Posts filed under ‘Bacteriemias’

Is This the Carbapenemase Test We’ve Been Waiting for? A Multicenter Evaluation of the Modified Carbapenem Inactivation Method

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2309-2312

Susan M. Butler-Wu and April N. Abbott

aDepartment of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

bDepartment of Pathology, Deaconess Health System, Evansville, Indiana, USA

ABSTRACT

A plethora of phenotypic methods exist for the detection of carbapenemases; however, clinical laboratories have struggled for years with accurate, objective phenotypic detection of carbapenemase activity in Enterobacteriaceae. In this issue of the Journal of Clinical Microbiology, V. M. Pierce et al. (J Clin Microbiol 55:2321–2333, 2017, https://doi.org/10.1128/JCM.00193-17) report on a multicenter evaluation of the modified carbapenem inactivation method (mCIM). The high sensitivity, specificity, reproducibility, and ease of interpretation associated with the mCIM for Enterobacteriaceae will likely lead to its adoption by clinical laboratories.

PDF

http://jcm.asm.org/content/55/8/2309.full.pdf+html

 

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2321-2333

Modified Carbapenem Inactivation Method for Phenotypic Detection of Carbapenemase Production among Enterobacteriaceae

Virginia M. Pierce, Patricia J. Simner, David R. Lonsway, Darcie E. Roe-Carpenter, J. Kristie Johnson, William B. Brasso, April M. Bobenchik, Zabrina C. Lockett, Angella Charnot-Katsikas, Mary Jane Ferraro, Richard B. Thomson Jr., Stephen G. Jenkins, Brandi M. Limbago, and Sanchita Das

aDepartment of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA

bDepartment of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

cDivision of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

dBeckman Coulter Diagnostics, Inc., West Sacramento, California, USA

eDepartment of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA

fBD Life Sciences–Diagnostic Systems, Sparks, Maryland, USA

gDepartment of Pathology and Laboratory Medicine, Lifespan Academic Medical Center, Providence, Rhode Island, USA

hDepartment of Pathology, University of Chicago Medical Center, Chicago, Illinois, USA

iDepartment of Pathology, NorthShore University HealthSystem, Evanston, Illinois, USA

jDepartment of Pathology and Laboratory Medicine, Weill-Cornell Medical College, New York, New York, USA

The ability of clinical microbiology laboratories to reliably detect carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is an important element of the effort to prevent and contain the spread of these pathogens and an integral part of antimicrobial stewardship. All existing methods have limitations. A new, straightforward, inexpensive, and specific phenotypic method for the detection of carbapenemase production, the carbapenem inactivation method (CIM), was recently described. Here we describe a two-stage evaluation of a modified carbapenem inactivation method (mCIM), in which tryptic soy broth was substituted for water during the inactivation step and the length of this incubation was extended. A validation study was performed in a single clinical laboratory to determine the accuracy of the mCIM, followed by a nine-laboratory study to verify the reproducibility of these results and define the zone size cutoff that best discriminated between CP-CRE and members of the family Enterobacteriaceae that do not produce carbapenemases. Bacterial isolates previously characterized through whole-genome sequencing or targeted PCR as to the presence or absence of carbapenemase genes were tested for carbapenemase production using the mCIM; isolates with Ambler class A, B, and D carbapenemases, non-CP-CRE isolates, and carbapenem-susceptible isolates were included. The sensitivity of the mCIM observed in the validation study was 99% (95% confidence interval [95% CI], 93% to 100%), and the specificity was 100% (95% CI, 82% to 100%). In the second stage of the study, the range of sensitivities observed across nine laboratories was 93% to 100%, with a mean of 97%; the range of specificities was 97% to 100%, with a mean of 99%. The mCIM was easy to perform and interpret for Enterobacteriaceae, with results in less than 24 h and excellent reproducibility across laboratories.

PDF

http://jcm.asm.org/content/55/8/2321.full.pdf+html

 

July 26, 2017 at 9:25 am

Staphylococcus aureus sensible a la meticilina frente a Staphylococcus aureus resistente en la artritis séptica aguda. Estudio experimental, epidemiológico y clínico en niños

Revista de la Asociación Argentina de Ortopedia y Traumatología Junio 2011 V.76 N.2

Paula Díaz Gallardo, Martín Mangupli, Horacio Galera, Pablo Bruno, Damián Bustos, Gerardo Ferrer y Christian Allende

Departamento de Cirugía Experimental, Universidad Católica de Córdoba

Servicio de Ortopedia y Traumatología, Hospital de Niños de la Santísima Trinidad

Servicio de Ortopedia y Traumatología, Sanatorio Allende – Hospital Misericordia Córdoba, Argentina

Introducción

Los objetivos principales de este estudio fueron establecer la epidemiología de la artritis séptica en nuestra comunidad, determinar las diferencias entre la artritis séptica producida por Staphylococcus aureus sensible a la meticilina y las secundarias a Staphylococcus aureus resistente a la meticilina, y determinar las propiedades bactericidas del líquido sinovial.

Materiales y métodos

Se utilizaron 28 conejos neozelandeses, divididos en cuatro grupos de 2 cada uno; en los de los grupos I y II se inocularon 0,3 mL de Staphylococcus aureus sensible a la meticilina y en los de los grupos III y IV, 0,3 mL de Staphylococcus aureus resistente a la meticilina. Se evaluó a 16 niños con artritis séptica, con un promedio de edad de 6 años. Se tomaron muestras de líquido sinovial de 10 rodillas, las cuales se colocaron en medios de cultivo inoculados con Staphylococcus aureus sensible a la meticilina y con Staphylococcus aureus resistente a la meticilina.

Resultados

La resonancia magnética evidenció signos de artritis en todos los casos. Los hemocultivos fueron negativos. La anatomía patológica evidenció edema, infiltrado inflamatorio purulento con material fibrinoleucocitario, tejido de granulación y áreas con destrucción de la membrana sinovial. En la investigación clínica, la articulación más afectada fue la rodilla (10 casos); el agente causal no se pudo identificar en 9 casos. El estudio experimental para determinar la capacidad bactericida del líquido sinovial reveló 75% de inhibición de crecimiento de colonias de Staphylococcus aureus sensible a la meticilina y 0% de inhibición para colonias de Staphylococcus aureus resistente.

Conclusiones

La elección de la antibioticoterapia para utilizar inicialmente en la artritis séptica debe variar de acuerdo con lo que muestren los estudios epidemiológicos de cada región. El líquido sinovial tiene propiedades bactericidas importantes frente a Staphylococcus aureus sensible a la meticilina, pero no en la artritis por Staphylococcus aureus resistente a la meticilina. La resonancia magnética es el estudio de elección en los pacientes con presunta artritis séptica.

PDF

http://www.scielo.org.ar/pdf/raaot/v76n2/v76n2a03.pdf

July 21, 2017 at 9:58 pm

LEPTOSPIROSIS – GUIA para el Equipo de Salud. Ministerio de Salud de la Nación Argentina – ABRIL 2014

INDICE

Pág 3. Información para el equipo de salud:

  1. Introducción
  2. Manifestaciones clínicas
  3. ¿Cuándo sospechar leptospirosis?
  4. ¿Cómo confirmar leptospirosis?
  5. ¿Cómo notificar el caso de leptospirosis?
  6. ¿Cómo se trata el paciente con leptospirosis?
  7. Flujograma de manejo de casos sospechosos de leptospirosis
  8. Diagnóstico diferencial
  9. ¿Qué hacer si se confirma?
  10. ¿Cómo se tratan los casos caninos de leptospirosis?
  11. Prevención de la leptospirosis en la familia y la comunidad

Pág 25. Recomendaciones para la organización de las actividades en el Equipo de Salud

  1. ¿Qué pueden Ud y su equipo de salud hacer para contribuir al control de la leptospirosis en su área?

Pág 29. Información para la población

  1. ¿Qué es la leptospirosis?
  2. ¿Cómo se transmite la leptospirosis?
  3. ¿Cómo ingresa la bacteria?
  4. ¿Cuáles son los síntomas de la leptospirosis?
  5. ¿Qué hacer en caso de padecer de algunos de los síntomas mencionados antes?
  6. ¿Cuál es el tratamiento?

7 ¿Cómo afecta la enfermedad a los animales domésticos?

  1. ¿Qué podemos hacer para prevenir la leptospirosis?

Pág 35. Anexos

  1. Muestras clínicas para examen
  2. Notificación a través del Módulo SIVILA del SNVS
  3. Bioseguridad
  4. Laboratorios de la Red de leptospirosis
  5. Algoritmo de diagnóstico y notificación por laboratorio
  6. Ficha de notificación de casos de síndrome febril
  7. Ficha de notificación de caso leptospirosis canina

PDF

http://www.msal.gob.ar/images/stories/bes/graficos/0000000489cnt-guia-medica-leptospirosis.pdf

July 17, 2017 at 8:32 am

Leptospirosis. Puesta al día

Rev. Chil. infectol. Junio 2007 V.24 N.3 P.220-226

Enna Zunino M. y Rolando Pizarro P.

Hospital Dr. Lucio Córdova Santiago, Chile

Resumen

Se revisan los aspectos clínicos, diagnóstico de laboratorio y alternativas terapéuticas para la leptospirosis.

Destaca en la epidemiología el riesgo ocupacional y laboral y la falta de datos, por no haber constituido en Chile tema de vigilancia epidemiológica hasta el año 2000.

Los datos clínicos evidencian una notable heterogeneidad de manifestaciones, muchas veces inespecíficas. La complejidad del diagnóstico diferencial que plantea hace necesario incluirlo en el análisis causal de múltiples situaciones clínicas.

El diagnóstico de laboratorio es aún complejo y poco accesible. Aunque es todavía controvertido, el análisis de la literatura apoya el beneficio del tratamiento antimicrobiano con varias alternativas de elección.

PDF

http://www.scielo.cl/pdf/rci/v24n3/art08.pdf

July 17, 2017 at 8:30 am

Oseltamivir Use Among Children and Adults Hospitalized With Community-Acquired Pneumonia.

Open Forum Infect Dis. Dec. 27, 2016 V.4 N.1

Oboho IK1,2, Bramley A1, Finelli L1, Fry A1, Ampofo K3, Arnold SR4,5, Self WH6, Williams DJ6, Courtney DM7, Zhu Y6, Anderson EJ8, Grijalva CG6, McCullers JA4,5, Wunderink RG7, Pavia AT3, Edwards KM6, Jain S1.

Author information

1 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

2 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.

3 University of Utah Health Sciences Center, Salt Lake City.

4 Le Bonheur Children’s Hospital, Memphis, Tennessee.

5 University of Tennessee Health Science Center, Memphis.

6 Vanderbilt University School of Medicine, Nashville, Tennessee.

7 Northwestern University Feinberg School of Medicine, Chicago, Illinois.

8 Emory University School of Medicine, Atlanta, Georgia.

Abstract

BACKGROUND:

Data on oseltamivir treatment among hospitalized community-acquired pneumonia (CAP) patients are limited.

METHODS:

Patients hospitalized with CAP at 6 hospitals during the 2010-2012 influenza seasons were included. We assessed factors associated with oseltamivir treatment using logistic regression.

RESULTS:

Oseltamivir treatment was provided to 89 of 1627 (5%) children (<18 years) and 143 of 1051 (14%) adults. Among those with positive clinician-ordered influenza tests, 39 of 61 (64%) children and 37 of 48 (77%) adults received oseltamivir. Among children, oseltamivir treatment was associated with hospital A (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.36-4.88), clinician-ordered testing performed (aOR, 2.44; 95% CI, 1.47-5.19), intensive care unit (ICU) admission (aOR, 2.09; 95% CI, 1.27-3.45), and age ≥2 years (aOR, 1.43; 95% CI, 1.16-1.76). Among adults, oseltamivir treatment was associated with clinician-ordered testing performed (aOR, 8.38; 95% CI, 4.64-15.12), hospitals D and E (aOR, 3.46-5.11; 95% CI, 1.75-11.01), Hispanic ethnicity (aOR, 2.06; 95% CI, 1.18-3.59), and ICU admission (aOR, 2.05; 95% CI, 1.34-3.13).

CONCLUSIONS:

Among patients hospitalized with CAP during influenza season, oseltamivir treatment was moderate overall and associated with clinician-ordered testing, severe illness, and specific hospitals. Increased clinician education is needed to include influenza in the differential diagnosis for hospitalized CAP patients and to test and treat patients empirically if influenza is suspected.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413989/pdf/ofw254.pdf

July 16, 2017 at 11:44 am

Practices of Lyme disease diagnosis and treatment by general practitioners in Quebec, 2008-2015.

BMC Fam Pract. 2017 May 22;18(1):65.

Gasmi S1,2, Ogden NH3,4, Leighton PA5, Adam-Poupart A6, Milord F6, Lindsay LR7, Barkati S8, Thivierge K9.

Author information

1 Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, 20045, chemin Sainte-Marie, Sainte-Anne-de-Bellevue, H9X 3R5, Canada.

2 Policy Integration and Zoonoses Division, Centre for Food-borne, Environmental & Zoonotic Infectious Diseases, Public Health Agency of Canada, 3200 Sicotte, Saint-Hyacinthe, J2S 7C6, Canada.

3 Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, 3200 Sicotte, Saint-Hyacinthe, J2S 7C6, Canada.

4 Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), 3200 Sicotte, Saint-Hyacinthe, J2S 7C6, Canada.

5 Faculty of Veterinary Medicine, University of Montreal, 3200 Sicotte, Saint-Hyacinthe, J2S 7C6, Canada.

6 Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, 190, boulevard Crémazie Est, Montréal, H2P 1E2, Canada.

7 Zoonotic Diseases & Special Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, R3E 3R2, Canada.

8 Department of Microbiology and Immunology, Faculty of Medicine, University of Montreal, 2900, boul. Édouard-Montpetit, Montréal, H3T 1J4, Canada.

9 Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, 20045, chemin Sainte-Marie, Sainte-Anne-de-Bellevue, H9X 3R5, Canada. karine.thivierge@inspq.qc.ca

Abstract

BACKGROUND:

Lyme disease (LD), a multisystem infection caused by the spirochete Borrelia burgdorferi sensu stricto (B. burgdorferi), is the most reported vector-borne disease in North America, and by 2020, 80% of the population in central and eastern Canada could live in LD risk areas. Among the key factors for minimising the impact of LD are the accurate diagnosis and appropriate management of patients bitten by ticks. In this study, the practices of Quebec general practitioners (GPs) on LD diagnosis and management of patients bitten by infected ticks are described.

METHODS:

Eight years (2008 to 2015) of retrospective demographic and clinical data on patients bitten by infected Ixodes scapularis (I. scapularis) ticks and on the management of suspected and confirmed LD cases by Quebec GPs were analysed.

RESULTS:

Among 50 patients, all the antimicrobial treatments of LD clinical cases were appropriate according to current guidelines. However, more than half (62.8%) of erythema migrans (EM) were possibly misdiagnosed, 55.6%, (n = 27) of requested serologic tests were possibly unnecessary and the majority (96.5%, n = 57) of prophylactic antimicrobial treatments were not justified according to current guidelines.

CONCLUSIONS:

These observations underline the importance for public health to enhance the knowledge of GPs where LD is emerging, to minimise the impact of the disease on patients and the financial burden on the health system

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441092/pdf/12875_2017_Article_636.pdf

July 15, 2017 at 2:12 pm

Update of the Swiss guidelines on post-treatment Lyme disease syndrome.

Swiss Med Wkly. 2016 Dec 5;146:w14353.

Nemeth J1, Bernasconi E2, Heininger U3, Abbas M4, Nadal D5, Strahm C6, Erb S7, Zimmerli S8, Furrer H8, Delaloye J9, Kuntzer T10, Altpeter E11, Sturzenegger M12, Weber R1, For The Swiss Society For Infectious Diseases And The Swiss Society For Neurology.

Author information

1 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.

2 Division of Infectious Diseases, Regional Hospital Lugano, Switzerland.

3 Paediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland.

4 Division of Infectious Diseases, Geneva University Hospital, Switzerland.

5 Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zürich, Switzerland.

6 Division of Infectious Diseases, Cantonal Hospital St. Gallen, Switzerland.

7 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland.

8 Division of Infectious Diseases, University Hospital Bern, Switzerland.

9 Division of Infectious Diseases, University Hospital Lausanne (CHUV), Switzerland.

10 Service of Neurology, University Hospital Lausanne (CHUV), Switzerland.

11 Swiss Federal Office of Public Health, Bern, Switzerland.

12 Department of Neurology, Inselspital, University Hospital of Bern, Switzerland.

Abstract

Lyme borreliosis is caused by Borrelia burgdorferi sensu lato infection, which responds well to antibiotic therapy in the overwhelming majority of cases.

However, despite adequate antibiotic treatment some patients report persisting symptoms which are commonly summarised as post-treatment Lyme disease syndrome (PTLDS). In 2005, the Swiss Society of Infectious Diseases published a case definition for PTLDS.

We aimed to review the scientific literature with a special emphasis on the last 10 years, questioning whether the definitions from 2005 are still valid in the light of current knowledge.

Furthermore, we describe the clinical history of infection with Borrelia burgdorferi sensu lato, the estimated prevalence of PTLDS, the possible pathogenesis of PTLDS, and treatment options with an emphasis on clinical studies. In summary, we were unable to find a scientific reason for modification of the PTLDS definitions published in 2005.

Thus, the diagnostic criteria remain unchanged, namely documented clinical and laboratory evidence of previous infection with B. burgdorferi, a completed course of appropriate antibiotic therapy, symptoms including fatigue, arthralgia, myalgia, cognitive dysfunction or radicular pain persisting for >6 months, a plausible timely association between documented B. burgdorferi infection and onset of symptoms (i.e., persistent or recurrent symptoms that began within 6 months of completion of a recommended antibiotic therapy for early or late Lyme borreliosis), and exclusion of other somatic or psychiatric causes of symptoms.

The main therapeutic options remain cognitive behavioural therapy and low-impact aerobic exercise programmes. Growing and unequivocal evidence confirms that prolonged or repeated antibiotic therapy for PTLDS is not beneficial, but potentially harmful and therefore contraindicated.

The Guidelines of the Swiss Society of Infectious Diseases offer an evidence based, diagnostic and therapeutic framework for physicians caring for patients suffering from presumptive PTLDS in Switzerland.

FULL TEXT

https://smw.ch/article/doi/smw.2016.14353

July 15, 2017 at 2:11 pm

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