Archive for March, 2014

Epidemiology and outcome of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) in Canadian hospitals.

PLoS One. 2013 Sep 17;8(9):e75171.

Tadros M1, Williams V, Coleman BL, McGeer AJ, Haider S, Lee C, Iacovides H, Rubinstein E, John M, Johnston L, McNeil S, Katz K, Laffin N, Suh KN, Powis J, Smith S, Taylor G, Watt C, Simor AE.

1University of Toronto, Toronto, Ontario, Canada.



MRSA remains a leading cause of hospital-acquired (HAP) and healthcare-associated pneumonia (HCAP). We describe the epidemiology and outcome of MRSA pneumonia in Canadian hospitals, and identify factors contributing to mortality.


Prospective surveillance for MRSA pneumonia in adults was done for one year (2011) in 11 Canadian hospitals. Standard criteria for MRSA HAP, HCAP, ventilator-associated pneumonia (VAP), and community-acquired pneumonia (CAP) were used to identify cases. MRSA isolates underwent antimicrobial susceptibility testing, and were characterized by pulsed-field gel electrophoresis (PFGE) and Panton-Valentine leukocidin (PVL) gene detection. The primary outcome was all-cause mortality at 30 days. A multivariable analysis was done to examine the association between various host and microbial factors and mortality.


A total of 161 patients with MRSA pneumonia were identified: 90 (56%) with HAP, 26 (16%) HCAP, and 45 (28%) CAP; 23 (14%) patients had VAP. The mean (± SD) incidence of MRSA HAP was 0.32 (± 0.26) per 10,000 patient-days, and of MRSA VAP was 0.30 (± 0.5) per 1,000 ventilator-days. The 30-day all-cause mortality was 28.0%. In multivariable analysis, variables associated with mortality were the presence of multiorgan failure (OR 8.1; 95% CI 2.5-26.0), and infection with an isolate with reduced susceptibility to vancomycin (OR 2.5, 95% CI 1.0-6.3).


MRSA pneumonia is associated with significant mortality. Severity of disease at presentation, and infection caused by an isolate with elevated MIC to vancomcyin are associated with increased mortality. Additional studies are required to better understand the impact of host and microbial variables on outcome.


March 31, 2014 at 8:22 pm

The effect of antibiotic therapy on the incidence of Staphylococcus aureus infections in orthopaedic patients.

Ortop Traumatol Rehabil. 2007 Sep-Oct;9(5):532-47.

Dzwonkowska J1, Kurlenda J, Baczkowski B, Mazurkiewicz S, Uzunov I, Ziółkowski W, Markowicz A.

1Hand Surgery Department, Department of Orthopaedics and Musculoskeletal Traumatology, Medical University, Gdañsk.



This paper reports on aetiological factors, including mostly S. aureus infections, and antibiotic use in the pretreatment and treatment of complicating infections in patients hospitalised at the Department of Orthopaedics and Musculoskeletal Traumatology, Gdańsk Medical University, between 1995 and 2004. The analysis sought to establish a correlation, via statistical analysis, between the usage of specific antibiotic classes, with special regard to lincosamides, and S. aureus infection rates.


The study population included 22,686 patients admitted for elective surgery (accounting for 86.9% to 75.1% of the sample in different years) or with acute injuries.


The rate of infections ranged from 2.79% to 1%, decreasing in a statistically significant manner over time. S. aureus was the dominant pathogen, accounting for 67.3% to 27.6% of the total number of bacterial strains. During the time frame of the study, the incidence of osteitis fell considerably, from 0.8% to 0.05% of the total number of patients. This was paralleled by a major increase in the use of lincosamides, mostly clindamycin. The increase in lincosamide use correlated with the decreasing incidence of S. aureus infections.


The statistical outcome of this 10-year study has been used to develop schemes of antibiotic therapy in the Department, a necessary component of the Hospital’s economic policy at the moment.A major fall in the incidence of nosocomial infections can be achieved by focussing on adequate antibiotic prophylaxis, pretreatment and appropriate treatment of acute infections.



March 30, 2014 at 4:27 pm

The role of prophylactic antibiotics in open fractures in an era of community-acquired methicillin-resistant Staphylococcus aureus.

Orthopedics. 2011 Aug;34(8):611-6

Saveli CC1, Belknap RW, Morgan SJ, Price CS.

1University of Colorado, Aurora, Colorado 80045, USA.


Infection is a feared complication and a common cause of loss of function following open fractures. Despite the evidence supporting the administration of prophylactic antibiotics after open fractures, data demonstrating the optimal regimen is lacking.

We reviewed the data supporting the current prophylaxis recommendations and the changing epidemiology of Staphylococcus aureus, the most common cause of surgical site infection in patients with open fractures.

Although widespread emergence of methicillin-resistant Staphylococcus aureus (MRSA) has been described in both hospital and community settings, to date, no studies have addressed the need for prophylaxis against MRSA in patients with open fractures.

Until well-designed randomized trials are conducted, we recommend that providers consider selecting antibiotics active against MRSA for open fracture prophylaxis based on the local prevalence of MRSA carriage and individualized risk factors.




March 30, 2014 at 4:24 pm

What You Should Know for the 2013-2014 Influenza Season

Centers for Disesease Control and Prevention CDC

CDC Influenza News and Highlights March 28, 2014


On this page:

When did flu activity peak?

Who was most severely impacted by flu this season?

How many children died from the flu this season?

Are new flu viruses circulating this season?

How well is the vaccine working this season?

Should I still get vaccinated since flu season has started?

Is vaccine still available?

Where can I get a flu vaccine?

Should I still get vaccinated even if I have already gotten sick with the flu?

What kind of vaccines will be available in the United States for 2013-2014?

What flu viruses does this season’s vaccine protect against?

How long does a flu vaccine protect me from getting the flu?

Can I get vaccinated and still get the flu?

Has CDC received reports of people who have gotten a flu vaccine and then tested positive for flu?

Is this season’s vaccine a good match for circulating viruses?

How do we know if there is a good match between the vaccine viruses and those causing illness?

Can the vaccine provide protection even if the vaccine is not a good match?

What will CDC do to monitor vaccine effectiveness for the 2013-2014 season?

Where can I find information about vaccine supply?

Is there treatment for the flu?

What is antiviral resistance?

What will CDC do to monitor antiviral resistance in the United States during the 2013-2014 season?

Has CDC received reports of antiviral resistant flu viruses during the 2013-2014 season?

Has CDC recommended any changes to the current guidance on the use of antivirals for the 2013-2014 flu season?

What can people do to protect themselves against antiviral resistant flu viruses this season?

What is CDC doing in response to antiviral resistant flu viruses detected this season?

How do I know if I have seasonal influenza, H7N9 influenza, or MERS-CoV (Middle Eastern Respiratory Syndrome Coronavirus)?

What are the challenges doctors face in identifying and distinguishing between cases of seasonal flu, avian influenza A (H7N9) and MERS-CoV this season?



March 30, 2014 at 12:37 pm

Carbapenem-resistant Enterobacteriaceae – Epidemiology and prevention.

Clin Infect Dis 2011 Jul 1; 53(1) :60-7.

Gupta N, Limbago BM, Patel JB, et al.

Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-35, Atlanta, GA 30333, USA.

Over the past 10 years, dissemination of Klebsiella pneumoniae carbapenemase (KPC) has led to an increase in the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the United States.

Infections caused by CRE have limited treatment options and have been associated with high mortality rates. In the previous year, other carbapenemase subtypes, including New Delhi metallo-β-lactamase, have been identified among Enterobacteriaceae in the United States.

Like KPC, these enzymes are frequently found on mobile genetic elements and have the potential to spread widely. As a result, preventing both CRE transmission and CRE infections have become important public health objectives.

This review describes the current epidemiology of CRE in the United States and highlights important prevention strategies.



March 30, 2014 at 12:35 pm

Ciprofloxacin Resistance and Gonorrhea Incidence Rates in 17 Cities, United States, 1991–2006

Emerging Infectious Diseases April 2014 V.20 N.4

Harrell W. ChessonComments to Author , Robert D. Kirkcaldy, Thomas L. Gift, Kwame Owusu-Edusei, and Hillard S. Weinstock

Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Antimicrobial drug resistance can hinder gonorrhea prevention and control efforts.

In this study, we analyzed historical ciprofloxacin resistance data and gonorrhea incidence data to examine the possible effect of antimicrobial drug resistance on gonorrhea incidence at the population level.

We analyzed data from the Gonococcal Isolate Surveillance Project and city-level gonorrhea incidence rates from surveillance data for 17 cities during 1991–2006.

We found a strong positive association between ciprofloxacin resistance and gonorrhea incidence rates at the city level during this period. Their association was consistent with predictions of mathematical models in which resistance to treatment can increase gonorrhea incidence rates through factors such as increased duration of infection.

These findings highlight the possibility of future increases in gonorrhea incidence caused by emerging cephalosporin resistance.


March 29, 2014 at 11:11 am

Influenza Antiviral Drug Resistance – Questions & Answers

Centers for Disesease Control and Prevention CDC

CDC Influenza News and Highlights March 28, 2014

On this Page

What is antiviral resistance?

How does antiviral resistance happen?

How is antiviral resistance detected?

What is oseltamivir resistance?

What causes oseltamivir resistance?

How does CDC improve monitoring of influenza viruses for antiviral resistance?

How is this surveillance information used?

How did influenza antiviral resistance patterns change during the 2012-2013 influenza season?

What antiviral drugs are recommended for use during the 2013-2014 flu season?

What can people do to protect themselves against antiviral resistant flu viruses?

What implications does antiviral resistance have for the U.S. antiviral stockpile that was created as part of the United States pandemic plans?


March 29, 2014 at 11:07 am

Correlación entre los niveles de biomarcadores inflamatorios y cardiovasculares con los índices de severidad de neumonía

Enf Inf & Microb Clin. Marzo 2014 V.32 N.3 P.140-146

Alicia Lacoma, Albert Bas, Pere Tudela, Montse Giménez, Josep Maria Mòdol, Miguel Pérez, Vicente Ausina, Jose Dominguez, Cristina Prat-Aymerich

a Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autonòma de Barcelona, Badalona, Spain

b CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain

c Unitat de Curta Estada-Urgències, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autonòma de Barcelona, Badalona, Spain


To assess the correlation of procalcitonin (PCT), C-reactive protein (CRP), neopterin, mid-regional pro-atrial natriuretic peptide (MR-proANP), and mid-regional pro-adrenomedullin (MR-proADM) with severity risk scores: severe CAP (SCAP) and SMART-COP in patients with community-acquired pneumonia (CAP), as well as short term prognosis and to determine the correlation with mortality risk scores.


Eighty-five patients with a final diagnosis of pneumonia were consecutively included during a two month period. Epidemiological, clinical, microbiological, and radiological data were recorded. Patients were stratified according to the PSI, CURB-65, SCAP and SMART-COP. Complications were defined as respiratory failure/shock, need of ICU, and death. Plasma samples were collected at admission.


MR-proANP and MR-proADM showed significantly higher levels in high risk SCAP group in comparison to low risk. When considering SMART-COP none of the biomarkers showed statistical differences. MR-proADM levels were high in patients with high risk of needing intensive respiratory or vasopressor support according to SMRT-CO. Neopterin and MR-proADM were significantly higher in patients that developed complications. PCT and MR-proADM showed significantly higher levels in cases of a definite bacterial diagnosis in comparison to probable bacterial, and unknown origin. MR-proANP and MR-proADM levels increased statistically according to PSI and CURB-65.


Biomarker levels are higher in pneumonia patients with a poorer prognosis according to SCAP and SMART-COP indexes, and to the development of complications.



March 29, 2014 at 11:04 am

Spread of Virulent Group A Streptococcus Type emm59 from Montana to Wyoming, USA

Emerging Infectious Diseases April 2014 V.20 N.4

Christopher C. Brown1, Randall J. Olsen, Nahuel Fittipaldi, Monica L. Morman, Peter L. Fort, Robert Neuwirth, Mohammed Majeed, William B. Woodward, and James M. Musser

Campbell County Memorial Hospital, Gillette, Wyoming, USA (C.C. Brown, M.L. Morman, P. Fort, R. Neuwirth, M. Majeed, W.B. Woodward); Houston Methodist Research Institute, Houston, Texas, USA (R.J. Olsen, J.M. Musser); Houston Methodist Hospital System, Houston (R.J. Olsen, J.M. Musser); Public Health Ontario, Toronto, Ontario, Canada (N. Fittipaldi); University of Toronto, Toronto (N. Fittipaldi)

Full-genome sequencing showed that a recently emerged and hypervirulent clone of group A Streptococcus type emm59 active in Canada and parts of the United States has now caused severe invasive infections in rural northeastern Wyoming. Phylogenetic analysis of genome data indicated that the strain was likely introduced from Montana.



March 28, 2014 at 2:41 pm

Elizabethkingia meningoseptica: Emerging nosocomial pathogen in bedside hemodialysis patients.

Indian J Crit Care Med. 2013 Sep;17(5):304-7.

Ratnamani MS1, Rao R.

1Department of Microbiology, Apollo Hospitals, Hyderabad, Andhra Pradesh, India.


Elizabethkingia meningoseptica, a ubiquitous gram-negative aerobic bacillus, is an emerging hospital acquired pathogen in patients on dialysis. It has been isolated in the hospital environment in water supplies, disinfectants, and medical devices. We present here an analysis of eight healthcare-acquired infections with this organism in adults. To the best of our our knowledge, this is the first report of infections with this organism in patients on hemodialysis.


Over a 6-month period, eight patients were infected with E. meningoseptica in our hospital. These patients had bacteremia and lower respiratory tract infection. All these patients were on on mechanical ventilation and undergoing bedside hemodialysis in the intensive care unit (ICU). Environmental surveillance was done to detect the possible source.


These patients had a common denominator of bedside hemodialysis, and use of broad-spectrum antibiotics. E. meningoseptica was isolated from the water and sink of the ICU.


E. meningoseptica is emerging as a nosocomial pathogen among patients on hemodialysis. Its unusual resistance pattern coupled with inherent resistance to colistin makes this organism difficult to treat unless susceptibility patterns are available. Isolation of this organism in handwash sink and water is a significant finding as they have been reported to survive in chlorinated water. Disinfecting the sinks and using filtered water for hand washing in critical areas may help in preventing infections with this organism.


March 28, 2014 at 2:39 pm

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