Archive for July 21, 2013

Inducible clindamycin resistance in β-hemolytic streptococci and Streptococcus pneumoniae.

Isr Med Assoc J. 2013 Jan;15(1):27-30.

Megged O, Assous M, Weinberg G, Schlesinger Y.

Source

Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, affiliated with Hadassah-Hebrew University Medical School, Jerusalem, Israel. orlimegged@szmc.org.il

Abstract

BACKGROUND:

Resistance to macrolides in beta-hemolytic streptococci and Streptococcus pneumoniae arises primarily due to Erm(B) or Mef(A). Erm(B) typically confers high level resistance to macrolides, lincosamides and streptogramin B (MLSB phenotype), whereas Mef(A) confers low level resistance to macrolides only (M phenotype).

OBJECTIVES:

To investigate the incidence of macrolide resistance mechanisms in isolates of beta-hemolytic streptococci and pneumococci in Israel, with particular emphasis on inducible MLSB phenotype.

METHODS:

We collected 316 clinical isolates of streptococci during May-August 2010. Erythromycin resistance mechanism was determined by the erythromycin-clindamycin double disk diffusion method.

RESULTS:

Erythromycin and clindamycin resistance rates were 19.4% and 13.4% for S. pneumoniae, 4.7% and 1.6% for group A Streptococcus (GAS), 17% and 17% for group B Streptococcus (GBS), and 38.8% and 27.8% for group G Streptococcus (GGS) respectively. The most common resistance mechanism for all streptococci was constitutive MLSB (cMLSB). Inducible MLSs (iMLSB) mechanism was found in 3% of all strains and represented 25% of resistance mechanisms.

CONCLUSIONS : The prevalence of macrolide resistance and the distribution of resistance mechanisms differ among beta-hemolytic streptococci and S. pneumoniae, with GBS, GGS and S. pneumoniae showing the highest resistance rate. Macrolide or lincosamide cannot be empirically used for severe streptococcal infections before strains are proved to be susceptible. Continuous surveillance of erythromycin and clindamycin resistance patterns among streptococci is needed.

PDF

http://www.ima.org.il/FilesUpload/IMAJ/0/48/24199.pdf

July 21, 2013 at 12:11 pm

Candida: Epidemiology and risk factors for non-albicans species.

Enferm Infecc Microbiol Clin. 2012 Nov 19.

Article in Spanish

Cornistein W, Mora A, Orellana N, Capparelli FJ, Del Castillo M.

Source

Servicio de Infectología, Fundación para la Lucha de las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina. Electronic address: wcornistein@fleni.org.ar.

Abstract

INTRODUCTION:

Nosocomial fungal infections have increased significantly in the last decade. Candida detection in clinical specimens can mean either colonization or an infection which can be local (muguet) or invasive. Knowledge of the species helps in choosing the best treatment. The aims of this study were to determine the frequency and distribution of Candida species detected in clinical samples, to analyze the clinical characteristics of the involved population and to determine the risk factors for Candida non-albicans species.

METHODS:

Retrospective, observational. Period: 2006-2010. Inclusion criteria: all isolates of Candida in clinical specimens from patients hospitalized -at least 48hours in a neurological center. We analyzed epidemiological characteristics, co morbidities, risk factors, factors associated with Candida non-albicans detection, antifungal treatment, development of adverse events and mortality.

RESULTS:

Candida spp. was isolated from 321 clinical specimens: 139 (43.3%) were C. albicans and 182 (56.7%) Candida non-albicans. The distribution of the sample was: urine 122 (Candida non-albicans 67.2%), airway 81, oropharynx 45 (C. albicans) and candidemia 40 (Candida non-albicans 75%). The most frequent co-morbidity was solid tumor (35.5%). The main risk factors were antibiotic therapy (85.5%), steroid therapy (61.7%) and in ICU at diagnosis (61.6%). The analysis of risk factors and the isolation of Candida non-albicans shows that chemotherapy, previous surgery, treatment with aminopenicillins, carbapenems and glycopeptides were statistically significant (P<.05). There is a trend in neutropenic patients (P=.055) and in ICU at diagnosis (P=.076). Overall survival was 71%.

CONCLUSIONS:

Candida species distribution varies with the type of sample analyzed. Non-albicans species make up the majority of the isolates. The identification of the species involved per sample helps to optimize treatment. The high frequency of isolation of Candida in patients on steroids and antibiotics and admitted to ICU, is worth pointing out. Patients with previous surgery, treated with the aforementioned antibiotics or chemotherapy, could receive non-azole antifungals in the initial empirical treatment strategy.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=19842&pident_usuario=0&pcontactid=&pident_revista=28&ty=6&accion=L&origen=elsevier&web=www.elsevier.es&lan=es&fichero=S0213-005X(12)00322-9.pdf&eop=1

 

July 21, 2013 at 12:09 pm

Frequency, severity, and prediction of tuberculous meningitis immune reconstitution inflammatory syndrome.

Clin Infect Dis. 2013 Feb;56(3):450-60.

Marais S, Meintjes G, Pepper DJ, Dodd LE, Schutz C, Ismail Z, Wilkinson KA, Wilkinson RJ.

Source

Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa. marais.suzaan@gmail.com

Abstract

BACKGROUND:

Tuberculosis immune reconstitution inflammatory syndrome (IRIS) is a common cause of deterioration in human immunodeficiency virus (HIV)-infected patients receiving tuberculosis treatment after starting antiretroviral therapy (ART). Potentially life-threatening neurological involvement occurs frequently and has been suggested as a reason to defer ART.

METHODS:

We conducted a prospective study of HIV-infected, ART-naive patients with tuberculous meningitis (TBM). At presentation, patients started tuberculosis treatment and prednisone; ART was initiated 2 weeks later. Clinical and laboratory findings were compared between patients who developed TBM-IRIS (TBM-IRIS patients) and those who did not (non-TBM-IRIS patients). A logistic regression model was developed to predict TBM-IRIS.

RESULTS:

Forty-seven percent (16/34) of TBM patients developed TBM-IRIS, which manifested with severe features of inflammation. At TBM diagnosis, TBM-IRIS patients had higher cerebrospinal fluid (CSF) neutrophil counts compared with non-TBM-IRIS patients (median, 50 vs 3 cells ×10(6)/L, P = .02). Mycobacterium tuberculosis was cultured from CSF of 15 TBM-IRIS patients (94%) compared with 6 non-TBM-IRIS patients (33%) at time of TBM diagnosis; relative risk of developing TBM-IRIS if CSF was Mycobacterium tuberculosis culture positive = 9.3 (95% confidence interval [CI], 1.4-62.2). The combination of high CSF tumor necrosis factor (TNF)-α and low interferon (IFN)-γ at TBM diagnosis predicted TBM-IRIS (area under the curve = 0.91 [95% CI, .53-.99]).

CONCLUSIONS:

TBM-IRIS is a frequent, severe complication of ART in HIV-associated TBM and is characterized by high CSF neutrophil counts and Mycobacterium tuberculosis culture positivity at TBM presentation. The combination of CSF IFN-γ and TNF-α concentrations may predict TBM-IRIS and thereby be a means to individualize patients to early or deferred ART

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540040/pdf/cis899.pdf

July 21, 2013 at 12:06 pm

Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence.

Patient Prefer Adherence. 2012;6:887-91.

Nachega JB, Morroni C, Chaisson RE, Goliath R, Efron A, Ram M, Maartens G.

Source

University of Cape Town, Department of Medicine, Division of Clinical Pharmacology, Cape Town, South Africa ; Johns Hopkins University, Bloomberg School of Public Health, Departments of International Health and Epidemiology, Baltimore, Maryland, USA ; Johns Hopkins University, Center for Tuberculosis Research, Baltimore, Maryland, USA.

Abstract

OBJECTIVE:

We determined the impact of immune reconstitution inflammatory syndrome (IRIS) on antiretroviral therapy (ART) adherence in a cohort of 274 human immunodeficiency virus (HIV)-infected South African adults initiating ART.

METHODS:

We carried out a secondary analysis of data from a randomized controlled trial of partially supervised ART in Cape Town, South Africa. Monthly pill count adherence, viral suppression (HIV viral load < 50 c/mL), and IRIS events were documented. Poisson regression was used to identify variables associated with ART adherence below the median in the first 6 months of ART.

RESULTS:

We enrolled 274 patients: 58% women, median age 34 years, median CD4 count 98 cells/μL, 46% World Health Organization clinical stage IV, and 40% on treatment for tuberculosis (TB). IRIS and TB-IRIS developed in 8.4% and 6.6% of patients, respectively. The median cumulative adherence at 6 months for those with an IRIS event vs no IRIS was 95.5% vs 98.2% (P = 0.04). Although not statistically significant, patients developing IRIS had a lower 6-month viral load suppression than those without IRIS (68% vs 80%, P = 0.32). ART adherence below the median of 98% was independently associated with alcohol abuse (relative risk [RR] 1.5; 95% confidence interval [CI] 1.2-1.9; P = 0.003) and IRIS events (RR 1.7; 95% CI 1.2-2.2; P = 0.001).

CONCLUSION:

Although IRIS events were associated with slightly lower adherence rates, overall adherence to ART remained high in this study population. Concerns about IRIS should not deter clinicians from early ART initiation.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526885/pdf/ppa-6-887.pdf

July 21, 2013 at 12:05 pm


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