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Meschiari M, Faltoni M, Kaleci S, Tassoni G, Orlando G, Franceschini E, Burastero G, Bedini A, Serio L, Biagioni E, Melegari G, Venturelli C, Sarti M, Bertellini E, Girardis M, Mussini C. Intravenous fosfomycin in combination regimens as a treatment option for difficult-to-treat infections due to multi-drug-resistant Gram-negative organisms: A real-life experience. Int J Antimicrob Agents 2024; 63:107134. [PMID: 38453094 DOI: 10.1016/j.ijantimicag.2024.107134] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/11/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
AIM To investigate the efficacy of intravenous (IV) fosfomycin as combination therapy for treatment of difficult-to-treat (DTT) acute and subacute infections with multi-drug-resistant (MDR) Gram-negative bacteria (GNB), and risk factors associated with 90-day mortality. METHODS A retrospective, observational, monocentric study enrolled patients treated with IV fosfomycin in combination regimens (≥72 h) for proven DTT-MDR-GNB infection. Multi-variate regression analysis identified independent risk factors for 90-day mortality. A propensity score for receiving fosfomycin was performed to control for confounding factors. RESULTS In total, 70 patients were included in this study: 54.3% had carbapenem-resistant isolates, 31.4% had ceftazidime/avibactam-resistant isolates and 28.6% had ceftolozane/tazobactam-resistant isolates. The main pathogens were Pseudomonas aeruginosa (57.1%) and Klebsiella pneumoniae (22.9%). The most prevalent infections were nosocomial pneumonia (42.9%), osteomyelitis (17.1%) and intra-abdominal infections. All-cause 30- and 90-day mortality were 15.7% and 31.4%, respectively (18.9% and 50% considering acute DTT-MDR-GNB infections alone). Relapse at 30 days occurred in 22.9% of cases (29% with emergence of fosfomycin resistance). Mortality at 90 days was independently associated with septic shock and ceftolozane/tazobactam resistance. The relationship between resistance to ceftolozane/tazobactam and 90-day mortality was confirmed to be significant after adjustment by propensity score analysis (hazard ratio 5.84, 95% confidence interval 1.65-20.68; P=0.006). CONCLUSIONS Fosfomycin seems to be a promising salvage, combination treatment in DTT-MDR-GNB infections. Resistance to ceftolozane/tazobactam seems to be independently associated with treatment failure. Randomized clinical trials focusing on pathogen and infection sites are needed urgently to demonstrate the superiority of fosfomycin in combination with other agents for the resolution of DTT-MDR-GNB infections.
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Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
| | - Matteo Faltoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Shaniko Kaleci
- Clinical and Experimental Medicine Department of Surgical, Medical , Dental and Morphological Sciences With Interest in Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Tassoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Giulia Burastero
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Lucia Serio
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Emanuela Biagioni
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Gabriele Melegari
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Claudia Venturelli
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Elisabetta Bertellini
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Massimo Girardis
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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El-Sherbeny EME, Khoris EA, Kassem S. Assessment the efficacy of some various treatment methods, in vitro and in vivo, against Aeromonas hydrophila infection in fish with regard to side effects and residues. Comp Biochem Physiol C Toxicol Pharmacol 2022; 253:109246. [PMID: 34801729 DOI: 10.1016/j.cbpc.2021.109246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
Aeromonas hydrophila is an opportunistic bacteria with an overwhelming impact on fish farming industry especially with upraising of drug resistant mutants. This study aimed to evaluate and compare the therapeutic and side effects of levofloxacin (LEV), chitosan-nanoparticles (CNPs), and fructooligosaccharides (FOS) in control of this infection in tilapia. A total of 160 Nile-tilapia divided into 8-groups; G1: negative-control, G2: infected-control, G3: non-infected-(levofloxacin (LEV) 10 mg/kg bwt), G4: non-infected-(chitosan-nanoparticles (CNPs) 1 g/kg ration), G5: non-infected-(fructooligosaccharides (FOS) 20 g/kg ration), G6: infected-LEV, G7: infected-CNPs and G8: infected-FOS for 7 days. MICs were (0.125 μg/ml and 1.25 mg/ml) for LEV and CNPs respectively. No mortalities or significant adverse effects were recorded in non-infected treated-groups while infected were (20%) LEV, (30%) CNPs, (40%) FOS and (70%) G2. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) decreased by LEV and CNPs than FOS while all increased total protein (TP) and albumin than G2. Malondialdehyde (MDA) significantly decreased and superoxide dismutase (SOD) and reduced glutathione (GSH) increased in all infected-treated groups than G2 in various degrees. Urea and creatinine descending order were FOS, LEV then CNPs decreased significantly than G2. LEV musculature residues, using HPLC, decreased gradually till the 5th day; 621.00 ± 0.66, 270.00 ± 0.48 then 64.00 ± 0.40, and 471.00 ± 0.79, 175.00 ± 0.52 ppb then not detected at 1st, 3rd, and 5th days of withdrawal in non-infected and infected groups respectively. Finally, LEV and CNPs were superior as bactericidal, decreasing mortalities and enzyme activities while CNPs and FOS increased performance, non-specific immunity, and antioxidant biomarkers.
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Affiliation(s)
- Eman M El El-Sherbeny
- Pharmacology unit, Tanta lab, Animal Health Research Institute, Agricultural Research Center, Giza, Egypt
| | - Enas A Khoris
- Fish disease unit, Tanta lab, Animal Health Research Institute, Agricultural Research Center, Giza, Egypt
| | - Samr Kassem
- Nanomaterials Research and Synthesis Unit, Animal Health Research Institute, Agricultural Research Center, Giza, Egypt.
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Sönmez AY, Bi Len S, Taştan Y, Serag KJB, Toring CC, Romero JB, Kenanoğlu ON, Terzi E. Oral administration of Sargassum polycystum extracts stimulates immune response and increases survival against Aeromonas hydrophila infection in Oncorhynchus mykiss. Fish Shellfish Immunol 2021; 117:291-298. [PMID: 34419600 DOI: 10.1016/j.fsi.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/03/2021] [Revised: 07/09/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
This study investigated the immunomodulatory effects of Sargassum polycystum extract administration in rainbow trout (Oncorhynchus mykiss). S. polycystum methanolic extract was administered orally using feeding needles to individual rainbow trout at the dose of 0 (control), 1 (S1), 3 (S3) and 5 (S5) mg/100 μl/per fish twice a day for 7 days. On 1st, 5th, 3rd and 7th day, blood and tissues were collected from the fish and changes in humoral immune responses and immune-related gene expressions were determined. The result of oxidative radical production showed no difference during early stage of the experiment and was lately decreased (P < 0.05). Lysozyme activity increased on 3rd and 7th day of the study in S5 fish group and on 5th day in S3 group compared to control (P < 0.05). Myeloperoxidase activity had an increased level on the 1st and 3rd day in S1, S5 and S5 fish groups, respectively. IL-1β gene was significantly up-regulated in kidney and intestine in all experimental groups (except on the 1st day, in the intestine of S5 fish group) compared to control (P < 0.05). IL-8 gene expression was elevated on 1st and 3rd day in kidney of all experimental fish groups. IL-6 transcript enhanced in a dose-dependent manner on 3rd and 7th day. IL-10 and IL-12 genes were also up-regulated. Survival in all treated fish groups challenged with Aeromonas hydrophila was significantly increased compared to that of control. The highest survival rate was recorded in S5 fish group (83.65%) followed by S3 fish group (82.62%). Our results suggest that S. polycystum aqueous methanolic extract is an effective immunostimulant and provide protection against A. hydrophila infection in rainbow trout at a dose of 3-10 mg/20 g body weight/day.
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Affiliation(s)
- Adem Yavuz Sönmez
- Kastamonu University, Faculty of Fisheries, Department of Basic Sciences, Kastamonu, Turkey
| | - Soner Bi Len
- Kastamonu University, Faculty of Fisheries, Department of Aquaculture, Kastamonu, Turkey.
| | - Yiğit Taştan
- Kastamonu University, Faculty of Fisheries, Department of Aquaculture, Kastamonu, Turkey
| | - Karen Joy B Serag
- Mindanao State University, Tawi-Tawi College of Technology and Oceanography, Tawi-Tawi, Philippines
| | - Concepcion C Toring
- Mindanao State University, Tawi-Tawi College of Technology and Oceanography, Tawi-Tawi, Philippines
| | - Jumelita B Romero
- Mindanao State University, Tawi-Tawi College of Technology and Oceanography, Tawi-Tawi, Philippines
| | - Osman Nezih Kenanoğlu
- Kastamonu University, Faculty of Fisheries, Department of Aquaculture, Kastamonu, Turkey
| | - Ertugrul Terzi
- Kastamonu University, Faculty of Fisheries, Department of Aquaculture, Kastamonu, Turkey
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Kazi F, Mushtaq A. ECCMID 2021. Lancet Infect Dis 2021; 21:1216. [PMID: 34450069 DOI: 10.1016/s1473-3099(21)00487-4] [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: 06/13/2023]
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5
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Lorenz A, Sobhanie MME, Orzel L, Coe K, Wardlow L. Clinical outcomes of combination versus monotherapy for gram negative non-HACEK infective endocarditis. Diagn Microbiol Infect Dis 2021; 101:115504. [PMID: 34375862 DOI: 10.1016/j.diagmicrobio.2021.115504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
The objective of this single-center, retrospective cohort study was to identify whether combination therapy is associated with a lower rate of adverse outcomes for the treatment of Gram negative non-HACEK IE. The primary endpoint was a composite of 60-day all-cause mortality, readmission, or recurrence of bacteremia. Of the 60 patients included, 56.7% met the primary composite outcome, with 20% overall mortality at 60 days. There was no difference in the primary composite outcome of 60-day readmission, infection recurrence or mortality between groups, with 62% of patients in the monotherapy group and 50% of patients in the combination therapy group experiencing the composite outcome (P = 0.36). Despite the high mortality and complicated nature of non-HACEK Gram negative IE, this study showed no difference in 60-day bacteremia recurrence, readmission or mortality among patients treated with combination therapy or monotherapy, suggesting that monotherapy may lead to similar clinical outcomes.
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Affiliation(s)
- Ashley Lorenz
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Libby Orzel
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kelci Coe
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lynn Wardlow
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Sands K, Carvalho MJ, Portal E, Thomson K, Dyer C, Akpulu C, Andrews R, Ferreira A, Gillespie D, Hender T, Hood K, Mathias J, Milton R, Nieto M, Taiyari K, Chan GJ, Bekele D, Solomon S, Basu S, Chattopadhyay P, Mukherjee S, Iregbu K, Modibbo F, Uwaezuoke S, Zahra R, Shirazi H, Muhammad A, Mazarati JB, Rucogoza A, Gaju L, Mehtar S, Bulabula ANH, Whitelaw A, Walsh TR. Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries. Nat Microbiol 2021; 6:512-523. [PMID: 33782558 PMCID: PMC8007471 DOI: 10.1038/s41564-021-00870-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2021] [Indexed: 01/31/2023]
Abstract
Antimicrobial resistance in neonatal sepsis is rising, yet mechanisms of resistance that often spread between species via mobile genetic elements, ultimately limiting treatments in low- and middle-income countries (LMICs), are poorly characterized. The Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) network was initiated to characterize the cause and burden of antimicrobial resistance in neonatal sepsis for seven LMICs in Africa and South Asia. A total of 36,285 neonates were enrolled in the BARNARDS study between November 2015 and December 2017, of whom 2,483 were diagnosed with culture-confirmed sepsis. Klebsiella pneumoniae (n = 258) was the main cause of neonatal sepsis, with Serratia marcescens (n = 151), Klebsiella michiganensis (n = 117), Escherichia coli (n = 75) and Enterobacter cloacae complex (n = 57) also detected. We present whole-genome sequencing, antimicrobial susceptibility and clinical data for 916 out of 1,038 neonatal sepsis isolates (97 isolates were not recovered from initial isolation at local sites). Enterobacterales (K. pneumoniae, E. coli and E. cloacae) harboured multiple cephalosporin and carbapenem resistance genes. All isolated pathogens were resistant to multiple antibiotic classes, including those used to treat neonatal sepsis. Intraspecies diversity of K. pneumoniae and E. coli indicated that multiple antibiotic-resistant lineages cause neonatal sepsis. Our results will underpin research towards better treatments for neonatal sepsis in LMICs.
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Affiliation(s)
- Kirsty Sands
- Division of Infection and Immunity, Cardiff University, Cardiff, UK.
- Department of Zoology, University of Oxford, Oxford, UK.
| | - Maria J Carvalho
- Division of Infection and Immunity, Cardiff University, Cardiff, UK.
- Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| | - Edward Portal
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Kathryn Thomson
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Calie Dyer
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Chinenye Akpulu
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- National Hospital Abuja, Abuja, Nigeria
- 54gene, Lagos, Nigeria
| | - Robert Andrews
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Ana Ferreira
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | | | - Thomas Hender
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jordan Mathias
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Rebecca Milton
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Maria Nieto
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | | | - Grace J Chan
- Division of Medical Critical Care, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Delayehu Bekele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Semaria Solomon
- Department of Microbiology, Immunology and Parasitology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sulagna Basu
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Pinaki Chattopadhyay
- Department of Neonatology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Suchandra Mukherjee
- Department of Neonatology, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | | | - Fatima Modibbo
- National Hospital Abuja, Abuja, Nigeria
- 54gene, Lagos, Nigeria
| | | | - Rabaab Zahra
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Haider Shirazi
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Adil Muhammad
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Aniceth Rucogoza
- The National Reference Laboratory, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Lucie Gaju
- The National Reference Laboratory, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Shaheen Mehtar
- Unit of IPC, Stellenbosch University, Cape Town, South Africa
- Infection Control Africa Network, Cape Town, South Africa
| | - Andre N H Bulabula
- Infection Control Africa Network, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Timothy R Walsh
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Ineos Oxford Institute for Antimicrobial Research, Department of Zoology, Oxford, UK
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Fleiss N, Coggins SA, Lewis AN, Zeigler A, Cooksey KE, Walker LA, Husain AN, de Jong BS, Wallman-Stokes A, Alrifai MW, Visser DH, Good M, Sullivan B, Polin RA, Martin CR, Wynn JL. Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants With Late-Onset Infection. JAMA Netw Open 2021; 4:e2036518. [PMID: 33538825 PMCID: PMC7862993 DOI: 10.1001/jamanetworkopen.2020.36518] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown. OBJECTIVE To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants. EXPOSURES Late-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis. MAIN OUTCOMES AND MEASURES The primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset. RESULTS In the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks' completed gestation did not reduce the association of the nSOFA score with infection-related mortality. CONCLUSIONS AND RELEVANCE The nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population.
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Affiliation(s)
- Noa Fleiss
- Department of Pediatrics, Columbia University School of Medicine, New York, New York
| | - Sarah A. Coggins
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Angela N. Lewis
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Angela Zeigler
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Krista E. Cooksey
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - L. Anne Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ameena N. Husain
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Brenda S. de Jong
- Department of Neonatology, Amsterdam UMC University of Amsterdam, Vrije Universiteit, Emma Children’s Hospital, Amsterdam, the Netherlands
| | - Aaron Wallman-Stokes
- Department of Pediatrics, Columbia University School of Medicine, New York, New York
| | - Mhd Wael Alrifai
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Douwe H. Visser
- Department of Neonatology, Amsterdam UMC University of Amsterdam, Vrije Universiteit, Emma Children’s Hospital, Amsterdam, the Netherlands
| | - Misty Good
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Brynne Sullivan
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Richard A. Polin
- Department of Pediatrics, Columbia University School of Medicine, New York, New York
| | - Camilia R. Martin
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - James L. Wynn
- Department of Pediatrics, University of Florida School of Medicine, Gainesville
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8
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Ferstl PG, Filmann N, Heilgenthal EM, Schnitzbauer AA, Bechstein WO, Kempf VAJ, Villinger D, Schultze TG, Hogardt M, Stephan C, Mutlak H, Weiler N, Mücke MM, Trebicka J, Zeuzem S, Waidmann O, Welker MW. Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates. PLoS One 2021; 16:e0245091. [PMID: 33481811 PMCID: PMC7822319 DOI: 10.1371/journal.pone.0245091] [Citation(s) in RCA: 23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail. Methods Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list. Results In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died. Conclusions Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.
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Affiliation(s)
- Philip G. Ferstl
- Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany
- * E-mail:
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Frankfurt, Germany
| | - Eva-Maria Heilgenthal
- Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Andreas A. Schnitzbauer
- Department of General and Visceral Surgery, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Wolf O. Bechstein
- Department of General and Visceral Surgery, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Volkhard A. J. Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University, Frankfurt am Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
| | - David Villinger
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University, Frankfurt am Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
| | - Tilman G. Schultze
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University, Frankfurt am Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
| | - Michael Hogardt
- Institute for Medical Microbiology and Infection Control, University Hospital, Goethe University, Frankfurt am Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
| | - Christoph Stephan
- Department for Internal Medicine II / Infectious Diseases, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Haitham Mutlak
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Nina Weiler
- Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Marcus M. Mücke
- Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Jonel Trebicka
- Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Oliver Waidmann
- Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Martin-Walter Welker
- Department for Internal Medicine I / Gastroenterology and Hepatology, University Hospital, Goethe University, Frankfurt am Main, Germany
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Elabd H, Wang HP, Shaheen A, Matter A. Nano spirulina dietary supplementation augments growth, antioxidative and immunological reactions, digestion, and protection of Nile tilapia, Oreochromis niloticus, against Aeromonas veronii and some physical stressors. Fish Physiol Biochem 2020; 46:2143-2155. [PMID: 32829476 DOI: 10.1007/s10695-020-00864-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/26/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
The current study evaluated the effects of nano delivery of Spirulina platensis on growth performance, digestive enzymes, and biochemical, immunological, and antioxidative status, as well as resistance to Aeromonas veronii and some physical stressor challenges in Nile tilapia, Oreochromis niloticus. Three experimental fish groups (n = 270) with mean weights of 26 ± 0.30 g and mean lengths of 10 ± 0.5 cm were used; the first additive-free basal diet served as the control group, whereas the following two groups were supplemented with spirulina nanoparticles (SPNP) at 0 (control), 0.25, and 0.5%/kg diet for 4 weeks. Following the feeding trial, fish were challenged with hypoxia, cold stresses, and pathogenic bacteria (A. veronii) infection (9 × 108 CFU/ml). SPNP supplementation, especially 0.5%, (p < 0.05) significantly increased growth performance (specific growth rate % day-1, feed conversion ratio, and length gain rate %), immunological (plasma lysozyme and liver nitrous oxide) antioxidants (superoxide dismutase, catalase, and glutathione peroxidase in liver), biochemical (aspartate aminotransferase, alanine transaminase, glucose, and cortisol concentrations in plasma) assays, and digestive enzymes (lipase and amylase in plasma). The expression of liver's heat shock protein 70 (HSP70) and interleukin 1, beta (IL-1β) genes showed a significant upregulation outline of 0.5% SPNP > 0.25% SPNP > 0% SPNP compared with the control. Protection in the incorporated fish groups exposed to A. veronii was 100% compared with the control group, which showed 50% cumulative mortalities. In conclusion, dietary SPNP supplementation improved growth performance, antioxidant activity, immune response, digestive enzymes, related gene expression, and resistance of Nile Tilapia to hypoxia, cold, and A. veronii infection. Thus, SPNP could be used as a natural therapy for controlling those stressors.
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Affiliation(s)
- Hiam Elabd
- Aquatic Animals Diseases and Management Department, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, 13736, Egypt.
| | - Han-Ping Wang
- Ohio Center for Aquaculture Research and Development, The Ohio State University South Centers, 1864 Shyville Road, Piketon, OH, 45661, USA.
| | - Adel Shaheen
- Aquatic Animals Diseases and Management Department, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, 13736, Egypt
| | - Aya Matter
- Aquatic Animals Diseases and Management Department, Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh, 13736, Egypt
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10
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Poudyal S, Pulpipat T, Wang PC, Chen SC. Comparison of the pathogenicity of Francisella orientalis in Nile tilapia (Oreochromis niloticus), Asian seabass (Lates calcarifer) and largemouth bass (Micropterus salmoides) through experimental intraperitoneal infection. J Fish Dis 2020; 43:1097-1106. [PMID: 32700447 DOI: 10.1111/jfd.13217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/03/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
Francisella orientalis is a highly virulent, emerging bacterium that causes mass mortalities in tilapia. This pathogen also affects numerous other warm-water fish species, including three-line grunt, hybrid striped bass and various ornamental fish. This study sheds light on two new species of fish that are susceptible to F. orientalis. Asian seabass and largemouth bass showed variable levels of susceptibility in a bacterial challenge experiment. After intraperitoneally injected with a dose of 106 CFU/fish, a total of 64.28% and 21.42% mortalities were obtained in Asian seabass and largemouth bass, respectively. Meanwhile, Nile tilapia showed acute mortality of 100%. All fish showed typical lesions of francisellosis, including multifocal granulomas in the spleen and head kidney. Immunohistochemical analysis revealed strong positive signals inside the granulomas of all fish. The bacterial recovery in solid media from infected fish was highest in Nile tilapia (85.71%), followed by Asian seabass (35.71%) and largemouth bass (21.42%). PCR results tested 100% positive for Nile tilapia, and 78.57% and 21.42% for Asian seabass and largemouth bass, respectively. In conclusion, Asian seabass and largemouth bass are susceptible to this pathogen, which warrants new management strategies when employing predation polyculture systems of these species with tilapia.
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Affiliation(s)
- Sayuj Poudyal
- International Degree Program of Ornamental Fish Technology and Aquatic Animal Health, International College, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Theeraporn Pulpipat
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Pei-Chi Wang
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Southern Taiwan Fish Diseases Research Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Research Center for Fish Vaccine and Diseases, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Shih-Chu Chen
- International Degree Program of Ornamental Fish Technology and Aquatic Animal Health, International College, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Southern Taiwan Fish Diseases Research Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Research Center for Fish Vaccine and Diseases, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Research Center for Animal Biologics, National Pingtung University of Science and Technology, Pingtung, Taiwan
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11
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Shah S, Singhal T, Naik R, Thakkar P. Predominance of multidrug-resistant Gram-negative organisms as cause of surgical site infections at a private tertiary care hospital in Mumbai, India. Indian J Med Microbiol 2020; 38:344-350. [PMID: 33154245 DOI: 10.4103/ijmm.ijmm_20_284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/04/2022]
Abstract
Background This study aims to study the incidence, microbial aetiology and antimicrobial susceptibility of surgical site infections (SSIs) at a private tertiary care hospital in Mumbai, India, and compare it with previously published data from the same institute as well as literature. Methods This is a prospective observational study done over 6 years (January 2013-December 2018) at a 750-bed private multi-specialty hospital in Mumbai, India, among all patients undergoing clean and clean-contaminated surgeries. Standard guidelines for preventing, diagnosing and classifying SSIs were followed. The incidence rates of SSI (overall and specialty specific), microbial aetiology and antibiotic susceptibility of SSI were calculated and expressed as percentages. Results A total of 55,553 patients underwent clean and clean-contaminated surgeries during the study period. The overall SSI rate was 1.0% (555 cases). The SSI rate in clean surgeries was 0.97% and in clean-contaminated surgeries was 1.03%. Sixty-five per cent of SSIs were due to Gram-negative bacilli, 30% were due to Gram-positive cocci and 4% were due to Candida. Klebsiella pneumoniae (19%), Escherichia coli (17%), Pseudomonas aeruginosa (13%), Staphylococcus aureus(12%) and Enterococcus (10%) were the top five organisms. The overall susceptibility rate of the Gram-negative isolates to beta-lactam-beta-lactamase inhibitor combinations was 60% and carbapenems was 73%. The prevalence of methicillin resistance in S. aureus was 44% and coagulase-negative Staphylococcus was 84%. The crude mortality rate was 1%. Conclusions Although the SSI rate is comparable to established international benchmarks, the predominance of multidrug-resistant Gram-negative organisms is a matter of serious concern.
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Affiliation(s)
- Sweta Shah
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Tanu Singhal
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Reshma Naik
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Pooja Thakkar
- Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
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von Dach E, Albrich WC, Brunel AS, Prendki V, Cuvelier C, Flury D, Gayet-Ageron A, Huttner B, Kohler P, Lemmenmeier E, McCallin S, Rossel A, Harbarth S, Kaiser L, Bochud PY, Huttner A. Effect of C-Reactive Protein-Guided Antibiotic Treatment Duration, 7-Day Treatment, or 14-Day Treatment on 30-Day Clinical Failure Rate in Patients With Uncomplicated Gram-Negative Bacteremia: A Randomized Clinical Trial. JAMA 2020; 323:2160-2169. [PMID: 32484534 PMCID: PMC7267846 DOI: 10.1001/jama.2020.6348] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Antibiotic overuse drives antibiotic resistance. Gram-negative bacteremia is a common infection that results in substantial antibiotic use. OBJECTIVE To compare the clinical effectiveness of C-reactive protein (CRP)-guided, 7-day, and 14-day antibiotic durations 30, 60, and 90 days after treatment initiation. DESIGN, SETTING, AND PARTICIPANTS Multicenter, noninferiority, point-of-care randomized clinical trial including adults hospitalized with gram-negative bacteremia conducted in 3 Swiss tertiary care hospitals between April 2017 and May 2019, with follow-up until August 2019. Patients and physicians were blinded between randomization and antibiotic discontinuation. Adults (aged ≥18 years) were eligible for randomization on day 5 (±1 d) of microbiologically efficacious therapy for fermenting, gram-negative bacteria in blood culture(s) if they were afebrile for 24 hours without evidence for complicated infection (eg, abscess) or severe immunosuppression. INTERVENTION Randomization in a 1:1:1 ratio to an individualized CRP-guided antibiotic treatment duration (discontinuation once CRP declined by 75% from peak; n = 170), fixed 7-day treatment duration (n = 169), or fixed 14-day treatment duration (n = 165). MAIN OUTCOMES AND MEASURES The primary outcome was the clinical failure rate at day 30, defined as the presence of at least 1 of the following, with a non-inferiority margin of 10%: recurrent bacteremia, local suppurative complication, distant complication (growth of the same organism causing the initial bacteremia), restarting gram-negative-directed antibiotic therapy due to clinical worsening suspected to be due to the initial organism, or death due to any cause. Secondary outcomes included the clinical failure rate on day 90 of follow-up. RESULTS Among 504 patients randomized (median [interquartile range] age, 79 [68-86] years; 306 of 503 [61%] were women), 493 (98%) completed 30-day follow-up and 448 (89%) completed 90-day follow-up. Median antibiotic duration in the CRP group was 7 (interquartile range, 6-10; range, 5-28) days; 34 of the 164 patients (21%) who completed the 30-day follow-up had protocol violations related to treatment assignment. The primary outcome occurred in 4 of 164 (2.4%) patients in the CRP group, 11 of 166 (6.6%) in the 7-day group, and 9 of 163 (5.5%) in the 14-day group (difference in CRP vs 14-day group, -3.1% [1-sided 97.5% CI, -∞ to 1.1]; P < .001; difference in 7-day vs 14-day group, 1.1% [1-sided 97.5% CI, -∞ to 6.3]; P < .001). By day 90, clinical failure occurred in 10 of 143 patients (7.0%) in the CRP group, 16 of 151 (10.6%) in the 7-day group, and 16 of 153 (10.5%) in the 14-day group. CONCLUSIONS AND RELEVANCE Among adults with uncomplicated gram-negative bacteremia, 30-day rates of clinical failure for CRP-guided antibiotic treatment duration and fixed 7-day treatment were noninferior to fixed 14-day treatment. However, interpretation is limited by the large noninferiority margin compared with the low observed event rate, as well as low adherence and wide range of treatment durations in the CRP-guided group. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03101072.
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Affiliation(s)
- Elodie von Dach
- Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Geneva, Switzerland
| | - Werner C. Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Anne-Sophie Brunel
- Infectious Diseases Service, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Virginie Prendki
- Faculty of Medicine, Division of Internal Medicine of the Aged, Geneva University Hospitals, Geneva, Switzerland
| | - Clémence Cuvelier
- Faculty of Medicine, Division of Internal Medicine of the Aged, Geneva University Hospitals, Geneva, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Angèle Gayet-Ageron
- Faculty of Medicine, Clinical Research Center, Geneva University Hospitals, Geneva, Switzerland
- Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Benedikt Huttner
- Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Eva Lemmenmeier
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Shawna McCallin
- Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Rossel
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stephan Harbarth
- Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Angela Huttner
- Faculty of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
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Carvalho LA, Whyte SK, Braden LM, Purcell SL, Manning AJ, Muckle A, Fast MD. Impact of co-infection with Lepeophtheirus salmonis and Moritella viscosa on inflammatory and immune responses of Atlantic salmon (Salmo salar). J Fish Dis 2020; 43:459-473. [PMID: 32100325 DOI: 10.1111/jfd.13144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/02/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
This study was conducted to determine the effects of a co-infection with Moritella viscosa at different exposure levels of sea lice Lepeophtheirus salmonis in Atlantic salmon (Salmo salar). M. viscosa (1.14 × 106 cfu/ml) was introduced to all experimental tanks at 10 days post-lice infection (dpLs). Mean lice counts decreased over time in both the medium lice co-infection (31.5 ± 19.0 at 7 dpLs; 16.9 ± 9.3 at 46 dpLs) and high lice co-infection (62.0 ± 10.8 at 7 dpLs; 37.6 ± 11.3 at 46 dpLs). There were significantly higher mortalities and more severe skin lesions in the high lice co-infected group compared to medium lice co-infected group or M. viscosa-only infection. Quantitative gene expression analysis detected a significant upregulation of genes in skin from the high lice co-infection group consistent with severe inflammation (il-8, mmp-9, hep, saa). Skin lesions retrieved throughout the study were positive for M. viscosa growth, but these were rarely located in regions associated with lice. These results suggest that while M. viscosa infection itself may induce skin lesion development in salmon, co-infection with high numbers of lice can enhance this impact and significantly reduce the ability of these lesions to resolve, resulting in increased mortality.
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Affiliation(s)
- Laura A Carvalho
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Shona K Whyte
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | | | - Sara L Purcell
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Anthony J Manning
- Food Fisheries and Aquaculture Department, The New Brunswick Research and Productivity Council (RPC), Fredericton, NB, Canada
| | - Anne Muckle
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Mark D Fast
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PE, Canada
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14
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Oku S, Takeshita T, Futatsuki T, Kageyama S, Asakawa M, Mori Y, Miyamoto T, Hata J, Ninomiya T, Kashiwazaki H, Yamashita Y. Disrupted tongue microbiota and detection of nonindigenous bacteria on the day of allogeneic hematopoietic stem cell transplantation. PLoS Pathog 2020; 16:e1008348. [PMID: 32150591 PMCID: PMC7082065 DOI: 10.1371/journal.ppat.1008348] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/19/2020] [Accepted: 01/23/2020] [Indexed: 12/19/2022] Open
Abstract
Disruption of the intestinal microbiota caused by intensive chemotherapy, irradiation and antibiotics can result in development of severe gut graft-versus-host disease and infectious complications, leading to poorer outcomes among allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Although the oral cavity is also densely colonized by indigenous microorganisms, the bacterial composition in allo-HSCT recipients remains unclear. We determined the tongue microbiota composition of 45 patients with hematological disorders on the day of transplantation and compared them to 164 community-dwelling adults. The V1–V2 regions of the 16S rRNA gene sequences demonstrated that the allo-HSCT recipients had less diverse and distinct microbiota from that of community-dwelling adults. The full-length 16S rRNA gene sequences identified 146 bacterial taxa in the microbiota of allo-HSCT recipients, of which 34 bacterial taxa did not correspond to bacteria primarily inhabiting the oral cavity deposited in the expanded Human Oral Microbiome Database. Notably, the detection of Staphylococcus haemolyticus and/or Ralstonia pickettii was significantly associated with a higher risk of mortality during the follow-up period. These results demonstrate that the oral cavity of allo-HSCT recipients is colonized by a disrupted microbiota on the day of transplantation and suggest that detection of specific nonindigenous taxa could be a predictor of transplant outcome. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients are subjected to intensive chemotherapy, irradiation and antibiotics which could affect the intestinal as well as oral microbiota. We employed full-length 16S rRNA gene sequencing analysis with high taxonomic resolution using a third-generation sequencer, PacBio Sequel, and determined the bacterial composition of the tongue microbiota of allo-HSCT recipients after conditioning regimens. This comprehensive molecular approach identified 34 taxa uncommon in the oral cavity, which constituted 0–99.4% (median, 0.27%) of each tongue microbiota. Of them, Staphylococcus haemolyticus and Ralstonia pickettii were frequently found in allo-HSCT recipients, and their detection was significantly associated with a higher risk of mortality during the follow-up period. These results suggest that careful attention should be given to the bacterial composition of the disrupted oral microbiota in allo-HSCT recipients.
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Affiliation(s)
- Saori Oku
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Toru Takeshita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
- OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Toshiko Futatsuki
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Shinya Kageyama
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Mikari Asakawa
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yasuo Mori
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Haruhiko Kashiwazaki
- Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
- * E-mail:
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15
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Maskarinec SA, Park LP, Ruffin F, Turner NA, Patel N, Eichenberger EM, van Duin D, Lodise T, Fowler VG, Thaden JT. Positive follow-up blood cultures identify high mortality risk among patients with Gram-negative bacteraemia. Clin Microbiol Infect 2020; 26:904-910. [PMID: 32114010 DOI: 10.1016/j.cmi.2020.01.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/08/2020] [Accepted: 01/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The role of follow-up blood cultures (FUBCs) in the management of Gram-negative bacteraemia (GNB) is poorly understood. We aimed to determine the utility of FUBCs in identifying patients with increased mortality risk. METHODS An observational study with a prospectively enrolled cohort of adult inpatients with GNB was conducted at Duke University Health System from 2002 to 2015. FUBCs were defined as blood cultures performed from 24 hours to 7 days from initial positive blood culture. RESULTS Among 1702 patients with GNB, 1164 (68%) had FUBCs performed. When performed, FUBCs were positive in 20% (228/1113) of cases. FUBC acquisition was associated with lower all-cause in-hospital mortality (108/538, 20%, vs. 176/1164, 15%; p 0.01) and attributable in-hospital mortality (78/538, 15%, vs. 98/1164, 8%; p < 0.0001). Propensity score-weighted Cox proportional hazards models revealed that obtaining FUBCs was associated with reductions in all-cause (hazard ratio (HR) 0.629; 95% confidence interval (CI), 0.511-0.772; p < 0.0001) and attributable mortality (HR 0.628; 95% CI, 0.480-0.820; p 0.0007). Positive FUBCs were associated with increased all-cause mortality (49/228, 21%, vs. 110/885, 11%; p 0.0005) and attributable mortality (27/228, 12%, vs. 61/885, 7%; p 0.01) relative to negative FUBCs. Propensity score-weighted Cox proportional hazards models revealed that positive FUBCs were associated with increased all-cause (HR 2.099; 95% CI, 1.567-2.811; p < 0.0001) and attributable mortality (HR 1.800; 95% CI, 1.245-2.603; p 0.002). In a calibration analysis, a scoring system accurately identified patients at high risk of positive FUBCs. CONCLUSIONS Rates of positive FUBCs were high and identified patients at increased risk for mortality. Clinical variables can identify patients at high risk for positive FUBCs. FUBCs should be considered in the management of GNB.
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Affiliation(s)
- S A Maskarinec
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA
| | - L P Park
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA
| | - F Ruffin
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA
| | - N A Turner
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA
| | - N Patel
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla, CA, USA
| | - E M Eichenberger
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA
| | - D van Duin
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Lodise
- Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - V G Fowler
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA.
| | - J T Thaden
- Division of Infectious Diseases and International Health, Duke University, Durham, NC, USA
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16
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Tabak YP, Sung A, Ye G, Vankeepuram L, Gupta V, McCann E. Attributable burden in patients with carbapenem-nonsusceptible gram-negative respiratory infections. PLoS One 2020; 15:e0229393. [PMID: 32084236 PMCID: PMC7034906 DOI: 10.1371/journal.pone.0229393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/05/2020] [Indexed: 11/24/2022] Open
Abstract
Objective We aimed to describe the clinical and economic burden attributable to carbapenem-nonsusceptible (C-NS) respiratory infections. Methods This retrospective matched cohort study assessed clinical and economic outcomes of adult patients (aged ≥18 years) who were admitted to one of 78 acute care hospitals in the United States with nonduplicate C-NS and carbapenem-susceptible (C-S) isolates from a respiratory source. A subset analysis of patients with principal diagnosis codes denoting bacterial pneumonia or other diagnoses was also conducted. Isolates were classified as community- or hospital-onset based on collection time. A generalized linear mixed model method was used to estimate the attributable burden for mortality, 30-day readmission, length of stay (LOS), cost, and net gain/loss (payment minus cost) using propensity score-matched C-NS versus C-S cohorts. Results For C-NS cases, mortality (25.7%), LOS (29.4 days), and costs ($81,574) were highest in the other principal diagnosis, hospital-onset subgroup; readmissions (19.4%) and net loss (-$9522) were greatest in the bacterial pneumonia, hospital-onset subgroup. Mortality and readmissions were not significantly higher for C-NS cases in any propensity score-matched subgroup. Significant C-NS–attributable burden was found for both other principal diagnosis subgroups for LOS (hospital-onset: 3.7 days, P = 0.006; community-onset: 1.5 days, P<0.001) and cost (hospital-onset: $12,777, P<0.01; community-onset: $2681, P<0.001). Conclusions Increased LOS and cost burden were observed in propensity score-matched patients with C-NS compared with C-S respiratory infections; the C-NS–attributable burden was significant only for patients with other principal diagnoses.
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Affiliation(s)
- Ying P. Tabak
- Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States of America
| | - Anita Sung
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Gang Ye
- Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States of America
| | - Latha Vankeepuram
- Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States of America
| | - Vikas Gupta
- Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States of America
| | - Eilish McCann
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, United States of America
- * E-mail:
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17
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McNamara JF, Avent M, Stewart A, Kwan C, Paterson DL. Evaluation of quick sequential organ failure assessment and systemic inflammatory response syndrome in patients with gram negative bloodstream infection. Infect Dis Health 2020; 25:151-157. [PMID: 32005586 DOI: 10.1016/j.idh.2020.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/05/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The quick sequential organ failure assessment (qSOFA) score predicts mortality in patients with suspected infection. We sought to understand how well qSOFA and the Systemic Inflammatory Response Syndrome (SIRS) criteria predict gram negative bacteraemia. METHODS We prospectively evaluated 99 patients with gram negative bloodstream infection from a single tertiary centre. We assessed the utility of SIRS and qSOFA for their rate of positivity and association with early delivery of antibiotics (<3 h). RESULTS The SIRS criteria had the highest positivity rate amongst patients with gram negative bacteraemia (85%) compared to the qSOFA criteria (25%) on the day of first positive culture. Positive SIRS criteria was the only score associated with delivery of antibiotics within 3 h (Relative risk 3.5, 95% Confidence interval 1.3 to 12.5, p = < 0.02). CONCLUSION In patients with gram negative bloodstream infection SIRS criteria was the most common positive risk score and had a higher association with early delivery of antibiotics when compared to qSOFA.
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Affiliation(s)
- John F McNamara
- University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia; The Prince Charles Hospital, Brisbane, Queensland, Australia.
| | - Minyon Avent
- University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia; Queensland Statewide Antimicrobial Stewardship Program, Queensland, Australia
| | - Adam Stewart
- University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Christopher Kwan
- University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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18
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Claudiano GS, Yunis-Aguinaga J, Marinho-Neto FA, Miranda RL, Martins IM, Otani FS, Mundim AV, Marzocchi-Machado CM, Moraes JRE, de Moraes FR. Hematological and immune changes in Piaractus mesopotamicus in the sepsis induced by Aeromonas hydrophila. Fish Shellfish Immunol 2019; 88:259-265. [PMID: 30716521 DOI: 10.1016/j.fsi.2019.01.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/26/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
The pathogenesis of sepsis involves complex systems and multiple interrelationships between the host and pathogen producing high mortality rates in various animal species. In this study, hematological disturbances, innate immunity and survival during the septic process in Piaractus mesopotamicus inoculated with Aeromonas hydrophila were studied. For this aim, fish blood samples were taken from control and infected groups 1, 3, 6, and 9 h post-inoculation (HPI). Leukogram showed reduction in the number of leukocytes and thrombocytes, followed by cessation of leukocyte chemotaxis 6 HPI and severe morphological changes in leukocytes and erythrocytes. At 3 HPI production of reactive oxygen species increased and at 6 HPI decreased. There was no change in serum lysozyme concentration and lytic activity of the complement system, despite the progressive increase in serum lytic activity and bacterial agglutination. Finally, the changes in clinical signs due to aeromonosis and increasing septicemia resulted in a reduction in survival to 57.14% after 36 HPI. It was possible concluded that these hematological and immune are crucial event in the worsening of sepsis in P. mesopotamicus, and these findings are utility for diagnosing and understanding the pathophysiology sepsis in pacu induced by A. hydrophila.
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Affiliation(s)
- Gustavo S Claudiano
- Department of Veterinarian Pathology, Faculty of Agrarian and Veterinarian Sciences, São Paulo State University, Unesp, Brazil; Institute of Biodiversity and Forests, Federal University of Western Pará, UFOPA, Pará, Brazil.
| | | | - Fausto A Marinho-Neto
- Department of Veterinarian Pathology, Faculty of Agrarian and Veterinarian Sciences, São Paulo State University, Unesp, Brazil.
| | - Renata L Miranda
- Clinical Analysis Laboratory, Veterinary Hospital, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil.
| | - Isabela M Martins
- Department of Veterinarian Pathology, Faculty of Agrarian and Veterinarian Sciences, São Paulo State University, Unesp, Brazil
| | - Fabrizia S Otani
- Institute of Biodiversity and Forests, Federal University of Western Pará, UFOPA, Pará, Brazil.
| | - Antonio V Mundim
- Clinical Analysis Laboratory, Veterinary Hospital, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil.
| | - Cleni M Marzocchi-Machado
- Department of Clinical, Toxicological and Bromatological Analyses, Ribeirão Preto School of Pharmaceutical Sciences, University of São Paulo (USP), Brazil.
| | - Julieta R E Moraes
- Department of Veterinarian Pathology, Faculty of Agrarian and Veterinarian Sciences, São Paulo State University, Unesp, Brazil; Aquaculture Center of UNESP, Jaboticabal, São Paulo, Brazil.
| | - Flávio Ruas de Moraes
- Department of Veterinarian Pathology, Faculty of Agrarian and Veterinarian Sciences, São Paulo State University, Unesp, Brazil
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19
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Xini A, Pistiki A, Lada M, Giamarellos-Bourboulis EJ, Dimopoulos G. Association of the early absolute CD64-expressing neutrophil count and sepsis outcome. Eur J Clin Microbiol Infect Dis 2019; 38:1123-1128. [PMID: 31011855 DOI: 10.1007/s10096-019-03507-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/10/2018] [Accepted: 02/07/2019] [Indexed: 11/26/2022]
Abstract
To evaluate the early absolute CD64/CD15/CD45 neutrophil count as a marker of prognosis of sepsis outcome the absolute CD64/CD15/CD45 count was measured by flow cytometry in 65 patients with confirmed or suspected Gram-negative sepsis and organ dysfunction. Serum interleukin(IL)-8 and interferon-gamma (IFNγ) were measured by an enzyme immunoassay. An absolute count lower than 2500 cells/mm3 could early discriminate non-survivors with sensitivity 82.9% (OR 3.46, 95%CIs 1.10-10.95, p 0.042). After forward step-wise Cox- regression analysis, it was found that acute coagulopathy, acute renal injury, and an early absolute CD64/CD15/CD45 count lower than 2500/mm3 were independently associated with unfavorable outcome. The OR for death among patients with an absolute CD64/CD15/CD45 neutrophil count greater than 2500/mm3 and circulating IL-8 greater than 95 pg/ml was 0.44; this was significantly increased to 7.44 among patients with an absolute CD64/CD15/CD45 neutrophil count lower than 2500/mm3 (p 0.045 by the Breslow-Day's test; p 0.046 by the Tarone's test). An absolute CD64/CD15/CD45 count below 2500/mm3 can be a useful prognosticator of sepsis outcome and a probable indicator of sepsis immunosuppression.
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Affiliation(s)
- Aggeliki Xini
- Intensive Care Unit, Chania General Hospital, Crete, Greece
| | - Aikaterini Pistiki
- 4th Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, Medical School, 1 Rimini Street, 12462, Athens, Greece
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismangleion General Hospital, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, Medical School, 1 Rimini Street, 12462, Athens, Greece.
| | - Georgios Dimopoulos
- 2nd Department of Intensive Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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20
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De León-Borrás R, Sánchez-Sergentón C, Mayor-Becerra A, Laureano-Cuadrado AF. Polymyxin B for Gram Negative Multidrug Resistant Bacteria in a Hispanic Population. P R Health Sci J 2019; 38:15-21. [PMID: 30924910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study intends to determine the prevalence of multidrug resistant (MDR) infections by A. baumannii, K. pneumoniae and P. aeruginosa in a tertiary care teaching hospital intensive care unit (ICU) in San Juan, PR, estimate the mortality rate and compare the morbidity and mortality differences among those treated with and without polymyxin B. METHODS We selected adults patients admitted to the ICU who had positive cultures from January 2012 to June 2013. Sample consisted of 25 patients with age ranges from 27-78 years, 13 women and 12 men. RESULTS The median age at death was 60 years. Polymyxin B nephrotoxicity was identified on 15% of the patients. Variables related to higher survival were younger age, female sex, use of polymyxin B, and the use of daptomycin. The use of vancomycin and vasopressors were associated with worse outcome. Mortality associated to single MDR bacteria was 88% for A. baumannii, 84% for K. pneumoniae and 67% for P. aeruginosa. All patients with more than one MDR infection died in the ICU. CONCLUSION The use of polymyxin B was associated with an ICU mortality reduction. Unexpectedly we found a significantly improved survival in patients who received polymyxin B in combination with daptomycin, which awaits prospective confirmation.
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Affiliation(s)
- Rafael De León-Borrás
- Division of Infectious Diseases, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Carlos Sánchez-Sergentón
- Division of Infectious Diseases, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Angel Mayor-Becerra
- Internal Medicine Departments, Universidad Central del Caribe and University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Angel F Laureano-Cuadrado
- Division of Pulmonary Diseases, Critical Care and Sleep Medicine, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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21
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Li R, Bai S, Yang D, Dong C. A crayfish Ras gene is involved in the defense against bacterial infection under high temperature. Fish Shellfish Immunol 2019; 86:608-617. [PMID: 30502469 DOI: 10.1016/j.fsi.2018.11.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/03/2018] [Revised: 11/03/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
Temperature is an important environmental factor influencing crustacean resistance to pathogen infection. However, the mechanism underlying immune regulation by temperature remains unclear in crustacean. Here, we report a Ras gene of crayfish (designated as PcRAS1) which is involved in immune regulation of crayfish under high temperature. PcRAS1 is induced by both high temperature and bacterial infection and the induction by bacterial infection is associated with temperature. Significant changes of PcRAS1 expression was observed at 32 °C and 24 °C after infection with Aeromonas hydrophila, but relative moderate alternation was found at 16 °C after challenged with A. hydrophila. PcRAS1 silencing significantly reduced crayfish survival from high temperature (32 °C and 24 °C) or bacterial infection at 32 °C, but there was no significant effect on survival from bacterial infection at 24 °C or 16 °C. Further analysis reveals that PO activity is reduced by high temperature or enhanced by bacterial infection. Moreover, both the decreased PO activity and the enhanced PO activity are affected by PcRAS1 expression. PcRAS1 silencing further reduces PO activity under high temperature and compromises the enhanced PO activity by bacterial infection. Lipid peroxidation (LPO) and total antioxidant capacity (TAC) are also involved in the responses to high temperature. LPO is enhanced by lower temperature. TAC is reduced by high temperature and TAC change resulting from high temperature is amplified by PcRAS1 silencing. These results collectively indicate that PcRAS1 is involved in immune regulation against bacterial infection mediated by temperature.
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Affiliation(s)
- Ronghui Li
- College of Life Science, Qingdao Agricultural University, Qingdao, 266109, China
| | - Suhua Bai
- College of Life Science, Qingdao Agricultural University, Qingdao, 266109, China
| | - Decui Yang
- College of Life Science, Qingdao Agricultural University, Qingdao, 266109, China
| | - Chaohua Dong
- College of Life Science, Qingdao Agricultural University, Qingdao, 266109, China.
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22
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Zhong H, Zhao XY, Zhang ZL, Gu ZC, Zhang C, Gao Y, Cui M. Evaluation of the efficacy and safety of ceftazidime/avibactam in the treatment of Gram-negative bacterial infections: a systematic review and meta-analysis. Int J Antimicrob Agents 2018; 52:443-450. [PMID: 30012440 DOI: 10.1016/j.ijantimicag.2018.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 02/21/2018] [Revised: 07/04/2018] [Accepted: 07/07/2018] [Indexed: 02/06/2023]
Abstract
Data on the efficacy and safety of ceftazidime/avibactam (CAZ-AVI) are limited. A systematic review and meta-analysis was conducted to clarify the role of CAZ-AVI for patients with serious Gram-negative bacterial infections. The PubMed, EMBASE and Cochrane Library databases were searched for randomised controlled trials (RCTs) and cohort studies involving CAZ-AVI. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a fixed- or random-effects model. Twelve articles (4951 patients) were included, consisting of nine RCTs and three observational studies comparing CAZ-AVI with other regimens, e.g. carbapenems or colistin. CAZ-AVI showed a comparable clinical response (RR = 0.99, 95% CI 0.96-1.02; I2 = 0%) and non-inferior bacterial eradication (RR = 1.04, 95% CI 0.93-1.17; I2 = 79.1%) to carbapenems. No significant difference was detected between groups regarding mortality and adverse events. Moreover, subgroup analyses demonstrated that CAZ-AVI improved the clinical response (RR = 1.61, 95% CI 1.13-2.29) with reduced mortality (RR = 0.29, 95% CI 0.13-0.63) in patients infected by carbapenem-resistant Enterobacteriaceae versus comparators. Likewise, CAZ-AVI improved the clinical cure rate of bloodstream infections (RR = 2.11, 95% CI 1.54-2.88). An improved ability of CAZ-AVI in microbiological eradication was also detected in patients with complicated urinary tract infections (RR = 1.13, 95% CI 1.05-1.21). CAZ-AVI exhibited comparable efficacy and safety with carbapenems. Therefore, this agent might be a potential powerful agent for patients with serious Gram-negative bacterial infections.
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Affiliation(s)
- Han Zhong
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China
| | - Xian-Yuan Zhao
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China
| | - Zai-Li Zhang
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China
| | - Zhi-Chun Gu
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China
| | - Chi Zhang
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China
| | - Yuan Gao
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China.
| | - Min Cui
- Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China.
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23
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Mohammed HH, Peatman E. Winter kill in intensively stocked channel catfish (Ictalurus punctatus): Coinfection with Aeromonas veronii, Streptococcus parauberis and Shewanella putrefaciens. J Fish Dis 2018; 41:1339-1347. [PMID: 29882217 DOI: 10.1111/jfd.12827] [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: 03/03/2018] [Revised: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
Unusual persistent natural mortality occurred in a floating in-pond raceway system intensively stocked with channel and hybrid catfish beginning in early November 2016 up until March 2017. The temperature during the period of outbreak ranged from 7.2 to 23.7°C. Gross examination of freshly dead and moribund fish revealed pale gills, slight abdominal distension and swollen inflamed vents. Comprehensive necropsy of 20 fish demonstrated vast amounts of bloody ascitic fluid in the coelomic cavity, visceral congestion, splenomegaly and pale friable livers but macroscopically normal kidneys, suggesting systemic bacterial infection. Bacterial cultures were initiated from skin, gills and major internal organs. Following incubation, a mixture of three bacterial colony phenotypes was observed on agar plates. Presumptive biochemical characterization of the isolates followed by 16S-rRNA sequence analysis resulted in the identification of Aeromonas veronii, Streptococcus parauberis and Shewanella putrefaciens. Channel catfish juveniles were experimentally infected with the recovered isolates to fulfil Koch's postulates. Moreover, an antibiogram was used to evaluate the susceptibility of the isolates to antimicrobial drugs approved for use in aquaculture. Aquaflor was used successfully for treatment. Here, we report bacterial coinfection lead by A. veronii and the first identification of S. parauberis and S. putrefaciens from cultured catfish in North America.
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Affiliation(s)
- Haitham H Mohammed
- School of Fisheries, Aquaculture, and Aquatic Sciences, Auburn University, Auburn, Alabama
- Faculty of Veterinary Medicine, Department of Aquatic Animals Medicine and Management, Assiut University, Assiut, Egypt
| | - Eric Peatman
- School of Fisheries, Aquaculture, and Aquatic Sciences, Auburn University, Auburn, Alabama
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24
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Vardakas KZ, Mavroudis AD, Georgiou M, Falagas ME. Intravenous plus inhaled versus intravenous colistin monotherapy for lower respiratory tract infections: A systematic review and meta-analysis. J Infect 2018; 76:321-327. [PMID: 29428226 DOI: 10.1016/j.jinf.2018.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 01/10/2018] [Accepted: 02/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate whether intravenous plus inhaled combination (IV/INHCC) compared to intravenous monotherapy (IVCM) was associated with patient outcomes and identify factors influencing study outcomes. METHODS PubMed and Scopus were searched till November 2016. Studies were included if they evaluated adult patients with lower respiratory tract infections due to MDR/XDR Gram-negative bacteria and reported comparative mortality data (adjusted and unadjusted) for patients receiving IV/INHCC versus IVCM. Random effects meta-analyses were performed. RESULTS Thirteen studies (11 retrospective, 2 prospective) were included. The overall quality of data was low to very low and characterized by the lack of adjusted data. The majority of the studies were designed to evaluate the outcome of the meta-analysis. Both IV and inhaled colistin were administered at variable doses. There was no difference in mortality between IV/INHCC and IVCM when all studies were combined (13 studies, 1115 patients, risk ratio 0.94, 95% confidence interval 0.81-1.08). Only the analysis that included studies with low-dose IV colistin showed significant difference in favor of IV/INHCC versus IVCM (0.65, 0.45-0.94). CONCLUSIONS Overall, low quality data suggest that IV/INHCC did not lower mortality in patients with MDR Gram negative infections unless low IV colistin dose was administered.
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Affiliation(s)
- Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
| | | | | | - Matthew E Falagas
- Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Medicine, Henry Dunant Hospital Center, Athens, Greece; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
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25
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Ali AM, Weisel D, Gao F, Uy GL, Cashen AF, Jacoby MA, Wartman LD, Ghobadi A, Pusic I, Romee R, Fehniger TA, Stockerl‐Goldstein KE, Vij R, Oh ST, Abboud CN, Schroeder MA, Westervelt P, DiPersio JF, Welch JS. Patterns of infectious complications in acute myeloid leukemia and myelodysplastic syndromes patients treated with 10-day decitabine regimen. Cancer Med 2017; 6:2814-2821. [PMID: 29058375 PMCID: PMC5727246 DOI: 10.1002/cam4.1231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 12/22/2022] Open
Abstract
Decitabine has been explored as a reduced-intensity therapy for older or unfit patients with acute myeloid leukemia (AML). To better understand the risk of infections during decitabine treatment, we retrospectively examined the culture results from each infection-related serious adverse event that occurred among 85 AML and myelodysplastic syndromes (MDS) patients treated in a prospective clinical study using 10-day cycles of decitabine at Washington University School of Medicine. Culture results were available for 163 infection-related complications that occurred in 70 patients: 90 (55.2%) events were culture-negative, 32 (19.6%) were gram-positive bacteria, 20 (12.3%) were gram-negative bacteria, 12 (7.4%) were mixed, 6 (3.7%) were viral, 2 (1.2%) were fungal, and 1 (0.6%) was mycobacterial. Infection-related mortality occurred in 3/24 (13%) of gram-negative events, and 0/51 gram-positive events. On average, nearly one third of patients experienced an infection-related complication with each cycle, and the incidence did not decrease during later cycles. In summary, in patients receiving 10-day decitabine, infectious complications are common and may occur during any cycle of therapy. Although febrile events are commonly culture-negative, gram-positive infections are the most frequent source of culture-positive infections, but gram-negative infections represent a significant risk of mortality in AML and MDS patients treated with decitabine.
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Affiliation(s)
- Alaa M. Ali
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Daniel Weisel
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Feng Gao
- Division of Public Health SciencesDepartment of SurgeryWashington UniversitySt. LouisMissouri
| | - Geoffrey L. Uy
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Amanda F. Cashen
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Meagan A. Jacoby
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Lukas D. Wartman
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Armin Ghobadi
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Iskra Pusic
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Rizwan Romee
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Todd A. Fehniger
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | | | - Ravi Vij
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Stephen T. Oh
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Camille N. Abboud
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Mark A. Schroeder
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - Peter Westervelt
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - John F. DiPersio
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
| | - John S. Welch
- Department of Internal MedicineDivision of OncologyWashington UniversitySaint LouisMissouri
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26
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Dong HT, Techatanakitarnan C, Jindakittikul P, Thaiprayoon A, Taengphu S, Charoensapsri W, Khunrae P, Rattanarojpong T, Senapin S. Aeromonas jandaei and Aeromonas veronii caused disease and mortality in Nile tilapia, Oreochromis niloticus (L.). J Fish Dis 2017; 40:1395-1403. [PMID: 28383126 DOI: 10.1111/jfd.12617] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [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: 10/20/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 05/20/2023]
Abstract
Diseases caused by motile aeromonads in freshwater fish have been generally assumed to be linked with mainly Aeromonas hydrophila while other species were probably overlooked. Here, we identified two isolates of non-A. hydrophila recovered from Nile tilapia exhibiting disease and mortality after exposed to transport-induced stress and subsequently confirmed their virulence in artificial infection. The bacterial isolates were identified as Aeromonas jandaei and Aeromonas veronii based on phenotypic features and homology of 16S rDNA. Experimental infection revealed that the high dose of A. jandaei (3.7 × 106 CFU fish-1 ) and A. veronii (8.9 × 106 CFU fish-1 ) killed 100% of experimental fish within 24 h, while a 10-fold reduction dose killed 70% and 50% of fish, respectively. When the challenge dose was reduced 100-fold, mortality of the fish exposed to A. jandaei and A. veronii decreased to 20% and 10%, respectively. The survivors from the latter dose administration were rechallenged with respective bacterial species. Lower mortality of rechallenged fish (0%-12.5%) compared to the control groups receiving a primary infection (37.5%) suggested that the survivors after primary infection were able to resist secondary infection. Fish exposed to either A. jandaei or A. veronii exhibited similar clinical signs and histological manifestation.
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Affiliation(s)
- H T Dong
- Department Microbiology, Faculty of Science, King Mongkut's University of Technology Thonburi (KMUTT), Bangkok, Thailand
| | - C Techatanakitarnan
- Department Microbiology, Faculty of Science, King Mongkut's University of Technology Thonburi (KMUTT), Bangkok, Thailand
- Center of Excellence for Shrimp Molecular Biology and Biotechnology (Centex Shrimp), Faculty of Science, Mahidol University, Bangkok, Thailand
| | - P Jindakittikul
- Department Microbiology, Faculty of Science, King Mongkut's University of Technology Thonburi (KMUTT), Bangkok, Thailand
| | - A Thaiprayoon
- Department Microbiology, Faculty of Science, King Mongkut's University of Technology Thonburi (KMUTT), Bangkok, Thailand
| | - S Taengphu
- Center of Excellence for Shrimp Molecular Biology and Biotechnology (Centex Shrimp), Faculty of Science, Mahidol University, Bangkok, Thailand
| | - W Charoensapsri
- Center of Excellence for Shrimp Molecular Biology and Biotechnology (Centex Shrimp), Faculty of Science, Mahidol University, Bangkok, Thailand
- National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - P Khunrae
- Department Microbiology, Faculty of Science, King Mongkut's University of Technology Thonburi (KMUTT), Bangkok, Thailand
| | - T Rattanarojpong
- Department Microbiology, Faculty of Science, King Mongkut's University of Technology Thonburi (KMUTT), Bangkok, Thailand
| | - S Senapin
- Center of Excellence for Shrimp Molecular Biology and Biotechnology (Centex Shrimp), Faculty of Science, Mahidol University, Bangkok, Thailand
- National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
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Horikoshi Y, Suwa J, Higuchi H, Kaneko T, Furuichi M, Aizawa Y, Fukuoka K, Okazaki K, Ito K, Shoji T. Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality. Int J Infect Dis 2017; 64:69-73. [PMID: 28941633 DOI: 10.1016/j.ijid.2017.09.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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] [Received: 07/25/2017] [Revised: 09/04/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The impact of pediatric antimicrobial stewardship programs (ASP) on antimicrobial resistance (AMR) remains largely unknown. This study aimed to evaluate the AMR for carbapenem of Gram-negative bacilli (GNB) and carbapenem use with infectious diseases consultation after the implementation of an ASP. METHODS This quasi-experimental study was conducted at Tokyo Metropolitan Children's Medical Center in Japan. The pre- and post-intervention periods were April 2010 to September 2011 and October 2011 to March 2017, respectively. The pre-intervention phase consisted of consultations with the infectious diseases service alone. The ASP was implemented during the post-intervention phase. The carbapenem resistance rates of GNB were calculated. The correlation between carbapenem resistance rates and carbapenem day of therapy (DOT) was examined. The outcome metrics were compared by average length of hospitalization, all-cause mortality, and infection-related mortality. RESULTS A positive correlation was observed between the carbapenem resistance rate in Pseudomonas aeruginosa and DOT (0.76, p=0.04). The carbapenem resistance rate in P. aeruginosa (p<0.01) and DOT (p<0.01) decreased significantly in the post-intervention period. The length of hospitalization (p<0.01) and infection-related mortality (p=0.05) decreased in the post-intervention period. CONCLUSIONS A sustained ASP with additional consultation with the infectious disease service reduced carbapenem use and resistance in P. aeruginosa, leading to favorable outcomes in terms of length of hospitalization and infection-related mortality.
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Affiliation(s)
- Yuho Horikoshi
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu City, Tokyo, 183-8561, Japan.
| | - Junichi Suwa
- Department of Pharmacy, Tokyo Metropolitan Children's Medical Center, Fuchu City, Tokyo, Japan
| | - Hiroshi Higuchi
- Division of Microbiology, Department of Laboratory, Tokyo Metropolitan Children's Medical Center, Fuchu City, Tokyo, Japan
| | - Tetsuji Kaneko
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Fuchu City, Tokyo, Japan
| | - Mihoko Furuichi
- Division of Infectious Diseases and Allergy, Saitama Children's Medical Center, Saitama City, Saitama, Japan
| | - Yuta Aizawa
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu City, Tokyo, 183-8561, Japan
| | - Kahoru Fukuoka
- Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu City, Tokyo, 183-8561, Japan
| | - Kaoru Okazaki
- Division of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu City, Tokyo, Japan
| | - Kenta Ito
- Division of General Pediatrics, Aichi Children's Health and Medical Center, Ohfu City, Aichi, Japan
| | - Takayo Shoji
- Division of Pediatric Infectious Diseases, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan
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Sharma SRK, Pradeep MA, Sadu N, Dube PN, Vijayan KK. First report of isolation and characterization of Photobacterium damselae subsp. damselae from cage-farmed cobia (Rachycentron canadum). J Fish Dis 2017; 40:953-958. [PMID: 27696450 DOI: 10.1111/jfd.12557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Affiliation(s)
- S R Krupesha Sharma
- Central Marine Fisheries Research Institute (Indian Council of Agricultural Research), Karwar Research Centre, Karwar, India
| | - M A Pradeep
- Central Marine Fisheries Research Institute, Kochi, India
| | - N Sadu
- Central Marine Fisheries Research Institute (Indian Council of Agricultural Research), Karwar Research Centre, Karwar, India
| | - Praveen N Dube
- Central Marine Fisheries Research Institute (Indian Council of Agricultural Research), Karwar Research Centre, Karwar, India
| | - K K Vijayan
- Central Institute of Brackish Water Aquaculture, Chennai, India
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Saito N, Sugiyama K, Ohnuma T, Kanemura T, Nasu M, Yoshidomi Y, Tsujimoto Y, Adachi H, Koami H, Tochiki A, Hori K, Wagatsuma Y, Matsumoto H. Efficacy of polymyxin B-immobilized fiber hemoperfusion for patients with septic shock caused by Gram-negative bacillus infection. PLoS One 2017; 12:e0173633. [PMID: 28358803 PMCID: PMC5373513 DOI: 10.1371/journal.pone.0173633] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
Septic shock-associated mortality in intensive care units (ICUs) remains high, with reported rates ranging 30–50%. In particular, Gram-negative bacilli (GNB), which induce significant inflammation and consequent multiple organ failure, are the etiological bacterial agent in 40% of severe sepsis cases. Hemoperfusion using polymyxin B-immobilized fiber (PMX), which adsorbs endotoxin, is expected to reduce the inflammatory sepsis cascade due to GNB. However, the clinical efficacy of this treatment has not yet been demonstrated. Here, we aimed to verify the efficacy of endotoxin adsorption therapy using PMX through a retrospective analysis of 413 patients who received broad spectrum antimicrobial treatment for GNB-related septic shock between January 2009 and December 2012 in 11 ICUs of Japanese tertiary hospitals. After aligning the patients' treatment time phases, we classified patients in two groups depending on whether PMX hemoperfusion (PMXHP) therapy was administered or not within 24 hours after ICU admission (PMXHP group: n = 134, conventional group: n = 279). The primary study endpoint was the mortality rate at 28 days after ICU admission. The mean age was 72.4 (standard deviation: 12.6) years, and the mean Sequential Organ Failure Assessment score at ICU admission was 9.9 (3.4). The infection sites included intra-abdominal (38.0%), pulmonary (18.9%), and urinary tract (32.2%), and two thirds of all patients had GNB-related bacteremia. Notably, the mortality at 28 days after ICU admission did not differ between the groups (PMXHP: 29.1% vs. conventional: 29.0%, P = 0.98), and PMXHP therapy was not found to improve this outcome in a Cox regression analysis (hazard ratio = 1.16; 95% confidence interval, 0.81–1.64, P = 0.407). We conclude that PMX-based endotoxin adsorption within 24 hours from ICU admission was not associated with mortality among patients with septic shock due to GNB. Trial registration: University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR ID: UMIN000012748).
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Affiliation(s)
- Nobuyuki Saito
- Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- Faculty of Medicine, Department of Clinical Trial and Clinical Epidemiology, University of Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Kazuhiro Sugiyama
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Testu Ohnuma
- Intensive Care Unit, Department of Anesthesiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takashi Kanemura
- Department of Emergency and Critical Care Medicine, National Disaster Medical Center, Tokyo, Japan
| | - Michitaka Nasu
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Yuya Yoshidomi
- Department of Emergency Medicine, Saga-Ken Medical Center Koseikan, Saga, Japan
| | - Yuta Tsujimoto
- Department of Emergency Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hiroshi Adachi
- Department Intensive Care Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Hiroyuki Koami
- Advanced Emergency Care Center, Saga University Hospital, Saga, Japan
| | - Aito Tochiki
- Department of Emergency and Critical Care Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Kota Hori
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Yukiko Wagatsuma
- Faculty of Medicine, Department of Clinical Trial and Clinical Epidemiology, University of Tsukuba, Ibaraki, Japan
| | - Hisashi Matsumoto
- Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
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Lampe EO, Tandberg JI, Rishovd AL, Winther-Larsen HC. Francisella noatunensis ssp. noatunensis iglC deletion mutant protects adult zebrafish challenged with acute mortality dose of wild-type strain. Dis Aquat Organ 2017; 123:123-140. [PMID: 28262634 DOI: 10.3354/dao03087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The intracellular fish pathogen Francisella noatunensis remains an unsolved problem for aquaculture worldwide and an efficient vaccine is needed. In Francisella sp., IglC is an important virulence factor necessary for intracellular growth and escape from phagolysosomes. Deletion of the intracellular growth locus C (iglC) in Francisella sp. causes attenuation, but vaccine potential has only been attributed to ΔiglC from Francisella noatunensis ssp. orientalis, a warm-water fish pathogen. A ΔiglC mutant was constructed in the cold-water fish pathogen F. noatunensis ssp. noatunensis (Fnn), which causes francisellosis in Atlantic cod; the mutant was assessed in primary head kidney leucocytes from Atlantic cod. Fluorescence microscopy revealed reduced growth, while qPCR revealed an initial increase followed by a reduction in mutant genomes. Mutant-infected cod leucocytes presented higher interleukin 1 beta (il1β) and interleukin 8 (il8) transcription than wild-type (WT)-infected cells. Two doses of mutant and WT were tested in an adult zebrafish model whereupon 3 × 109 CFU caused acute disease and 3 × 107 CFU caused low mortality regardless of strain. However, splenomegaly developed only in the WT-infected zebrafish. Immunization with 7 × 106 CFU of Fnn ΔiglC protected zebrafish against challenge with a lethal dose of Fnn WT, and bacterial load was minimized within 28 d. Immunized fish had lower interleukin 6 (il6) and il8 transcription in kidney and prolonged interferon-gamma (ifng) transcription in spleens after challenge compared with non-immunized fish. Our data suggest an immunogenic potential of Fnn ΔiglC and indicate important cytokines associated with francisellosis pathogenesis and protection.
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Affiliation(s)
- Elisabeth O Lampe
- Center for Integrative Microbiology and Evolution, Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, 0316 Oslo, Norway
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Ritchie ND, Irvine SC, Helps A, Robb F, Jones BL, Seaton RA. Restrictive antibiotic stewardship associated with reduced hospital mortality in gram-negative infection. QJM 2017; 110:155-161. [PMID: 27521583 DOI: 10.1093/qjmed/hcw134] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION : Antimicrobial stewardship has an important role in the control of Clostridium difficile infection (CDI) and antibiotic resistance. An important component of UK stewardship interventions is the restriction of broad-spectrum beta-lactam antibiotics and promotion of agents associated with a lower risk of CDI such as gentamicin. While the introduction of restrictive antibiotic guidance has been associated with improvements in CDI and antimicrobial resistance, evidence of the effect on outcome following severe infection is lacking. METHODS : In 2008, Glasgow hospitals introduced a restrictive antibiotic guideline. A retrospective before/after study assessed outcome following Gram-negative bacteraemia in the 2-year period around implementation. RESULTS : Introduction of restrictive antibiotic guidelines was associated with a reduction in utilization of ceftriaxone and co-amoxiclav and an increase in amoxicillin and gentamicin. Approximately 1593 episodes of bacteremia were included in the study. The mortality over 1-year following Gram-negative bacteraemia was lower in the period following guideline implementation (RR 0.852, P = 0.045). There was no evidence of a difference in secondary outcomes including ITU admission, length of stay, readmission, recurrence of bacteraemia and need for renal replacement therapy. There was a fall in CDI (RR 0.571, P = 0.014) and a reduction in bacterial resistance to ceftriaxone and co-amoxiclav but no evidence of an increase in gentamicin resistance after guideline implementation. CONCLUSION : Restrictive antibiotic guidelines were associated with a reduction in CDI and bacterial resistance but no evidence of adverse outcomes following Gram-negative bacteraemia. There was a small reduction in one year mortality.
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Affiliation(s)
- N D Ritchie
- From the Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow 8QQ 12, UK
| | - S C Irvine
- From the Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow 8QQ 12, UK
| | - A Helps
- Department of Renal Medicine, Queen Elizabeth University Hospital, Glasgow 4TF G51, UK
| | - F Robb
- Infectious Diseases Unit, Queen Elizabeth University Hospital, Glasgow, 4TF G51, UK
| | - B L Jones
- Department of Medical Microbiology, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - R A Seaton
- Infectious Diseases Unit, Queen Elizabeth University Hospital, Glasgow, 4TF G51, UK
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Abstract
Objective Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S. maltophilia bacteremia (SMB) is a rare condition, and its clinical characteristics in Japanese settings are not well known. Methods The medical charts of patients with SMB were retrospectively reviewed at two medical facilities (Okayama University Hospital and Tsuyama Chuo Hospital) for seven years. The data were analyzed along with those previously reported from other Japanese facilities. Result A total of 181 patients (110 men and 71 women) were evaluated. The major underlying diseases included hematologic malignancy (36.5%), solid organ malignancy (25.4%), and neutropenia (31.5%). The recent use of carbapenem was seen in 56.9% of the cases in total, and more than one-third of the patients in our hospitals were treated with carbapenem at the onset of SMB. Of 28 (63.6%) of 44 cases treated for S. maltophilia, those who did not survive were more likely to have been treated with broad-spectrum antibiotics. A multivariate analysis revealed that a higher updated Charlson Comorbidity Index [odds ratio (95% confidence interval), 1.75 (1.11-2.75); p=0.015] and intubation [odds ratio (95% confidence interval), 12.6 (1.62-97.9); p=0.016] were associated with mortality in our cases. Pathogens were often resistant to ceftazidime but susceptible to minocycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. The overall mortality rates within 30 and 90 days were 37.5% and 62.5%, respectively. Conclusion The clinical characteristics of SMB in Japanese cases were similar to those reported from other countries. Clinicians should be aware that breakthrough infection by S. maltophilia may occur during administration of carbapenem.
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Affiliation(s)
- Hirotaka Ebara
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Assis GBN, Tavares GC, Pereira FL, Figueiredo HCP, Leal CAG. Natural coinfection by Streptococcus agalactiae and Francisella noatunensis subsp. orientalis in farmed Nile tilapia (Oreochromis niloticus L.). J Fish Dis 2017; 40:51-63. [PMID: 27144661 DOI: 10.1111/jfd.12493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/21/2016] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 05/20/2023]
Abstract
Streptococcus agalactiae and Francisella noatunensis subsp. orientalis (Fno) are important pathogens for farm-raised tilapia worldwide. There are no reports of coinfection caused by S. agalactiae and Fno in fish. This study aimed to determine the aetiology of atypical mortalities in a cage farm of Nile tilapia and to characterize the genetic diversity of the isolates. Fifty-two fish were sampled and subjected to parasitological and bacteriological examination. The S. agalactiae and Fno isolates were genotyped using MLST and REP-PCR, respectively. Whole-genome sequencing was performed to confirm the MLST results. Seven fish were shown coinfected by S. agalactiae and Fno. Chronic hypoxia and a reduction in the water temperature were determined as risk factors for coinfection. Fno isolates were shown clonally related in REP-PCR. The MLST analysis revealed that the S. agalactiae isolates from seven coinfected fish were negative for the glcK gene; however, these were determined to be members of clonal complex CC-552. This is the first description of coinfection by S. agalactiae and Fno in farm-raised Nile tilapia. The coinfection was predisposed by chronic hypoxia and was caused by the main genotypes of S. agalactiae and Fno reported in Brazil. Finally, a new S. agalactiae genotype with glcK gene partially deleted was described.
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Affiliation(s)
- G B N Assis
- AQUAVET, Laboratory of Aquatic Animal Diseases, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - G C Tavares
- AQUAVET, Laboratory of Aquatic Animal Diseases, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - F L Pereira
- AQUACEN - National Reference Laboratory of Aquatic Animal Diseases, Ministry of Fisheries and Aquaculture, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - H C P Figueiredo
- AQUAVET, Laboratory of Aquatic Animal Diseases, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- AQUACEN - National Reference Laboratory of Aquatic Animal Diseases, Ministry of Fisheries and Aquaculture, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - C A G Leal
- AQUAVET, Laboratory of Aquatic Animal Diseases, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- AQUACEN - National Reference Laboratory of Aquatic Animal Diseases, Ministry of Fisheries and Aquaculture, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Djordjević ZM, Folić MM, Gavrilović J, Janković SM. Risk factors for healthcare-acquired urinary tract infections caused by multi-drug resistant microorganisms. SRP ARK CELOK LEK 2016; 144:490-496. [PMID: 29652464] [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: 06/08/2023] Open
Abstract
INTRODUCTION Healthcare-acquired urinary tract infections (HAUTI) make up to 40% of all healthcareacquired infections and contribute significantly to hospital morbidity, mortality, and overall cost of treatment. OBJECTIVE The aim of our study was to investigate possible risk factors for development of HAUTI caused by multi-drug resistant pathogens. METHODS The prospective case-control study in a large tertiary-care hospital was conducted during a five-year period. The cases were patients with HAUTI caused by multi-drug resistant (MDR) pathogens, and the controls were patients with HAUTI caused by non-MDR pathogens. RESULTS There were 562 (62.6%) patients with MDR isolates and 336 (37.4%) patients with non-MDR isolates in the study. There were four significant predictors of HAUTI caused by MDR pathogens: hospitalization before insertion of urinary catheter for more than eight days (ORadjusted = 2.763; 95% CI = 1.352–5.647; p = 0.005), hospitalization for more than 15 days (ORadjusted = 2.144; 95% CI = 1.547–2.970; p < 0.001), previous stay in another department (intensive care units, other wards or hospitals) (ORadjusted = 2.147; 95% CI = 1.585–2.908; p < 0.001), and cancer of various localizations (ORadjusted = 2.313; 95% CI = 1.255–4.262; p = 0.007). CONCLUSION Early removal of urinary catheter and reduction of time spent in a hospital or in an ICU could contribute to a decrease in the rate of HAUTI caused by MDR pathogens.
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Jeon YD, Jeong WY, Kim MH, Jung IY, Ahn MY, Ann HW, Ahn JY, Han SH, Choi JY, Song YG, Kim JM, Ku NS. Risk factors for mortality in patients with Stenotrophomonas maltophilia bacteremia. Medicine (Baltimore) 2016; 95:e4375. [PMID: 27495046 PMCID: PMC4979800 DOI: 10.1097/md.0000000000004375] [Citation(s) in RCA: 40] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Stenotrophomonas maltophilia is a nosocomial pathogen associated with high morbidity and mortality, particularly in immunocompromised or critically ill patients. In this study, we investigated the risk factors for mortality in patients with S. maltophilia bacteremia.Retrospectively, medical records from all patients with S. maltophilia bacteremia between December 2005 and 2014 at Severance Hospital, a 2000-bed tertiary care hospital in Seoul, Korea, were reviewed. Analysis was performed to identify factors associated with 28-day mortality.In total, 142 bacteremia patients were enrolled in this study. The overall 28-day mortality rate was 36.6%. Based on the univariate analysis, hematologic malignancy (P = 0.015), Sepsis-related Organ Failure Assessment (SOFA) score (P < 0.001) and the removal of a central venous catheter (CVC) (P = 0.040) were significantly related to mortality. In the intensive care unit patients, the Acute Physiology and Chronic Health Evaluation II score (P = 0.001) also had significance. Based on the multivariate analysis, the SOFA score (odds ratio [OR] = 1.323; 95% confidence interval [CI]: 1.159, 1.509; P < 0.001) and removal of the CVC (OR = 0.330; 95% CI: 0.109, 0.996; P = 0.049) were independent factors associated with mortality.Our results suggest that removing a CVC may considerably reduce mortality in patients with S. maltophilia bacteremia.
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Affiliation(s)
- Yong Duk Jeon
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | - Mi Young Ahn
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hea Won Ann
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Ahn
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Han
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Song
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Su Ku
- Department of Internal Medicine
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Correspondence: Nam Su Ku, Division of Infectious Disease, Department of Internal medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea (e-mail: )
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Cai Y, Chua NG, Lim TP, Teo JQM, Lee W, Kurup A, Koh TH, Tan TT, Kwa AL. From Bench-Top to Bedside: A Prospective In Vitro Antibiotic Combination Testing (iACT) Service to Guide the Selection of Rationally Optimized Antimicrobial Combinations against Extensively Drug Resistant (XDR) Gram Negative Bacteria (GNB). PLoS One 2016; 11:e0158740. [PMID: 27441603 PMCID: PMC4956091 DOI: 10.1371/journal.pone.0158740] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/21/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Combination therapy is increasingly utilized against extensively-drug resistant (XDR) Gram negative bacteria (GNB). However, choosing a combination can be problematic as effective combinations are often strain-specific. An in vitro antibiotic combination testing (iACT) service, aimed to guide the selection of individualized and rationally optimized combination regimens within 48 hours, was developed. We described the role and feasibility of the iACT service in guiding individualized antibiotic combination selection in patients with XDR-GNB infections. Methods A retrospective case review was performed in two Singapore hospitals from April 2009–June 2014. All patients with XDR-GNB and antibiotic regimen guided by iACT for clinical management were included. The feasibility and role of the prospective iACT service was evaluated. The following patient outcomes were described: (i) 30-day in-hospital all-cause and infection-related mortality, (ii) clinical response, and (iii) microbiological eradication in patients with bloodstream infections. Results From 2009–2014, the iACT service was requested by Infectious Disease physicians for 39 cases (20 P. aeruginosa, 13 A. baumannii and 6 K. pneumoniae). Bloodstream infection was the predominant infection (36%), followed by pneumonia (31%). All iACT recommendations were provided within 48h from request for the service. Prior to iACT-guided therapy, most cases were prescribed combination antibiotics empirically (90%). Changes in the empiric antibiotic regimens were recommended in 21 (54%) cases; in 14 (36%) cases, changes were recommended as the empiric regimens were found to be non-bactericidal in vitro. In 7 (18%) cases, the number of antibiotics used in combination empirically was reduced by the iACT service. Overall, low 30-day infection-related mortality (15%) and high clinical response (82%) were observed. Microbiological eradication was observed in 79% of all bloodstream infections. Conclusions The iACT service can be feasibly employed to guide the timely selection of rationally optimized combination regimens, and played a role in reducing indiscreet antibiotic use.
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Affiliation(s)
- Yiying Cai
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Nathalie Grace Chua
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Tze-Peng Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Jocelyn Qi-Min Teo
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Winnie Lee
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Asok Kurup
- Infectious Diseases Care, Mount Elizabeth Hospital, Singapore, Singapore
| | - Tse-Hsien Koh
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Thuan-Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Andrea L. Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
- Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
- * E-mail:
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Zhang ML, Xu J, Zhang W, Liu XY, Zhang M, Wang WL, Zheng SS. Microbial epidemiology and risk factors of infections in recipients after DCD liver transplantation. Int J Clin Pract 2016; 70 Suppl 185:17-21. [PMID: 27198000 DOI: 10.1111/ijcp.12812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/26/2022] Open
Abstract
AIM Infection is a major cause of increased mortality after a liver transplant (LT). This study sought to identify the incidence, prevalence and risk factors of microbial infection for recipients who underwent LT using grafts from donors after cardiac death (DCD). METHODS We retrospectively analysed the frequency and characteristics of post-transplantation infections in 236 recipients who underwent DCD LT between 1 January 2010 and 31 December 2014 in our centre and evaluated the risk factors of post-transplantation infection. RESULTS Overall, 162 recipients acquired at least one type of infection during hospitalisation after LT, and the morbidity rate was 68.6%. Moreover, 19 of the 236 recipients died, with an overall mortality rate of 8.1%. In total, 752 pathogens were isolated. Gram-positive bacteria, Gram-negative bacteria and fungi accounted for 26.1% (196), 58.2% (438) and 15.7% (118) of the pathogens, respectively. Kaplan-Meier curves of 1-year survival showed that recipients with infection had a significantly lower cumulative survival rate compared with those without infection (83.2% vs. 90.6%, p < 0.05). Multivariate analysis revealed that age > 60 years (p = 0.010) and severe hepatitis (p = 0.036) were independent risk factors for infection during hospitalisation after LT. CONCLUSION Infection is a common complication after a DCD-LT that could impair 1-year survival. We suggest physicians pay more attention to the infection of recipients post-LT, especially those recipients greater than 60 years of age and those who suffered from severe hepatitis.
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Affiliation(s)
- M-L Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - J Xu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - W Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - X-Y Liu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - M Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - W-L Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - S-S Zheng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
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Abstract
AIM The purpose of our study was to evaluate the incidence, timing, location and risk factors for bacterial and fungal infections after donation after cardiac death (DCD) liver transplant and clearly delineate any relationship between infection and survival in DCD liver transplant recipients. METHODS We retrospectively reviewed 257 consecutive patients undergoing DCD liver transplant between October 2010 and May 2015 at our centre. RESULTS A total of 133 patients (51.8%) developed at least one bacterial or fungal infection episode. The predominant infection site was the respiratory tract, followed by the blood stream. Most of the infections occurred within the first week after liver transplant (61.9%). A recipient respiratory support time greater than 7 days (p = 0.041), post-transplant hospital time greater than 24 days (p = 0.002) and renal failure after DCD liver transplant (p = 0.039) were independent predictors of bacterial and fungal infection. The area under the receiver operating characteristic (ROC) curve (AUC) of the transplant infection risk assessment model was 0.788. The 1- and 3-year survival rates for recipients without infection were significantly increased compared with recipients with infection (96.1% and 89.0% vs. 81.5% and 75.9%, p = 0.007). CONCLUSION This is the first study that offers detailed data revealing the timing and incidence of bacterial and fungal infection among adult DCD liver transplant recipients. Bacterial and fungal infection occurs at a high rate during the first week after DCD liver transplant, especially in patients with prolonged respiratory support time and renal failure, and infection is related to increased hospital stay.
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Affiliation(s)
- Z Tu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - P Xiang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - X Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - L Zhou
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - L Zhuang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - J Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - W Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - S Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
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Jondle CN, Sharma A, Simonson TJ, Larson B, Mishra BB, Sharma J. Macrophage Galactose-Type Lectin-1 Deficiency Is Associated with Increased Neutrophilia and Hyperinflammation in Gram-Negative Pneumonia. J Immunol 2016; 196:3088-96. [PMID: 26912318 PMCID: PMC4936400 DOI: 10.4049/jimmunol.1501790] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/27/2016] [Indexed: 12/25/2022]
Abstract
C-type lectin receptors (CLRs), the carbohydrate-recognizing molecules, orchestrate host immune response in homeostasis and in inflammation. In the present study we examined the function of macrophage galactose-type lectin-1 (MGL1), a mammalian CLR, in pneumonic sepsis, a deadly immune disorder frequently associated with a nonresolving hyperinflammation. In a murine model of pneumonic sepsis using pulmonary infection with Klebsiella pneumoniae, the expression of MGL1 was upregulated in the lungs of K. pneumoniae-infected mice, and the deficiency of this CLR in MGL1(-/-) mice resulted in significantly increased mortality to infection than in the MGL1-sufficient wild-type mice, despite a similar bacterial burden. The phagocytic cells from MGL1(-/-) mice did not exhibit any defects in bacterial uptake and intracellular killing and were fully competent in neutrophil extracellular trap formation, a recently identified extracellular killing modality of neutrophils. Instead, the increased susceptibility of MGL1(-/-) mice seemed to correlate with severe lung pathology, indicating that MGL1 is required for resolution of pulmonary inflammation. Indeed, the MGL1(-/-) mice exhibited a hyperinflammatory response, massive pulmonary neutrophilia, and an increase in neutrophil-associated immune mediators. Concomitantly, MGL1-deficient neutrophils exhibited an increased influx in pneumonic lungs of K. pneumoniae-infected mice. Taken together, these results show a previously undetermined role of MGL1 in controlling neutrophilia during pneumonic infection, thus playing an important role in resolution of inflammation. To our knowledge, this is the first study depicting a protective function of MGL1 in an acute pneumonic bacterial infection.
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Affiliation(s)
- Christopher N Jondle
- Department of Basic Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202
| | - Atul Sharma
- Department of Basic Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202
| | - Tanner J Simonson
- Department of Basic Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202
| | - Benjamin Larson
- Department of Basic Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202
| | - Bibhuti B Mishra
- Department of Basic Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202
| | - Jyotika Sharma
- Department of Basic Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202
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Trifi A, Abdellatif S, Daly F, Mahjoub K, Nasri R, Oueslati M, Mannai R, Bouzidi M, Ben Lakhal S. Efficacy and Toxicity of High-Dose Colistin in Multidrug-Resistant Gram-Negative Bacilli Infections: A Comparative Study of a Matched Series. Chemotherapy 2016; 61:190-6. [PMID: 26863534 DOI: 10.1159/000442786] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Colistimethate sodium (CMS) is the commercialized form of colistin that is effective against multiresistant Gram-negative bacilli. Its main side effects are nephrotoxicity and neurotoxicity. Pharmacodynamic dosages showed that they were infratherapeutic. Therefore, strategies with higher doses were proposed. The aim of this study was to assess the efficiency and toxicity of higher-dose CMS by comparing two treatment strategies: high-dose CMS versus standard-dose CMS. METHODS A prospective and comparative study of two matched groups was conducted. Fourty-six patients in each group were matched for age, severity and nature of infection. In the high-dose colistin group, CMS was administered at a loading dose of 9 MIU followed by a maintenance dose of 4.5 MIU/12 h. In the second group, retrospectively analyzed, colistin was administered at 6 MIU/day. For each group, clinical results, bacteriological eradication and daily creatinine clearance were recorded. Primary outcome measures were clinical cure defined as disappearance of infectious signs and eradication of microorganisms in all the follow-up cultures. Secondary outcome measures were incidence of acute renal failure and mortality. RESULTS Ninety-two patients were analyzed by matching. There was a higher cure rate in the high-dose group (63 vs. 41.3%, p = 0.04). No higher risk of nephrotoxicity was found by increasing daily doses of colistin (32.2 versus 26%, p = 0.64). Similarly, there was no significant difference in the time to onset of renal failure (8.32 vs. 11 days, p = 1) or in the requirement of hemodialysis (26.6 vs. 41%, p = 1). CONCLUSION The high-dose colistin regimen is more efficient, without significant renal or neurological toxicity.
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Roon SR, Alexander JD, Jacobson KC, Bartholomew JL. Effect of Nanophyetus salmincola and Bacterial Co-Infection on Mortality of Juvenile Chinook Salmon. J Aquat Anim Health 2015; 27:209-216. [PMID: 26671546 DOI: 10.1080/08997659.2015.1094150] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The freshwater trematode Nanophyetus salmincola has been demonstrated to impair salmonid immune function and resistance to the marine pathogen Vibrio anguillarum, potentially resulting in ocean mortality. We examined whether infection by the parasite N. salmincola similarly increases mortality of juvenile Chinook Salmon Oncorhynchus tshawytscha when they are exposed to the freshwater pathogens Flavobacterium columnare or Aeromonas salmonicida, two bacteria that juvenile salmonids might encounter during their migration to the marine environment. We used a two-part experimental design where juvenile Chinook Salmon were first infected with N. salmincola through cohabitation with infected freshwater snails, Juga spp., and then challenged with either F. columnare or A. salmonicida. Cumulative percent mortality from F. columnare infection was higher in N. salmincola-parasitized fish than in nonparasitized fish. In contrast, cumulative percent mortality from A. salmonicida infection did not differ between N. salmincola-parasitized and nonparasitized groups. No mortalities were observed in the N. salmincola-parasitized-only and control groups from either challenge. Our study demonstrates that a relatively high mean intensity (>200 metacercariae per posterior kidney) of encysted N. salmincola metacercariae can alter the outcomes of bacterial infection in juvenile Chinook Salmon, which might have implications for disease in wild fish populations.
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Affiliation(s)
- Sean R Roon
- a Department of Microbiology , Oregon State University , 226 Nash Hall, Corvallis , Oregon 97331 , USA
| | - Julie D Alexander
- a Department of Microbiology , Oregon State University , 226 Nash Hall, Corvallis , Oregon 97331 , USA
| | - Kym C Jacobson
- b National Oceanographic and Atmospheric Administration-Fisheries , Northwest Fisheries Science Center , Newport Research Station, 2030 Southeast OSU Drive, Newport , Oregon 97365 , USA
| | - Jerri L Bartholomew
- a Department of Microbiology , Oregon State University , 226 Nash Hall, Corvallis , Oregon 97331 , USA
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Wang L, Wang Y, Fan X, Tang W, Hu J. Prevalence of Resistant Gram-Negative Bacilli in Bloodstream Infection in Febrile Neutropenia Patients Undergoing Hematopoietic Stem Cell Transplantation: A Single Center Retrospective Cohort Study. Medicine (Baltimore) 2015; 94:e1931. [PMID: 26559260 PMCID: PMC4912254 DOI: 10.1097/md.0000000000001931] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Bloodstream infection (BSI) is an important cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). To evaluate the causative bacteria and identify risk factors for BSI associated mortality in febrile neutropenia patients undergoing HSCT, we collected the clinical and microbiological data from patients underwent HSCT between 2008 and 2014 and performed a retrospective analysis. Throughout the study period, among 348 episodes of neutropenic fever in patients underwent HSCT, 89 episodes in 85 patients had microbiological defined BSI with a total of 108 isolates. Gram-negative bacteria (GNB) were the most common isolates (76, 70.3%) followed by gram-positive bacteria (GPB, 29, 26.9%) and fungus (3, 2.8%). As to the drug resistance, 26 multiple drug resistance (MDR) isolates were identified. Resistant isolates (n = 23) were more common documented in GNB, mostly Escherichia coli (9/36, 25%) and Klebsiella pneumonia (6/24, 25%). A total of 12 isolated were resistant to carbapenem including 4 K pneumoniae (4/24, 16.7%), 3 Stenotrophomonas maltophilia, and 1 Pseudomonas aeruginosa and other 4 GNB isolates (Citrobacter freumdii, Pseudomonas stutzeri, Acinetobacter baumanii, and Chryseobacterium indologenes). As to the GPB, only 3 resistant isolates were documented including 2 methicillin-resistant isolates (Staphylococcus hominis and Arcanobacterium hemolysis) and 1 vancomycin-resistant Enterococcus faecium. Among these 85 patients with documented BSI, 11 patients died of BSI as primary or associated cause with a BSI-related mortality of 13.1 ± 3.7% and 90-day overall survival after transplantation at 80.0 ± 4.3%. Patients with high-risk disease undergoing allo-HSCT, prolonged neutropenia (≥15 days) and infection with carbapenem-resistant GNB were associated with BSI associated mortality in univariate and multivariate analyses. Our report revealed a prevalence of GNB in BSI of neutropenic patients undergoing HSCT. Patients with high-risk diseases with prolonged neutropenia and carbapenem-resistant GNB were independent risk factors for BSI-related mortality.
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Affiliation(s)
- Ling Wang
- From the Department of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (LW, YW, XF, WT, JH)
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Abstract
BACKGROUND Cefepime and ceftazidime are cephalosporins used for the treatment of serious Gram-negative infections. These cephalosporins are used off-label in the setting of minimal safety data for young infants. METHODS We identified all infants discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2012 who were exposed to either cefepime or ceftazidime in the first 120 days of life. We reported clinical and laboratory adverse events occurring in infants exposed to cefepime or ceftazidime and used multivariable logistic regression to compare the odds of seizures and death between the 2 groups. RESULTS A total of 1761 infants received 13,293 days of ceftazidime, and 594 infants received 4628 days of cefepime. Laboratory adverse events occurred more frequently on days of therapy with ceftazidime than with cefepime (373 vs. 341 per 1000 infant days, P < 0.001). Seizure was the most commonly observed clinical adverse event, occurring in 3% of ceftazidime-treated infants and 4% of cefepime-treated infants (P = 0.52). Mortality was similar between the ceftazidime and cefepime groups (5% vs. 3%, P = 0.07). There was no difference in the adjusted odds of seizure [odds ratio (OR) = 0.96 (95% confidence interval: 0.89-1.03)] or the combined outcome of mortality or seizures [OR = 1.00 (0.96-1.04)] in infants exposed to ceftazidime versus those exposed to cefepime. CONCLUSIONS In this cohort of infants, cefepime was associated with fewer laboratory adverse events than ceftazidime, although this may have been due to a significant difference in clinical exposures and severity of illness between the 2 groups. There was no difference in seizure risk or mortality between the 2 drugs.
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Affiliation(s)
- Christopher J. Arnold
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Duke University, Durham, NC
| | - Jessica Ericson
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - Nathan Cho
- Duke Clinical Research Institute, Durham, NC
| | - James Tian
- Duke Clinical Research Institute, Durham, NC
| | | | - Vivian H. Chu
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Duke University, Durham, NC
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | | | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
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Lanini S, Costa AN, Puro V, Procaccio F, Grossi PA, Vespasiano F, Ricci A, Vesconi S, Ison MG, Carmeli Y, Ippolito G. Incidence of carbapenem-resistant gram negatives in Italian transplant recipients: a nationwide surveillance study. PLoS One 2015; 10:e0123706. [PMID: 25835018 PMCID: PMC4383484 DOI: 10.1371/journal.pone.0123706] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/06/2015] [Indexed: 11/18/2022] Open
Abstract
Background Bacterial infections remain a challenge to solid organ transplantation. Due to the alarming spread of carbapenem-resistant gram negative bacteria, these organisms have been frequently recognized as cause of severe infections in solid organ transplant recipients. Methods and Findings Between 15 May and 30 September 2012 we enrolled 887 solid organ transplant recipients in Italy with the aim to describe the epidemiology of gram negative bacteria spreading, to explore potential risk factors and to assess the effect of early isolation of gram negative bacteria on recipients’ mortality during the first 90 days after transplantation. During the study period 185 clinical isolates of gram negative bacteria were reported, for an incidence of 2.39 per 1000 recipient-days. Positive cultures for gram negative bacteria occurred early after transplantation (median time 26 days; incidence rate 4.33, 1.67 and 1.14 per 1,000 recipient-days in the first, second and third month after SOT, respectively). Forty-nine of these clinical isolates were due to carbapenem-resistant gram negative bacteria (26.5%; incidence 0.63 per 1000 recipient-days). Carbapenems resistance was particularly frequent among Klebsiella spp. isolates (49.1%). Recipients with longer hospital stay and those who received either heart or lung graft were at the highest risk of testing positive for any gram negative bacteria. Moreover recipients with longer hospital stay, lung recipients and those admitted to hospital for more than 48h before transplantation had the highest probability to have culture(s) positive for carbapenem-resistant gram negative bacteria. Forty-four organ recipients died (0.57 per 1000 recipient-days) during the study period. Recipients with at least one positive culture for carbapenem-resistant gram negative bacteria had a 10.23-fold higher mortality rate than those who did not. Conclusion The isolation of gram-negative bacteria is most frequent among recipient with hospital stays >48 hours prior to transplant and in those receiving either heart or lung transplants. Carbapenem-resistant gram negative isolates are associated with significant mortality.
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Affiliation(s)
- Simone Lanini
- Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
- * E-mail:
| | - Alessandro Nanni Costa
- Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy
| | - Vincenzo Puro
- Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Francesco Procaccio
- Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy
| | - Paolo Antonio Grossi
- Division of Infectious Diseases, Department of Surgical and Morphological Sciences, University of Insubria-Ospedale di Circolo, Varese, Italy
| | - Francesca Vespasiano
- Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy
| | - Andrea Ricci
- Italian National Transplant Center, Italian National Institute of Health (ISS), Rome, Italy
| | - Sergio Vesconi
- Direzione Generale Salute Lombardia, Regione Lombardia, Milan, Italy
| | - Michael G. Ison
- Divisions of Infectious Diseases & Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Yehuda Carmeli
- Division of Epidemiology and the Laboratory for Molecular Epidemiology and Antibiotic Research, Sourasky Medical Center, Tel Aviv, Israel
| | - Giuseppe Ippolito
- Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
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Marks DJB, Hyams C, Koo CY, Pavlou M, Robbins J, Koo CS, Rodger G, Huggett JF, Yap J, Macrae MB, Swanton RH, Zumla AI, Miller RF. Clinical features, microbiology and surgical outcomes of infective endocarditis: a 13-year study from a UK tertiary cardiothoracic referral centre. QJM 2015; 108:219-29. [PMID: 25223570 DOI: 10.1093/qjmed/hcu188] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 11/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) causes substantial morbidity and mortality. Patient and pathogen profiles, as well as microbiological and operative strategies, continue to evolve. The impact of these changes requires evaluation to inform optimum management and identify individuals at high risk of early mortality. AIM Identification of clinical and microbiological features, and surgical outcomes, among patients presenting to a UK tertiary cardiothoracic centre for surgical management of IE between 1998 and 2010. DESIGN Retrospective observational cohort study. METHODS Clinical, biochemical, microbiological and echocardiographic data were identified from clinical records. Principal outcomes were all-cause 28-day mortality and duration of post-operative admission. RESULTS Patients (n = 336) were predominantly male (75.0%); median age 52 years (IQR = 41-67). Most cases involved the aortic (56.0%) or mitral (53.9%) valves. Microbiological diagnoses, obtained in 288 (85.7%) patients, included streptococci (45.2%); staphylococci (34.5%); Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella (HACEK) organisms (3.0%); and fungi (1.8%); 11.3% had polymicrobial infection. Valve replacement in 308 (91.7%) patients included mechanical prostheses (69.8%), xenografts (24.0%) and homografts (6.2%). Early mortality was 12.2%, but fell progressively during the study (P = 0.02), as did median duration of post-operative admission (33.5 to 10.5 days; P = 0.0003). Multivariable analysis showed previous cardiothoracic surgery (OR = 3.85, P = 0.03), neutrophil count (OR = 2.27, P = 0.05), albumin (OR = 0.94, P = 0.04) and urea (OR = 2.63, P < 0.001) predicted early mortality. CONCLUSIONS This study demonstrates reduced post-operative early mortality and duration of hospital admission for IE patients over the past 13 years. Biomarkers (previous cardiothoracic surgery, neutrophil count, albumin and urea), predictive of early post-operative mortality, require prospective evaluation to refine algorithms, further improve outcomes and reduce healthcare costs associated with IE.
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Affiliation(s)
- D J B Marks
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Hyams
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Y Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M Pavlou
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Robbins
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C S Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - G Rodger
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J F Huggett
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Yap
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M B Macrae
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R H Swanton
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - A I Zumla
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R F Miller
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
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Pękala A, Kozińska A, Paździor E, Głowacka H. Phenotypical and genotypical characterization of Shewanella putrefaciens strains isolated from diseased freshwater fish. J Fish Dis 2015; 38:283-293. [PMID: 24552171 DOI: 10.1111/jfd.12231] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 10/03/2013] [Revised: 01/03/2014] [Accepted: 01/04/2014] [Indexed: 06/03/2023]
Abstract
Between 2007 and 2012, a variety of disease outbreaks most often characterized by skin disorders were observed among different species of freshwater fish in Poland. In most cases, the clinical signs included focally necrotized gills, necrotic skin lesions or ulcers. Internally, haemorrhages, oedematous kidney and abnormal spleen enlargement were generally noted. The disorders were accompanied by increased mortality. Most of the problems concerned cultured common carp Cyprinus carpio L. and rainbow trout Oncorhynchus mykiss (Walbaum). Fish have been examined from a number of these farms, and additionally, the wild and ornamental fish with similar clinical signs of diseases were also tested. Bacteria were isolated consistently from lesions and internal organs. They had characteristic orange-pigmented colonies which grew in pure culture or constituted 55-95% of total bacterial flora. One hundred and eighteen isolates were collected and biochemically identified as Shewanella putrefaciens group, and this was confirmed by sequencing. Challenge tests confirmed the pathogenicity of these bacteria. This is the first report characterizing and describing S. putrefaciens as a pathogen of different species of freshwater fish in Europe.
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Affiliation(s)
- A Pękala
- Department of Fish Diseases, National Veterinary Research Institute, Puławy, Poland
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47
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Wu CJ, Chen PL, Hsueh PR, Chang MC, Tsai PJ, Shih HI, Wang HC, Chou PH, Ko WC. Clinical implications of species identification in monomicrobial Aeromonas bacteremia. PLoS One 2015; 10:e0117821. [PMID: 25679227 PMCID: PMC4334500 DOI: 10.1371/journal.pone.0117821] [Citation(s) in RCA: 32] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/30/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Advances in Aeromonas taxonomy have led to the reclassification of aeromonads. Hereon, we aimed to re-evaluate the characteristics of Aeromonas bacteremia, including those of a novel species, Aeromonas dhakensis. METHODOLOGY/PRINCIPAL FINDINGS A retrospective study of monomicrobial Aeromonas bacteremia at a medical center in southern Taiwan from 2004-2011 was conducted. Species identification was based on rpoB sequencing. Of bacteremia of 153 eligible patients, A. veronii (50 isolates, 32.7%), A. dhakensis (48, 31.4%), A. caviae (43, 28.1%), and A. hydrophila (10, 6.5%) were the principal causative species. A. dhakensis and A. veronii bacteremia were mainly community-acquired and presented as primary bacteremia, spontaneous bacterial peritonitis, or skin and soft-tissue infection, whereas A. caviae was associated with hospital-onset bacteremia. The distribution of the AmpC β-lactamase and metallo-β-lactamase genes was species-specific: bla(AQU-1), bla(MOX), or bla(CepH) was present in A. dhakensis, A. caviae, or A. hydrophila, respectively, and bla(CphA) was present in A. veronii, A. dhakensis, and A. hydrophila. The cefotaxime resistance rates of the A. caviae, A. dhakensis, and A. hydrophila isolates were higher than that of A. veronii (39.5%%, 25.0%, and 30% vs. 2%, respectively). A. dhakensis bacteremia was linked to the highest 14-day sepsis-related mortality rate, followed by A. hydrophila, A. veronii, and A. caviae bacteremia (25.5%, 22.2%, 14.0%, and 4.7%, respectively; P = 0.048). Multivariate analysis revealed that A. dhakensis bacteremia, active malignancies, and a Pitt bacteremia score ≥ 4 was an independent mortality risk factor. CONCLUSIONS/SIGNIFICANCE Characteristics of Aeromonas bacteremia vary between species. A. dhakensis prevalence and its associated poor outcomes suggest it an important human pathogen.
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Affiliation(s)
- Chi-Jung Wu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
- Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan
- Departments of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Lin Chen
- Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan
- Departments of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Ming-Chung Chang
- Biochemistry and Molecular Biology Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Pei-Jane Tsai
- Medical Laboratory Science and Biotechnology, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Hsin-I Shih
- Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsuan-Chen Wang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - Pei-Hsin Chou
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - Wen-Chien Ko
- Departments of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Departments of Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan
- * E-mail:
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48
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Cuenca AG, Joiner DN, Gentile LF, Cuenca AL, Wynn JL, Kelly-Scumpia KM, Scumpia PO, Behrns KE, Efron PA, Nacionales D, Lui C, Wallet SM, Reeves WH, Mathews CE, Moldawer LL. TRIF-dependent innate immune activation is critical for survival to neonatal gram-negative sepsis. J Immunol 2015; 194:1169-77. [PMID: 25548220 PMCID: PMC4297742 DOI: 10.4049/jimmunol.1302676] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Current evidence suggests that neonatal immunity is functionally distinct from adults. Although TLR signaling through the adaptor protein, MyD88, has been shown to be critical for survival to sepsis in adults, little is known about the role of MyD88 or TRIF in neonatal sepsis. We demonstrate that TRIF(-/-) but not MyD88(-/-) neonates are highly susceptible to Escherichia coli peritonitis and bacteremia. This was associated with decreased innate immune recruitment and function. Importantly, we found that the reverse was true in adults that MyD88(-/-) but not TRIF(-/-) or wild-type adults are susceptible to E. coli peritonitis and bacteremia. In addition, we demonstrate that TRIF but not MyD88 signaling is critical for the TLR4 protective adjuvant effect we have previously demonstrated. These data suggest a differential requirement for the survival of neonates versus adults to Gram-negative infection, and that modulation of TRIF in neonates can be used to augment survival to neonatal sepsis.
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Affiliation(s)
- Alex G Cuenca
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Dallas N Joiner
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Lori F Gentile
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Angela L Cuenca
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - James L Wynn
- Division of Neonatology, Department of Pediatrics Vanderbilt University, Nashville, TN 37232
| | - Kindra M Kelly-Scumpia
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Philip O Scumpia
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Kevin E Behrns
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Philip A Efron
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Dina Nacionales
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Chao Lui
- Department of Pathology, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Shannon M Wallet
- University of Florida College of Medicine and Dentistry, Gainesville, FL 32610; and
| | - Westley H Reeves
- Department of Medicine, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Clayton E Mathews
- Department of Pathology, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610
| | - Lyle L Moldawer
- Department of Surgery, University of Florida College of Medicine and Dentistry, Gainesville, FL 32610;
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Tsai YH, Shen SH, Yang TY, Chen PH, Huang KC, Lee MS. Monomicrobial Necrotizing Fasciitis Caused by Aeromonas hydrophila and Klebsiella pneumoniae. Med Princ Pract 2015; 24:416-23. [PMID: 26066555 PMCID: PMC5588256 DOI: 10.1159/000431094] [Citation(s) in RCA: 22] [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] [Received: 08/28/2014] [Accepted: 05/04/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To compare specific characteristics and clinical outcomes of monomicrobial necrotizing fasciitis caused by Aeromonashydrophila and Klebsiella pneumoniae. MATERIAL AND METHODS Cases of monomicrobial necrotizing fasciitis caused by A. hydrophila (n = 11) and K. pneumoniae (n = 7) over an 8-year period were retrospectively reviewed. Differences in mortality, patient characteristics, clinical presentations, and laboratory data were compared between the A. hydrophila and the K. pneumoniae groups. RESULTS The clinical signs and symptoms at the time of presentation did not differ significantly (p > 0.05) between the two groups. The A. hydrophila group had a significantly shorter interval between contact and admission (1.55 ± 0.52 vs. 5.14 ± 2.12 days, p < 0.001) and significant lower total white blood cell counts (10,245 ± 5,828 vs. 19,014 ± 11,370 cells/mm(3), p < 0.045) than the K. pneumoniae group in the emergency room. Hepatic dysfunction was associated with mortality in patients with A. hydrophila infection, while diabetes mellitus was associated with mortality in patients with K. pneumoniae infection. Overall, 5 (45.5%) patients in the A. hydrophila group and 3 (42.8%) in the K. pneumoniae group died. CONCLUSION The initial clinical course of A. hydrophila monomicrobial necrotizing fasciitis was characterized by more rapidly progressive disease than that of the K. pneumoniae infection. Patients with hepatic dysfunction and necrotizing fasciitis should be suspected of having A. hydrophila infection, and diabetic patients with necrotizing fasciitis should be suspected of having K. pneumoniae infection initially.
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Affiliation(s)
- Yao-Hung Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi City, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
- *Yao-Hung Tsai, MD, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec, Chia-Pu Road, Puzi City, Cha-I 613 Taiwan (ROC), E-Mail
| | - Shih-Hsun Shen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi City, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tien-Yu Yang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi City, Taiwan, ROC
| | - Po-Han Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi City, Taiwan, ROC
| | - Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi City, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Mel S. Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Puzi City, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
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50
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Ruane NM, Bolton-Warberg M, Rodger HD, Colquhoun DJ, Geary M, McCleary SJ, O'Halloran K, Maher K, O'Keeffe D, Mirimin L, Henshilwood K, Geoghegan F, Fitzgerald RD. An outbreak of francisellosis in wild-caught Celtic Sea Atlantic cod, Gadus morhua L., juveniles reared in captivity. J Fish Dis 2015; 38:97-102. [PMID: 24261672 DOI: 10.1111/jfd.12210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/15/2013] [Accepted: 10/16/2013] [Indexed: 06/02/2023]
Affiliation(s)
- N M Ruane
- Fish Health Unit, Marine Institute, Oranmore, County Galway, Ireland
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