Hanako Kurai

Moraxella osloensis: an unusual cause of central venous catheter infection in a cancer patient.

Moraxella osloensis is a rare causative organism of infections in humans, with most cases reported in cancer patients. We report the case of a 67-year-old Japanese man with advanced cancer of the pancreatic head and multiple liver metastases who developed fever with chills. Blood culture was found to be positive for Gram-negative bacilli that were aerobic, oxidase-positive, and catalase-positive. M. osloensis was identified by 16 rRNA gene sequencing. Prompt control of the infection was achieved by treatment with cefepime for 14 days, without the need for removal of the central venous catheter.

Campylobacter showae bacteremia with cholangitis

We report a case of Campylobacter showae bacteremia associated with cholangitis. A 71-year-old man with advanced bile duct cancer was admitted to our hospital because of cholangitis with shock, hypoglycemia, and impaired renal function. After replacement of the biliary drainage tube, pus was drained from the tube. Specimens for blood and bile cultures were obtained, and fluid resuscitation and antimicrobial treatment were then begun. Although anaerobic blood culture yielded small curved gram-negative rods, the isolate could not be identified by conventional identification methods. The isolate was identified as C. showae by 16S rRNA gene sequencing analysis. We consider here the pathogenicity of C. showae and the association of C. showae with cholangitis.

Surveillance of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae at a comprehensive cancer center in Japan, 2009-2013

We examined the results of surveillance of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae, which are pathogens known to cause nosocomial outbreaks, at a comprehensive cancer center in Japan over a 5-year period. We found that the admission prevalence and the incidence of ESBL-producing E coli increased during the study period, in contrast with ESBL-producing K pneumoniae, in which the parameters remained low throughout the study period.

Microbiology of Pelvic Lymphocyst Infection after Lymphadenectomy for Malignant Gynecologic Tumors

BACKGROUND Pelvic lymphocyst infection is a rare complication after lymphadenectomy for malignant gynecologic tumors. Although medical therapy is a useful addition to surgical drainage, the appropriate antibiotic regimen is unknown because few studies have examined the causative organisms. The purpose of this case series was to identify the micro-organisms infecting pelvic lymphocysts. METHODS This was a single-center, retrospective, case-series review conducted at a tertiary-care cancer center between October 2002 and March 2013. The participants included all patients who experienced their first pelvic lymphocyst infection after undergoing pelvic lymphadenectomy for cervical, endometrial, or ovarian cancer and exhibited positive lymphocyst fluid culture. Computed tomography- or sonography-guided percutaneous aspiration procedures were performed to obtain lymphocyst fluid for culture. RESULTS During the study period, 878 patients underwent lymphadenectomy for gynecologic malignant tumors, and 13 developed a pelvic lymphocyst infection documented microbiologically. Cultures identified Staphylococcus aureus (three patients), S. epidermidis (one patient), Streptococcus agalactiae (three patients), Enterococcus (two patients), Escherichia coli (one patient), and anaerobic bacteria (three patients). They were all monomicrobial infections. CONCLUSIONS Our study and other smaller ones suggest that lymphocyst infections following pelvic lymphadenectomy for malignant gynecologic tumors usually are monomicrobial and caused by gram-positive cocci, including Staphylococcus, Streptococcus, and Enterococcus, and anaerobes such as Bacteroides fragilis. These bacteria should be considered when selecting empiric antibiotic therapy.

Helicobacter fennelliae Bacteremia: Three Case Reports and Literature Review.

AbstractHelicobacter fennelliae is a gram-negative, spiral bacillus that appears as thin-spread colonies on sheep blood agar and is similar to Helicobacter cinaedi. H fennelliae is diagnosed by genetic testing, which is not readily available in all laboratories. Therefore, H fennelliae bacteremia has only been reported sporadically, and little is known about its clinical characteristics.We describe 3 cases of H fennelliae bacteremia with gastrointestinal symptoms, including nausea, vomiting, and diarrhea. Isolates could be differentiated from H cinaedi by biochemical reaction testing, including nitrate reduction and alkaline phosphatase hydrolysis.We retrospectively reviewed 24 cases of H fennelliae bacteremia reported in the literature. Most of the patients had immunosuppressive backgrounds, including solid tumors, hematological malignancies, and autoimmune diseases. Although gastrointestinal symptoms were common, cellulitis was not often observed in patients with H fennelliae bacteremia.Clinicians should bear in mind that H fennelliae may be a differential diagnosis in patients with gastrointestinal manifestations and gram-negative, spiral bacilli. In addition, biochemical reactions, such as nitrate reduction and alkaline phosphatase hydrolysis, are useful in differentiating H fennelliae from H cinaedi.

Preventing the transmission of methicillin-resistant Staphylococcus aureus at a tertiary care cancer center in Japan: Quality improvement report

Although methicillin-resistant Staphylococcus aureus (MRSA) is endemic in the majority of Japanese hospitals, national guidelines for the control and prevention of MRSA continue to be lacking. Also, the metrics to survey the incidence of MRSA transmission in health care facilities is not standardized. We improved MRSA control practices referring to the 2003 Society for Healthcare Epidemiology of America guidelines and assessed the effect of multifaceted interventions by quasiexperimental analysis at a tertiary hospital in Japan.

Coagulase-negative staphylococcal bacteraemia in cancer patients. Time to positive culture can distinguish bacteraemia from contamination

Abstract Background: Coagulase-negative staphylococci (CoNS) are the most common contaminants of blood cultures, however, we sometimes have difficulties in determining their clinical significance. It is still controversial that there is a significant difference between the contamination group and the true bacteraemia group in the time to positivity (TTP) of blood cultures. We validated the relationship between a TTP and the presence of CoNS bacteraemia in cancer patients by using an objective, non-judgmental definition for CoNS contamination. Methods: We retrospectively reviewed 175 sets of blood cultures drawn from 95 patients that yielded CoNS from October 2011 to March 2013. We considered as contamination if an isolate of CoNS was identified in one out of multiple sets of blood cultures. We investigated the TTP, the threshold values and corresponding likelihood ratios to distinguish CoNS bacteraemia from contamination. Results: The median TTP in CoNS bacteraemia group was significantly shorter than that in contamination group (14 h 45 min and 20 h 31 min, respectively, p = .0157). A TTP of ≤16 h had a specificity of 83% for predicting CoNS bacteraemia, and that of >20 h had a sensitivity of 86% for predicting CoNS contamination. Conclusions: We validated that the median TTP in CoNS bacteraemia group was significantly shorter than that in their contamination group, and that a TTP of ≤16 h was associated with CoNS bacteraemia, while that of >20 h was associated with CoNS contamination, if evaluated with an objective, non-judgmental definition for CoNS contamination.

Cellulitis and Bacteremia due to Corynebacterium striatum Identified by Matrix-assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry

Corynebacterium striatum has been described as a pathogen in immunocompromised patients; however, correctly identifying Corynebacterium spp. is often difficult, and cases of cellulitis caused by C. striatum are only rarely reported. We herein describe a case of cellulitis and bacteremia due to C. striatum identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antimicrobial susceptibility testing was performed using the Strepto-Haemo Supplement method, and vancomycin was replaced by a narrow-spectrum oral amoxicillin.

Infection control for extrapulmonary tuberculosis at a tertiary care cancer center.

Extrapulmonary tuberculosis (TB) can be infectious when diagnostic or therapeutic procedures are performed on infected lesions. We retrospectively describe infection control and evaluate isolation failure rates during the manipulation of active extrapulmonary TB lesions at a comprehensive cancer center over a 5-year period. Among patients with a high suspicion of cancer, extrapulmonary TB was not suspected, and airborne precautions often were not used when manipulating infected lesions.

Third-generation cephalosporin for antimicrobial prophylaxis in pancreatoduodenectomy in patients with internal preoperative biliary drainage

Background: The aim of the present study was to investigate whether the incidence of surgical site infection after pancreatoduodenectomy decreased after changing the prophylactic antibiotic to a third‐generation cephalosporin in patients with unknown preoperative bile culture results after biliary drainage. Methods: In a retrospective study of 138 pancreatoduodenectomy patients who underwent endoscopic biliary stenting and for whom recent preoperative bile culture results were unavailable, cefazolin sodium hydrate was administered as perioperative prophylactic antibiotic therapy from 2010 to 2014 (n = 69); whereas ceftriaxone was administered from 2014 to 2017 (n = 69) based on the results of institutional culture surveillance. The incidence of surgical site infection was compared between the two groups and the risk factor of surgical site infection was also evaluated. Results: The incidence of overall surgical site infection in the ceftriaxone group was significantly lower than that in the cefazolin sodium hydrate group for both Clavien‐Dindo grade ≥II (28% versus 52%, P = .005) and Clavien‐Dindo grade ≥IIIa (20% vs 41%, P = .016). A multivariate analysis revealed that the prophylactic administration of cefazolin sodium hydrate was associated with a higher incidence of overall surgical site infection in both Clavien‐Dindo grade ≥II and Clavien‐Dindo grade ≥IIIa (odds ratio 2.56, P = .019; odds ratio 3.03, P = .020, respectively). In the cefazolin sodium hydrate group, most of the patients with positive perioperative cultures had Enterobacteriaceae, which were intrinsically resistant to cefazolin sodium hydrate, and most were susceptible to ceftriaxone. Conclusion: The prophylactic administration of third‐generation cephalosporin reduced the incidence of surgical site infection after pancreatoduodenectomy in patients who underwent preoperative endoscopic biliary stenting.