Sing On Teng

Clinical and epidemiological features of Chryseobacterium indologenes infections: Analysis of 215 cases *

PURPOSE This study investigates the clinical and epidemiological features of Chryseobacterium indologenes infections and antimicrobial susceptibilities of C indologenes. METHODS With 215 C indologenes isolates between January 1, 2004 and September 30, 2011, at a medical center, we analyzed the relationship between the prevalence of C indologenes infections and total prescription of colistin and tigecycline, clinical manifestation, antibiotic susceptibility, and outcomes. RESULTS Colistin and tigecycline were introduced into clinical use at this medical center since August 2006. The increasing numbers of patients with C indologenes pneumonia and bacteremia correlated to increased consumption of colistin (p = 0.018) or tigecycline (p = 0.049). Among patients with bacteremia and pneumonia, the in-hospital mortality rate was 63.6% and 35.2% (p = 0.015), respectively. Administration of appropriate antibiotics showed significant benefit in 14-day survival in patients with C indologenes bloodstream infection (p = 0.040). In bacteremic patients, old cardiovascular accident (p = 0.036) and cancer (p = 0.014) were the most common comorbidity. The most common co-infection pathogen in patients with C indologenes pneumonia was Acinetobacter baumannii (36/91, 39.6%), followed by Pseudomonas aeruginosa (23/91, 25.3%), carbapenem-resistant A baumannii (22/91, 24.2%), and Klebseilla pneumoniae (13/91, 14.3%). Antimicrobial susceptibility testing of the 215 isolates showed that trimethoprim-sulfamethoxazole was the most active agent (susceptibility rate: 87.4%), followed by cefoperazone-sulbactam (48.0%). CONCLUSION The present study showed a trend of increasing prevalence of C indologenes infection after introduction of colistin and tigecycline usage. The bacteremia group had higher mortality rate than the pneumonia group. Increasing resistance to piperacillin-tazobactam, ceftazidime, cefepime, and newer fluoroquinolone were noticed in our analysis. Trimethoprim-sulfamethoxazole was a potential antimicrobial agent in vitro for C indologenes. To avoid collateral damage, we emphasize the importance of antibiotic stewardship program.

Corynebacterium striatum bacteremia associated with central venous catheter infection

Corynebacterium striatum (C striatum) has been considered a contaminant of blood culture in past decades. Here we report the case of a patient with acute deterioration of chronic renal failure. She received hemodialysis and died from C striatum bacteremia. By using a randomly amplified polymorphic DNA (RAPD) method, we found that an association existed between C striatum from the bloodstream and that from the central venous catheter. We suggest that C striatum could be a pathogen of bloodstream infection in patients with such a catheter in place.

Lemierre syndrome complicating multiple brain abscesses caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae cured by fosfomycin and meropenem combination therapy

A woman aged 56 years of age had a community-acquired left neck abscess and internal jugular vein thrombosis with septicemia due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae. Even though she was treated with intravenous meropenem, the bacteremia persisted. She was complicated with multiple brain abscesses, seizure, and leucopenia. After a combination of intravenous fosfomycin and meropenem, her clinical condition became stable. Combination treatment was continued for 2 months and she recovered. In individual cases of Lemierre syndrome with brain abscess caused by ESBL-producing Enterobacteriaceae, fosfomycin combination therapy may be the alternative choice.

Comparison of pneumonia- and non-pneumonia-related Acinetobacter baumannii bacteremia: Impact on empiric therapy and antibiotic resistance

OBJECTIVE Acinetobacter baumannii (AB) bacteremia has increasingly emerged as a nosocomial pathogen in healthcare settings, associated with high patient morbidity and mortality. The objective of this study was to compare clinical features, risk factors, treatment outcome, and antibiotic resistance in patients with pneumonia- and non-pneumonia-related AB bacteremia. METHODS We conducted a retrospective study in a tertiary teaching hospital in northern Taiwan. The medical records of the 141 episodes of hospital-acquired AB bacteremia between July 1, 2006 and June 30, 2012 were reviewed, and sorted into groups of AB bacteremia with (n = 59) and without pneumonia (n = 82). RESULTS The hospital-acquired pneumonia-related AB bacteremia group were found to be significantly more frequently treated in intensive care units (49.2%, p < 0.001), but the AB bacteremia without pneumonia group were significantly more frequently treated on general wards (85.4%, p < 0.001). Patients with pneumonia tended to be older than the nonpneumonia group (72.8 years vs. 65.2 years in mean age, p < 0.01), and more likely to use mechanical ventilators (62.7% vs. 15.9 %, p < 0.001). Pneumonia patients were found to receive broad-spectrum antibiotics significantly earlier than nonpneumonia patients (p < 0.001). Compared to those without pneumonia, the patients with pneumonia had significantly higher incidence of antibiotic-resistance (p < 0.05), longer hospital stay (p < 0.01), and higher mortality rate (p < 0.001). The incidence of multidrug-resistant AB was significantly higher in patients with pneumonia (p < 0.05), and only colistin (p < 0.01) and tigecycline (p < 0.01) were significantly active against multidrug-resistant AB isolates. CONCLUSION Pneumonia-related AB bacteremia has a worse outcome, more antibiotic resistance, and more comorbidity than the nonpneumonia group.

Breakthrough disseminated cryptococcosis during micafungin therapy

Echinocandins are not active against basidiomycetous yeasts, such as Cryptococcus neoformans, Trichosporon, and Rhodotorula species, and zygomycosis. We present a patient with renal failure and candidemia, who developed a breakthrough fungal infection with cryptococcemia and cryptococcuria while receiving micafungin therapy.