Archive for July 14, 2018

Bloodstream infections in cancer patients. Risk factors associated with mortality

International Journal of Infectious Diseases June 2018 V.71 P.59-64

Beda Islas-Muñoz, Patricia Volkow-Fernández, Cynthia Ibanes-Gutiérrez, Alberto Villamar-Ramírez, Diana Vilar-Compte, Patricia Cornejo-Juárez


  • Bloodstream infections (BSI) cause severe complications in cancer patients.
  • Secondary BSI and central-related BSI were the most common in solid tumors.
  • Primary BSI and mucosal barrier injury BSI were described in hematological patients.
  • Mortality at 30-days was increased with multidrug resistant Gram-negative bacteria.
  • Inappropriate antimicrobial treatment in the first 24 h was related with mortality.


The aim of this study was to evaluate the clinical characteristics and risk factors associated with mortality in cancer patients with bloodstream infections (BSI), analyzing multidrug resistant bacteria (MDR).


We conducted a prospective observational study at a cancer referral center from August 2016 to July 2017, which included all BSI.


4220 patients were tested with blood cultures; 496 were included. Mean age was 48 years. In 299 patients with solid tumors, secondary BSI and Central Line-Associated BSI (CLABSI) were the most common (55.9% and 31.8%, respectively). In 197 hematologic patients, primary and mucosal barrier injury (MBI) BSI were the main type (38.6%). Gram-negative were the most frequent bacteria (72.8%), with Escherichia coli occupying the first place (n = 210, 42.3%), 48% were Extended-Spectrum Beta-Lactamase (ESBL) producers, and 1.8% were resistant to carbapenems. Mortality at day 30, was 22%, but reached 70% when patients did not receive an appropriate antimicrobial treatment. Multivariate analysis showed that progression or relapse of the oncologic disease, inappropriate antimicrobial treatment, and having resistant bacteria were independently associated with 30-day mortality.


Emergence of MDR bacteria is an important healthcare problem worldwide. Patients with BSI, particularly those patients with MDR bacteria have a higher mortality risk.


July 14, 2018 at 7:25 pm

Influence of multidrug resistant organisms on the outcome of diabetic foot infection

International Journal of Infectious Diseases May 2018 V.70 P.10-14

Nese Saltoglu, Onder Ergonul, Necla Tulek, Mucahit Yemisen, Ayten Kadanali, Gul Karagoz, Ayse Batirel, Oznur Ak, Cagla Sonmezer, Haluk Eraksoy, Atahan Cagatay, Serkan Surme, Salih A. Nemli, Tuna Demirdal, Omer Coskun, Derya Ozturk, Nurgul Ceran, Filiz Pehlivanoglu, Gonul Sengoz, Turan Aslan, Yasemin Akkoyunlu, Oral Oncul, Hakan Ay, Lutfiye Mulazımoglu, Buket Erturk, Fatma Yilmaz, Gulsen Yoruk, Nuray Uzun, Funda Simsek, Taner Yildirmak, Kadriye Kart Yaşar, Meral Sonmezoglu, Yasar Küçükardali, Nazan Tuna, Oguz Karabay, Nail Ozgunes, Fatma Sargın, Turkish Society of Clinical Microbiology and Infectious Diseases, Diabetic Foot Infections Study Group


We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms.


We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge.


In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19–90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82–38.15, p = 0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24–47.96, p = 0.028), and chronic heart failure (OR: 3, CI: 1.01–9.04, p = 0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p < 0.001).


Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.


July 14, 2018 at 7:19 pm

Healthcare-associated sepsis and the role of clean hands: When we do not see the trees for the forest

International Journal of Infectious Diseases May 2018 V.70 P.101-103


Healthcare-associated sepsis and the role of clean hands: When we do not see the trees for the forest

Alexandra Peters, Sarah Masson-Roy, Didier Pittet

As of this past year, sepsis has been redefined as a “life threatening organ dysfunction caused by a deregulated host response to infection”, which often leads to high rates of morbidity and mortality (Singer et al., 2016). Although the real burden of this challenging condition is unknown, a systematic review estimated that there are around 30 million cases and 6 million deaths attributed to sepsis per year (Fleischmann et al., 2016). There is a distinct possibility that this estimate, although immense, is low, as the condition disproportionally affects the developing world. In areas where information gathering is often limited, the real incidence of sepsis is difficult to quantify. (“Recognizing Sepsis as a Global Health Priority — A WHO Resolution | NEJM, ” n.d). “The burden of sepsis in the developing world is enormous, outcomes are often …


July 14, 2018 at 7:14 pm

Outcomes of infective endocarditis in the current era: Early predictors of a poor prognosis

International Journal of Infectious Diseases March 2018 V.68 P.102-107

Maria Carmo Pereira Nunes, Milton Henriques Guimarães-Júnior, Pedro Henrique Oliveira Murta Pinto, Rodrigo Matos Pinto Coelho, Thais Lins Souza Barros, Nicole de Paula Aarão Faleiro Maia, Dayane Amaral Madureira, Rodrigo Citton Padilha Reis, Paulo Henrique Nogueira Costa, Renato Bráulio, Cláudio Léo Gelape, Teresa Cristina Abreu Ferrari


The early identification of patients at risk of complications of infective endocarditis (IE) using parameters obtained as part of routine practice is essential for guiding clinical decision-making. This study aimed to identify a parameter at hospital admission that predicts the outcome, adding value to other well-known factors of a poor prognosis in IE.


Two hundred and three patients with IE were included in this study. Clinical evaluation, echocardiography, blood cultures, and routine laboratory tests were performed at hospital admission. The endpoint was in-hospital mortality.


The mean age of the patients was 48.2 ± 16.6 years; 62% were male and 38% had rheumatic heart disease. During treatment, cardiac surgery was performed in 111 patients (55%), and the overall in-hospital mortality rate was 32%. In the multivariable analysis, the independent predictors of death were age (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02–1.13), C-reactive protein (CRP) at hospital admission (OR 1.12, 95% CI 1.04–1.21), length of the vegetation at diagnosis (OR 1.15, 95% CI 1.03–1.28), development of heart failure (OR 6.43, 95% CI 2.14–19.33), and embolic events during antimicrobial therapy (OR 12.14, 95% CI 2.11–71.89).


An elevated CRP level at hospital admission and vegetation length at diagnosis were strong predictors of in-hospital mortality in IE, independent of other prognostic parameters, specifically taking into account patient characteristics and complications during therapy.


July 14, 2018 at 7:09 pm

First report of sporadic cases of Candida auris in Colombia

International Journal of Infectious Diseases April 2018 V.69 P.63-67

Claudia M. Parra-Giraldo, Sandra L. Valderrama, Gloria Cortes-Fraile, Javier R. Garzón, Beatriz E. Ariza, Florent Morio, Melva Y. Linares-Linares, Andrés Ceballos-Garzón, Alejandro de la Hoz, Catalina Hernandez, Carlos Alvarez-Moreno, Patrice Le Pape

  • El hongo emergente Candida auris es una amenaza global seria. A menudo es resistente a múltiples fármacos, es un problema de salud pública.
  • La levadura Candida auris es difícil de identificar con herramientas de laboratorio estándar, y puede identificarse erróneamente en laboratorios sin tecnología específica.
  • Candida auris se ha diseminado rápidamente y ha causado infecciones en más de una docena de países, este es el primer caso reportado con Candida auris en Colombia.


Candida auris is a recently reported Candida species that is phenotypically similar to Candida haemulonii and related to hospital outbreaks. This organism can be misidentified as Candida haemulonii, Candida famata, Candida catenulata, or Rhodotorula glutinis by phenotypic approaches. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and DNA sequence analysis using internal transcribed spacer rDNA bar-coding provide an accurate identification.

Case reports

Three cases of C. auris infection in patients with risk factors for fungal infection (one admitted to the intensive care unit, one with lymphoma, and one with HIV; all three with previous antibiotic use) are reported; these infections were not epidemiologically related. Yeast isolates were recovered from blood, ocular secretion, and bronchoalveolar lavage and were misidentified as C. catenulata and Candida albicans by the phenotypic MicroScan method. The isolates were confirmed to be C. auris by means of MALDI-TOF MS and DNA sequence analysis. Antifungal susceptibility testing was performed on these C. auris isolates, which exhibited high minimum inhibitory concentrations to triazoles and amphotericin B. One patient survived and the other two died. Only one of these deaths was related to fungemia.


C auris is an emerging and opportunistic multidrug-resistant human pathogen. It is necessary to strengthen measures to achieve an accurate and quick identification and also to avoid its dissemination. This will require improvements in health and infection control measures, as well as the promotion of antifungal stewardship in healthcare facilities.


July 14, 2018 at 7:05 pm


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