Posts filed under ‘Sepsis’

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

Zooanthroponotic Transmission of Drug-Resistant Pseudomonas aeruginosa, Brazil

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

R. Fernandes et al.

Universidade de São Paulo, São Paulo, Brazil (M.R. Fernandes, F.P. Sellera, Q. Moura, M.P.N. Carvalho, L. Cerdeira, N. Lincopan); Centro Universitário Monte Serrat, Santos, São Paulo (P.N. Rosato)

We recovered VIM-2 carbapenemase-producing Pseudomonas aeruginosa isolates from an infected dog, its owner, and the domestic environment. Genomic investigation revealed household transmission of the high-risk hospital clone sequence type 233 in the human–animal–environment interface. Results suggest zooanthroponotic transmission of VIM-2–producing P. aeruginosa in the household following the patient’s hospital discharge.


Recuperamos VIM-2 cepas de PAE productoras de carbapenemasas de un perro infectado, su dueño y el entorno doméstico. La investigación genómica reveló la transmisión domiciliaria de la secuencia clon hospitalaria de alto riesgo tipo 233 en la interfaz humano-animal-ambiente.

Los resultados sugieren la transmisión zooantroprópica de P.AE productora de VIM-2 en el hogar después del alta hospitalaria del paciente.




May 19, 2018 at 10:34 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

Hydrogel delivery of lysostaphin eliminates orthopedic implant infection by Staphylococcus aureus and supports fracture healing.

Proc Natl Acad Sci U S A. 2018 May 14. pii: 201801013.

Johnson CT1,2, Wroe JA1,2, Agarwal R2,3, Martin KE2,3, Guldberg RE2,3, Donlan RM4, Westblade LF5, García AJ6,3.


Orthopedic implant infections are a significant clinical problem, with current therapies limited to surgical debridement and systemic antibiotic regimens. Lysostaphin is a bacteriolytic enzyme with high antistaphylococcal activity. We engineered a lysostaphin-delivering injectable PEG hydrogel to treat Staphylococcus aureus infections in bone fractures. The injectable hydrogel formulation adheres to exposed tissue and fracture surfaces, ensuring efficient, local delivery of lysostaphin. Lysostaphin encapsulation within this synthetic hydrogel maintained enzyme stability and activity. Lysostaphin-delivering hydrogels exhibited enhanced antibiofilm activity compared with soluble lysostaphin. Lysostaphin-delivering hydrogels eradicated S. aureus infection and outperformed prophylactic antibiotic and soluble lysostaphin therapy in a murine model of femur fracture. Analysis of the local inflammatory response to infections treated with lysostaphin-delivering hydrogels revealed indistinguishable differences in cytokine secretion profiles compared with uninfected fractures, demonstrating clearance of bacteria and associated inflammation. Importantly, infected fractures treated with lysostaphin-delivering hydrogels fully healed by 5 wk with bone formation and mechanical properties equivalent to those of uninfected fractures, whereas fractures treated without the hydrogel carrier were equivalent to untreated infections. Finally, lysostaphin-delivering hydrogels eliminate methicillin-resistant S. aureus infections, supporting this therapy as an alternative to antibiotics. These results indicate that lysostaphin-delivering hydrogels effectively eliminate orthopedic S. aureus infections while simultaneously supporting fracture repair.


May 18, 2018 at 7:50 am

Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort study

European Journal of Clinical Microbiology & Infectious Diseases. June 2018 V.37 N.6 P.1103–1111

Pelle Trier Petersen, Gertrud Baunbæk Egelund, Andreas Vestergaard Jensen, Stine Bang Andersen, Merete Frejstrup Pedersen, Gernot Rohde & Pernille Ravn

To investigate whether hemoglobin, white blood cell count (WBC), urea, sodium, albumin, and C-reactive protein at discharge in patients hospitalized for community-acquired pneumonia (CAP) are associated with 30-day readmission. This study is a retrospective cohort study, which included all adult patients discharged after hospitalization for CAP from three Danish hospitals between January 2011 and July 2012. The outcome was all-cause, unplanned, 30-day readmission. Biomarker concentrations at discharge were transformed into binary variables by using either upper or lower quartiles as cut-off; the upper quartile was used for WBC, urea, and C-reactive protein, and the lower quartile was used for hemoglobin, sodium, and albumin. The study population consisted of 1149 patients. One hundred eighty-four (16.0%) patients were readmitted. Independent risk factors of readmission were WBC ≥ 10.6 cells × 109/L (hazard ratio 1.50; 95% CI, 1.07–2.11) and albumin <32 g/L (hazard ratio 1.78; 95% CI, 1.24–2.54) at discharge and the presence of ≥ 2 co-morbidities (hazard ratio 1.74; 95% CI, 1.15–2.64). When WBC, albumin, and co-morbidities were combined into a risk-stratification tool, there was a step-wise increase in risk of readmission for patients with 1, 2, or 3 risk factors with hazard ratios of 1.76 (95% CI, 1.25–2.49), 2.59 (95% CI, 1.71–3.93), and 6.15 (95% CI 3.33–11.38), respectively. WBC ≥ 10.6 cells × 109/L and albumin < 32 g/L at discharge and the presence of ≥ 2 co-morbidities were independently associated with increased risk of 30-day readmission.



May 16, 2018 at 9:08 am

Prophylactic effect of trimethoprim-sulfamethoxazole for pneumocystis pneumonia in patients with rheumatic diseases exposed to prolonged high-dose glucocorticoids

Ann Rheum Dis. May 2018 V.77 N.5 P.644-649.

Park JW1, Curtis JR2, Moon J1, Song YW1, Kim S3,4, Lee EB1.

Author information

1 Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

2 Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

3 Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

4 Seoul Kidney Clinic, Seoul, Republic of Korea.



To investigate the efficacy and safety of trimethoprim/sulfamethoxazole (TMP-SMX) as primary prophylaxis for pneumocystis pneumonia (PCP) in patients with rheumatic diseases receiving high-dose steroids.


The study included 1522 treatment episodes with prolonged (≥4 weeks) high-dose (≥30 mg/day prednisone) steroids in 1092 patients over a 12-year period. Of these, 262 treatment episodes involved TMP-SMX (prophylaxis group) while other episodes involved no prophylaxis (control group). Differences in 1-year PCP incidence and its mortality between the two groups were estimated using Cox regression. To minimise baseline imbalance, propensity score matching was performed and efficacy outcome was mainly assessed in the postmatched population (n=235 in both groups).


During a total of 1474.4 person-years, 30 PCP cases occurred with a mortality rate of 36.7%. One non-fatal case occurred in the prophylaxis group. TMP-SMX significantly reduced the 1-year PCP incidence (adjusted HR=0.07(95% CI 0.01 to 0.53)) and related mortality (adjusted HR=0.08 (95% CI 0.0006 to 0.71)) in the postmatched population. The result of the same analysis performed in the whole population was consistent with that of the primary analysis. Incidence rate of adverse drug reactions (ADR) related to TMP-SMX was 21.2 (14.8-29.3)/100 person-years. Only two serious ADRs (including one Stevens-Johnson syndrome case) occurred. The number needed to treat for preventing one PCP (52 (33-124)) was lower than the number needed to harm for serious ADR (131 (55-∞)).


TMP-SMX prophylaxis significantly reduces the PCP incidence with a favourable safety profile in patients with rheumatic disease receiving prolonged, high-dose steroids.


May 10, 2018 at 8:42 am

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