Thomas Fekete

Potential Clindamycin Resistance in Clindamycin-Susceptible, Erythromycin-Resistant Staphylococcus aureus: Report of a Clinical Failure

ABSTRACT The erm gene product confers clindamycin resistance on Staphylococcus aureus. We report a clindamycin clinical failure where resistance developed on therapy in a D-test-positive strain. D tests of 91 clindamycin-susceptible, erythromycin-resistant S. aureus isolates showed that 68% of methicillin-susceptible and 12.3% of methicillin-resistant S. aureus strains were D-test positive.

Cladophialophora bantiana brain abscess in a solid-organ transplant recipient: case report and review of the literature.

ABSTRACT Cerebral phaeohyphomycosis caused by Cladophialophora bantiana is a rare disease. We describe a heart and bilateral lung transplant recipient who was unsuccessfully treated for a C. bantiana brain abscess. This report compares the present case to those of other solid-organ transplant recipients with the same infection and to those of patients who did not receive transplants.

Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV.

Background HIV suppression at parturition is beneficial for maternal, fetal and public health. To eliminate mother-to-child transmission of HIV, an understanding of missed opportunities for antiretroviral therapy (ART) use during pregnancy and HIV suppression at delivery is required. Methodology We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013. Multivariable regression examined associations between patient (age, race/ethnicity, insurance status, drug use) and clinical factors such as adequacy of prenatal care measured by the Kessner index which classifies prenatal care as inadequate, intermediate, or adequate prenatal care; timing of HIV diagnosis; and the outcomes: receipt of ART during pregnancy and viral suppression at delivery. Results Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care. Eight-five percent of mother-to-child pairs received ART during pregnancy but only 52% achieved suppression at delivery. Adjusting for patient factors, pairs diagnosed with HIV during pregnancy were less likely to receive ART (AOR 0.39, 95% CI 0.25-0.61) and achieve viral suppression (AOR 0.70, 95% CI 0.49-1.00) than those diagnosed before pregnancy. Similarly, women with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03-0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20-0.47) than those with adequate prenatal care. Conclusions Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.

Bacterial Peritonitis Caused by Kingella kingae

ABSTRACT Kingella kingae is a commensal of the upper respiratory tract that occasionally causes skeletal infections in children and endocarditis in children and adults. We report a case of a 55-year-old man with liver disease and tense ascites who performed a paracentesis on himself and developed K. kingae peritonitis and bacteremia.

Comparative susceptibilities of Klebsieila species, Enterobacter species, and Pseudomonas aeruginosa to 11 antimicrobial agents in a tertiary-care university hospital

The in vitro activity of cefepime was compared versus that of 10 antimicrobial agents commonly used in the treatment of serious infections caused by common aerobic gram-negative bacteria: aztreonam, cefoperazone, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin, imipenem, piperacillin, ticarcillin-clavulanic acid, and tobramycin. We tested 30 clinical isolates representing a cross section of Klebsiella and Enterobacter species and Pseudomonas aeruginosa collected at our tertiary-care university hospital. The most potent beta-lactams were imipenem and cefepime, which demonstrated significant activity against the majority of strains in all 3 genera of bacteria tested, as did ciprofloxacin and tobramycin. Ceftazidime was active against Pseudomonas aeruginosa but was less potent against Klebsiella and Enterobacter spp. Cefoperazone and ceftriaxone were less active than ceftazidime against Pseudomonas aeruginosa. Cefepime was found to be highly active against many resistant organisms that traditionally have been difficult to treat.

Longitudinal epidemiology of multidrug-resistant (MDR) Acinetobacter species in a tertiary care hospital

BACKGROUND Acinetobacter species are well-known causes of health care-associated infections. The longitudinal epidemiology of this species in the hospital setting is poorly understood. A sudden, persistent increase in multidrug-resistant (MDR) A baumannii infections occurred beginning in June 2006 at Temple University Hospital in Philadelphia. An analysis was done to describe the longitudinal molecular epidemiology of MDR A baumannii in a tertiary care hospital. METHODS This was an epidemiologic investigation using repetitive extragenic palindromic-PCR (rep-PCR) of patients with a positive culture for MDR A baumannii admitted to the hospital between February 2006 and January 2010. MDR A baumannii were defined as susceptible only to colistin and/or tigecycline. RESULTS The incidence rate of MDR A baumannii rose from 0.36 cases per 1,000 patient-days (pre-epidemic) to 0.86 cases per 1,000 patient-days, due mainly to an increase in the surgical intensive care unit. Enhanced infection control measures were implemented, but waves of MDR A baumannii continued to be documented through routine surveillance. Of 32 strains collected in 2006-2007, a single predominant clone and 2 minor clones accounted for almost all of the cases of MDR A baumannii studied. Of 24 strains collected in 2008-2009, another clone, different from those studied in the earlier period, predominated, and was accompanied by 3 minor variants. CONCLUSION Following an outbreak in the surgical intensive care unit, MDR A baumannii persisted in our institution for a 3-year period despite rigorous infection control measures. An unexpected strain replacement occurred during this period, with the original predominant strain disappearing completely and new minor clones displacing the original minor clones.

Use of Fungal Blood Cultures in an Academic Medical Center

ABSTRACT We studied the use of fungal blood cultures in our hospital. They added little compared to routine culture results, but clinicians ordered them for sicker patients, when facing diagnostic uncertainty, or after prior candidemia. We need a practical guideline for when to order fungal blood cultures.

Major articleLongitudinal epidemiology of multidrug-resistant (MDR) Acinetobacter species in a tertiary care hospital

BACKGROUND Acinetobacter species are well-known causes of health care-associated infections. The longitudinal epidemiology of this species in the hospital setting is poorly understood. A sudden, persistent increase in multidrug-resistant (MDR) A baumannii infections occurred beginning in June 2006 at Temple University Hospital in Philadelphia. An analysis was done to describe the longitudinal molecular epidemiology of MDR A baumannii in a tertiary care hospital. METHODS This was an epidemiologic investigation using repetitive extragenic palindromic-PCR (rep-PCR) of patients with a positive culture for MDR A baumannii admitted to the hospital between February 2006 and January 2010. MDR A baumannii were defined as susceptible only to colistin and/or tigecycline. RESULTS The incidence rate of MDR A baumannii rose from 0.36 cases per 1,000 patient-days (pre-epidemic) to 0.86 cases per 1,000 patient-days, due mainly to an increase in the surgical intensive care unit. Enhanced infection control measures were implemented, but waves of MDR A baumannii continued to be documented through routine surveillance. Of 32 strains collected in 2006-2007, a single predominant clone and 2 minor clones accounted for almost all of the cases of MDR A baumannii studied. Of 24 strains collected in 2008-2009, another clone, different from those studied in the earlier period, predominated, and was accompanied by 3 minor variants. CONCLUSION Following an outbreak in the surgical intensive care unit, MDR A baumannii persisted in our institution for a 3-year period despite rigorous infection control measures. An unexpected strain replacement occurred during this period, with the original predominant strain disappearing completely and new minor clones displacing the original minor clones.

Review: Antibiotics have no effect on diarrhea and increase bacteriologic relapse in salmonella intestinal infection

Source Citation Sirinavin S, Garner P. Antibiotics in salmonella gut infections. Cochrane Review, latest version 12 May 1998. In: The Cochrane Library. Oxford: Update Software.

A Randomised Comparative Trial of Aztreonam Plus Cefazolin versus Ceftazidime for the Treatment of Nosocomial Pneumonia

SummaryA multicentre prospective randomised open-label controlled trial was conducted to compare the efficacy and safety of aztreonam (1 to 2g every 8 hours) plus cefazolin (1g every 8 hours) with that of ceftazidime (1 to 2g every 8 hours) in patients with nosocomial pneumonia. 66 adults were enrolled who had a presumptive diagnosis of pneumonia made at least 48 hours after hospitalisation. Patients exhibited the classic clinical picture of pneumonia and/or fever and/or leucocytosis and a newly developed or expanding infiltrate on chest x-ray.Among 48 evaluable patients treated, clinical cure or improvement was reported in 18 of 20 (90%) aztreonam patients as compared with 24 of 28 (85.7%) patients treated with ceftazidime. Bacteriological eradication or presumptive eradication was reported in 11 of 13 (84.6%) aztreonam patients and 15 of 19 (78.9%) ceftazidime recipients. Five patients with positive blood cultures prior to therapy (2 aztreonam, 3 ceftazidime) had negative blood cultures at study completion.Superinfection was reported in 2 patients randomised to aztreonam (both Staphylococcus aureus) and in 3 ceftazidime patients (2 with Pseudomonas aeruginosa and 1 with β-haemolytic Streptococcus). Colonisation was observed following ceftazidime (n = 4) and aztreonam (n = 2) therapy. Six aztreonam and 3 ceftazidime recipients experienced adverse events, which were possibly related to study therapy.Aztreonam plus cefazolin appears to be as effective as ceftazidime for the treatment of adults with nosocomial pneumonia.