Suresh J. Antony

Acinetobacter lwoffii: Bacteremia associated with acute gastroenteritis

Acinetobacter lwoffii is a non-fermentative aerobic gram-negative bacillus that is seen as a normal flora of the oropharynx and skin in approximately 25% of the healthy individuals. Due to its ubiquitous nature, it is a potential opportunistic pathogen in patients with impaired immune systems, and it has been identified as a cause of nosocomial infections like septicemia, pneumonia, meningitis, urinary tract infections, skin and wound infections. To our knowledge, this is the first case reported of a community acquired A. lwoffii bacteremia associated with gastroenteritis.

High-level Aminoglycoside-resistant Enterococcus causing Endocarditis Successfully Treated with a Combination of Ampicillin, Imipenem and Vancomycin

We describe a case of bacterial endocarditis caused by Enterococcus faecalis, which was highly resistant to aminoglycosides. The patient was successfully treated with a combination of ampicillin, imipenem and vancomycin. We believe this to be the first case in the literature to be treated successfully with this combination.

Prosthetic Joint and Orthopedic Device Related Infections. The Role of Biofilm in the Pathogenesis and Treatment.

Prosthetic joint infections (PJI) in orthopedic related devices (ORD) are major issues following replacement of joints. It results in serious morbidity and mortality and is expensive to treat and manage. The pathogenesis of these infections is related to the presence of biofilm on the metallic and plastic surfaces of the devices. This biofilm results in poor penetration of antibiotics resulting in persistence and difficulty in eradication of the infection despite appropriate antibiotics. This paper summarizes the present data of biofilm as it relates to PJI/ORD.

Study of methicillin-resistant Staphylococcus aureus on the U.S./Mexico border

BACKGROUNDnEl Paso, Texas and Ciudad Juarez, Mexico comprise the largest U.S./Mexico border population.nnnMETHODSnBacterial samples were collected from two hospitals in El Paso and two in Ciudad Juarez and transported to a reference microbiology laboratory in El Paso for microbial identification and antimicrobial susceptibility testing according to NCCLS standards. The presence of the MecA gene, and the prevalence of both the SSCmec IV element and the Panton-Valentine leukocidin were investigated by PCR in all MRSA isolates.nnnRESULTSnA total of 201 isolates in El Paso and 128 in Ciudad Juarez of Staphylococcus aureus were identified, of those, MRSA were significantly more prevalent in El Paso than in Ciudad Juarez [89 (44.3%) versus 10 (7.8%) respectively (p<0.0001)]. Thirty one (35%) of MRSA strains isolated in El Paso were community associated.nnnCONCLUSIONnSignificantly higher prevalence of MRSA infections was documented in El Paso compared to Ciudad Juarez.

Idiopathic CD4 lymphopenia associated with neuroinvasive West Nile disease: Case report and review of the literature

Idiopathic CD4 lymphocytopenia is a very rare condition resulting in an immunodeficiency disorder that may or may not result in opportunistic infections. Since its description in the early 1990s, the reason for this immune deficiency has remained unclear. Its association with viral illnesses, such as West Nile virus infection, has yet to be described. We report a 26-year-old patient who presented with fever, ascending paralysis, and progressive weakness of the upper extremities. To our knowledge, this is the first case of neuroinvasive West Nile virus occurring in the context of a diagnosis of idiopathic CD4 lymphocytopenia.

Use of Oritavancin (Novel New Lipoglycopeptide) in the Treatment of Prosthetic Joint Infections (PJI): A Possible Alternative Novel Approach to a Difficult Problem

Prosthetic joint infections (PJI) result in significant morbidity, mortality and cost to patients and the health system. Traditional treatment involves a twostaged revision and occasionally a single staged revision along with intravenous antibiotics (IV) and or oral antibiotics for several weeks to months. The use of a single staged revision along with an antibiotic which has a prolonged half life and is bactericidal would be ideal. We present 2 patients who were treated successfully with a single stage revision/antibiotic spacer and a new novel long acting lipoglycopeptide called oritavancin.

Extended-Spectrum Beta-Lactamase Infections in Orthopedic-Related Devices and Prosthetic Joints.

Extended-spectrum beta-lactamase-producing Enterobacteriaceae have increasingly become a public health issue in a variety of infections, including urinary tract infections and postoperative infections. The complications that occur due to these organisms in bone, joint, and prosthetic joints have not been well defined. This study reviewed the clinical characteristics, risk factors, and outcomes of patients with extended-spectrum beta-lactamase-producing Enterobacteriaceae infections of prosthetic joints or orthopedic-related hardware. Six infections met the inclusion criteria that resulted in a 100% failure rate when the hardware or prosthetic joint was not replaced initially. However, when the hardware or prosthetic joint was replaced, all of the patients did well. The use of carbapenems remains effective in these cases. [Orthopedics. 2016; 39(4):e668-e673.].

Case series describing an outbreak of highly resistant vancomycin Staphylococcus aureus (possible VISA/VRSA) infections in orthopedic related procedures in Guatemala.

This is a case series describing an outbreak of VRSA/VISA associated infections in orthopedic related procedures that occurred on a medical mission trip in Antigua, Guatemala. The paper describes the clinical features, microbiology and treatment options available to treat such infections in a Third World country. It also highlights the difficulty in making an accurate diagnosis with suboptimal microbiological support.

ESBL E coli and P. aeruginosa Resistance to Ceftolozane-Tazobactam in a Patient with a Liver Abscess. The Search for an Omnipotent Antibiotic Goes On!

Multi drug resistant (MDR) Pseudomonas aeruginosa and Extended- Spectrum-lactamase (ESBL) Enterobacteriaceae are becoming an increasing difficult clinical problem. Immediate resistance to some of the new antimicrobials such as ceftolozane/tazobactam is unusual and is due to a variety of mechanisms such as hyper-production of inactivating enzymes and gene mutation. In addition, previous antimicrobial administration is a well-recognized risk factor to develop resistance. We present a patient with a liver abscess where the organism was resistant to ceftolozane/tazobactam resulting in a poor clinical outcome.

Citrobacter braakii Bacteremia: Case Report and Review of the Literature

Bacteremia is frequently caused by gram-positive organisms such as Staphylococcus aureus or β hemolytic streptococci. While there is adequate information for the diagnosis and management of these common bacteria, less information is available to address bacteremia that is caused by uncommon bacteria such as Citrobacter. Citrobacter species are gram-negative bacilli that have been noted to cause infections in immune compromised patients. The re-speciation of Citrobacter by its varied genetic composition has produced 11 distinct species. While C. braakii is part of the genome species 6 of the previous Citrobacter freundii complex, there is a lack of definitive research on the subject of Citrobacter bacteremia caused by lesser- known species. We report an unusual case of Citrobacter braakii bacteremia in a patient with multiple comorbidities that presented to the hospital with cellulitis and pleural effusion. Blood cultures grew Citrobacter braakii. Despite good response to antibiotic treatment, the patients infection proved to be persistent and he succumbed to the cirrhosis of the liver and subsequent renal failure. Multiple and fatal underlying disease processes seem to worsen the likelihood of recovery from unusual infections. We believe our case report can add to the limited data available for C. braakii.