Pavani Reddy

Postpartum Mastitis and Community-acquired Methicillin-resistant Staphylococcus aureus

This single-center, case-control study documents a relative increase in methicillin resistance among 48 cases of Staphylococcus aureus–associated postpartum mastitis during 1998–2005. Of 21 cases with methicillin resistance, 17 (81%) occurred in 2005. Twenty (95%) isolates contained the Staphylococcus cassette chromosome mec type IV gene; this suggests that the increase is due to community-acquired methicillin-resistant Staphylococcus aureus.

Carbapenem‐resistant Acinetobacter baumannii infections after organ transplantation

P. Reddy, T.R. Zembower, M.G. Ison, T.A. Baker, V. Stosor. Carbapenem‐resistant Acinetobacter baumannii infections after organ transplantation.
Transpl Infect Dis 2010: 12: 87–93. All rights reserved

Bat-Associated Leptospirosis

ABSTRACTLeptospirosis is a globally prevalent disease that affects humans, causing systemic illness that may lead to multi-organ involvement. Clinical signs include sudden fever, general malaise, muscular pain, conjunctival suffusion, and jaundice. Disease is caused by pathogenic bacteria including over 200 serologic variants. Most serologic variants have primary reservoirs in wild mammals, which continually infect and colonize domesticated animals. The organism has been recovered from rats, swine, dogs, cattle, and other animals, notably bats. Most studies have focused on domestic animals as reservoir hosts; however, because of their abundance, spatial distribution, and interrelationship with domestic animals, bats are becoming an epidemiologically significant source of leptospires. We present a case of serologically confirmed leptospirosis after bat exposure to add to the growing literature of bats as a possible source of transmission. Recognition of the common presentation of leptospirosis and Weil’s disease, and identification of animal vectors, including bats, allows for the selection of appropriate antibiotic management to aid in resolution of symptomotology.

Peritoneal Fluid Penetration of Tigecycline

Objective: To describe the peritoneal fluid penetration of tigecycline. Case Summary: A 33-year-old critically ill man who had undergone orthotopic liver and cadaveric renal transplant presented with sepsis. The patient required empiric antimicrobial coverage, continuous veno–venous hemofiltration, prolonged mechanical ventilation, tracheostomy placement, and maintenance immunosuppressive therapy. After multiple infections with multidrug-resistant pathogens, the patient developed vancomycin-resistant Enterococcus faecium peritonitis. Tigecycline 50 mg was administered every 12 hours, and ascites fluid drug concentrations were obtained. Drug concentrations in the peritoneal fluid were determined by high-performance liquid chromatography and revealed a tigecycline concentration of 0.074 μg/mL Despite aggressive measures, the patients condition continued to decline; he died 2 weeks after tigecycline initiation. Discussion: As of October 3, 2006, these are the first data to describe tigecycline peritoneal fluid penetration. Tigecycline was aggressively administered at twice the recommended dosage for overt liver failure in light of the severity of this patients condition. A tigecycline peritoneal fluid concentration of 44–54% of serum concentration was calculated based on the patients peritoneal fluid drug concentration and previously published serum concentrations from a similar population. Conclusions: Peritoneal penetration of tigecycline was approximately 50% in this critically ill patient. Establishment of site-specific breakpoints for tigecycline may be necessary. Future studies will need to evaluate the penetration of tigecycline into peritoneal fluid and other tissues.

Infection Control Practices among Interventional Radiologists: Results of an Online Survey

PURPOSE To assess current infection control practices of interventional radiologists (IRs) in the context of recommendations by the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration. MATERIALS AND METHODS From November 2006 to January 2007, members of the Society of Interventional Radiology (SIR) were invited to participate in an anonymous, online infection control questionnaire. RESULTS A total of 3,019 SIR members in the United States were contacted via e-mail, and 1,061 (35%) completed the 57-item survey. Of the respondents, 283 (25%) experienced a needlestick injury within the previous year, most often as a result of operator error (76%). Less than 65% reported compliance with annual tuberculosis skin testing; notably, those who received a yearly reminder were much more likely to receive annual testing than those who did not (odds ratio, 19.0; 95% CI, 12.6-28.7; P < .05). During central venous catheter placement, only 56% wore gowns, 50% wore caps, and 54% used full barrier precautions. Only 19% reported routine hand washing between glove applications. More than 40% noted a change in infection control practices within the previous 5 years, citing new hospital guidelines and recommendations by a professional organization as the reasons for change. Only 44% had infection control training at the onset of their practice. CONCLUSIONS IRs demonstrate a wide variety of infection control practices that are not in accordance with current guidelines. IRs were most likely to change infection control practice if required to do so by their own hospitals or a professional organization. SIR can play an important role in the prevention of health care-associated infection by reinforcing current infection control guidelines as they pertain to interventional radiology.

Antibiotic considerations in the treatment of multidrug‐resistant (MDR) pathogens: A case‐based review

The recent rise in antimicrobial resistance among health-care associated pathogens is a growing public health concern. According to the National Nosocomial Infections Surveillance System, rates of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units have nearly doubled over the last decade. Of equal importance, gram-negative agents such as Pseudomonas aeruginosa, Acinetobacter baumannii, and extended-spectrum beta lactamase-producing Enterobacteriaceae demonstrate increasing resistance to third-generation cephalosporins, fluoroquinolones, and, in some cases, carbapenems. As a consequence, hospitalists may find themselves utilizing new antibiotics in the treatment of bacterial infections. This case-based review will highlight 8 antibiotics that have emerging clinical indications in treating these multidrug-resistant (MDR) pathogens.

Life-Years Gained with Meropenem over Ciprofloxacin in Penicillin-Allergic Patients with Gram-Negative Bacilli Sepsis: Results of a Probabilistic Model

Study Objective. To compare meropenem with ciprofloxacin for treatment of gram‐negative bacilli sepsis in penicillin‐allergic patients in the intensive care unit (ICU) to determine if increased anaphylaxis risk with meropenem precluded its use when weighed against risks of inactive therapy with ciprofloxacin.

Carbapenem-resistantAcinetobacter baumanniiinfections after organ transplantation

P. Reddy, T.R. Zembower, M.G. Ison, T.A. Baker, V. Stosor. Carbapenem‐resistant Acinetobacter baumannii infections after organ transplantation.
Transpl Infect Dis 2010: 12: 87–93. All rights reserved

Carbapenem-resistant Acinetobacter baumannii infections after organ transplantation: Short communication

P. Reddy, T.R. Zembower, M.G. Ison, T.A. Baker, V. Stosor. Carbapenem‐resistant Acinetobacter baumannii infections after organ transplantation.
Transpl Infect Dis 2010: 12: 87–93. All rights reserved

Toxin-mediated syndromes of the nervous system

Publisher Summary This chapter discusses the epidemiology, etiology, pathogenesis, clinical features, diagnosis, and management of the toxin-mediated syndromes of the nervous system. Botulism is a paralytic illness caused by neurotoxin production by Clostridium botulinum . Clinical botulism results from the entry of botulinum toxin into the systemic circulation and subsequent inhibition of acetylcholine release from the presynaptic nerve terminals. Acetylcholine release at the neuromuscular junction is mediated by a synaptic fusion complex. This complex consists of three soluble, N -ethylmaleimide-sensitive fusion attachment protein receptors (SNARE proteins): synaptosomal-associated protein of 25 kDa (SNAP-25), syntaxin, and synaptobrevin. A fourth protein, synaptophysin, forms the fusion pore that allows the release of the vesicle contents into the synaptic cleft. The differential diagnosis of botulism is limited. The most common considerations include Guillain–Barre syndrome (GBS), myasthenia gravis, stroke, tick paralysis, and the Lambert–Eaton myasthenic syndrome (LEMS). A conventional diagnosis of botulism relies on the demonstration of toxin in serum, gastric secretions, stool, or food samples. The most sensitive means of botulism toxin detection is the mouse bioassay.