Daniel Glikman

Urinary Tract Infections Caused by Community-Acquired Extended-Spectrum β-Lactamase-Producing and Nonproducing Bacteria: A Comparative Study

OBJECTIVEnTo study the clinical characteristics and associated risk factors of urinary tract infections (UTIs) caused by community-acquired extended-spectrum β-lactamase (CA-ESBL)-producing Enterobacteriaceae.nnnSTUDY DESIGNnA case-control study at a large community hospital in northern Israel, comparing children who had UTI due to CA-ESBL (n = 25) and CA non-ESBL (n = 125) in 2008-2011. Data were collected from medical charts, telephonic questionnaires administered to all participants, and groups were compared.nnnRESULTSnDuring the study period, the yearly incidence of CA-ESBL UTI increased significantly. There were no significant differences between the CA-ESBL and CA non-ESBL groups in demographics and clinical outcome. Compared with CA non-ESBL UTI, children with CA-ESBL UTI had a longer hospital stay (5.9 ± 3.3 vs 3.9 ± 2.3 days; P = .003) and higher rates of recent hospitalization (28% vs 4%; P = .001), previous UTI (40% vs 13%; P = .003), urinary tract anomalies (32% vs 5%; P < .001), UTI prophylaxis with cephalexin (32% vs 2%; P < .005), and aminoglycoside resistance. In a multivariate analysis, UTI prophylaxis (OR 12.5 [CI 2.7-58]), recent hospitalization (OR 4.8 [CI 1.1-21]), and Klebsiella spp. UTI (OR 4.7 [CI 1.3-17]), were risk factors for CA-ESBL UTI.nnnCONCLUSIONSnChildren prescribed UTI prophylaxis (due to urinary tract anomalies or recurrent UTI) with cephalexin and those with previous hospitalizations are at increased risk for CA-ESBL UTI. Although not associated with higher rates of complications, the multidrug resistant phenotype of CA-ESBL isolates poses a challenge in choosing appropriate empiric and definitive therapy and prolongs hospital stay.

Legionella pneumophila and Pneumocystis jirovecii coinfection in an infant treated with adrenocorticotropic hormone for infantile spasm: case report and literature review.

We describe an 8-month-old infant with infantile spasms treated with adrenocorticotropic hormone (ACTH) who presented with fatal Legionella pneumophila and Pneumocystis jirovecii infection. Emphasis is placed on the ensuing immunosuppression and infectious sequelae of ACTH therapy. Given that ACTH therapy may increase the risk of fatal infection, patients undergoing such treatment should be closely monitored, with particular attention paid to the functioning of the immune system.

Brucellosis Outbreak in Children and Adults in Two Areas in Israel.

Two parallel outbreaks of Brucella melitensis infection occurred in 2014 in two geographical areas in Israel. In two medical centers in northern Israel and one medical center in Jerusalem, 102 patients (58 children, 47 adults) were diagnosed with brucellosis. Most patients (N = 76, 72%) were Muslim Arabs, 28 (27%) were Druze, and one was Jewish. The source of infection was often traced to cheese from the Palestinian Authority. Biovar-1 was evident in 98% in northern Israel but only in 42% in Jerusalem. Most common manifestations were fever (82%) and osteoarticular symptoms (49%). The major differences between the geographic areas were ethnicity and duration until diagnosis. Compared with adults, children had higher rates of hospitalization (93% versus 64%, P = 0.001), osteoarticular symptoms (60% versus 36%, P = 0.05), elevated alanine aminotransferase (12% versus 0%, P = 0.01), and lower C-reactive protein (2.28 ± 2.08 versus 5.57 ± 6.3l mg/dL, P = 0.001). Two unrelated brucellosis outbreaks occurred in 2014 in two different geographic areas of Israel and were limited to sections of the Arab and Druze populations. Most of the demographic and clinical aspects of patients were not affected by geographic variability. Clinical and laboratory differences were found between children and adults emphasizing the nonuniformity of the disease in different age groups. Effective control of unpasteurized dairy foods, health education programs, and improved regional cooperation are required to control brucellosis in Israel.

Monitoring and managing antibiotic resistance in refugee children

ABSTRACT Introduction: The past decade the Middle East and Southeastern Europe have witnessed an enormous movement of refugees due to the Syrian war and conflicts in Asia and Africa. Although carriage of and infections with multi-drug resistant (MDR) pathogens in refugees have been reported, pediatric data are scarce. Areas covered: MDR bacterial carriage and infections, and MDR-tuberculosis (TB) in refugee children from 2010. Expert commentary: High MDR carriage rates in refugee children are attributed to high pre-civil war MDR rates, war-damaged infrastructure and healthcare systems, and poor hygiene conditions. Currently there are no international guidelines about MDR screening in refugee children. Given the medical importance of MDRs, challenging therapeutics and risk of importation in non/low-endemic countries, we recommend routine screening and contact isolation upon hospitalization of refugees. TB, including MDR-TB, is highly-endemic in many Asian and African countries, however, current data in refugee children are lacking. TB Screening in refugees is widely implemented but there is no consensus on methods and target populations. Coordinated TB detection and treatment, use of rapid molecular tests and drug-susceptibility testing, better access to healthcare, cross border TB care collaboration, and protection from deportation while on treatment should be integrated parts of TB control and prevention.

Hospital clones of methicillin-resistant Staphylococcus aureus are carried by medical students even before healthcare exposure

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community. Few studies have examined MRSA carriage among medical students.The aim of this study is to examine Staphylococcus aureus (SA) carriage, and particular MRSA, over time in cohort medical studentsMethodsProspective collection of nasal swabs from medical students in Israel and assessment of SA carriage. Three samples were taken per student in preclinical and clinical parts of studies. Antibiotic susceptibilities were recorded and MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine Leukocidin (PVL) encoding genes, and spa types. Clonality was assessed by pulsed-field gel electrophoresis.ResultsAmong 58 students, SA carriage rates increased from 33% to 38% to 41% at baseline (preclinical studies), 13 and 19xa0months (clinical studies), respectively (pu2009=u20090.07). Methicillin-susceptible SA (MSSA) carriage increased in the clinical studies period (22 to 41%, pu2009=u20090.01). Overall, seven students (12%) carried 13 MRSA isolates. MRSA isolates were PVL negative and were characterized as SCCmecII-t002, SCCmecIV-t032, or t12435 with untypable SCCmec. MRSA carriage during the pre-clinical studies was evident in 4/7 students. Two students carried different MRSA clones at various times and persistent MRSA carriage was noted in one student. Simultaneous carriage of MRSA and MSSA was not detected.ConclusionsMSSA carriage increased during the clinical part of studies in Israeli medical students. Compared with previous reports, higher rates of MRSA carriage were evident. MRSA strains were genotypically similar to Israeli healthcare-associated clones; however, carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains.

A 2-Year-Old Girl with a Limp

A 2-year-old girl with no past medical history was transferred from another hospital to our tertiary care medical center for evaluation of a limp. She had been healthy until a month prior, when she was noted to be limping on her right leg. This problem progressed, and she refused to walk 3 weeks later. Her mother recalled that the child fell while walking about a week before the symptoms started. The child had a mild fever for 2 days during the illness. There was no history of upper airway illness, cough, diarrhea, skin rash, sick contacts, travel, or animal exposure. Her past medical history was unremarkable. She was healthy, up-to-date with immunizations, lived with both parents and two siblings in Chicago, and did not attend day care.

Traditional empiric antibiotic treatment is still effective forneonatal fever

Fever may be the only sign of a serious bacterial infection (SBI) in neonates. Ampicillin plus cefotaxime (A+C) and ampicillin plus gentamicin (A+G) are commonly used as empiric therapies for Escherichia coli, Group B Streptococcus (GBS) and Listeria monocytogenes, which are the most likely neonatal SBI pathogens (1). Culture-based screening and prophylaxis has significantly lowered GBS infections and an alarming increase in the antimicrobial resistance rates of Gram-negative bacteria, including cefotaxime and gentamicin resistance, has been reported (1-3). We examined whether the current empiric treatment for neonatal SBI, namely A+G and A+C was still appropriate and identified easily recognisable risk factors for antimicrobial resistance. n nThis article is protected by copyright. All rights reserved.

Genetic and Phenotypic Characterization of a Salmonella enterica serovar Enteritidis Emerging Strain with Superior Intra-macrophage Replication Phenotype

Salmonella enterica serovar Enteritidis (S. Enteritidis) is one of the ubiquitous Salmonella serovars worldwide and a major cause of food-born outbreaks, which are often associated with poultry and poultry derivatives. Here we report a nation-wide S. Enteritidis clonal outbreak that occurred in Israel during the last third of 2015. Pulsed field gel electrophoresis and whole genome sequencing identified genetically related strains that were circulating in Israel as early as 2008. Global comparison linked this outbreak strain to several clinical and marine environmental isolates that were previously isolated in California and Canada, indicating that similar strains are prevalent outside of Israel. Phenotypic comparison between the 2015 outbreak strain and other clinical and reference S. Enteritidis strains showed only limited intra-serovar phenotypic variation in growth in rich medium, invasion into Caco-2 cells, uptake by J774.1A macrophages, and host cell cytotoxicity. In contrast, significant phenotypic variation was shown among different S. Enteritidis isolates when biofilm-formation, motility, invasion into HeLa cells and uptake by THP-1 human macrophages were studied. Interestingly, the 2015 outbreak clone was found to possess superior intra-macrophage replication ability within both murine and human macrophages in comparison to the other S. Enteritidis strains studied. This phenotype is likely to play a role in the virulence and host-pathogen interactions of this emerging clone.