates from the stool of 3 patients, the hands of a nurse, and an ice machine water outlet spout and drain. Our findings suggest that contaminated ice machines could serve as a potential reservoir for dissemination of multidrug-resistant gram-negative bacilli.
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Affiliation(s)
- Anubhav Kanwar
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | | | - Sreelatha Koganti
- Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | - Peter Fuldauer
- Pathology and Laboratory Medicine Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | - Robert A Bonomo
- Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
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Fang YQ, Zhan RC, Jia W, Zhang BQ, Wang JJ. A case report of intraventricular tigecycline therapy for intracranial infection with extremely drug resistant Acinetobacter baumannii. Medicine (Baltimore) 2017; 96:e7703. [PMID: 28767605 PMCID: PMC5626159 DOI: 10.1097/md.0000000000007703] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
RATIONALE Intracranial infection with Acinetobacter baumannii is a tough problem due to the presence of multiresistance and drugs poor penetration through the blood brain barrier (BBB). Tigecycline is effective to cure A baumannii, but it can only be used intravenously which is also difficult to pass BBB. So, it will be a breakthrough if intraventricular (IVT) tigecycline is used in the clinical therapy. However, this treatment has been reported quite rarely until now. PATIENT CONCERNS We described a case of a 50-year-old male worker whose clinical futures were high fever and cerebral rigidity after neurosurgery. DIAGNOSES Intracranial infection with extensive drug resistant (XDR) A baumannii. INTERVENTIONS The patient was treated with IVT tigecycline. OUTCOMES The symptoms of intracranial infection disappeared. The temperature of this patient decreased to normal and cerebral rigidity disappeared. The cerebrospinal fluid culture became negative, with normal levels of white blood cell, glucose and chlorine. LESSONS IVT tigecycline therapy maybe effective to intracranial infection with XDR A baumannii. However, more studies will further demonstrate the therapeutic values of IVT tigecycline to intracranial infection, and not only restricted to A baumannii infections.
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Affiliation(s)
| | | | - Wei Jia
- Department of Gastroenterology, Qianfoshan Hospital, Shandong University, Jinan
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Kumar A, Agrawal D, Sharma BS. The Role of Endoscopic Lavage in Recalcitrant Multidrug-Resistant Gram-Negative Ventriculitis Among Neurosurgical Patients. World Neurosurg 2016; 93:315-23. [PMID: 27312390 DOI: 10.1016/j.wneu.2016.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Ventriculitis is a serious infection associated with high mortality even when both intravenous (IV) and intrathecal (IT) antibiotics are administered. Poor outcome in patients with ventriculitis indicates the need to be more aggressive in our attempts to expeditiously eradicate the infection. The purpose of this study was to evaluate the role of endoscopic lavage (EL) in patients with severe purulent ventriculitis, unresponsive to IV and IT antibiotics. METHODS All consecutive patients with severe ventriculitis caused by multidrug-resistant gram-negative bacteria, undergoing EL after failure of prolonged courses of IV and IT antibiotics, were included in the study. The outcome in all these patients was otherwise expected to be uniformly dismal. RESULTS There were 5 males and 2 females. The age range was one month to 45 years. All patients had frank intraventricular pus. Acinetobacter baumannii was the most common organism grown in cultures. Two patients had multiple bacterial growth in cerebrospinal fluid cultures. The duration of pre-EL IV/IT antibiotics ranged from 3 to 8 weeks. Microbiological cure was achieved in all (7/7) and clinical cure in 86% of patients (6/7). One patient died despite achieving cerebrospinal fluid sterilization 3 months later as a result of progressive white matter edema. CONCLUSIONS The addition of IT antibiotics has resulted in improved outcome in patients with ventriculitis; however, some patients continue to be unresponsive to antibiotics. EL can play a complementary role in eradicating such recalcitrant infections. EL should be considered in any patient with ventriculitis, if infection persists even after ∼7-10 days of IVand IT antibiotics.
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Affiliation(s)
- Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhawani S Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Patil AD, Karnik ND, Nadkar MY, Gupta VA, Muralidhara K, Passidhi S. Guillain Barré Syndrome, Systemic Lupus Erythematosus and Acute Intermittent Porphyria – A Deadly Trio. J Assoc Physicians India 2015; 63:60-63. [PMID: 29900713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Peripheral nervous system involvement occurs in 3-18% patients of systemic lupus erythematosus (SLE) cases. American College of Rheumatology (ACR) includes 19 neuropsychiatric syndromes for diagnosis of SLE divided into neurological syndromes of central, peripheral and autonomic nervous systems along with the psychiatric syndromes. Sensorimotor quadriparesis in a suspected case of SLE could be due to a Guillain Barré (GBS)-like illness, mononeuritis multiplex presenting as plexopathies, an anterior spinal artery syndrome or it can present like an acute transverse myelitis or hypokalemic periodic paralysis related to Sjogren’s syndrome with renal tubular acidosis. We here report a case of a fulminant quadriparesis due to a SLE flare which subsequently was also found to be a case of Acute Intermittent Porphyria.
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Guo W, Sheng J, Gu Y, Xing TH, Peng ZH, Zhong L. Analysis and forecast for multidrug-resistant Acinetobacter baumannii Infections among liver transplant recipients. Transplant Proc 2015; 46:1448-52. [PMID: 24935312 DOI: 10.1016/j.transproceed.2014.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 02/27/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acinetobacter baumannii (Ab) has become an important pathogenic bacterium with specific epidemic features in the intensive care unit. We explored the epidemiology of multidrug-resistant Ab infections among liver transplant recipients at the Liver Transplantation Center, 1st Affiliated Hospital of Shanghai Jiao Tong University. METHODS Seventeen multidrug-resistant Ab strains were isolated from the sputum and bronchoalveolar lavage fluid specimens of 249 liver transplant recipients from January 2007 to December 2009. The drug resistance and minimum inhibitory concentration (MIC) for the 17 Ab strains were determined. The Ab strains were genotyped with the use of repetitive element-based polymerase chain reaction. The risk factors were also characterized by single-factor and multifactor analysis to the clinical data of the 249 liver transplant recipients. RESULTS The drug sensitivity results showed that the 17 Ab strains isolated displayed 100% drug resistance rate to aminoglycosides (gentamicin), quinolones (ciprofloxacin), penicillins (piperacillin), cephalosporins (ceftazidime, cefotaxime, and cefepime), and carbapenems (imipenem and meropenem). The 17 Ab strains could be divided into 3 genotypes: 1, 1, and 15 strains for types A, C, and B, respectively. Fungal culture positivity after operation (odds ratio [OR], 5.470) and tracheal intubation twice (OR, 11.538) were the independent risk factors for multidrug-resistant Ab strain infection. CONCLUSIONS Type B multidrug-resistant Ab strains are prevalent in the liver transplantation center, and they could be transmitted clonally. Liver transplant recipients with postoperational fungal culture positivity and tracheal intubation twice are prone to multidrug-resistant Ab infections. Therefore, a high degree of vigilance should be paid to those recipients to avoid nosocomial Ab infections.
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Affiliation(s)
- W Guo
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - J Sheng
- Department of General Surgery, Shanghai First People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Y Gu
- Department of General Surgery, Shanghai First People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - T-H Xing
- Department of General Surgery, Shanghai First People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Z-H Peng
- Department of General Surgery, Shanghai First People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - L Zhong
- Department of General Surgery, Shanghai First People's Hospital, Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China.
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Bogomolova NS, Bol'shakov LV, Kuznetsova SM. [Problem of treatment for pyo-inflammatory complications caused by Acinetobacter]. Anesteziol Reanimatol 2014:26-32. [PMID: 24749305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The article deals with analysis of a detection frequency and antibacterial treatment resistance of Acinetobacter spp.of different species affiliation. Strains of bacteria detected in patients with pyo-inflammatory complications after surgeries (period from 2010 to 2012) were involved in the study 137 strains of Acinetobacter spp. were detected and studied Fraction of Acinetobacter spp. in 2010, 2011 and 2012 was 2.3, 3 and 3.4% respectively. Fraction of P. aeruginosain all non-fermentative Gram-negative bacteria (NFGNB) decreased by 120% and fraction of Acinetobacter spp. increased by 200-250%. Acinetobacter spp. detection frequency was not significantly changed in the period from 2006 to 2012. However the fraction of Acinetobacter spp. in NFGNB increased by 150% and was 29% in 2012. Detection frequency of A. baumanii sharply increased in 2012. A study of antibacterial treatment resistance of Acinetobacter spp. (10 antibacterial medicines) showed that Polymyxin B and E (Colistin) was the most effective medicine for A. baumanii and A. calcoaceticus infection. 85-95% of Acinetobacter spp.strains kept sensitivity to this antibacterial medicine. 66-88.9% of A. baumanii strains, 66.7-81.8% of A. alcoaceticus and 66.6% of other Acinetobacter spp. were sensitive to Tigecycline. Dioxidine effectiveness was close to Tigecycline in 66.7-80% of A. baumanii strains. 85-100% of A. calcoaceticus strains were sensitive to Dioxidine. There is a trend of decreasing of A. baumanii sensitivity to Carbapenems by 200%. Fraction of strains sensitive to Meropenem and Imipenem in 2012 was 21.4% and 16.7% respectively. All studied strains of A. lwoffi and A. haemolyticus kept sensitivity to Carbapenems. In 2012 23.8% of A. baumanii and 50% of A. calcoaceticus strains were sensitivity to Amikacin, meanwhile A. lwoffi and A. haemolyticus were not sensitive to this medicine. 31.3% of A. baumanii and 50% of A. calcoaceticus strains were sensitive to Ceftazidime/Sulbactam. 5.3% of A. baumanii and 15.8% of A. calcoaceticus strains were sensitive to Piperacillin/Sulbactam. Gentamicin effectiveness was fixed in 12.5% of A. baumanii and 45.5% of unidentified Acinetobacter-strains. Gentamicin was not effective against A. lwoffii and A. haemolyticus. Thus Polymyxins (in monotherapy or in combination with glycopeptides), Dioxidine and Tigecycline in combination with Carbapenems or Cefiazidime/Sulbactam are to be drugs of choice in treatment for pyo-inflammatory complications caused by Acinetobacter spp.
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Kaitlin V, Zinn Z, Powers R. Macerated foot dermatitis related to occlusive footwear. W V Med J 2013; 109:8-9. [PMID: 24371857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gram-negative bacterial toe-web infections (GNBTWI's) are relatively under-recognized among physicians. Even though skin infections are usually thought to involve gram-positive bacteria, gram-negative organisms have a particular affinity for the toe-web. We present two patients with GNBTWI's who presented with maceration of the toe-webs, vesiculopustules and a hyperkeratotic rim. Treatment includes using both oral and topical antibiotics along with antifungals to treat co-existing dermatophyte infections. Awareness of this condition is particularly important for primary care physicians in West Virginia, as a few of the potential risk factors include wearing occlusive footwear, such as work boots, and type II diabetes mellitus.
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Affiliation(s)
- Vaughan Kaitlin
- West Virginia University, Dept. of Med., Dermatology Section, P.O. Box 9158, Morgantown, WV 26506-9158, USA.
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Al Shirawi N, Memish ZA, Cherfan A, Al Shimemeri A. Post-Neurosurgical Meningitis Due to Multidrug-ResistantAcinetobacter baumaniiTreated with Intrathecal Colistin: Case Report and Review of the Literature. J Chemother 2013; 18:554-8. [PMID: 17127235 DOI: 10.1179/joc.2006.18.5.554] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Intrathecal colistin (Polymxin E) is becoming an important option for the treatment of post-neurosurgical meningitis caused by multidrug resistant (MDR) Acinetobacter baumannii. We report a case of 28-year-old man who developed meningitis due to MDR A. baumannii associated with an external ventricular drain. The patient was cured using a 4-week course of intrathecal colistin 3.2 mg via external ventricular drain (EVD) daily without any serious side effects.
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Affiliation(s)
- N Al Shirawi
- Department of Intensive Care Unit, King Abdulaziz Medical City-King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Jin ZP, Cheng YB, Wang QS, Wang Q, Ge YJ. [Drug resistance of Acinetobacter baumanii isolated from children in the pediatric intensive care unit]. Zhongguo Dang Dai Er Ke Za Zhi 2012; 14:229-230. [PMID: 22433415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Yamada K, Yanagihara K, Araki N, Harada Y, Morinaga Y, Akamatsu N, Matsuda J, Izumikawa K, Kakeya H, Yamamoto Y, Hasegawa H, Kohno S, Kamihira S. Clinical characteristics of tertiary hospital patients from whom Acinetobacter calcoaceticus-Acinetobacter baumannii complex strains were isolated. Intern Med 2012; 51:51-7. [PMID: 22214623 DOI: 10.2169/internalmedicine.51.6018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Acinetobacter baumannii is a worldwide nosocomial pathogen that has become increasingly common over the past few decades, and strains of multidrug-resistant A. baumannii have been increasing. The aim of this study was to assess the clinical characteristics of A. calcoaceticus-A. baumannii complex (Acb complex) strains and to determine the risk factors of this infection. METHODS The medical records of 121 patients at Nagasaki University Hospital from whom Acb complex had been isolated between January 2007 and December 2009 were retrospectively reviewed. Patient backgrounds, sensitivity to antibiotics, risk factors for infection, and prognosis were evaluated. RESULTS Lower respiratory isolates accounted for 73% (147 strains) of all 201 isolates. Most of the isolates were sensitive to carbapenems. Of the 121 patients (74 males and 47 females; mean age: 62.1 years), 48 (39.7%) had malignancy and 75 (62.0%) were treated with antibiotics prior to isolation. Thirty-seven of the patients in this study (30.6%) were infected by Acb complex and the most frequent clinical manifestation was pneumonia (18 cases; 48.6%). Approximately 60% of infected patients were treated with β-lactam agent in combination with β-lactamase inhibitors or carbapenems. The mortality rate of infected patients was significantly higher than that of colonized patients (infected: 24.3%, colonized: 6.0%, p<0.05). Risk factors for Acb complex infection include being over 60 years of age, chronic liver disease, and the use of first-generation cephalosporins prior to isolation. CONCLUSION Acb complex was relatively sensitive to antibiotics. The appropriate usage of antibiotics should be continued for the prevention of drug resistance in Acb complex.
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Affiliation(s)
- Koichi Yamada
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Mioljević V, Simić AP, Radenković D, Galun D, Palibrk I, Ostojić S, Stojakov D, Varagić Z, Pavlović M, Milićević MN. Acinetobacter spp. colonization and infection risk factors in surgical patients. Acta Chir Iugosl 2011; 58:81-87. [PMID: 22519197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The results of numerous studies carried out over the last two decades have increasingly important cause of intrahospital infections (IHI). The aim of the study was to determine potential differences in distribution of individual risk factors between the group of patients in whom multiresistant Acinetobacter spp. was isolated and the group of patients in whom it was not. MATERIAL AND METHODS A prospective cohort study of 64 patients hospitalized with recorded IHI at the University Hospital for Digestive Surgery, Clinical Center of Serbia in the period between January and July 2011. The subjects were divided into two groups: patients with IHI in whom multiresistant Acinetobacter spp. was isolated from the biological material samples, and those with IHI without the presence of Acinetobacter spp. RESULTS Univariate data analysis indicated presence of statistically significant difference in distribution of certain types of surgeries (esophageal, pancreatic and hepatobiliary) among the two groups of subjects, distribution of CVC placement, application of mechanical ventilation and nasogastric tube placement, length of stay in ICU, lethal outcomes and administration of third generation cephalosporins. The results of multivariate analysis indicated that length of hospitalization in ICU (> 7 days), CVC, mechanical ventilation, esophageal, pancreatic and hepatobiliary surgeries as well as administration of third generation cephalosporins are independent risk factors for colonization and infection of patients with Acinetobacter spp. CONCLUSION Colonized or infected patients with Acinetobacter spp. play a major role in contamination of hands of the medical staff in the course of care and treatment, while inadequate hand hygiene of the staff leads to cross transmission of the causative organism to infection-free patients. Selective antibiotic pressure, particularly administration of quinolones and broad-spectrum cephalosporins, favor onset of multiresistant species of Acinetobacter spp., and therefore appropriate prophylaxis and treatment represent basic preventive measures against the onset and spreading of the causative organisms.
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Affiliation(s)
- Vesna Mioljević
- Department of hospital epidemiology and hygiene, Clinical Center of Serbia, Belgrade
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18
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19
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Sullivan DR, Shields J, Netzer G. Fatal case of multi-drug resistant Acinetobacter baumannii necrotizing fasciitis. Am Surg 2010; 76:651-653. [PMID: 20583528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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20
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Gandhi AD, Saleem A, Sperling D, Piccorelli GO. Leptomeningitis: a rare outcome after cervical stab wound. J Trauma 2010; 68:E57-E60. [PMID: 20220401 DOI: 10.1097/ta.0b013e318166d754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Alok D Gandhi
- Departments of Surgery, St. Barnabas Hospital, Bronx, New York, USA.
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Abstract
Acinetobacter is a highly resistant microorganism, commonly isolated in intensive and post-operative care units. Although rarely reported, it may constitute 1 of the several causes of early prosthetic valve endocarditis. A diffuse, red maculopapular rash may be encountered in patients with Acinetobacter endocarditis. Here we present a case of early prosthetic valve endocarditis due to Acinetobacter baumannii and accompanied by a cutaneous eruption.
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Affiliation(s)
- Ali Ilgin Olut
- Unit of Infectious Diseases and Clinical Microbiology, Tepecik SSK Training Hospital, Izmir.
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22
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Sanduende Otero Y, Moreno López E, Rodríguez Losada M, Roibal MA. [Amphotericin and posaconazole for gastrointestinal mucormycosis]. Rev Esp Anestesiol Reanim 2009; 56:131-132. [PMID: 19334671 DOI: 10.1016/s0034-9356(09)70353-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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23
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Walker M. Preventing contamination. Crit Care Nurse 2008; 28:17. [PMID: 18515604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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24
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Affiliation(s)
| | | | - Desmond T. Chih
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Craig S. Boutlis
- Charles Darwin University, Darwin, Northern Territory, Australia
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Friedman O, Jassal SV, Bargman JM. Acinetobacter peritoneal dialysis peritonitis: description and relation to the SPICE family of organisms. Perit Dial Int 2008; 28:195-197. [PMID: 18332457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Oded Friedman
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
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26
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Lin GM, Lin JC, Chen PJ, Siu LK, Huang LY, Chang FY. Pan-drug resistant Acinetobacter baumannii bacteremia following endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 2008; 103:498-9. [PMID: 18289224 DOI: 10.1111/j.1572-0241.2007.01646_17.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
We report a rare case of prosthetic valve endocarditis caused by Acinetobacter genomic species 13 TU. This patient had rheumatic heart disease and received prosthetic mitral valve replacement eleven years previously. He was admitted due to tarry stool. Endoscopic procedure showed two gastric ulcers and some mucous breaks at the distal esophagus. He had a fever on the eleventh hospital day. Persistent Acinetobacter bacteremia was noted with conjunctiva hemorrhage. The pathogen was identified as Acinetobacter genomic species 13 TU by PCR-based method. According to his whole course of disease, the most possible portal of entry was via the endoscopic procedure.
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Affiliation(s)
- Lai Yu-Hsien
- Section of Infectious Disease, Department of Medicine, Buddhist Tzu Chi General Hospital, Chiayi, Taiwan
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28
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Lee HC, Lee NY, Chang CM, Chou CY, Wu YH, Wang LR, Ko NY, Liu CC, Ko WC. Outbreak of Acinetobacter baumannii bacteremia related to contaminated morphine used for patient-controlled analgesia. Infect Control Hosp Epidemiol 2007; 28:1213-7. [PMID: 17828703 DOI: 10.1086/520741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 05/08/2007] [Indexed: 12/26/2022]
Abstract
We investigated a cluster of postoperative febrile episodes and episodes of Acinetobacter baumannii bacteremia in obstetrics and gynecology wards after an electrical blackout and loss of the water supply. The use of patient-controlled analgesia was the only independent risk factor associated with postoperative fever, and A. baumannii isolates recovered from the blood of patients who had received patient-controlled analgesia were genetically related to an isolate recovered from the diluted morphine solution used for this procedure. After inappropriate preparation of the morphine solution was identified and stopped, the outbreak ended.
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Affiliation(s)
- Hsin-Chun Lee
- Department of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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29
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Surasarang K, Narksawat K, Danchaivijitr S, Siripanichgon K, Sujirarat D, Rongrungrueng Y, Kiratisin P. Risk factors for multi-drug resistant Acinetobacter baumannii nosocomial infection. J Med Assoc Thai 2007; 90:1633-1639. [PMID: 17926995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess factors associated with multi-drug resistant Acinetobacter baumannii (MDR-AB) nosocomial infection. MATERIAL AND METHOD This hospital-based case-control study was conducted in patients admitted to Siriraj Hospital, Bangkok, Thailand between January 1, 2005 and December 31, 2005. The study population consisted of 155 cases with MDR-AB nosocomial infection and 310 controls without nosocomial infection. The cases were matched with controls by age and ward of admission with a ratio of 1:2. RESULTS The average age of the present study population was 63.5 +/- 18.7 years among cases and 62.9 +/- 18.2 years among controls. The mean of length of stay in hospital among cases was 4.9 +/- 1.4 weeks and controls 1.8 +/- 1.0 weeks. The most common site of MDR-AB nosocomial infection was lower respiratory tract (74.8%). The antimicrobial susceptibility of MDR-AB was 3.9% to cetriaxone and 42.1% to cefoperazone/sulbactam. Multiple logistic regression analysis showed the following associated factors with MDR-AB nosocomial infection: duration of admission prior to MDR-AB nosocomial infection > 1 week (OR = 2.06; 95% CI 1.09-3.89), indwelling urinary catheter > 1 week (OR = 8.24; 95% CI 3.81-17.82), mechanical ventilation > 1 week (OR = 5.73; 95% CI 2.96-11.10), central venous line > 1 week (OR = 3.29; 95% CI 1.48-7.31), nasogastric intubation > 1 week (OR = 6.22; 95% CI 3.24-11.93), prior administration of 3rd-4th generation cephalosporins (OR = 1.80; 95% CI 1.04-3.13), metrodazole (OR = 2.59; 95% CI 1.21-5.56), and piperacillin-tazobactam (OR = 4.68; 95% CI 1.93-11.32). CONCLUSION A case-control study in medical and surgical patients in Siriraj Hospital in 2005 revealed risk factors for AB nosocomial infection. Prolonged admission of more than 2 weeks, use of devices, and prior treatment with certain antimicrobials were found to be significant risk factors for the infection. To reduce the infection, strict infection control measures must be applied to the patients with these risk factors. Education to medical personnel and enforcement of infection control practices are all needed to reduce antimicrobial resistant bacterial nosocomial infection.
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Affiliation(s)
- Kunlayanee Surasarang
- Center for Nosocomial Infection Control, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
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30
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Russell K, Waghorn D, Devi R. The potential perils of a visit to botanical gardens in a patient with a central intravascular device. J Hosp Infect 2007; 66:402-4. [PMID: 17573153 DOI: 10.1016/j.jhin.2007.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 05/02/2007] [Indexed: 11/17/2022]
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Affiliation(s)
| | - Katia Raieta
- Istituto di Scienze dell’Alimentazione, Avellino, Italy
| | - Donatella Ottaviani
- Istituto Zooprofilattico Sperimentale dell’Umbria e delle Marche, Ancona, Italy
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32
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Zanetti G, Blanc DS, Federli I, Raffoul W, Petignat C, Maravic P, Francioli P, Berger MM. Importation of Acinetobacter baumannii into a burn unit: a recurrent outbreak of infection associated with widespread environmental contamination. Infect Control Hosp Epidemiol 2007; 28:723-5. [PMID: 17520548 DOI: 10.1086/517956] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 09/25/2006] [Indexed: 11/04/2022]
Abstract
A burn patient was infected with Acinetobacter baumannii on transfer to the hospital after a terrorist attack. Two patients experienced cross-infection. Environmental swab samples were negative for A. baumannii. Six months later, the bacteria reemerged in 6 patients. Environmental swab samples obtained at this time were inoculated into a minimal mineral broth, and culture results showed widespread contamination. No case of infection occurred after closure of the unit for disinfection.
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Affiliation(s)
- Giorgio Zanetti
- Service of Hospital Preventive Medicine, the Service of Infectious Diseases, Department of Medicine, University Hospital, Lausanne, Switzerland.
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Playford EG, Craig JC, Iredell JR. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: risk factors for acquisition, infection and their consequences. J Hosp Infect 2007; 65:204-11. [PMID: 17254667 DOI: 10.1016/j.jhin.2006.11.010] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 11/10/2006] [Indexed: 02/06/2023]
Abstract
A retrospective case-control study was performed to assess risk factors and the clinical and economic consequences associated with acquisition of carbapenem-resistant Acinetobacter baumannii (CR-AB) in an intensive care unit (ICU) over a 24-month period. CR-AB was acquired by 64 of 1431 ICU admissions; each was matched with two controls. Risk factors associated with CR-AB acquisition included ICU-wide variables, such as 'colonization pressure' (the prevalence of ICU colonized patients) and ICU antibiotic use over the preceding three months, as well as patient-related variables. Among colonized patients, risk factors for CR-AB infection included transfusion and 'colonization density' (the proportion of body sites colonized with CR-AB). CR-AB infection was independently associated with increased hospital mortality [mortality difference: 20%; 95% confidence interval (CI): 1-40%], prolonged ICU stay (median length of stay difference: 15 days; 95% CI: 9-21 days) and prolonged hospital stay (30 days, 11-38 days) compared with matched controls.
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Affiliation(s)
- E G Playford
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia.
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34
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Choi SH, Choo EJ, Kwak YG, Kim MY, Jun JB, Kim MN, Kim NJ, Jeong JY, Kim YS, Woo JH. Clinical characteristics and outcomes of bacteremia caused by Acinetobacter species other than A. baumannii: comparison with A. baumannii bacteremia. J Infect Chemother 2007; 12:380-6. [PMID: 17235644 DOI: 10.1007/s10156-006-0488-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 09/01/2006] [Indexed: 11/25/2022]
Abstract
Previous reports have suggested that bacteremia caused by Acinetobacter species other than A. baumannii is frequently associated with intravascular catheters, and that A. baumannii is less virulent than non-baumannii Acinetobacter. To validate these observations, 28 patients with bacteremia caused by Acinetobacter species other than A. baumannii (cases) were compared with 112 randomly selected patients with A. baumannii bacteremia (controls). Only 1/28 (3.6%) case episodes and 13/112 (11.6%) control episodes of bacteremia were definitely catheter-related (P = 0.301). Even if probable catheter-related episodes were included, the frequency did not differ significantly between cases and controls (46.4% vs 39.3%; P = 0.491). No significant differences between cases and controls were noted in crude mortality (17.9% vs 32.4%; P = 0.131) or bacteremia-related mortality (14.3% vs 12.6%; P = 0.760). In conclusion, we found that the portals of entry and the mortality of bacteremia associated with Acinetobacter species other than A. baumannii and with A. baumannii were similar.
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Affiliation(s)
- Sang-Ho Choi
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Center for Antimicrobial Resistance and Microbial Genetics, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea
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35
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Femenía F, Ferre MA, Ruiz JI, Montero M. [Infections in patients with extensive burns in the critical care unit]. Rev Esp Anestesiol Reanim 2006; 53:666-8. [PMID: 17302084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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36
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George RS, Birks EJ, Haj-Yahia S, Bowles CT, Hall A, Khaghani A, Petrou M. Acinetobacter mediastinitis in a heart transplant patient. Ann Thorac Surg 2006; 82:715-6. [PMID: 16863793 DOI: 10.1016/j.athoracsur.2005.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Revised: 11/01/2005] [Accepted: 11/04/2005] [Indexed: 11/18/2022]
Abstract
We report a 56-year-old who underwent orthotopic heart transplantation following left ventricular assist device bridge to transplantation. His postoperative course was complicated by severe sternal wound infection with Acinetobacter species requiring extensive debridement and reconstruction with a pectoralis major flap. This was followed by a total sternectomy, pectoralis flap debridement, and vacuum-assisted dressing.
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Affiliation(s)
- Robert S George
- Department of Artificial Heart and Transplant, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, United Kingdom
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Koulenti D, Rello J. Hospital-acquired pneumonia in the 21st century: a review of existing treatment options and their impact on patient care. Expert Opin Pharmacother 2006; 7:1555-69. [PMID: 16872259 DOI: 10.1517/14656566.7.12.1555] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hospital-acquired pneumonia is a common nosocomial infection, with significant morbidity and mortality, and represents a major therapeutic challenge to clinicians. The therapeutic approach must be patient-oriented and institution-specific. The specific risk factors of each patient, such as previous antibiotic exposure, underlying diseases, length of hospital stay and the local patterns of antimicrobial resistance, should guide physicians in their decision of the initial optimal empirical therapy. Delays in the initiation or inappropriate/inadequate initial therapy are related to increased mortality and worse outcomes. In responding patients, as soon as culture data are available, efforts should be made to change the initial broad spectrum antibiotic regimen to a more targeted one (de-escalation). The optimal duration of treatment is a matter of debate, but courses longer than 1 week are rarely justified.
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MESH Headings
- Acinetobacter Infections/drug therapy
- Acinetobacter Infections/etiology
- Acinetobacter Infections/mortality
- Administration, Inhalation
- Aminoglycosides/administration & dosage
- Aminoglycosides/therapeutic use
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/therapeutic use
- Carbapenems/administration & dosage
- Carbapenems/therapeutic use
- Cephalosporins/administration & dosage
- Cephalosporins/therapeutic use
- Cross Infection/drug therapy
- Cross Infection/etiology
- Cross Infection/mortality
- Drug Administration Schedule
- Drug Resistance, Multiple, Bacterial
- Drug Therapy, Combination
- Humans
- Methicillin Resistance
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/etiology
- Pneumonia, Bacterial/mortality
- Pneumonia, Staphylococcal/drug therapy
- Pneumonia, Staphylococcal/etiology
- Pneumonia, Staphylococcal/mortality
- Practice Guidelines as Topic
- Pseudomonas Infections/drug therapy
- Pseudomonas Infections/etiology
- Pseudomonas Infections/mortality
- Respiration, Artificial/adverse effects
- Vancomycin/administration & dosage
- Vancomycin/therapeutic use
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Affiliation(s)
- Despoina Koulenti
- Critical Care Department, Joan XXIII University Hospital/ Institut Pere Virgili, Mallafre Guasch, 4, 43007 Tarragona, Spain.
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Buke C, Sipahi OR, Yurtseven T, Zileli M. High dose of intrathecal netilmicin in the treatment of nosocomial Acinetobacter baumannii meningitis. J Infect 2006; 51:420-2. [PMID: 16321655 DOI: 10.1016/j.jinf.2005.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Accepted: 02/08/2005] [Indexed: 10/25/2022]
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39
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Rabbai O, Hachimi A, Charra B, Benslama A, Motaouakkil S. [Vertex extradural haematoma by superior sagittal sinus rupture]. Ann Fr Anesth Reanim 2006; 25:469-70. [PMID: 16524689 DOI: 10.1016/j.annfar.2005.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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40
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Sacar S, Turgut H, Toprak S, Cirak B, Coskun E, Yilmaz O, Tekin K. A retrospective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period. BMC Infect Dis 2006; 6:43. [PMID: 16524475 PMCID: PMC1421408 DOI: 10.1186/1471-2334-6-43] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 03/08/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunts are used for intracranial pressure management and temporary cerebrospinal fluid (CSF) drainage. Infection of the central nervous system (CNS) is a major cause of morbidity and mortality in patients with CSF shunts. The aim of the present study was to evaluate the clinical features, pathogens, and outcomes of 22 patients with CSF shunt infections collected over 4 years. METHODS The patients with shunt insertions were evaluated using; age, sex, etiology of hydrocephalus, shunt infection numbers, biochemical and microbiological parameters, prognosis, clinical infection features and clinical outcome. RESULTS The most common causes of the etiology of hydrocephalus in shunt infected patients were congenital hydrocephalus-myelomeningocele (32%) and meningitis (23%). The commonest causative microorganism identified was Staphylococcus (S.) aureus, followed by Acinetobacter spp., and S. epidermidis. CONCLUSION In a case of a shunt infection the timely usage of appropriate antibiotics, according to the antimicrobial susceptibility testing, and the removal of the shunt apparatus is essential for successful treatment.
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Affiliation(s)
- Suzan Sacar
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Huseyin Turgut
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Semra Toprak
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Bayram Cirak
- Department of Neurosurgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Erdal Coskun
- Department of Neurosurgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ozlem Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Koray Tekin
- Department of General Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
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Abstract
Infection with antibiotic-resistant Acinetobacter spp. is an increasing problem in critical care environments worldwide. Acinetobacter spp. are known to produce an insulin-cleaving protease. We hypothesized that infection with Acinetobacter spp. was associated with the acquisition of glucose intolerance in burn patients. Data were collected prospectively on all 473 patients admitted to the Burns Centre between January 2002 and March 2003. A total of 3.4% of patients acquired glucose intolerance during admission. Patients with Acinetobacter spp. infection were 9.8 times more likely to develop glucose intolerance than those without the infection (P < .0001). The association persisted after controlling for TBSA (P < .001). In patients with deep Acinetobacter spp. infection, 47% had glucose intolerance, compared with 12% in those with infection of the burn only (P = .03). In patients with pre-existing diabetes mellitus, 27% developed Acinetobacter spp. infection compared with only 8.5% of patients without diabetes (P = .04). This study demonstrates a clear association between Acinetobacter spp. infection and glucose intolerance in burns patients.
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Affiliation(s)
- Dominic Furniss
- Burns Centre, Chelsea and Westminster Hospital, London, United Kingdom
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Yeh YH, Chang CJ, Hsu TS, Ko YS, Hsu LA, Kuo CT. Cardiac catheterization complicated by iliacus abscess: a rare complication of transfemoral approach--a case report. Angiology 2005; 56:623-5. [PMID: 16193203 DOI: 10.1177/000331970505600515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iliacus abscess is an extremely rare complication of percutaneous transfemoral artery catheterization. This is a report of a case of iliacus abscess and Acinetobacter baumanii sepsis following percutaneous transfemoral artery catheterization. After a 43-day course of intravenous antibiotics treatment and repeated drainage, clinical recovery was achieved, though without complete radiologic resolution.
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Affiliation(s)
- Yung-Hsin Yeh
- First Cardiovascular Division, Chang-Gung Memorial Hospital, Taipei, Taiwan
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Denton M, Wilcox MH, Parnell P, Green D, Keer V, Hawkey PM, Evans I, Murphy P. Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. Intensive Crit Care Nurs 2005; 21:94-8. [PMID: 15778073 DOI: 10.1016/j.iccn.2003.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Accepted: 10/24/2003] [Indexed: 11/15/2022]
Abstract
An outbreak of Acinetobacter baumannii colonization and infection occurred in 19 patients over a 14-month period during 1998-1999 on a neurosurgical intensive care unit. During efforts to control the outbreak a significant correlation was observed between the number of environmental isolates of A. baumannii obtained during each monthly screening and the number of patients with A. baumannii colonization/infection in the same calendar month (P=0.004). Use of 1000 ppm hypochlorite solution and the introduction of new cleaning protocols reduced the number of environmental isolates. Failure to maintain low levels of environmental contamination with A. baumannii resulted in increases in patient colonization. This study showed that high standards of cleaning play an integral role in controlling outbreaks of A. baumannii in the intensive care unit setting.
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Affiliation(s)
- M Denton
- Department of Microbiology, Great George Street, Leeds LS1 3EX, UK.
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Jeong SH, Bae IK, Kwon SB, Lee K, Yong D, Woo GJ, Lee JH, Jung HI, Jang SJ, Sung KH, Lee SH. Investigation of a nosocomial outbreak of Acinetobacter baumannii producing PER-1 extended-spectrum beta-lactamase in an intensive care unit. J Hosp Infect 2005; 59:242-8. [PMID: 15694982 DOI: 10.1016/j.jhin.2004.09.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Accepted: 09/10/2004] [Indexed: 02/06/2023]
Abstract
We investigated an outbreak of Acinetobacter baumannii in an adult intensive care unit of Kosin University Gospel Hospital in Busan, Republic of Korea. The outbreak involved 10 cases of infection by A. baumannii producing PER-1 extended-spectrum beta-lactamase over a seven-month period, and was caused by a single pulsed-field gel electrophoresis clone. The epidemic isolates were characterized by slight synergy between clavulanic acid and cefepime. Isoelectric focusing of crude bacterial extracts detected two nitrocefin-positive bands with pI values of 8.0 and 5.3. Polymerase chain reaction amplification and characterization of the amplicons by restriction analysis and direct sequencing indicated that the epidemic isolates carried a bla(PER-1) determinant. The epidemic isolates were characterized by a multidrug-resistant phenotype that remained unchanged over the outbreak, including penicillins, beta-lactam/beta-lactamase inhibitor, extended-spectrum cephalosporins and monobactams. Isolation of infected patients and appropriate carbapenem therapy were successful in ending the outbreak. Our report indicates that the bla(PER-1) resistance determinant may become an emerging therapeutic problem.
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Affiliation(s)
- S H Jeong
- Department of Laboratory Medicine and Graduate School of Public Health, Kosin University College of Medicine, Busan, Republic of Korea
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Garnacho-Montero J, Ortiz-Leyba C, Fernández-Hinojosa E, Aldabó-Pallás T, Cayuela A, Marquez-Vácaro JA, Garcia-Curiel A, Jiménez-Jiménez FJ. Acinetobacter baumannii ventilator-associated pneumonia: epidemiological and clinical findings. Intensive Care Med 2005; 31:649-55. [PMID: 15785929 DOI: 10.1007/s00134-005-2598-0] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Accepted: 02/21/2005] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate prognostic factors and predictors of Acinetobacter baumannii isolation in ventilator-associated pneumonia (VAP). We specifically analyzed these issues for imipenem-resistant episodes. DESIGN AND SETTING All episodes of VAP are prospectively included in a database. Information about risk factors was retrieved retrospectively. PATIENTS Eighty-one patients exhibiting microbiologically documented VAP: 41 by A. baumannii (26 by imipenem-resistant) and 40 by other pathogens. MEASUREMENTS AND RESULTS The following variables were noted: underlying diseases, severity of illness, duration of mechanical ventilation and of hospitalization before VAP, prior episode of sepsis, previous antibiotic, corticosteroid use, type of nutrition, renal replacement therapy, reintubation, transportation out of the ICU, micro-organisms involved in VAP, concomitant bacteremia, clinical presentation, Sequential Organ Failure Assessment (SOFA) scale on the day of diagnosis, and adequacy of empirical antibiotic therapy. Prior antibiotic use was found to be associated with development of VAP by A. baumannii (OR 14). Prior imipenem exposure was associated with the isolation of imipenem-resistant strains (OR 4). SOFA score on the day of diagnosis was the only predictor of in-hospital mortality (OR 1.22); adequacy of empirical antibiotic therapy was a protective factor (OR 0.067). CONCLUSIONS Our results confirm that prior exposure to antimicrobials is an independent predictor for the development of A. baumannii VAP, the prognosis of which is similar to that of infections caused by other pathogens. This study highlights the importance of initial antibiotic choice in VAP or whatever cause.
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Balasundaram RP, Anandaraja S, Juneja R, Choudhary SK. Infective endocarditis following implantation of amplatzer atrial septal occluder. Indian Heart J 2005; 57:167-9. [PMID: 16013359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Infective endocarditis is a rare but serious complication following device closure of atrial septal defect. Surgical removal of the device is mandatory in such cases. We report a rare case of polymicrobial endocarditis following implantation of Amplatzer septal occluder in an eight-year-old child.
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Pimentel JD, Low J, Styles K, Harris OC, Hughes A, Athan E. Control of an outbreak of multi-drug-resistant Acinetobacter baumannii in an intensive care unit and a surgical ward. J Hosp Infect 2005; 59:249-53. [PMID: 15694983 DOI: 10.1016/j.jhin.2004.09.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Accepted: 09/19/2004] [Indexed: 11/21/2022]
Abstract
We describe an outbreak of multi-drug-resistant Acinetobacter baumannii (MRAB) that occurred in an intensive care unit (ICU) and a surgical ward from December 2003 to March 2004. Mapping patient movements on a timeline indicated that the outbreak was confined to these two areas. Investigation by the hospital's infection prevention service found that a possible source of spread was improper cleaning methods used on respiratory equipment. Pulsed-field gel electrophoresis analysis of available isolates indicated the presence of two distinct strains. One strain was seen in patients from the ICU and the other strain was seen in the surgical ward patients. Cleaning and environmental decontamination as well as staff education were implemented to halt further immediate spread. The deficiencies identified during the investigation were also resolved. The final outcome was the successful termination of this outbreak.
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Affiliation(s)
- J D Pimentel
- Department of Microbiology, Pathcare Consulting Pathologists, P.O. Box 1088, Geelong, Vic. 3220, Australia; Infection Prevention Service, Barwon Health, Geelong, Vic, Australia.
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Abstract
INTRODUCTION This article describes changes in regional cerebral perfusion and brain metabolism in a case of bacterial meningitis complicating severe traumatic brain injury. CASE REPORT As part of clinical monitoring of patients with severe head injury, cerebral microdialysis was performed and extracellular concentration of glucose, lactate, glutamate, and pyruvate was determined. A thermal diffusion probe was used for bedside monitoring of cerebral blood flow. Acinetobacter meningitis complicated the clinical course on the seventh post-admission day and dramatically altered the neurochemistry. Microdialysate analysis showed glucose under the detection limit, lactate at moderately high levels, and a marked increase in glutamate and pyruvate levels. A reduction of cerebral perfusion was detected in the early phase of meningitis, probably secondary to vascular complications related to the inflammatory process. DISCUSSION This case describes an emerging area of study and practice in patients with brain injury. It demonstrates how cerebral perfusion monitoring and study of brain metabolism can provide an early detection of secondary events that complicate severe head injury and can contribute to a better understanding of the complex pathogenetic mechanisms responsible for neuronal damage.
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Affiliation(s)
- Anna Teresa Mazzeo
- Division of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 29238, USA.
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Bureau-Chalot F, Drieux L, Pierrat-Solans C, Forte D, de Champs C, Bajolet O. Blood pressure cuffs as potential reservoirs of extended-spectrum β-lactamase VEB-1-producing isolates of Acinetobacter baumannii. J Hosp Infect 2004; 58:91-2. [PMID: 15350724 DOI: 10.1016/j.jhin.2004.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Indexed: 10/26/2022]
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