Posts filed under ‘Bacteriemias’

The Role of Trimethoprim/Sulfamethoxazole in the Treatment of Infections Caused by Carbapenem-Resistant Enterobacteriaceae


Courtney L Luterbach; Ashley Boshe; Heather I Henderson; Eric Cober; Sandra S Richter

In the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE), trimethoprim-sulfamethoxazole (TMP-SMX) had a limited role in the treatment of less severe carbapenem-resistant Enterobacteriaceae (CRE) infections, especially urinary tract infections. Of tested CRE, only 29% were susceptible to TMP-SMX. Development of resistance further limits the use of TMP-SMX in CRE infections.




January 20, 2019 at 12:18 pm

First literature review of carbapenem-resistant Providencia.

New Microbes New Infect. 2018 Jun 4;25:16-23.

Abdallah M1, Balshi A2.

Author information

1 Pharmaceutical Care Services, Riyadh, Saudi Arabia.

2 Intensive Care Unit, King Saud Medical City, Riyadh, Saudi Arabia.


Providencia species are Gram-negative bacteria that belong to the Enterobacteriaceae family. They have intrinsic resistance to colistin and tigecycline, which makes treatment of the multidrug-resistant strains of Providencia challenging. Carbapenem-resistant Providencia species are increasingly reported. In this review, patients’ characteristics, resistance mechanisms, treatment and infection control measures of carbapenem-resistant Providencia species in the literature are described.



January 18, 2019 at 9:37 am

First report of carbapenem-resistant Providencia stuartii in Saudi Arabia.

New Microbes New Infect. September 20, 2018 V.26 P.107-109.

Abdallah M1, Alhababi R2, Alqudah N3, Aldyyat B4, Alharthy A5.

Author information

1 Pharmaceutical Care Services, King Saud Medical City, Riyadh, Saudi Arabia.

2 Microbiology Department, King Saud Medical City, Riyadh, Saudi Arabia.

3 Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia.

4 Pharmacy Department, Dr. Sulaiman Al Habib Hospital (As-Suwaidi), Riyadh, Saudi Arabia.

5 Intensive Care Unit, King Saud Medical City, Riyadh, Saudi Arabia.


We present the case of 31-year-old man who developed hospital-acquired pneumonia in the intensive care unit. Pathogens were identified to be carbapenem-resistant isolates of Providencia stuartii and Klebsiella pneumoniae. The patient was treated with an extended infusion of double-dose meropenem (targeting the carbapenem-resistant P. stuartii) and colistin (targeting the carbapenem-resistant K. pneumoniae) for 2 weeks. The patient’s disease responded well to the prescribed regimen; his chest X-ray became normal, and all other signs of infection subsided. To our knowledge, this is the first description of the emergence of carbapenem-resistant P. stuartii due to AmpC hyperproduction in Saudi Arabia.


January 18, 2019 at 9:36 am

Providencia stuartii form biofilms and floating communities of cells that display high resistance to environmental insults.

PLoS One. March 23, 2017 V.12 N.3 P.e0174213.

El Khatib M1, Tran QT2, Nasrallah C1, Lopes J1, Bolla JM3, Vivaudou M1, Pagès JM3, Colletier JP1.

Author information

1 Institut de Biologie Structurale, Université Grenoble Alpes – Commissariat à l’Énergie Atomique – Centre National de la Recherche Scientifique, Grenoble, France.

2 School of Biophysics, Jacobs University of Bremen, Bremen, Germany.

3 Équipe Transporteurs Membranaires, Chimiorésistance et Drug-Design, Université Aix-Marseille – Institut de Recherche Biomédicale des Armées, Marseille, France.


Biofilms are organized communities of bacterial cells that are responsible for the majority of human chronic bacterial infections. Providencia stuartii is a Gram-negative biofilm-forming bacterium involved in high incidence of urinary tract infections in catheterized patients. Yet, the structuration of these biofilms, and their resistance to environmental insults remain poorly understood. Here, we report on planktonic cell growth and biofilm formation by P. stuartii, in conditions that mimic its most common pathophysiological habitat in humans, i.e. the urinary tract. We observed that, in the planktonic state, P. stuartii forms floating communities of cells, prior to attachment to a surface and subsequent adoption of the biofilm phenotype. P. stuartii planktonic and biofilm cells are remarkably resistant to calcium, magnesium and to high concentrations of urea, and show the ability to grow over a wide range of pHs. Experiments conducted on a P. stuartii strain knocked-out for the Omp-Pst2 porin sheds light on the role it plays in the early stages of growth, as well as in the adaptation to high concentration of urea and to varying pH.


January 18, 2019 at 9:34 am

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis

Journal of Infection November 2018 V.77 N.5 P.379–390

Oghenekome A. Gbinigie, José M. Ordóñez-Mena, Thomas R. Fanshawe, Annette Plüddemann, Carl Heneghan


  • Older adults may present atypically with UTI and making a diagnosis can be difficult.
  • There is limited authoritative guidance on how older adult outpatients present with UTI.
  • Symptoms and signs traditionally associated with UTI (e.g. nocturia, urgency and abnormal vital signs) may have limited utility in diagnosing these infections in older adult outpatients.
  • Disability in performing a number of acts of daily living may be better predictors of UTI; high quality studies should be conducted in this area to confirm this


To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies.


We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool.


We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65–4259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, + ve LR: 11.8 (95% CI 5.51–25.2) and disability in washing one’s hands and face, + ve LR: 6.84 (95% CI 4.08–11.5).


The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.



January 12, 2019 at 9:59 am

Review – Vibrio vulnificus, an important cause of severe sepsis and skin and soft-tissue infection.

International Journal of Infectious Diseases 2011 V.15 e157-e166

Michael A. Horseman a,b,c,*, Salim Surani c,d,e

aDepartment of Pharmacy Practice, College of Pharmacy, Texas A&M Health Sciences Center, Kingsville, Texas, USA

bDepartment of Family Medicine & Community Medicine, School of Medicine, University of Texas Health Sciences Center, San Antonio, Texas, USA

c Christus Spohn Hospital Corpus Christi – Memorial, 2606 Hospital Blvd, Corpus Christi, Texas 78405, USA

dDepartment of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA

eDepartment of Internal Medicine, Texas A&M Health Science Center – College of Medicine, Scott and White Hospital, Temple, Texas, USA

Vibrio vulnificus is a halophilic Gram-negative bacillus found worldwide in warm coastal waters.

The pathogen has the ability to cause primary sepsis in certain high-risk populations, including patients with chronic liver disease, immunodeficiency, iron storage disorders, end-stage renal disease, and diabetes mellitus.

Most reported cases of primary sepsis in the USA are associated with the ingestion of raw or undercooked oysters harvested from the Gulf Coast.

The mortality rate for patients with severe sepsis is high, exceeding 50% in most reported series.

Other clinical presentations include wound infection and gastroenteritis.

Mild to moderate wound infection and gastroenteritis may occur in patients without obvious risk factors.

Severe wound infection is often characterized by necrotizing skin and soft-tissue infection, including fasciitis and gangrene.

V. vulnificus possesses several virulence factors, including the ability to evade destruction by stomach acid, capsular polysaccharide, lipopolysaccharide, cytotoxins, pili, and flagellum.

The preferred antimicrobial therapy is doxycycline in combination with ceftazidime and surgery for necrotizing soft-tissue infection.


January 10, 2019 at 8:32 am

Vibrio vulnificus, una bacteria al acecho en las playas.

Highlights en investigación December 2014

Iván Renato Zúñiga Carrasco*, Janett Caro Lozano**.

*Jefe del Departamento de Epidemiología. Miembro del Comité Local de

Investigación y Ética en Salud (CLIES). H.G.Z. # 18 IMSS Playa del Carmen, Quintana


**Jefa del Departamento de Epidemiología. Miembro del Comité Local de

Investigación y Ética en Salud (CLIES) H.G.Z. C/M.F. 1 IMSS Chetumal, Quintana Roo.

Un patógeno que puede ser transmitido por los ostiones es Vibrio vulnificus.

Descrito en 1976, se le denominó “Vibrio lactosa positivo”, posteriormente se le llamó Beneckea vulnificus y finalmente V. vulnificus. Pertenece a la familia Vibrionaceae, son bacilos Gramnegativos, rectos y curvos, móviles por la presencia de un flagelo polar, oxidasa positivos, no esporulados.

Son termolábiles y se comportan como anaerobios facultativos.

Entre las más de 30 especies del género Vibrio, se han reportado 12 como patógenas para el hombre, entre las que sobresalen V. cholerae, V. parahaemolyticus y V vulnificus . . .


January 10, 2019 at 8:30 am

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