Archive for December, 2014

Fatal Legionellosis after Water Birth, Texas, USA, 2014

Emerging Infectious Diseases January 2015 V.21 N.1 P.130-132

Elyse Fritschel, Kay Sanyal, Heidi Threadgill, and Diana Cervantes

Texas Department of State Health Services, Arlington, Texas, USA

In 2014, a fatal infection with Legionella pneumophila serogroup 1 occurred in a neonate after a water birth. The death highlighted the need for infection control education, client awareness, and standardization of cleaning procedures in Texas midwife facilities …


December 30, 2014 at 3:51 pm

Severe Ebola virus disease with vascular leakage and multiorgan failure -Treatment of a patient in intensive care. / Ebola – The battle plan must include specific treatments.

Lancet 2014 Dec 19; [e-pub ahead of print].

Severe Ebola virus disease with vascular leakage and multiorgan failure -Treatment of a patient in intensive care. 

Wolf T et al.




Lancet 2014 Dec 19; [e-pub ahead of print].

Ebola – The battle plan must include specific treatments.

Dunning J and Fischer W II.



December 25, 2014 at 12:23 pm

Infectious prosthetic hip joint loosening: bacterial species involved in its aetiology and their antibiotic resistance profiles against antibiotics recommended for the therapy of implant-associated infections.

New Microbiol. 2014 Apr;37(2):209-18.

Bogut A1, Niedźwiadek J, Strzelec-Nowak D, Blacha J, Mazurkiewicz T, Marczyński W, Kozioł-Montewka M.

Author information

1Department of Medical Microbiology, Medical University of Lublin, Poland.


Reliable microbiological diagnosis along with surgery and prolonged antibiotic therapy are key elements in the management of prosthetic-joint infections (PJIs).

The purpose of this study was to characterize antibiotic resistance profiles of bacteria involved in the aetiology of PJIs.

A total of 33 bacterial isolates cultured from 31 patients undergoing exchange of total hip prostheses were analyzed.

The diagnostic approach toward isolation of prosthesis- associated microorganisms included sonication of retrieved implants and conventional cultures of periprosthetic tissues and synovial fluid.

The in vitro resistance profiles of bacterial isolates were determined in relation to antibiotics recommended for the therapy of PJIs using the disc diffusion method, E-tests(®) and broth microdilution system.

Coagulase-negative staphylococci (CNS) were predominant microorganisms followed by Staphylococcus aureus, Enterobacter cloacae, Streptococcus mitis, and Propionibacterium acnes.

Twenty out of 30 and 12 out of 30 staphylococcal isolates were methicillin- and multi-drug resistant, respectively. Only two isolates were rifampicinresistant. All staphylococci were susceptible to glycopeptides and linezolid.

This paper stresses the pathogenic role of staphylococci in patients suffering from implant loosening and reports high methicillin- and multidrug-resistance rates in these bacteria.

Hence, antimicrobial susceptibility tests of individual bacterial isolates must always be performed to guide selection of the optimal therapeutic option.



2014-04 Infectious prosthetic hip joint loosening

December 24, 2014 at 7:51 pm

Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia.

Am J Respir Crit Care Med. 2004 Aug 15;170(4):440-4.

Baddour LM1, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, Morris AJ, Luna CM, Snydman DR, Ko WC, Chedid MB, Hui DS, Andremont A, Chiou CC; International Pneumococcal Study Group.

Author information

1Mayo Clinic, Rochester, NY, USA.


Retrospective studies have suggested that combination antibiotic therapy for severe bacteremic pneumococcal pneumonia may reduce mortality.

We assessed this issue in a prospective, multicenter, international observational study of 844 adult patients with bacteremia due to Streptococcus pneumoniae.

The effect of combination antibiotic therapy versus monotherapy on mortality was examined by univariate analyses and by logistic regression models.

The 14-day mortality was not significantly different for the two groups. However, among critically ill patients, combination antibiotic therapy was associated with lower 14-day mortality (23.4 versus 55.3%, p = 0.0015).

This improvement in survival was independent of country of origin, intensive care unit support, class of antibiotics, or in vitro activity of the antibiotics prescribed.

Combination antibiotic therapy improved survival among critically ill patients with bacteremic pneumococcal illness.


December 24, 2014 at 7:46 pm

Community acquired pneumonia. New guidelines of the Spanish Society of Chest Diseases and Thoracic Surgery (SEPAR).

Arch Bronconeumol. 2010 Oct;46(10):543-58.

Menéndez R1, Torres A, Aspa J, Capelastegui A, Prat C, Rodríguez de Castro F; Sociedad Española de Neumología y Cirugía Torácica.

Author information

1Hospital Universitario La Fe, Valencia, CIBERES, España.


December 24, 2014 at 7:43 pm

Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods.

Clin Infect Dis. 2010 Jan 15;50(2):202-9.

Johansson N1, Kalin M, Tiveljung-Lindell A, Giske CG, Hedlund J.

Author information

1Department of Medicine, Karolinska Institutet, Stockholm, Sweden.



The microbial etiology of community-acquired pneumonia (CAP) is still not well characterized. During the past few years, polymerase chain reaction (PCR)-based methods have been developed for many pathogens causing respiratory tract infections. The aim of this study was to determine the etiology of CAP among adults-especially the occurrence of mixed infections among patients with CAP-by implementing a new diagnostic PCR platform combined with conventional methods.


Adults admitted to Karolinska University Hospital were studied prospectively during a 12-month period. Microbiological testing methods included culture from blood, sputum, and nasopharyngeal secretion samples; sputum samples analyzed by real-time quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; nasopharyngeal specimens analyzed by use of PCR; serological testing for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses common in the respiratory tract; and urine antigen assays for detection of pneumococcal and Legionella pneumophila antigens.


A microbial etiology could be identified for 67% of the patients (n = 124). For patients with complete sampling, a microbiological agent was identified for 89% of the cases. The most frequently detected pathogens were S. pneumoniae (70 patients [38%]) and respiratory virus (53 patients [29%]). Two or more pathogens were present in 43 (35%) of 124 cases with a determined etiology.


By supplementing traditional diagnostic methods with new PCR-based methods, a high microbial yield was achieved. This was especially evident for patients with complete sampling.

Mixed infections were frequent (most commonly S. pneumoniae together with a respiratory virus).


December 24, 2014 at 7:40 pm

Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia.

Clin Infect Dis. 2003 Dec 15;37(12):1617-24.

Mortensen EM1, Kapoor WN, Chang CC, Fine MJ.

Author information

1Division of General Internal Medicine, Department of Medicine, and Center for Research on Health Care, University of Pittsburgh, Pennsylvania, USA.


Although studies have assessed short-term mortality among patients with community-acquired pneumonia, there is limited data on prognosis and risk factors that affect long-term mortality.

The mortality among patients enrolled at 4 sites of the Pneumonia Patient Outcome Research Team cohort study who survived at least 90 days after presentation to the hospital was compared with that among age-matched control subjects.

Overall, 1419 of 1555 patients survived for >90 days, with a mean follow-up period of 5.9 years. There was significantly higher long-term mortality among patients with pneumonia than among age-matched controls.

Factors significantly associated with long-term mortality were age (stratified by decade), do-not-resuscitate status, poor nutritional status, pleural effusion, glucocorticoid use, nursing home residence, high school graduation level or less, male sex, preexisting comorbid illnesses, and the lack of feverishness.

This study demonstrates that there is significantly higher long-term mortality among patients with pneumonia than among age-matched controls and that long-term mortality largely is not affected by acute physiologic derangements.


December 24, 2014 at 7:36 pm

Carbapenem-Resistance in Gram-Negative Bacilli and Intravenous Minocycline: An Antimicrobial Stewardship Approach at the Detroit Medical Center

Clinical Infectious Diseases November 15, 2014 V.59 N.10 S388-S393

Jason M. Pogue1,2, Anupama Neelakanta2, Ryan P. Mynatt3, Sarit Sharma2, Paul Lephart2,4, and Keith S. Kaye2,5

1Department of Pharmacy, Sinai-Grace Hospital, Detroit Medical Center

2Wayne State University School of Medicine, Detroit

3Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center

4Detroit Medical Center University Laboratories

5Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Michigan

Correspondence: Jason M. Pogue, PharmD, BCPS-ID, Clinical Pharmacist, Infectious Diseases, Sinai-Grace Hospital; Detroit Medical Center, Clinical Assistant Professor of Medicine, Wayne State University School of Medicine, 6071 W Outer Dr, Detroit, MI 48235 (

In the era of carbapenem-resistance in Acinobacter baumannii and Enterobacteriaceae, there are limited treatment options for these pathogens. It is essential that clinicians fully assess all available therapeutic alternatives for these multidrug-resistant organisms.

We herein describe the approach of the antimicrobial stewardship team at the Detroit Medical Center (DMC) for the evaluation and use of intravenous (IV) minocycline for the treatment of these resistant organisms, given potential advantages of IV minocycline over tigecycline and doxycycline.

In vitro analyses at the DMC demonstrated good activity against A. baumannii (78% susceptibility), including 74% of carbapenem-resistant strains, but limited activity against our carbapenem-resistant K.pneumoniae (12% susceptibility.) Based in part on these results, IV minocycline was added to the formulary, primarily for the treatment of carbapenem-resistant A. baumannii.

Early experience has been positive: 6/9 (67%) of patients who received IV minocycline had infections due to these organisms cured, including 6/7 (86%) who received doses of 200 mg twice daily.


December 23, 2014 at 4:01 pm

Guidelines for the management of adult lower respiratory tract infections.

Clin Microbiol Infect. 2011 Nov;17 Suppl 6:E1-59.

Woodhead M1, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJ; Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases.

Author information

1Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK.


This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010.

It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI.

Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention.

Background sections and graded evidence tables are also included.

The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.



December 23, 2014 at 3:54 pm

Clinical Care of Two Patients with Ebola Virus Disease in the United States

N Engl J of Medicine Dec.18, 2014 V.371 P.2402-2409

Brief Report

Marshall Lyon, M.D., M.M.Sc., Aneesh K. Mehta, M.D., Jay B. Varkey, M.D., Kent Brantly, M.D., Lance Plyler, M.D., Anita K. McElroy, M.D., Ph.D., Colleen S. Kraft, M.D., Jonathan S. Towner, Ph.D., Christina Spiropoulou, Ph.D., Ute Ströher, Ph.D., Timothy M. Uyeki, M.D., M.P.H., M.P.P., and Bruce S. Ribner, M.D., M.P.H. for the Emory Serious Communicable Diseases Unit

West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history.

Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD.

The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities.

We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction.

As the patients’ condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma…


December 20, 2014 at 7:55 pm

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