Archive for August 16, 2015

The Times They Are a-Changin’: Carbapenems for Extended-Spectrum-β-Lactamase-Producing Bacteria

Antimicrobial Agents and Chemotherapy Sept 2015 V.59 N.9 P.5095-5096


Jesús Rodríguez-Baño

aUnidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena and Virgen del Rocío, Seville, Spain

bDepartamento de Medicina, Universidad de Sevilla, Seville, Spain

Several antimicrobial agents are being investigated as alternatives to carbapenems in the treatment of infections caused by ESBL-producing Enterobacteriaceae, which may be useful in avoiding overuse of carbapenems in the context of recent global spread of carbapenem-resistant Enterobacteriaceae.

The most promising candidates for invasive infections so far are β-lactam/β-lactamase inhibitor combinations and cephamycins.



August 16, 2015 at 6:36 pm

Noninvasive Streptococcus pneumoniae Serotypes Recovered from Hospitalized Adult Patients in the United States in 2009 to 2012

Antimicrobial Agents and Chemotherapy Sept 2015 V.59 N.9 P.5595-5601

Rodrigo E. Mendes, Rosalind C. Hollingsworth, Andrew Costello, Ronald N. Jones, Raul E. Isturiz, Dial Hewlett Jr., and David J. Farrell

aJMI Laboratories, North Liberty, Iowa, USA

bPfizer Inc., Specialty Care—Medicines Development Group, Collegeville, Pennsylvania, USA

This study was conducted to determine the serotype distribution and trends over time of Streptococcus pneumoniae strains associated with noninvasive infections among adult patients ≥18 years of age in the United States (2009 to 2012). A total of 2,927 S. pneumoniae isolates recovered from patients presenting with respiratory infections and obtained mainly (87.0%) from lower respiratory tract specimens (sputum) were included.

The levels of the 7-valent pneumococcal conjugate vaccine (PCV7) serotypes remained stable over the 4-year study period (4.6% to 5.5%; P = 0.953).

Overall, 13-valent pneumococcal conjugate vaccine (PCV13) serotypes were identified in 32.7% of samples, declining from 33.7% to 35.5% in 2009 to 2011 to 28.2% in 2012 (P = 0.007), with a significant decrease in the levels of serotypes 7F (P = 0.013) and 6A (P = 0.010). The levels of 19A remained constant (15.8% to 17.1%) during 2009 to 2011, dropping to 12.2% in 2012 (P = 0.089).

The prevalence of serotypes associated with the 23-valent pneumococcal polysaccharide vaccine (PPSV23), but not PCV13, remained generally stable; however, the prevalence of serotypes 15B and 15C (15B/15C) increased from 2.7% to 6.3% (P = 0.010).

The proportion of nonvaccine serotypes increased gradually during the study period (P = 0.044), particularly for serotype 35B (from 3.6% in 2009 to 8.2% in 2012; P = 0.001). Nonsusceptibility rates for penicillin (susceptible breakpoint, ≤2 μg/ml) and clindamycin against PCV7 serotypes decreased over the period.

These results suggest the emergence of indirect effects following introduction of PCV13 for infants and young children; continued surveillance is needed to assess the burden of PCV13 serotypes in the adult population after the implementation of age-based recommendations in the United States.



August 16, 2015 at 6:35 pm

Multicenter Retrospective Study of Cefmetazole and Flomoxef for Treatment of Extended-Spectrum-β-Lactamase-Producing Escherichia coli Bacteremia

Antimicrobial Agents and Chemotherapy Sept 2015 V.59 N.9 P.5107-5113

Yasufumi Matsumura, Masaki Yamamoto, Miki Nagao, Toshiaki Komori, Naohisa Fujita, Akihiko Hayashi, Tsunehiro Shimizu, Harumi Watanabe, Shoichi Doi, Michio Tanaka, Shunji Takakura, and Satoshi Ichiyama

aDepartment of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

bDepartment of Infection Control and Clinical Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan

cDepartment of Clinical Laboratory, Kyoto City Hospital, Kyoto, Japan

dDepartment of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan

eDepartment of Clinical Laboratory, Kyoto-Katsura Hospital, Kyoto, Japan

fDivision of Hematology, Department of Internal Medicine, Kyoto-Katsura Hospital, Kyoto, Japan

The efficacy of cefmetazole and flomoxef (CF) for the treatment of patients with extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) bacteremia (ESBL-CF group) was compared with that of carbapenem treatment for ESBL-EC patients (ESBL-carbapenem group) and with that of CF treatment in patients with non-ESBL-EC bacteremia (non-ESBL-CF group).

Adult patients treated for E. coli bacteremia in four hospitals were retrospectively evaluated. The 30-day mortality rates in patients belonging to the ESBL-CF, ESBL-carbapenem, and non-ESBL-CF groups were compared as 2 (empirical and definitive therapy) cohorts.

The adjusted hazard ratios (aHRs) for mortality were calculated using Cox regression models with weighting according to the inverse probability of propensity scores for receiving CF or carbapenem treatment. The empirical-therapy cohort included 104 patients (ESBL-CF, 26; ESBL-carbapenem, 45; non-ESBL-CF, 33), and the definitive-therapy cohort included 133 patients (ESBL-CF, 59; ESBL-carbapenem, 54; non-ESBL-CF, 20). The crude 30-day mortality rates for patients in the ESBL-CF, ESBL-carbapenem, and non-ESBL-CF groups were, respectively, 7.7%, 8.9%, and 3.0% in the empirical-therapy cohort and 5.1%, 9.3%, and 5.0% in the definitve-therapy cohort.

In patients without hematological malignancy and neutropenia, CF treatment for ESBL-EC patients was not associated with mortality compared with carbapenem treatment (empirical-therapy cohort: aHR, 0.87; 95% confidence interval [CI], 0.11 to 6.52; definitive therapy cohort: aHR, 1.04; CI, 0.24 to 4.49).

CF therapy may represent an effective alternative to carbapenem treatment for patients with ESBL-EC bacteremia for empirical and definitive therapy in adult patients who do not have hematological malignancy and neutropenia.



August 16, 2015 at 6:33 pm

Cat-scratch disease: a wide spectrum of clinical pictures.

Postepy Dermatol Alergol. 2015 Jun;32(3):216-20.

Mazur-Melewska K1, Mania A1, Kemnitz P1, Figlerowicz M1, Służewski W1.

Author information

1Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland. Head of the Department: Prof. Wojciech Służewski MD, PhD.


The aim of this review is to present an emerging zoonotic disease caused by Bartonella henselae.

The wide spectrum of diseases connected with these bacteria varies from asymptomatic cases, to skin inflammation, fever of unknown origin, lymphadenopathy, eye disorders, encephalitis and endocarditis.

The reservoirs of B. henselae are domestic animals like cats, guinea pigs, rabbits and occasionally dogs. Diagnosis is most often based on a history of exposure to cats and a serologic test with high titres of the immunoglobulin G antibody to B. henselae.

Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment. If an antibiotic is chosen, however, azithromycin has been shown to speed recovery.


August 16, 2015 at 10:53 am

Cat-scratch Disease.

Am Fam Physician. 2011 Jan 15;83(2):152-5.

Klotz SA1, Ianas V, Elliott SP.

Author information

1University of Arizona, Tucson, 85724, USA.


Cat-scratch disease is a common infection that usually presents as tender lymphadenopathy. It should be included in the differential diagnosis of fever of unknown origin and any lymphadenopathy syndrome.

Asymptomatic, bacteremic cats with Bartonella henselae in their saliva serve as vectors by biting and clawing the skin. Cat fleas are responsible for horizontal transmission of the disease from cat to cat, and on occasion, arthropod vectors (fleas or ticks) may transmit the disease to humans.

Cat-scratch disease is commonly diagnosed in children, but adults can present with it as well. The causative microorganism, B. henselae, is difficult to culture.

Diagnosis is most often arrived at by obtaining a history of exposure to cats and a serologic test with high titers (greater than 1:256) of immunoglobulin G antibody to B. henselae. Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment.

If an antibiotic is chosen, azithromycin has been shown in one small study to speed recovery.

Infrequently, cat-scratch disease may present in a more disseminated form with hepatosplenomegaly or meningoencephalitis, or with bacillary angiomatosis in patients with AIDS.


August 16, 2015 at 10:51 am


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