Felix A. Sarubbi

A Decline in Mupirocin Resistance in Methicillin-Resistant Staphylococcus aureus Accompanied Administrative Control of Prescriptions

ABSTRACT Susceptibility to mupirocin was assessed in methicillin-resistant Staphylococcus aureus isolates selected from eras corresponding to differences in usage rate and prescription policies at a Veterans Affairs medical center. The eras studied encompassed from the time of introduction of the drug to its widespread use, through recommended judicious use, and finally to subsequent stringent administrative control. Prescriptions declined from 3.0 to 0.1 per 1,000 patient days. Precipitous declines first in the numbers of isolates with high-level resistance (from 31% to 4%) and then in those with low-level resistance (from 26% to 10%) accompanied prescription control.

Nosocomial transmission clusters and risk factors in Moraxella catarrhalis.

We report an objective examination of nosocomial transmission events derived from long-term (10-year) data from a single medical centre. Cluster analysis, based on the temporal proximity of genetically identical isolates of the respiratory pathogen Moraxella catarrhalis, identified 40 transmission events involving 33 of the 52 genotypes represented by multiple isolates. There was no evidence of highly transmissible or outbreak-prone genotypes. Although most clusters were small (mean size 3.6 isolates) and of short duration (median duration 25 days), clustering accounted for 38.7% of all isolates. Significant risk factors for clustering were multi-bed wards, and winter and spring season, but bacterial antibiotic resistance, manifested as the ability to produce a beta-lactamase was not a risk factor. The use of cluster analysis to identify transmission events and its application to long-term data demonstrate an approach to pathogen transmission that should find wide application beyond hospital populations.

Blastomycosis in the Mountainous Region of Northeast Tennessee

BACKGROUNDnIn the United States, cases of human blastomycosis are largely described in defined geographic areas, with Mississippi reporting the highest prevalence of disease in the southeast region. The infection is uncommonly recognized in mountainous areas, and our previous report of blastomycosis in the southern Appalachian mountains of northeast Tennessee appeared to be an exception to the usual disease distribution.nnnMETHODSnOur current retrospective study was undertaken to determine whether blastomycosis has persisted as an endemic fungal infection in our northeast Tennessee geographic area and whether epidemiologic features have changed over a 25-year time period.nnnRESULTSnResults show that clinical aspects of the disease have remained fairly constant with few exceptions; mass-type pulmonary lesions have become more common, and itraconazole has emerged as the therapy of choice. Most notably, however, are the observations that blastomycosis persists as a major endemic fungal infection in our mountain region, more than half of all cases occurring during the period from 1996 to 2005 were found in a core area centered on two counties, Washington and Unicoi; three of five counties surrounding the core counties experienced rate increases compared to our previous study.nnnCONCLUSIONSnThese findings suggest a further expansion of this endemic fungal disease beyond the core region.

Unusual presentation of Blastomyces dermatitidis infection as pelvic abscess and osteomyelitis: A report of two cases and review of the literature

Pulmonary, cutaneous, genitourinary, and bone infections due to Blastomyces dermatitidis have been well documented in the literature. To date, however, the diagnosis and treatment of pelvic abscess and osteomyelitis caused by this organism have been rarely described. We report two cases of pelvic osteomyelitis and abscess due to B. dermatitidis that were successfully treated with oral itraconazole and review the literature on this unusual presentation. The causative agent of blastomycosis, Blastomyces dermatitidis, is a soil-dwelling, dimorphic fungus that leads to systemic infection in both healthy and immunocompromised hosts [1]. This fungus is endemic in different parts of the world but is most highly associated with infections in the south-central and midwestern United States [2,3]. We previously described our experience with blastomycosis infections in northeast Tennessee, where the majority of patients presented with pulmonary disease and only four of 72 patients (5.6%) had bone involvement [3]. Subsequent to our report, we encountered two patients with pelvic abscess and pelvic osteomyelitis due to B. dermatitidis. Because a literature review revealed that this was an exceptionally rare event, we chose to present these two cases along with the few previously published cases to elaborate on this unusual presentation of systemic blastomycosis.