Posts filed under ‘Sepsis’

The Brief Case: Bacteremia Caused by Helicobacter cinaedi

Journal of Clinical Microbiology January 2017 V.55 N.1 P.5-9

Allen C. Bateman and Susan M. Butler-Wu* Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA

Carey-Ann D. Burnham, Editor Washington University School of Medicine

CASE

A 61-year-old male with relapsed multiple myeloma presented to clinic with fatigue and chills.

The patient had undergone two rounds of autologous stem cell transplantation in 2012 and was undergoing chemotherapy with pomalidomide, cyclophosphamide, and dexamethasone.

He was admitted for neutropenic fever (absolute neutrophil count of 1.4 × 109/liter, temperature of 38.4°C). His physical exam was normal, and he denied any other symptoms.

Two sets of blood cultures were obtained (VersaTREK Redox; Trek Diagnostic Systems), and the patient was started on levofloxacin, vancomycin, and cefepime. His fever subsided after 24 h, and he was discharged home to complete a 30-day course of oral levofloxacin…

PDF

http://jcm.asm.org/content/55/1/5.full.pdf+html

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October 19, 2017 at 3:04 pm

Pregnant Women Hospitalized with Chikungunya Virus Infection, Colombia, 2015

Emerging Infectious Diseases November 2017 V.23 N.11

Maria Escobar, Albaro J. Nieto, Sara Loaiza-Osorio, Juan S. Barona, and Fernando Rosso

Fundación Clínica Valle del Lili, Cali, Colombia (M. Escobar, A.J. Nieto, S. Loaiza-Osorio, F. Rosso); Icesi University, Cali (M. Escobar, A.J. Nieto, J.S. Barona, F. Rosso)

In 2015 in Colombia, 60 pregnant women were hospitalized with chikungunya virus infections confirmed by reverse transcription PCR.

Nine of these women required admission to the intensive care unit because of sepsis with hypoperfusion and organ dysfunction; these women met the criteria for severe acute maternal morbidity. No deaths occurred.

Fifteen women delivered during acute infection; some received tocolytics to delay delivery until after the febrile episode and prevent possible vertical transmission. As recommended by a pediatric neonatologist, 12 neonates were hospitalized to rule out vertical transmission; no clinical findings suggestive of neonatal chikungunya virus infection were observed.

With 36 women (60%), follow-up was performed 1 year after acute viremia; 13 patients had arthralgia in >2 joints (a relapse of infection).

Despite disease severity, pregnant women with chikungunya should be treated in high-complexity obstetric units to rule out adverse outcomes. These women should also be followed up to treat potential relapses.

PDF

https://wwwnc.cdc.gov/eid/article/23/11/pdfs/17-0480.pdf

October 18, 2017 at 8:27 am

Antimicrobial Nonsusceptibility of Gram-Negative Bloodstream Isolates, Veterans Health Administration System, United States, 2003–2013

Emerging Infectious Diseases November 2017 V.23 N.11

Michihiko Goto, Jennifer S. McDanel, Makoto M. Jones, Daniel J. Livorsi, Michael E. Ohl, Brice F. Beck, Kelly K. Richardson, Bruce Alexander, and Eli N. Perencevich

Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA (M. Goto, J.S. McDanel, D.J. Livorsi, M.E. Ohl, B.F. Beck, K.K. Richardson, B. Alexander, E.N. Perencevich); University of Iowa Carver College of Medicine, Iowa City (M. Goto, J.S. McDanel, D.J. Livorsi, M.E. Ohl, E.N. Perencevich); Salt Lake City Veterans Affairs Health Care System, Salt Lake City, Utah, USA (M.M. Jones); University of Utah School of Medicine, Salt Lake City USA (M.M. Jones)

Bacteremia caused by gram-negative bacteria is associated with serious illness and death, and emergence of antimicrobial drug resistance in these bacteria is a major concern.

Using national microbiology and patient data for 2003–2013 from the US Veterans Health Administration, we characterized nonsusceptibility trends of community-acquired, community-onset; healthcare-associated, community-onset; and hospital-onset bacteremia for selected gram-negative bacteria (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter spp.).

For 47,746 episodes of bacteremia, the incidence rate was 6.37 episodes/10,000 person-years for community-onset bacteremia and 4.53 episodes/10,000 patient-days for hospital-onset bacteremia.

For Klebsiella spp., P. aeruginosa, and Acinetobacter spp., we observed a decreasing proportion of nonsusceptibility across nearly all antimicrobial drug classes for patients with healthcare exposure; trends for community-acquired, community-onset isolates were stable or increasing.

The role of infection control and antimicrobial stewardship efforts in inpatient settings in the decrease in drug resistance rates for hospital-onset isolates needs to be determined.

PDF

https://wwwnc.cdc.gov/eid/article/23/11/pdfs/16-1214.pdf

October 18, 2017 at 8:25 am

Blood Culture–Negative Endocarditis, Morocco

Emerging Infectious Diseases November 2017 V.23 N.11

Research Letter

Najma Boudebouch, M’hammed Sarih, Abdelfattah Chakib, Salma Fadili, Drissi Boumzebra, Zahira Zouizra, Badie Azamane Mahadji, Hamid Amarouch, Didier Raoult, and Pierre-Edouard Fournier

Institut Pasteur du Maroc, Casablanca, Morocco (N. Boudebouch, M. Sarih); Centre Hospitalier Universitaire Ibn Rochd, Casablanca (A. Chakib, S. Fadili, B.A. Mahadji); Centre Hospitalier Universitaire Ibn Toufail Marrakech, Marrakech, Morocco (D. Boumzebra, Z. Zouizra); Faculté des Sciences Ain Chock, Casablanca (H. Amarouch); Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France (D. Raoult, P.-E. Fournier)

We investigated the microorganisms causing blood culture–negative endocarditis (BCNE) in Morocco.

We tested 19 patients with BCNE by serologic methods, molecular methods, or both and identified Bartonella quintana, Staphylococcus aureus, Streptococcus equi, and Streptococcus oralis in 4 patients.

These results highlight the role of these zoonotic agents in BCNE in Morocco.

PDF

https://wwwnc.cdc.gov/eid/article/23/11/pdfs/16-1066.pdf

October 18, 2017 at 8:23 am

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

Clin Infect Dis. 2016 Sep 1;63(5):e61-e111.

Kalil AC1, Metersky ML2, Klompas M3, Muscedere J4, Sweeney DA5, Palmer LB6, Napolitano LM7, O’Grady NP8, Bartlett JG9, Carratalà J10, El Solh AA11, Ewig S12, Fey PD13, File TM Jr14, Restrepo MI15, Roberts JA16, Waterer GW17, Cruse P18, Knight SL18, Brozek JL19.

Author information

1 Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha.

2 Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington.

3 Brigham and Women’s Hospital and Harvard Medical School Harvard Pilgrim Health Care Institute, Boston, Massachusetts.

4 Department of Medicine, Critical Care Program, Queens University, Kingston, Ontario, Canada.

5 Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego.

6 Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, State University of New York at Stony Brook.

7 Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, University of Michigan, Ann Arbor.

8 Department of Critical Care Medicine, National Institutes of Health, Bethesda.

9 Johns Hopkins University School of Medicine, Baltimore, Maryland.

10 Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases, University of Barcelona, Spain.

11 Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Veterans Affairs Western New York Healthcare System, New York.

12 Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany.

13 Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.

14 Summa Health System, Akron, Ohio.

15 Department of Medicine, Division of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio.

16 Burns, Trauma and Critical Care Research Centre, The University of Queensland Royal Brisbane and Women’s Hospital, Queensland.

17 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.

18 Library and Knowledge Services, National Jewish Health, Denver, Colorado.

19 Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Abstract

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations.

IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.

These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia.

The panel’s recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981759/pdf/ciw353.pdf

October 13, 2017 at 3:54 pm

International ERS/ESICM/ESCMID/ALAT Guidelines for the Management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT)

Eur Respir Journal  September 2017 V.50 N.3

ERS/ESICM/ESCMID/ALAT guidelines

Antoni Torres, Michael S. Niederman, Jean Chastre, Santiago Ewig, Patricia Fernandez-Vandellos, Hakan Hanberger, Marin Kollef, Gianluigi Li Bassi, Carlos M. Luna, Ignacio Martin-Loeches, J. Artur Paiva, Robert C. Read, David Rigau, Jean François Timsit, Tobias Welte and Richard Wunderink

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.

The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.

A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).

Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population–intervention–comparison–outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.

PDF

http://erj.ersjournals.com/content/erj/50/3/1700582.full.pdf

October 5, 2017 at 9:28 am

Specific Biomarkers Associated With Neurological Complications and Congenital Central Nervous System Abnormalities From Zika Virus–Infected Patients in Brazil

Journal of Infectious Diseases July 15, 2017 V.216 N.2 P.172–181

Yiu-Wing Kam; Juliana Almeida Leite; Fok-Moon Lum; Jeslin J L Tan; Bernett Lee …

Background

Zika virus (ZIKV) infections have been linked to different levels of clinical outcomes, ranging from mild rash and fever to severe neurological complications and congenital malformations.

Methods

We investigated the clinical and immunological response, focusing on the immune mediators profile in 95 acute ZIKV-infected adult patients from Campinas, Brazil. These patients included 6 pregnant women who later delivered during the course of this study. Clinical observations were recorded during hospitalization. Levels of 45 immune mediators were quantified using multiplex microbead-based immunoassays.

Results

Whereas 11.6% of patients had neurological complications, 88.4% displayed mild disease of rash and fever. Several immune mediators were specifically higher in ZIKV-infected patients, and levels of interleukin 10, interferon gamma-induced protein 10 (IP-10), and hepatocyte growth factor differentiated between patients with or without neurological complications. Interestingly, higher levels of interleukin 22, monocyte chemoattractant protein 1, TNF-α, and IP-10 were observed in ZIKV-infected pregnant women carrying fetuses with fetal growth–associated malformations. Notably, infants with congenital central nervous system deformities had significantly higher levels of interleukin 18 and IP-10 but lower levels of hepatocyte growth factor than those without such abnormalities born to ZIKV-infected mothers.

Conclusions

This study identified several key markers for the control of ZIKV pathogenesis. This will allow a better understanding of the molecular mechanisms of ZIKV infection in patients.

PDF

https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAdgwggHUBgkqhkiG9w0BBwagggHFMIIBwQIBADCCAboGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMuj_a-VAMddE_zlaHAgEQgIIBi63-XH3OORdTvNkyg01iIpJuW3POLRfocSGreL0dwgD_6lfvv3yIkhP83MPEjgbyM9hazTt8DxQ_2IqEP6eND0h1g-VCwKcveB1byxBTEz8KSJ33u-ZLO-0iet2RmKK6HMazACV8sW8KfaiLYfdKTUnyv4RSn2jfuq4U0F2hnTo_1WGmLFnsCrbfRbbQHnrudA9e_MPedHJfZAnRm53kkbzUtza0KfnfJx80cCVKJu2wGYXY5INohc43UMAEgsI2wAbXr7Xwd2RE8CXHlNPJnhI8YYhhjz_Yj4dnOfsSbzwL0inCX7tnqdFt5GsWbaM7Oa3zpl391yhxwE1HYUvCOZnyEAQpu2XTB_4h6ko7T1WDr_Jd-4H9W1HtVK1_ILzddKywF3yVCYmk35oC1RXv9gPslai0Hkjlpnb46k9VPEeQOOhXMzRYU7koX2RpuWfXAah7nfzaS0evT50mVl2GoS7mcMwtfDNFOCP_5mujf0ZaGhrTLgav_RbLq-dKMQA7DP0LVlBEsjtL61zI

September 27, 2017 at 8:50 am

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