Posts filed under ‘Bacteriemias’

Antibiotic Resistance and the Risk of Recurrent Bacteremia

Clinical Infectious Diseases June 1, 2018 V.66 N.11 P.1651–1657

Sjoukje H S Woudt; Sabine C de Greeff; Annelot F Schoffelen; Anne L M Vlek; Marc J M Bonten …


Direct health effects of antibiotic resistance are difficult to assess. We quantified the risk of recurrent bacteremia associated with resistance.


We extracted antimicrobial susceptibility testing data on blood isolates from the Dutch surveillance system for antimicrobial resistance between 2008 and 2017. First and first recurrent (4–30 days) bacteremia episodes were categorized as susceptible, single nonsusceptible, or co-nonsusceptible to third-generation cephalosporins without or with carbapenems (Enterobacteriaceae), ceftazidime without or with carbapenems (Pseudomonas species), aminopenicillins without or with vancomycin (Enterococcus species), or as methicillin-sensitive/-resistant S. aureus (MSSA/MRSA). We calculated risks of recurrent bacteremia after nonsusceptible vs susceptible first bacteremia, estimated the crude population attributable effect of resistance for the Netherlands, and calculated risks of nonsusceptible recurrent bacteremia after a susceptible first episode.


Risk ratios for recurrent bacteremia after a single- and co-nonsusceptible first episode, respectively, vs susceptible first episode, were 1.7 (95% confidence interval [CI], 1.5–2.0) and 5.2 (95% CI, 2.1–12.4) for Enterobacteriaceae, 1.3 (95% CI, 0.5–3.1) and 5.0 (95% CI, 2.9–8.5) for Pseudomonas species, 1.4 (95% CI, 1.2–1.7) and 1.6 (95% CI, 0.6–4.2) for Enterococcus species, and 1.6 (95% CI, 1.1–2.4) for MRSA vs MSSA. The estimated population annual number of recurrent bacteremias associated with nonsusceptibility was 40. The risk of nonsusceptible recurrent bacteremia after a susceptible first episode was at most 0.4% (Pseudomonas species).


Although antibiotic nonsusceptibility was consistently associated with higher risks of recurrent bacteremia, the estimated annual number of additional recurrent episodes in the Netherlands (40) was rather limited.




June 10, 2018 at 7:22 pm

Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: a nested case-control study

Journal of Antimicrobial Chemotherapy June 2018 V.73 N.6 P.1692–1699

Theodore Gouliouris; Ben Warne; Edward J P Cartwright; Luke Bedford; Chathika K Weerasuriya …


VRE bacteraemia has a high mortality and continues to defy control. Antibiotic risk factors for VRE bacteraemia have not been adequately defined. We aimed to determine the risk factors for VRE bacteraemia focusing on duration of antibiotic exposure.


A retrospective matched nested case-control study was conducted amongst hospitalized patients at Cambridge University Hospitals NHS Foundation Trust (CUH) from 1 January 2006 to 31 December 2012. Cases who developed a first episode of VRE bacteraemia were matched 1:1 to controls by length of stay, year, specialty and ward type. Independent risk factors for VRE bacteraemia were evaluated using conditional logistic regression.


Two hundred and thirty-five cases were compared with 220 controls. Duration of exposure to parenteral vancomycin, fluoroquinolones and meropenem was independently associated with VRE bacteraemia. Compared with patients with no exposure to vancomycin, those who received courses of 1–3 days, 4–7 days or >7 days had a stepwise increase in risk of VRE bacteraemia [conditional OR (cOR) 1.2 (95% CI 0.4–3.8), 3.8 (95% CI 1.2–11.7) and 6.6 (95% CI 1.9–22.8), respectively]. Other risk factors were: presence of a central venous catheter (CVC) [cOR 8.7 (95% CI 2.6–29.5)]; neutropenia [cOR 15.5 (95% CI 4.2–57.0)]; hypoalbuminaemia [cOR 8.5 (95% CI 2.4–29.5)]; malignancy [cOR 4.4 (95% CI 1.6–12.0)]; gastrointestinal disease [cOR 12.4 (95% CI 4.2–36.8)]; and hepatobiliary disease [cOR 7.9 (95% CI 2.1–29.9)].


Longer exposure to vancomycin, fluoroquinolones or meropenem was associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.



June 10, 2018 at 7:20 pm

Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β-Lactam/βLI Combinations.

Clinical Infectious Diseases July 15, 2016 V.63 N.2 P.234-41.

van Duin D1, Bonomo RA2.


Ceftolozane/tazobactam and ceftazidime/avibactam are 2 novel β-lactam/β-lactamase combination antibiotics. The antimicrobial spectrum of activity of these antibiotics includes multidrug-resistant (MDR) gram-negative bacteria (GNB), including Pseudomonas aeruginosa. Ceftazidime/avibactam is also active against carbapenem-resistant Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases. However, avibactam does not inactivate metallo-β-lactamases such as New Delhi metallo-β-lactamases. Both ceftolozane/tazobactam and ceftazidime/avibactam are only available as intravenous formulations and are dosed 3 times daily in patients with normal renal function. Clinical trials showed noninferiority to comparators of both agents when used in the treatment of complicated urinary tract infections and complicated intra-abdominal infections (when used with metronidazole). Results from pneumonia studies have not yet been reported. In summary, ceftolozane/tazobactam and ceftazidime/avibactam are 2 new second-generation cephalosporin/β-lactamase inhibitor combinations. After appropriate trials are conducted, they may prove useful in the treatment of MDR GNB infections. Antimicrobial stewardship will be essential to preserve the activity of these agents.



June 10, 2018 at 10:52 am

Clinical and Epidemiological Features of Enterococcus casseliflavus/flavescens and Enterococcus gallinarum Bacteremia: A Report of 20 Cases

Clinical Infectious Diseases June 1, 2001 V.32 N.11 P.1540-1546

Karlene C. Reid  Franklin R. Cockerill, III  Robin Patel

The clinical significance of intrinsically vancomycin-resistant enterococci is not yet fully established, as these organisms are infrequently recovered from clinical specimens. We report our experience with 20 cases of Enterococcus gallinarum and Enterococcus casseliflavus/flavescens bacteremia in humans from 1992 through 1998. Sixteen cases of bacteremia were caused by E. gallinarum. Underlying conditions were present in 19 (95%) of the patients and included malignancy, receipt of transplant, and Caroli’s disease. Polymicrobial bacteremia was present in 9 patients (45%). E. gallinarum and E. casseliflavus/flavescens, although they are infrequently isolated from clinical specimens, may cause serious invasive infections.

La importancia clínica de los enterococos intrínsecamente resistentes a la vancomicina todavía no está completamente establecida, ya que estos organismos se recuperan con poca frecuencia de las muestras clínicas. Presentamos nuestra experiencia con 20 casos de bacteriemias en humanos por Enterococcus gallinarum y Enterococcus casseliflavus/flavescens bacteriemia 1992 hasta 1998.

Dieciséis casos de bacteriemia fueron causados por E. gallinarum. Las condiciones subyacentes estuvieron presentes en 19 (95%) de los pacientes e incluyeron malignidad, recepción de trasplante y enfermedad de Caroli.

La bacteriemia polimicrobiana estuvo presente en 9 pacientes (45%). E. gallinarum y E. casseliflavus / flavescens, aunque rara vez se aíslan de muestras clínicas, pueden causar infecciones invasivas graves.



June 8, 2018 at 8:23 am

Urban Wild Boars and Risk of Zoonotic Streptococcus suis, Spain

Emerging Infectious Diseases June 2018 V.24 N.6

Fernández-Aguilar et al.

Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Bellaterra, Spain (X. Fernández-Aguilar, V. Aragon, N. Galofré-Milà, O. Cabezón); Universitat Autònoma de Barcelona, Bellaterra (X. Fernández-Aguilar, R. Velarde, R. Castillo-Contreras, J.R. López-Olvera, G. Mentaberre, A. Colom-Cadena, S. Lavín, O. Cabezón); Université de Montréal, St.-Hyacinthe, Québec, Canada (M. Gottschalk); Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain (J. Càmara, C. Ardanuy); CIBER de Enfermedades Respiratorias, Madrid, Spain (C. Ardanuy)

Urban wild boars (Sus scrofa) from Barcelona, Spain, harbor great diversity of Streptococcus suis strains, including strains with the cps2 gene and with the same molecular profile as local human cases. The increasing trend of potential effective contacts for S. suis transmission is of public health concern.




May 21, 2018 at 8:40 am

Genomic Epidemiology of Global Carbapenemase-Producing Enterobacter spp., 2008–2014

Emerging Infectious Diseases Journal June 2018 V.24 N.6

Peirano, Yasufumi Matsumura1, Mark D. Adams2, Patricia Bradford, Mary Motyl, Liang Chen, Barry N. Kreiswirth, and Johann D.D. Pitou

University of Calgary, Calgary, Alberta, Canada (G. Peirano, J.D.D. Pitout); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y. Matsumura); J. Craig Venter Institute, La Jolla, California, USA (M.D. Adams); AstraZeneca Pharmaceuticals LP, Waltham, Massachusetts, USA (P. Bradford); Merck & Co., Inc., Rahway, New Jersey, USA (M. Motyl); Rutgers University, Newark, New Jersey, USA (L. Chen, B.N. Kreiswirth); University of Pretoria, Pretoria, South Africa (J.D.D. Pitout)

We performed whole-genome sequencing on 170 clinical carbapenemase-producing Enterobacter spp. isolates collected globally during 2008–2014. The most common carbapenemase was VIM, followed by New Delhi metallo-β-lactamase (NDM), Klebsiella pneumoniae carbapenemase, oxacillin 48, and IMP. The isolates were of predominantly 2 species (E. xiangfangensis and E. hormaechei subsp. steigerwaltii) and 4 global clones (sequence type [ST] 114, ST93, ST90, and ST78) with different clades within ST114 and ST90. Particular genetic structures surrounding carbapenemase genes were circulating locally in various institutions within the same or between different STs in Greece, Guatemala, Italy, Spain, Serbia, and Vietnam. We found a common NDM genetic structure (NDM-GE-U.S.), previously described on pNDM-U.S. from Klebsiella pneumoniae ATCC BAA-214, in 14 different clones obtained from 6 countries spanning 4 continents. Our study highlights the importance of surveillance programs using whole-genome sequencing in providing insight into the molecular epidemiology of carbapenemase-producing Enterobacter spp.


Realizamos la secuenciación del genoma completo en 170 Enterobacter spp. productoras de carbapenemasas clínicas. aislados recogidos a nivel mundial durante 2008-2014.

La carbapenemasa más común fue VIM, seguida de metalo-β-lactamasa (NDM) de Nueva Delhi, carbapenemasas de Klebsiella pneumoniae, oxacilina 48 e IMP.

Los aislamientos fueron predominantemente de 2 especies (E. xiangfangensis y E. hormaechei subsp steigerwaltii) y 4 clones globales (secuencia tipo [ST] 114, ST93, ST90 y ST78) con diferentes clados dentro de ST114 y ST90. Las estructuras genéticas particulares que rodean los genes de la carbapenemasa circulaban localmente en varias instituciones dentro de la misma o entre diferentes ST en Grecia, Guatemala, Italia, España, Serbia y Vietnam.

Encontramos una estructura genética NDM común (NDM-GE-U.S.), descrita previamente en pNDM-U.S. de K pneumoniae ATCC BAA-214, en 14 clones diferentes obtenidos de 6 países que abarcan 4 continentes.

Nuestro estudio resalta la importancia de los programas de vigilancia que usan la secuenciación del genoma completo para proporcionar información sobre la epidemiología molecular de Enterobacter spp. que produce carbapenemasas.



May 19, 2018 at 10:33 am

Osteoarticular infections in a tertiary care children’s hospital: Epidemiology and clinical characteristics in association with bacteremia.

Arch Argent Pediatr. 2018 Apr 1;116(2):e204-e209.

[Article in English, Spanish; Abstract available in Spanish from the publisher]

Highton E1, Pérez MG2, Cedillo Villamagua C1, Sormani MI1, Mussini MS1, Isasmendi A3, Pinheiró J3, Reijtman V3, Taicz M1, Mastroianni A3, García ME3, Rosanova MT1.

Author information

1 Servicio de Control Epidemiológico e Infectología, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina.

2 Servicio de Control Epidemiológico e Infectología, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina.

3 Servicio de Microbiología, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina.


Osteoarticular infections are an important cause of morbidity and may present with bacteremia. The epidemiology has changed in recent years.


To describe the epidemiological, clinical, and evolutionary characteristics of children with osteoarticular infections and compare patients with and without bacteremia.


Retrospective cohort. Patients younger than 18 years admitted between January 1st, 2016 and December 31st, 2016 suspected of osteoarticular infections who had undergone an arthrocentesis and/or joint biopsy were included. Clinical and laboratory characteristics were compared between patients with and without bacteremia. The Stata 10 software was used.


N: 62. Patients’ median age was 59.5 months (interquartile range [IQR]: 24-84). Fever developed in 44 patients (70%). Arthritis predominated (54 patients, 87%). An etiologic agent was identified in 29 patients (47%). Staphylococcus aureus was prevalent (n: 20, 32%). Among these, 15 developed bacteremia (24%). Clindamycin was administered to 56 patients (90%) as empirical therapy. The median intravenous treatment duration was 7 days (IQR: 5-11) and the median length of stay, 7 days (IQR: 4-12). Patients with bacteremia were younger (26 months versus 60 months, p < 0.05), had a higher baseline C-reactive protein level (101 U/L versus 33 U/L, p < 0.05), a lower hemoglobin level at the time of admission (10.8 g/dL versus 12.5 g/dL, p = 0.04), and a higher frequency of fever (100% versus 57%, p < 0.05).


Staphylococcus aureus was prevalent. Children with bacteremia were younger, had a higher C-reactive protein level, a lower hemoglobin level at the time of admission, and 100% presented fever.



May 18, 2018 at 8:17 am

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