Ali Hassoun

Seasonal variation of respiratory pathogen colonization in asymptomatic health care professionals: A single-center, cross-sectional, 2-season observational study

Background The purpose of this study was to determine the seasonal variance of potentially pathogenic bacterial and viral organisms in nasopharyngeal specimens obtained from asymptomatic health care professionals (HCPs) during the 2014 winter and summer months. Methods Nasopharyngeal specimens from 100 HCPs were collected from Huntsville Hospital (Huntsville, AL) during the winter and from 100 HCPs during the summer. All subjects were tested for 22 viruses and 19 bacteria using Target Enriched Multiplex Polymerase Chain Reaction. Both seasonal cohorts were composed of students, nurses, physicians, and residents. Results Of the 100 HCPs tested during the winter, 34 subjects were colonized with at least 1 bacterium, and 11 tested positive for at least 1 virus. Methicillin-resistant Staphylococcus aureus (MRSA), Moraxella catarrhalis, and coronavirus were the most frequently detected potentially infectious agents. Of the 100 HCPs tested during the summer, 37 tested positive for at least 1 bacterium, and 4 tested positive for a viral agent. The most prevalent bacteria were MRSA and Klebsiella pneumonia. Conclusion Nasopharyngeal carriage among asymptomatic HCPs was common, but the frequency and presence of potential pathogens varied with each season. Understanding the colonization and infection potential of upper respiratory organisms is important, particularly for viruses. Although asymptomatic HCPs certainly harbor a number of different potentially infectious agents, future studies are needed to determine whether colonized pathogens are transmitted or initiate infection in at-risk patient populations.

The Utility of Rapid Microbiological and Molecular Techniques in Optimizing Antimicrobial Therapy

Early treatment of bloodstream infections with appropriate, definitive antimicrobial therapy has proven to reduce mortality, length of hospital stay, and healthcare costs. Culture-based testing methods require up to five days for final pathogen identification and susceptibility reporting, forcing use of broad spectrum empiric therapy. Recently, multiple rapid microbiological and molecular testing methods have been developed that reduce the time to identify the pathogen and susceptibility, allowing optimal antimicrobial therapy to be prescribed earlier. Real-time polymerase chain reaction and gene microarray have been described in literature, yet only peptide nucleic acid fluorescent in-situ hybridization has published data justifying its use based on clinical outcomes and cost savings. Target enriched multiplex polymerase chain reaction was developed to identify both the pathogen and multiple genes associated with resistance from blood within 6 hours and this methodology was studied in our hospital to assess effectiveness at optimizing antimicrobials in staphylococcal bloodstream infections.

Ceftaroline Fosamil Use in 2 Pediatric Patients With Invasive Methicillin-Resistant Staphylococcus aureus Infections

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is one of the most common pathogens causing pediatric infections including skin and soft tissue infections, pyogenic arthritis, osteomyelitis, and septic shock. For decades, patients were treated with antibiotics such as vancomycin and clindamycin, but there is an increasing incidence of resistance to these traditional therapies. We describe 2 cases of patients with CA-MRSA invasive infections with bacteremia who experienced vancomycin therapy failure but who were successfully treated with ceftaroline fosamil. Case 1 involves an 8-year-old Hispanic male who was diagnosed with CA-MRSA bacteremia, thigh abscess, and osteomyelitis. The patient was admitted to the pediatric intensive care unit in septic shock. Case 2 involves an 8-year-old Caucasian male who was diagnosed with CA-MRSA sepsis, right arm abscess, and osteomyelitis. We were able to successfully treat both patients with CA-MRSA sepsis and invasive infection-who failed vancomycin therapy-with ceftaroline fosamil with no adverse efiects. Despite the positive outcome in both pediatric patients, clinical trials with ceftaroline fosamil are needed to further support its use in pediatric patients.

Antibiotic bladder irrigation in preventing and reducing chronic urinary catheter related urinary tract infections (UTI)

Abstract Background Recurrent UTI is a common complication of chronic urinary catheter use. We report our experience with the use of antibiotic bladder irrigation to reduce catheter associated UTI and systemic antibiotics use. Methods Retrospective chart review of patients treated with antibiotic bladder irrigation for recurrent UTI related to chronic urinary catheter (2013–2016). Data collected include demographic, co-morbidities, urological anomalies, symptoms, documented pathogens during episodes of infection, and irrigation medication used. Antibiotic regimen included: gentamicin, gentamicin alternated with piperacillin-tazobactam, or tobramycin once weekly. Parameters for successful therapy and alleviation of symptoms included complete relief of symptoms for six months and no systemic antibiotics use for six months post initiation of therapy, or reduced frequency of infections for one year post initiation of therapy. Results 39 patients were enrolled, all were patients who had been referred to infectious disease physicians after persistence of symptoms despite multiple rounds of systemic antibiotics and had at least 6 episode of documented UTI despite following guideline for aseptic urinary catheter insertion and care. Mean age 66.5 y (range 27–92), 69% male. Most common urologic problem was neurogenic bladder in 48% and prostate or bladder surgery. 5 self-catheterize, 12 had suprapubic catheter and 22 had chronic indwelling catheter. Most common co-morbidities include: DM, BPH, paraplegia, spina bifida and multiple sclerosis. Most common presenting symptoms were abdominal pain 49% and fever 34%. Most common organisms were Escherichia coli 38%, Pseudomonas aeruginosa 23% and Enterococcus faecalis 18%. 67% used gentamicin bladder irrigation. 26 (66.67%) met the criteria for alleviation of symptoms and success with antibiotic irrigation therapy, and a further four featured improvement of frequency of symptoms despite not successfully meeting the study’s pre-set criteria for full improvement. Patient did not report any associated side effect. Conclusion Use of antibiotic bladder irrigation was successful in reducing symptom frequency and requirement of systemic antibiotics. Further Studies needed to assess the benefit of this mode of therapy. Disclosures All authors: No reported disclosures.

Successful salvage treatment of native valve Enterococcus faecalis infective endocarditis with telavancin: two case reports

Abstract Infective endocarditis (IE) one-year mortality rates approach 40%. Here, we report two native valve Enterococcus faecalis IE cases in patients successfully treated with telavancin. An 88-year-old with mitral valve endocarditis and a penicillin allergy, initially treated with intravenous vancomycin, was switched to telavancin. A 69-year-old, who previously received amoxicillin and intravenous vancomycin for presumed enterococcal bacteraemia, was diagnosed with dual valve endocarditis for which he received telavancin. Both received six weeks of telavancin. Neither had telavancin-related adverse events, evidence of infection at six months, nor required telavancin dosing adjustments. Documented use of novel treatments for serious enterococcal infections is needed.

1429Nasopharyngeal Carriage of Potential Bacterial and Viral Pathogens in Hospitalized Patients with Respiratory Symptoms

• Respiratory samples obtained and screened for 22 different viruses, 16 bacteria, and 5 genetic drug resistance targets by Target Enriched Multiplex Polymerase Chain Reaction Methods To determine the frequency of detecting potentially pathogenic bacterial and viral gene targets in respiratory specimens collected from symptomatic patients during the 2013-2014 influenza season Hospitalized patients with respiratory symptoms admitted during the influenza season 2013-2014 showed high rate of H1N1 detected of 30%, it showed co-detection of viral and bacterial targets, females were more commonly infected . Those with other viral infections were commonly RSV and coronavirus. Detection of MRSA target was high in our patient population whether been carrier or infected. H1N1 and MRSA were detected more common in elderly. Esmeralda Asis Gutierrez asise@uab.edu Phone : 256-551-4557 Abstract #47909

Cauliflower Mass Obstructing the Left Main-Stem Bronchus

Clinical Infectious Diseases 2008:47:540-1