Archive for October 9, 2010

New Delhi metallo-beta-lactamase (NDM-1): towards a new pandemia?

Clinical Microbiology and Infection  Sept 2010

Jean Marc Rolain1,*, Philippe Giuseppe Cornaglia3

abstract

http://onlinelibrary.wiley.com:80/doi/10.1111/j.1469-0691.2010.03385.x/abstract

PDF

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2010.03385.x/pdf

 

October 9, 2010 at 5:59 pm Leave a comment

The paradox in pneumococcal serotypes: highly invasive does not mean highly lethal

European Respiratory Journal  October 2010  V.36  N.4  p.712-713

M.W. Pletz*, T. Welte* and K.P. Klugman#

*Dept of Pulmonary Medicine, Hannover Medical School, Hannover, Germany

#The Rollins School of Public Health, Emory University, Atlanta, GA, USA

Streptococcus pneumoniae is a major bacterial pathogen and a predominant cause of community-acquired pneumonia, acute exacerbations of chronic bronchitis, meningitis, sinusitis and bacteraemia in both developed and developing countries. Each year millions of people die from pneumococcal diseases. Even in developed countries, the case-fatality rate of pneumococcal pneumonia is still high. This is in contrast to the fact that 1) appropriate antibiotic treatment is available, and 2) to date, antimicrobial resistance rates of pneumococci for non-meningeal infections are still low in most countries or antimicrobial resistance (e.g. penicillin-resistance) is not related to treatment failure in pneumococcal pneumonia. A considerable number of patients die within the first 48 h and these early deaths have not been prevented by antibiotic treatment….

abstract

http://erj.ersjournals.com/content/36/4/712.extract

PDF

http://erj.ersjournals.com/content/36/4/712.full.pdf+html

October 9, 2010 at 5:38 pm Leave a comment

High Prevalence of Clarithromycin-Resistant Helicobacter pylori Strains and Risk Factors Associated with Resistance in Madrid, Spain

Journal of Clinical Microbiology  1 October 2010 V.48 N.10

Sonia Agudo,1* Guillermo Pérez-Pérez,2 Teresa Alarcón,1 and Manuel López-Brea1

Hospital de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain,1 Departments of Medicine and Microbiology, NYU School of Medicine, New York, New York2

Clarithromycin is one of the antibiotics used for the treatment of Helicobacter pylori infections, and clarithromycin resistance is the most important factor when it comes to predicting eradication failure. The present study analyzed H. pylori isolates for the presence of 23S rRNA gene mutations and determined the risk factors associated with resistance among H. pylori isolates collected in Madrid, Spain, in 2008. We studied 118 H. pylori strains isolated from the same number of patients. A total of 76.3% of the patients were born in Spain, 52.7% were children, 20.3% had previously been treated, and 66.1% were female. Clarithromycin resistance was determined by Etest. H. pylori strains were considered resistant if the MIC was 1 mg/liter. DNA extraction was carried out by use of the NucliSens easyMAG platform with NucliSens magnetic extraction reagents (bioMérieux). The DNA sequences of the 23S rRNA genes of clarithromycin-resistant and -sensitive strains were determined to identify specific point mutations. The vacA genotype and cagA status were determined by PCR. We found that 42 (35.6%) strains were resistant to clarithromycin by Etest. Etest results were confirmed by detection of the presence of point mutations in 34 (88.1%) of these strains. Eight H. pylori strains were resistant to clarithromycin by Etest but did not have a point mutation in the 23S rRNA gene. Mutation at A2143G was found in 85.3% of the strains, mutation at A2142G in 8.8%, and mutation at T2182C in 5.9%. Dual mutations were found in 8.8% of the strains. H. pylori clarithromycin-resistant strains were strongly associated with pediatric patients, with patients born in Spain, and with patients who had previously been treated (P  0.02). In addition, H. pylori strains resistant to clarithromycin more frequently presented the vacA s2/m2 genotype and were more likely to be cagA negative than susceptible strains (39.1% and 11.2%, respectively; P value < 0.001). We concluded that, in the present study, H. pylori clarithromycin-resistant strains are more frequently found in children, in patients mostly born in Spain, and in individuals who were previously treated for H. pylori infection and that these individuals are more likely colonized with a less virulent H. pylori strain.

abstract

http://jcm.asm.org/cgi/content/abstract/48/10/3703

October 9, 2010 at 5:37 pm Leave a comment

Is Repeat PCR Needed for Diagnosis of Clostridium difficile Infection?

Journal of Clinical Microbiology  1 October 2010 V.48 N.10

Robert F. Luo1* and Niaz Banaei1,2,3

Departments of Pathology,1 Medicine (Infectious Diseases), Stanford University School of Medicine, Stanford, California 94305,2 Clinical Microbiology Laboratory, Stanford Hospital and Clinics, Palo Alto, California 943043

Patients with diarrhea, defined as loose or watery stool, and two or more Clostridium difficile tcdB PCR tests within 14 days of each other were investigated. Repeat PCR for 293 patients with a prior negative result yielded negative results in 396 (97.5%) of 406 tests. Ten new positives were detected, including one false positive. Repeat PCR within 7 days appears rarely useful, except for patients with evidence of a new infection.

abstract

http://jcm.asm.org/cgi/content/abstract/48/10/3738

October 9, 2010 at 5:35 pm Leave a comment

The impact of a delay in intensive care unit admission for community-acquired pneumonia

European Respiratory Journal  October 2010  V.36  N.4  p.826-833

J. Phua, W.J. Ngerng and T.K. Lim

Division of Respiratory and Critical Care Medicine, Dept of Medicine, National University Hospital, National University Health System, Singapore

T.K. Lim, Division of Respiratory and Critical Care MedicineDept of MedicineNational University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074. E-mail: tow_keang_lim{at}nuhs.edu.sg

Abstract

The primary objective of the present study was to evaluate the effect on hospital mortality of a delay in intensive care unit (ICU) admission for severe community-acquired pneumonia (CAP). The secondary objectives were to assess if such delays were associated with treatment variations by the emergency department (ED) and deterioration in the general wards, and to evaluate the prognostic ability of the Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria.

We retrospectively compared patients who were admitted straight from the ED to the ICU (direct group, n = 54) and those who were first admitted from the ED to the general wards before ICU transfer (delayed group, n = 49), over 2.5 yrs.

Even after excluding patients who required mechanical ventilation and/or vasopressors at the ED, delayed ICU admission was an independent predictor of hospital mortality (OR 9.61). The delayed group received fewer fluid boluses in the ED and rapidly deteriorated in the general wards. The presence of ≥3 IDSA/ATS minor criteria was associated with increased mortality in the delayed group.

In conclusion, prompt recognition of severe CAP using the IDSA/ATS minor criteria, followed by aggressive management at the ED and direct ICU admission, are all crucial toward improving outcomes.

abstract

http://erj.ersjournals.com/content/36/4/826.abstract

 

October 9, 2010 at 5:34 pm Leave a comment


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