Note: This page contains sample records for the topic paucimobilis bloodstream infections from Science.gov.
While these samples are representative of the content of Science.gov,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of Science.gov
to obtain the most current and comprehensive results.
Last update: November 12, 2013.
1

Sphingomonas paucimobilis Bloodstream Infections Associated with Contaminated Intravenous Fentanyl1  

PubMed Central

Nationally distributed medications from compounding pharmacies, which typically adhere to less stringent quality-control standards than pharmaceutical manufacturers, can lead to multistate outbreaks. We investigated a cluster of 6 patients in a Maryland hospital who had Sphingomonas paucimobilis bloodstream infections in November 2007. Of the 6 case-patients, 5 (83%) had received intravenous fentanyl within 48 hours before bacteremia developed. Cultures of unopened samples of fentanyl grew S. paucimobilis; the pulsed-field gel electrophoresis pattern was indistinguishable from that of the isolates of 5 case-patients. The contaminated fentanyl lot had been prepared at a compounding pharmacy and distributed to 4 states. Subsequently, in California, S. paucimobilis bacteremia was diagnosed for 2 patients who had received intravenous fentanyl from the same compounding pharmacy. These pharmacies should adopt more stringent quality-control measures, including prerelease product testing, when compounding and distributing large quantities of sterile preparations.

Chaiwarith, Romanee; Srinivasan, Arjun; Torriani, Francesca J.; Avdic, Edina; Lee, Andrew; Ross, Tracy R.; Carroll, Karen C.; Perl, Trish M.

2009-01-01

2

Sphingomonas paucimobilis bloodstream infections associated with contaminated intravenous fentanyl.  

PubMed

Nationally distributed medications from compounding pharmacies, which typically adhere to less stringent quality-control standards than pharmaceutical manufacturers, can lead to multistate outbreaks. We investigated a cluster of 6 patients in a Maryland hospital who had Sphingomonas paucimobilis bloodstream infections in November 2007. Of the 6 case-patients, 5 (83%) had received intravenous fentanyl within 48 hours before bacteremia developed. Cultures of unopened samples of fentanyl grew S. paucimobilis; the pulsed-field gel electrophoresis pattern was indistinguishable from that of the isolates of 5 case-patients. The contaminated fentanyl lot had been prepared at a compounding pharmacy and distributed to 4 states. Subsequently, in California, S. paucimobilis bacteremia was diagnosed for 2 patients who had received intravenous fentanyl from the same compounding pharmacy. These pharmacies should adopt more stringent quality-control measures, including prerelease product testing, when compounding and distributing large quantities of sterile preparations. PMID:19116043

Maragakis, Lisa L; Chaiwarith, Romanee; Srinivasan, Arjun; Torriani, Francesca J; Avdic, Edina; Lee, Andrew; Ross, Tracy R; Carroll, Karen C; Perl, Trish M

2009-01-01

3

Gram-negative bloodstream infections  

Microsoft Academic Search

Gram-negative bloodstream infection (BSI) is both dangerous and challenging. The incidence of Gram-negative BSI rises with age in both men and women, but there are still some gender differences in terms of aetiology and acquisition. Clinical elements such as organ dysfunction are helpful in determining prognosis. During the last few years we have observed dramatic increases in resistance among Gram-negative

Martin E. Stryjewski; Helen W. Boucher

2009-01-01

4

Candida Infection of the Bloodstream - Candidemia  

MedlinePLUS

... in a hospital (also called “nosocomial” infection or hospital acquired infection). There are 17 different species of Candida. Of these, Candida albicans (C. albicans ), C. glabrata , C. parapsilosis and C. ... I get Candidemia? In the hospital, 40% of bloodstream infections are caused by the ...

5

Circulating biomarkers as surrogates for bloodstream infections  

Microsoft Academic Search

The use of biomarkers provides a novel approach to diagnosing infection, its severity and treatment response. Biomarkers, especially procalcitonin and, to a lesser extent, C-reactive protein and interleukin 8, can improve the diagnostic and prognostic assessment of bloodstream infections. Both strengths and weaknesses of biomarkers must be recognized for rational and safe use in clinical settings. Cut-off ranges must be

Beat Müller; Philipp Schuetz; Andrej Trampuz

2007-01-01

6

Intravascular Catheter-Related Bloodstream Infection  

PubMed Central

Intravascular catheters required for the care of many hospitalized patients can give rise to bloodstream infection, a complication of care that has occurred most frequently in intensive care unit (ICU) settings. Elucidation of the pathogenesis of catheter-related bloodstream infections (CRBSIs) has guided development of effective diagnostic, management, and prevention strategies. When CRBSIs occur in the ICU, physicians must be prepared to recognize and treat them. Prevention of these infections requires careful attention to optimal catheter selection, insertion and maintenance, and to removal of catheters when they are no longer needed. This review provides a succinct summary of the epidemiology, pathogenesis, and microbiology of CRBSIs and a review of current guidance for the diagnosis, management, and prevention of these infections.

Shah, Harshal; Bosch, Wendelyn; Thompson, Kristine M.; Hellinger, Walter C.

2013-01-01

7

Pantoea agglomerans Bloodstream Infection in Preterm Neonates  

Microsoft Academic Search

Objective: To report an uncommon incidence of sporadic bloodstream infection (BSI) caused by Pantoea agglomerans in preterm neonates. Case Presentation and Intervention: Fives cases of nosocomial BSI with P. agglomerans in preterm neonates (weight ?1,500 g; age 8–17 days; gestational age 26–30 weeks) are presented. All cases were late onset neonatal sepsis (>7 days of age). Lethargy, skin mottling and

Nasser Yehia A. Aly; Hadeel N. Salmeen; Reda A. Abo Lila; Prem A. Nagaraja

2008-01-01

8

Pseudomonas aeruginosa Bloodstream Infection: Importance of Appropriate Initial Antimicrobial Treatment  

Microsoft Academic Search

Pseudomonas aeruginosa bloodstream infection is a serious infection with significant patient mortality and health-care costs. Nevertheless, the relationship between initial appropriate antimicrobial treatment and clinical outcomes is not well established. This study was a retrospective cohort analysis employing automated patient medical records and the pharmacy database at Barnes-Jewish Hospital. Three hundred five patients with P. aeruginosa bloodstream infection were identified

Scott T. Micek; Ann E. Lloyd; David J. Ritchie; Richard M. Reichley; Victoria J. Fraser; Marin H. Kollef

2005-01-01

9

Bloodstream infection caused by Campylobacter lari.  

PubMed

We describe a case of bloodstream infection (BSI) caused by Campylobacter lari in a 58-year-old man diagnosed with lumbar pyogenic spondylitis. Anaerobic blood cultures, taken on the day of admission and on hospital day 4, were positive after 30 h of incubation, although no bacteria were detected by Gram staining. After subculture on 5 % sheep blood agar for 2 days at 35 °C in a 5 % CO2 environment, capnophilic, curved, gram-negative bacteria were recovered. The bacteria were identified as C. lari using a combination of phenotypic identification methods and partial 16S rRNA gene sequencing. The BSI was eradicated following combination therapy with intravenous tazobactam/piperacillin, oral erythromycin, and sulfamethoxazole/trimethoprim. These results suggest that accurate identification, to the species level, is important to determine effective treatment of BSI caused by Campylobacter spp. and can help us to understand the epidemiology. PMID:22965843

Morishita, Shota; Fujiwara, Hiromitsu; Murota, Hiromi; Maeda, Yumi; Hara, Ayako; Horii, Toshinobu

2012-09-12

10

Nosocomial Bloodstream Infection and Clinical Sepsis  

PubMed Central

Primary bloodstream infection (BSI) is a leading, preventable infectious complication in critically ill patients and has a negative impact on patients’ outcome. Surveillance definitions for primary BSI distinguish those that are microbiologically documented from those that are not. The latter is known as clinical sepsis, but information on its epidemiologic importance is limited. We analyzed prospective on-site surveillance data of nosocomial infections in a medical intensive care unit. Of the 113 episodes of primary BSI, 33 (29%) were microbiologically documented. The overall BSI infection rate was 19.8 episodes per 1,000 central-line days (confidence interval [CI] 95%, 16.1 to 23.6); the rate fell to 5.8 (CI 3.8 to 7.8) when only microbiologically documented episodes were considered. Exposure to vascular devices was similar in patients with clinical sepsis and patients with microbiologically documented BSI. We conclude that laboratory-based surveillance alone will underestimate the incidence of primary BSI and thus jeopardize benchmarking.

Hugonnet, Stephane; Sax, Hugo; Eggimann, Philippe; Chevrolet, Jean-Claude

2004-01-01

11

Nosocomial bloodstream infection and clinical sepsis.  

PubMed

Primary bloodstream infection (BSI) is a leading, preventable infectious complication in critically ill patients and has a negative impact on patients' outcome. Surveillance definitions for primary BSI distinguish those that are microbiologically documented from those that are not. The latter is known as clinical sepsis, but information on its epidemiologic importance is limited. We analyzed prospective on-site surveillance data of nosocomial infections in a medical intensive care unit. Of the 113 episodes of primary BSI, 33 (29%) were microbiologically documented. The overall BSI infection rate was 19.8 episodes per 1,000 central-line days (confidence interval [CI] 95%, 16.1 to 23.6); the rate fell to 5.8 (CI 3.8 to 7.8) when only microbiologically documented episodes were considered. Exposure to vascular devices was similar in patients with clinical sepsis and patients with microbiologically documented BSI. We conclude that laboratory-based surveillance alone will underestimate the incidence of primary BSI and thus jeopardize benchmarking. PMID:15078600

Hugonnet, Stéphane; Sax, Hugo; Eggimann, Philippe; Chevrolet, Jean-Claude; Pittet, Didier

2004-01-01

12

A Rare Cause of Bacteremia in a Pediatric Patient with Down Syndrome: Sphingomonas Paucimobilis  

PubMed Central

Sphingomonas paucimobilis, is a yellow-pigmented, aerobic, non fermentative, gram negative motile bacillus. S. paucimobilis which is widely found in nature and hospital environments rarely cause serious or life threatening infections. In this report, a case of hospital acquired bloodstream infection due to S. paucimobilis in a patient with Down syndrome who was on treatment for presumed pneumonia is presented. A one year-old child patient who was a known case of Down syndrome and had previously experienced cardiac surgery was hospitalized and treated for pneumonia. On the 12th day of hospitalization, blood cultures were taken because of a high body temperature. One of the blood cultures was positive for gram-negative rods. After 48 hour of incubation, the sub-cultures on blood agar medium yielded pure growth of a yellow, non-fermentative, gram-negative, rod-shaped bacterium. The microorganism was positive for oxidase, and esculin hydrolysis, while negative for urea and nitrate reduction, citrate utilisation and motility. The isolate had been identified as S. paucimobilis by using Vitek 2 system. The antibiotic susceptibility test was also performed with the same system and the strain was found to be susceptible to piperacillin-tazobactam and other antibiotics. Treatment with intravenous piperacilin-tazobactam (150 mg/kg/day) was initiated. He responded well to the treatment and was discharged after 10 days. This case is reported to emphasize that S. paucimobilis should be kept in mind as a nosocomial infectious agent in patients with Down syndrome and immunosuppressive patients and the infections should be treated according to the sensitivity test results.

Ozdemir, Mehmet; Pekcan, Sevgi; Demircili, Mehmet Emin; Tasbent, Fatma Esenkaya; Feyzioglu, Bahad?r; Pirinc, Serife; Baykan, Mahmut

2011-01-01

13

Update on catheter-related bloodstream infections in ICU patients.  

PubMed

The present article is an update of the literature on catheter-related bloodstream infections in ICU patients. A multidisciplinary group of Spanish physicians with an interest in bloodstream infections selected the most important recently published papers produced in the field. One of the members of the group discussed the content of each of the selected papers, with a critical review by other members of the panel. After a review of the state of the art, papers from the fields of epidemiology, causative microorganisms (bacterial and fungal), risk factors and prognosis, pathogenesis, laboratory diagnosis and prevention were discussed by the group. PMID:21458715

Maseda Garrido, Emilio; Alvarez, Julián; Garnacho-Montero, José; Jerez, Vicente; Lorente, Leonardo; Rodríguez, Oscar

2011-03-01

14

Association of secondary and polymicrobial nosocomial bloodstream infections with higher mortality  

Microsoft Academic Search

The objective of this study was to characterize microbiological factors independently associated with higher mortality rates following nosocomial bloodstream infection. All patients admitted to the University of Iowa Hospitals and Clinics between 1 July 1989 and 30 June 1990 who developed a nosocomial bloodstream infection were included. The crude in-house mortality for the 364 patients with nosocomial bloodstream infections was

D. Pittetl; N. Li; R. P. Wenzel

1993-01-01

15

Pichia farinosa Bloodstream Infection in a Lymphoma Patient?  

PubMed Central

We describe a case of Pichia farinosa bloodstream infection in a lymphoma patient. Phenotypic methods failed to identify the isolate, which was identified by sequence-based methods. This case highlights the importance of implementing molecular methods for the identification of rare fungal pathogens.

Adler, A.; Hidalgo-Grass, C.; Boekhout, T.; Theelen, B.; Sionov, E.; Polacheck, I.

2007-01-01

16

Evidence of nosocomial spread of Candida albicans causing bloodstream infection in a neonatal intensive care unit  

Microsoft Academic Search

Candida albicans is an increasingly important bloodstream pathogen. We investigated a cluster of bloodstream infections in the neonatal intensive care unit (NICU) to determine whether nosocomial transmission occurred. Subjects included any patient in the NICU who developed clinically significant bloodstream infection with C. albicans from January 1984 to December 1987 (N = 7). Isolates were typed by restriction fragment length

David R. Reagan; Michael A. Pfaller; Richard J. Hollis; Richard P. Wenzel

1995-01-01

17

Strategies for prevention of catheter-related bloodstream infections  

Microsoft Academic Search

Prevention of catheter-related bloodstream infections is critically dependent on an accurate knowledge of the two main routes\\u000a by which intravascular devices become contaminated: the extraluminal (skin-related) and the intraluminal (hub-related) routes.\\u000a Extraluminal catheter seeding results from infection of the catheter entry site by microorganisms and leads to bacteremia\\u000a most often during the week following catheter placement. The main ways of

Antonio Sitges-Serra

1999-01-01

18

Excess mortality in women with hospital-acquired bloodstream infection  

Microsoft Academic Search

PURPOSE: We examined the outcomes of bloodstream infection in men and in women and whether any sex-related differences were explained by underlying disorders, severity of disease, or clinical management.SUBJECTS AND METHODS: Using a prospectively collected database, we compared in-hospital mortality in men and women. We used multivariable logistic regression analysis to test whether sex-related differences could be due to potential

Leonard Leibovici; Mical Paul; Miriam Weinberger; Hanna Koenigsberger; Moshe Drucker; Zmira Samra; Jacob Yahav; Silvio D Pitlik

2001-01-01

19

Impact of a dedicated intravenous therapy team on nosocomial bloodstream infection rates  

Microsoft Academic Search

Background: Meticulous care of intravenous catheters could be expected to minimize associated nosocomial bloodstream infections, but care is often suboptimal.Methods: To examine the ostensible benefits of a professional, dedicated intravenous therapy team, we compared the secular trends in nosocomial bloodstream infections before and after such a team was established.Results: After the introduction of the team at the Veterans Administration Medical

Patricia A. Meier; Mary Fredrickson; Michael Catney; Mary D. Nettleman

1998-01-01

20

Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study  

PubMed Central

Background Bloodstream infection is a common cause of hospitalization, morbidity and death in children. The impact of antimicrobial resistance and HIV infection on outcome is not firmly established. Methods We assessed the incidence of bloodstream infection and risk factors for fatal outcome in a prospective cohort study of 1828 consecutive admissions of children aged zero to seven years with signs of systemic infection. Blood was obtained for culture, malaria microscopy, HIV antibody test and, when necessary, HIV PCR. We recorded data on clinical features, underlying diseases, antimicrobial drug use and patients' outcome. Results The incidence of laboratory-confirmed bloodstream infection was 13.9% (255/1828) of admissions, despite two thirds of the study population having received antimicrobial therapy prior to blood culture. The most frequent isolates were klebsiella, salmonellae, Escherichia coli, enterococci and Staphylococcus aureus. Furthermore, 21.6% had malaria and 16.8% HIV infection. One third (34.9%) of the children with laboratory-confirmed bloodstream infection died. The mortality rate from Gram-negative bloodstream infection (43.5%) was more than double that of malaria (20.2%) and Gram-positive bloodstream infection (16.7%). Significant risk factors for death by logistic regression modeling were inappropriate treatment due to antimicrobial resistance, HIV infection, other underlying infectious diseases, malnutrition and bloodstream infection caused by Enterobacteriaceae, other Gram-negatives and candida. Conclusion Bloodstream infection was less common than malaria, but caused more deaths. The frequent use of antimicrobials prior to blood culture may have hampered the detection of organisms susceptible to commonly used antimicrobials, including pneumococci, and thus the study probably underestimates the incidence of bloodstream infection. The finding that antimicrobial resistance, HIV-infection and malnutrition predict fatal outcome calls for renewed efforts to curb the further emergence of resistance, improve HIV care and nutrition for children.

Blomberg, Bj?rn; Manji, Karim P; Urassa, Willy K; Tamim, Bushir S; Mwakagile, Davis SM; Jureen, Roland; Msangi, Viola; Tellevik, Marit G; Holberg-Petersen, Mona; Harthug, Stig; Maselle, Samwel Y; Langeland, Nina

2007-01-01

21

Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis  

PubMed Central

Data on the prevalence and causes of community-acquired bloodstream infections in Africa are scarce. We searched three databases for studies that prospectively studied patients admitted to hospital with at least a blood culture, and found 22 eligible studies describing 58 296 patients, of whom 2051 (13.5%) of 15 166 adults and 3527 (8.2%) of 43 130 children had bloodstream infections. 1643 (29.1%) non-malaria bloodstream infections were due to Salmonella enterica (58.4% of these non-typhoidal Salmonella), the most prevalent isolate overall and in adults, and 1031 (18.3% overall) were due to Streptococcus pneumoniae, the most common isolate in children. Other common isolates included Staphylococcus aureus (531 infections; 9.5%) and Escherichia coli (412; 7.3%). Mycobacterium tuberculosis complex accounted for 166 (30.7%) of 539 isolates in seven studies that used mycobacterial culture techniques. HIV infection was associated with any bloodstream infection, particularly with S enterica and M tuberculosis complex bacteraemia. Where recorded, patients with bloodstream infections had an in-hospital case fatality of 18.1%. Our results show that bloodstream infections are common and associated with high mortality. Improved clinical microbiology services and reassessment of empirical treatment guidelines that account for the epidemiology of bloodstream infections might contribute to better outcomes.

Reddy, Elizabeth A; Shaw, Andrea V; Crump, John A

2011-01-01

22

Strategies for prevention of catheter-related bloodstream infections.  

PubMed

Prevention of catheter-related bloodstream infections is critically dependent on an accurate knowledge of the two main routes by which intravascular devices become contaminated: the extraluminal (skin-related) and the intraluminal (hub-related) routes. Extraluminal catheter seeding results from infection of the catheter entry site by microorganisms and leads to bacteremia most often during the week following catheter placement. The main ways of preventing it are appropriate skin disinfection and the adoption of maximal antiseptic barriers at the time of catheter insertion. Avoiding the internal jugular and the femoral veins, whenever possible, will reduce the likelihood of bacteremia. Intraluminal contamination is the consequence of improper handling of the catheter hub at the time of connection and disconnection of the administration set. It is the most common origin of catheter infections after the first week of catheter placement. Multiple-lumen catheters, side-ports and multipurpose catheters particularly increase the risk of endoluminal contamination. To prevent it, strict asepsis should be observed in hub handling and hubs should be protected against environmental soiling with an antiseptic impregnated gauze at all times. New technology is available for prevention of catheter infections: antibiotic and antiseptic-coated catheters, antiseptic hubs, disinfecting caps and flushing solutions are currently undergoing scientific assessment. PMID:10541980

Sitges-Serra, A

1999-11-01

23

An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU  

Microsoft Academic Search

Background Catheter-related bloodstream infections occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. Methods We conducted a collaborative cohort study predominantly in ICUs in Michigan. An evidence-based intervention was used to reduce the incidence of catheter-related bloodstream infections. Multilevel Poisson regression modeling was used to com- pare infection rates before, during, and up to 18 months

Peter Pronovost; Dale Needham; Sean Berenholtz; David Sinopoli; Haitao Chu; Sara Cosgrove; Bryan Sexton; Robert Hyzy; Robert Welsh; Gary Roth; Joseph Bander; John Kepros; Christine Goeschel

2006-01-01

24

Implantable arterial port-related bloodstream infection in patients with primary or metastatic hepatic malignancies.  

PubMed

The incidence of implantable arterial post-related bloodstream infections (IAP-RBSI) among patients with unresectable hepatic malignancies is not well defined. We reviewed the 9-year incidence of implantable arterial post-related bloodstream infections in patients with hepatic malignancies, at a tertiary care center in Japan. The incidence was 1.9 infections per 10,000 catheter-days. PMID:23594477

Honda, Hitoshi; Sakurai, Yasuo; Kang, Jong-Hon; Nakamura, Tadahiro; Matsuura, Hirotaka; Warren, David K

2013-04-14

25

Catheter-associated bloodstream infections in the NICU: getting to zero.  

PubMed

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI. PMID:19451076

Curry, Sabra; Honeycutt, Michele; Goins, Gail; Gilliam, Craig

26

Neonatal late-onset bloodstream infection: Attributable mortality, excess of length of stay and risk factors  

Microsoft Academic Search

Background: Bloodstream infection represents a major threat among neonates under intensive care with considerable impact on morbidity and mortality. This study evaluated extra stay, attributable mortality and the risk factors associated with late-onset bloodstream infection (LO-BSI) among neonates admitted to a neonatal intensive care unit during a 4-year period. Methods: A retrospective matched cohort study was conducted. For each case,

C. L. Pessoa-Silva; C. H. Miyasaki; M. F. de Almeida; B. I. Kopelman; R. L. Raggio; S. B. Wey

2001-01-01

27

Efficacy of an infection control programme in reducing nosocomial bloodstream infections in a Senegalese neonatal unit.  

PubMed

Neonatal nosocomial infections are public health threats in the developing world, and successful interventions are rarely reported. A before-and-after study was conducted in the neonatal unit of the Hôpital Principal de Dakar, Senegal to assess the efficacy of a multi-faceted hospital infection control programme implemented from March to May 2005. The interventions included clustering of nursing care, a simple algorithm for empirical therapy of suspected early-onset sepsis, minimal invasive care and promotion of early discharge of neonates. Data on nosocomial bloodstream infections, mortality, bacterial resistance and antibiotic use were collected before and after implementation of the infection control programme. One hundred and twenty-five infants were admitted immediately before the programme (Period 1, January-February 2005) and 148 infants were admitted immediately after the programme (Period 2, June-July 2005). The two groups of infants were comparable in terms of reason for admission and birth weight. After implementation of the infection control programme, the overall rate of nosocomial bloodstream infections decreased from 8.8% to 2.0% (P=0.01), and the rate of nosocomial bloodstream infections/patient-day decreased from 10.9 to 2.9/1000 patient-days (P=0.03). Overall mortality rates did not differ significantly. The proportion of neonates who received antimicrobial therapy for suspected early-onset sepsis decreased significantly from 100% to 51% of at-risk infants (P<0.001). The incidence of drug-resistant bacteria was significantly lower after implementation of the programme (79% vs 12%; P<0.001), and remained low one year later. In this neonatal unit, simple, low-cost and sustainable interventions led to the control of a high incidence of bacterial nosocomial bloodstream infections, and the efficacy of these interventions was long-lasting. Such interventions could be extended to other low-income countries. PMID:21820760

Landre-Peigne, C; Ka, A S; Peigne, V; Bougere, J; Seye, M N; Imbert, P

2011-08-05

28

Clinical and Microbiological Analysis of Bloodstream Infections Caused by Chryseobacterium meningosepticum in Nonneonatal Patients  

Microsoft Academic Search

Chryseobacterium meningosepticum bloodstream infections in 11 nonneonatal patients were reported. More than half of the infections were community acquired. PCR assays indicated that the organisms produced extended-spectrum -lactamases as well as metallo--lactamases. Genotyping showed diverse fingerprints among the isolates. Six patients survived without appropriate antibiotic treatment. Host factors are the major determinant of the outcomes of C. meningosepticum infections. Chryseobacterium

Pen-Yi Lin; Chishih Chu; Lin-Hui Su; Chung-Tsui Huang; Wen-Ya Chang; Cheng-Hsun Chiu

29

Risk Factors for Fluconazole-Resistant Candida glabrata Bloodstream Infections  

PubMed Central

Background Bloodstream infections (BSIs) caused by Candida glabrata have increased substantially. Candida glabrata is often associated with resistance to fluconazole therapy. However, to our knowledge, risk factors for fluconazole-resistant C glabrata BSIs have not been studied. Methods A case-case-control study was conducted at 3 hospitals from January 1, 2003, to May 31, 2007. The 2 case groups included patients with fluconazole-resistant C glabrata BSIs (minimum inhibitory concentration ?16 ?g/mL) and patients with fluconazole-susceptible C glabrata BSIs (minimum inhibitory concentration ?8 ?g/mL). Hospitalized patients without C glabrata BSIs were randomly selected for inclusion in the control group and were frequency matched to cases on the basis of time at risk. Two case-control studies were performed using this shared control group. The primary risk factor of interest, previous fluconazole use, was evaluated at multivariate analyses, adjusting for demographic data, comorbid conditions, and antimicrobial exposures. Results We included 76 patients with fluconazole-resistant C glabrata BSIs, 68 patients with fluconazole-susceptible C glabrata BSIs, and 512 control patients. Previous fluconazole use (adjusted odds ratio [95% confidence interval], 2.3 [1.3–4.2]) and linezolid use (4.6 [2.2–9.3]) were independent risk factors for fluconazole-resistant C glabrata BSIs; previous cefepime use (2.2 [1.2–3.9]) and metronidazole use (2.0 [1.1–3.5]) were independent risk factors for fluconazole-susceptible C glabrata BSIs. Conclusions Previous fluconazole use is a significant risk factor for health care–associated fluconazole-resistant C glabrata BSIs. Future studies will be needed to evaluate the effect of decreasing fluconazole use on rates of fluconazole-resistant C glabrata BSIs.

Lee, Ingi; Fishman, Neil O.; Zaoutis, Theoklis E.; Morales, Knashawn H.; Weiner, Mark G.; Synnestvedt, Marie; Nachamkin, Irving; Lautenbach, Ebbing

2010-01-01

30

Mycobacterium neoaurum bloodstream infection: report of 4 cases and review of the literature.  

PubMed

We describe a cluster of 4 bloodstream infections with Mycobacterium neoaurum and 5 additional cases from the literature. Infections occurred mainly in immunocompromised hosts who had central venous catheters. Fever was universal at presentation, but local signs of inflammation were rare. Combination antimicrobial therapy and catheter removal resulted in clinical cure. PMID:17578768

Washer, Laraine L; Riddell, James; Rider, Jennifer; Chenoweth, Carol E

2007-06-12

31

Bloodstream infection following 217 consecutive systemic-enteric drained pancreas transplants  

Microsoft Academic Search

BACKGROUND: Combined kidney pancreas transplantation (PTx) evolved as excellent treatment for diabetic nephropathy. Infections remain common and serious complications. METHODS: 217 consecutive enteric drained PTxs performed from 1997 to 2004 were retrospectively analyzed with regard to bloodstream infection. Immunosuppression consisted of antithymocyteglobuline induction, tacrolimus, mycophenolic acid and steroids for the majority of cases. Standard perioperative antimicrobial prophylaxis consisted of pipercillin\\/tazobactam

Natalie Berger; Siegmund Guggenbichler; Wolfgang Steurer; Christian Margreiter; Gert Mayer; Reinhold Kafka; Walter Mark; Alexander R Rosenkranz; Raimund Margreiter; Hugo Bonatti

2006-01-01

32

Multilumen Central Venous Catheters Increase Risk for Catheter-Related Bloodstream Infection: Prospective Surveillance Study  

Microsoft Academic Search

Background: Catheter-related bloodstream infections (CRBSI) are a leading cause of nosocomial infections associated with significant mortality and costs. The objective of this study was to determine the rate of CRBSI in two large Swiss hospitals and to identify risk factors for this condition. Patients and Methods: During 1 year all central venous catheter (CVC)-inserted in patients admitted for visceral, orthopedic

A. Templeton; M. Schlegel; F. Fleisch; G. Rettenmund; B. Schöbi; S. Henz; G. Eich

2008-01-01

33

Nosocomial bloodstream infections in patients with implantable left ventricular assist devices  

Microsoft Academic Search

Background. Implantable left ventricular assist devices (LVAD) are used as a bridge to transplantation but are associated with a high risk of infection including nosocomial bloodstream infections (BSI).Methods. We retrospectively reviewed the medical records of all patients with implantable LVAD at the Cleveland Clinic with 72 hours or longer of LVAD support from January 1992 through June 2000, to determine

Steven M Gordon; Steven K Schmitt; Micah Jacobs; Nicolas M Smedira; Marlene Goormastic; Michael K Banbury; Mike Yeager; Janet Serkey; Katherine Hoercher; Patrick M McCarthy

2001-01-01

34

Is Bloodstream Infection Preventable Among Premature Infants? A Tale of Two Cities  

Microsoft Academic Search

Background. Bloodstream infection (BSI) is a significant cause of morbidity and death encountered in the NICU. The rates of BSIs vary significantly in NICUs across the nation. However, no attempt has been made to correlate this variation with specific infection- control practices and policies. We experienced a signifi- cant increase in BSIs in the NICU at the George Wash- ington

Hany Aly; Victor Herson; Anne Duncan; Jill Herr; Jean Bender; Kantilal Patel; Ayman A. E. El-Mohandes

35

Bench-to-bedside review: Rapid molecular diagnostics for bloodstream infection - a new frontier?  

PubMed Central

Among critically ill patients, the diagnosis of bloodstream infection poses a major challenge. Current standard bacterial identification based on blood culture platforms is intrinsically time-consuming and slow. The continuous evolvement of molecular techniques has the potential of providing a faster, more sensitive and direct identification of causative pathogens without prior need for cultivation. This may ultimately impact clinical decision-making and antimicrobial treatment. This review summarises the currently available technologies, their strengths and limitations and the obstacles that have to be overcome in order to develop a satisfactory bedside point-of-care diagnostic tool for detection of bloodstream infection.

2012-01-01

36

Analysis of central line-associated bloodstream infections in the intensive care unit after implementation of central line bundles.  

PubMed

Central line-associated bloodstream infections (CLABSIs) have been reduced in number but not eliminated in our intensive care units with use of central line bundles. We performed an analysis of remaining CLABSIs. Many bloodstream infections that met the definition of CLABSI had sources other than central lines or represented contaminated blood samples. PMID:20334506

Shuman, Emily K; Washer, Laraine L; Arndt, Jennifer L; Zalewski, Christy A; Hyzy, Robert C; Napolitano, Lena M; Chenoweth, Carol E

2010-05-01

37

Using evidence, rigorous measurement, and collaboration to eliminate central catheter-associated bloodstream infections.  

PubMed

Healthcare-associated infections are common, costly, and often lethal. Although there is growing pressure to reduce these infections, one project thus far has unprecedented collaboration among many groups at every level of health care. After this project produced a 66% reduction in central catheter-associated bloodstream infections and a median central catheter-associated bloodstream infection rate of zero across >100 intensive care units in Michigan, the Agency for Healthcare Research and Quality awarded a grant to spread this project to ten additional states. A program, called On the CUSP: Stop BSI, was formulated from the Michigan project, and additional funding from the Agency for Healthcare Research and Quality and private philanthropy has positioned the program for implementation state by state across the United States. Furthermore, the program is being implemented throughout Spain and England and is undergoing pilot testing in several hospitals in Peru. The model in this program balances the tension between being scientifically rigorous and feasible. The three main components of the model include translating evidence into practice at the bedside to prevent central catheter-associated bloodstream infections, improving culture and teamwork, and having a data collection system to monitor central catheter-associated bloodstream infections and other variables. If successful, this program will be the first national quality improvement program in the United States with quantifiable and measurable goals. PMID:20647786

Sawyer, Melinda; Weeks, Kristina; Goeschel, Christine A; Thompson, David A; Berenholtz, Sean M; Marsteller, Jill A; Lubomski, Lisa H; Cosgrove, Sara E; Winters, Bradford D; Murphy, David J; Bauer, Laura C; Duval-Arnould, Jordan; Pham, Julius C; Colantuoni, Elizabeth; Pronovost, Peter J

2010-08-01

38

[Prevention and nursing care of central line-associated bloodstream infections in critically ill patients].  

PubMed

Catheter-related bloodstream infections are associated with significantly increased morbidity, mortality, and expenditures. Such infections are a serious threat to patient safety in the intensive care unit. This review describes the latest protocols related to preventing and treating central venous catheter-associated bloodstream infections in critically ill patients. According to 2011 Center for Disease Control (CDC) guidelines and central line care bundles by the institute for healthcare improvement (IHI), prevention measures for catheter-related bloodstream infections include the following: hand hygiene, maximal barrier precautions insertion, chlorhexidine skin antisepsis, optimal catheter site selection, proper catheter maintenance, insertion site care, and daily review of line necessity, with prompt removal of unnecessary lines. These are important and effective infection prevention measures. Guidelines and care bundles also recommend organizing care modules based on unit characteristics; integrating resources and empirical measures; education and training to promote comprehensive implementation; and auditing and monitoring to ensure staff continue to follow procedures. Effectively preventing central venous catheter-related bloodstream infections can enhance care quality and move healthcare closer to achieving the goal of zero tolerance. PMID:22851388

Lu, Shu-Fen; Chen, Ji-Han; Shang, Wan-Ming; Chou, Shin-Shang

2012-08-01

39

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study  

PubMed Central

Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients’ safety. Setting Intensive care units predominantly in Michigan, USA. Intervention Conceptual model aimed at improving clinicians’ use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders. Main outcome measures Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention). Results Ninety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300?310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (?1%, 95% confidence interval ?9% to 7%). Conclusions The reduced rates of catheter related bloodstream infection achieved in the initial 18 month post-implementation period were sustained for an additional 18 months as participating intensive care units integrated the intervention into practice. Broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.

2010-01-01

40

Prevention of bloodstream infections by photodynamic inactivation of multiresistant Pseudomonas aeruginosa in burn wounds  

NASA Astrophysics Data System (ADS)

Bloodstream infections are potentially life-threatening diseases. They can cause serious secondary infections, and may result in endocarditis, severe sepsis or toxic-shock syndrome. Pseudomonas aeruginosa is an opportunistic pathogen and one of the most important etiological factors responsible for nosocomial infections, mainly in immuno-compromissed hosts, characteristic of patients with severe burns. Its multiresistance to antibiotics produces many therapeutic problems, and for this reason, the development of an alternative method to antibiotic therapy is needed. Photodynamic inactivation (PDI) may be an effective and alternative therapeutic option to prevent bloodstream infections in patients with severe burns. In this study we report the use of PDI to prevent bloodstream infections in mice with third-degree burns. Burns were produced on the back of the animals and they were infected with 109 cfu/mL of multi-resistant (MR) P. aeruginosa. Fifteen animals were divided into 3 groups: control, PDT blue and PDT red. PDT was performed thirty minutes after bacterial inoculation using 10?M HB:La+3 and a light-emitting diode (LED) emitting at ?=460nm+/-20nm and a LED emitting at ?=645 nm+/-10nm for 120s. Blood of mice were colected at 7h, 10h, 15h, 18h and 22h pos-infection (p.i.) for bacterial counting. Control group presented 1×104 cfu/mL in bloodstream at 7h p.i. increasing to 1×106 at 22h, while mice PDT-treated did not present any bacteria at 7h; only at 22h p.i. they presented 1×104cfu/mL. These results suggest that HB:La+3 associated to blue LED or red LED is effective to delay and diminish MR P.aeruginosa bloodstream invasion in third-degree-burned mice.

Hashimoto, M. C. E.; Prates, R. A.; Toffoli, D. J.; Courrol, L. C.; Ribeiro, M. S.

2010-02-01

41

The Influence of Inadequate Antimicrobial Treatment of Bloodstream Infections on Patient Outcomes in the ICU Setting  

Microsoft Academic Search

Study objective: To evaluate the relationship between the adequacy of antimicrobial treatment for bloodstream infections and clinical outcomes among patients requiring ICU admission. Design: Prospective cohort study. Setting: A medical ICU (19 beds) and a surgical ICU (18 beds) from a university-affiliated urban teaching hospital. Patients: Between July 1997 and July 1999, 492 patients were prospectively evaluated. Intervention: Prospective patient

Emad H. Ibrahim; Glenda Sherman; Suzanne Ward; Victoria J. Fraser; Marin H. Kollef

2006-01-01

42

Nosocomial Bloodstream Infections in Medical-Surgical Intensive Care Units: Epidemiologic Characteristics and Factors influencing Outcome  

Microsoft Academic Search

A prospective study was performed at four medical-surgical Intensive Care Units in Athens, Greece in order to analyze the epidemiology and to identify risk factors influencing mortality of ICU- acquired bloodstream infections (BSI). PATIENTS AND METHOD: We recorded variables from 35 consecutive ICU-acquired episodes for five months. Risk factors were determined using single and multivariate analyses. RESULTS: The crude mortality

43

Variation in Public Reporting of Central Line–Associated Bloodstream Infections by State  

Microsoft Academic Search

Central line–associated bloodstream infections (CLABSIs) are common, costly, and largely preventable. Consumers who want high-quality care should have access to CLABSI rates to make health care decisions. The authors searched state health department Web sites for publicly available CLABSI data. Fourteen states, all with mandatory CLABSI monitoring laws, had publicly available data. The authors identified significant variation in the presentation

Monica S. Aswani; Julie Reagan; Linda Jin; Peter J. Pronovost; Christine Goeschel

2011-01-01

44

Should we use closed or open infusion containers for prevention of bloodstream infections?  

Microsoft Academic Search

BACKGROUND: Hospitalized patients in critical care settings are at risk for bloodstream infections (BSI). Most BSIs originate from a central line (CL), and they increase length of stay, cost, and mortality. Open infusion containers may increase the risk of contamination and administration-related (CLAB) because they allow the entry of air into the system, thereby also providing an opportunity for microbial

Manuel S Rangel-Frausto; Francisco Higuera-Ramirez; Jose Martinez-Soto; Victor D Rosenthal

2010-01-01

45

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study  

Microsoft Academic Search

Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections.Design Collaborative cohort study to implement and evaluate interventions to improve patients’ safety. Setting Intensive care units predominantly in Michigan, USA.Intervention Conceptual model aimed at improving clinicians’ use of five evidence based recommendations to reduce

Peter J Pronovost; Christine A Goeschel; Elizabeth Colantuoni; Sam Watson; Lisa H Lubomski; Sean M Berenholtz; David A Thompson; David J Sinopoli; Sara Cosgrove; J Bryan Sexton; Jill A Marsteller; Robert C Hyzy; Robert Welsh; Patricia Posa; Kathy Schumacher; Dale Needham

2010-01-01

46

Occurrence of yeast bloodstream infections between 1987 and 1995 in five Dutch university hospitals  

Microsoft Academic Search

The aim of this study was to identify retrospectively trends in fungal bloodstream infections in The Netherlands in the period from 1987 to 1995. Results of over 395,000 blood cultures from five Dutch university hospitals were evaluated. Overall, there were more than 12 million patient days of care during the nine-year study period. The rate of candidemia doubled in the

A. Voss; J. A. J. W. Kluytmans; J. G. M. Koeleman; L. Spanjaard; C. M. J. E. Vandenbroucke-Grauls; H. A. Verbrugh; M. C. Vos; A. Y. L. Weersink; J. A. A. Hoogkamp-Korstanje; J. F. G. M. Meis

1996-01-01

47

The Attributable Mortality and Costs of Primary Nosocomial Bloodstream Infections in the Intensive Care Unit  

Microsoft Academic Search

Primary nosocomial bloodstream infection (BSI) is a common occurrence in the intensive care unit (ICU) and is associated with a crude mortality of 31.5 to 82.4%. However, an accurate estimate of the attributable mortality has been limited because of confounding by severity of illness. We undertook this study to assess the attributable mortality and costs associated with an episode of

BRUNO D I GIOVINE; CAROL CHENOWETH; CHARLES WATTS; MILLICENT HIGGINS

1999-01-01

48

Bloodstream infections caused by qnr-positive Enterobacteriaceae: clinical and microbiologic characteristics and outcomes  

Microsoft Academic Search

The clinical significance of plasmid-mediated quinolone resistance determinant qnr has not been well characterized. We investigated the clinical and microbiologic characteristics and outcomes of bloodstream infections (BSIs) caused by qnr-positive Enterobacteriaceae. We prospectively collected 351 nonduplicate consecutive blood isolates of Enterobacter spp. and Klebsiella pneumoniae. qnr genes were detected by polymerase chain reaction and confirmed by sequencing. The medical records

Yong Pil Chong; Sang-Ho Choi; Eun Sil Kim; Eun Hee Song; Eun Jung Lee; Ki-Ho Park; Oh-Hyun Cho; Sung-Han Kim; Sang-Oh Lee; Mi-Na Kim; Jin-Yong Jeong; Jun Hee Woo; Yang Soo Kim

2010-01-01

49

Achieving zero central line-associated bloodstream infection rates in your intensive care unit.  

PubMed

Central line-associated bloodstream infection (CLABSI) is one of the most common health care-associated infections in the United States. The costs associated with CLABSIs include an estimated 28,000 deaths in the intensive care unit and up to $2.3 billion annually. Best practice guidelines, checklists, and establishing a culture of safety in hospitals are all initiatives designed to reduce the rate of CLABSI to zero. PMID:23182523

Sagana, Rommel; Hyzy, Robert C

2013-01-01

50

Impact of Bloodstream Infection on the Outcome of Children Undergoing Cardiac Surgery  

Microsoft Academic Search

Bloodstream infections (BSIs) are a main cause of nosocomial infection in the critical care area. The development of BSI affects\\u000a the surgical outcome and increases intensive care unit (ICU) morbidity and mortality. This prospective cohort study was undertaken\\u000a to determine the incidence, etiology, risk factors, and outcome of BSI for postoperative pediatric cardiac patients in the\\u000a pediatric cardiac ICU setup.

Raja Abou Elella; Hani K. Najm; Hanan Balkhy; Lily Bullard; Mohamed S. Kabbani

2010-01-01

51

The Long-Term Effect of Antibiotic-Impregnated Catheters on Bloodstream Infection Rate in a PICU  

Microsoft Academic Search

BACKGROUND: Bloodstream infections are the most common reported healthcare-associated infections in pediatric facilities. To measure the effect, we compare catheter-related bloodstream infection (CR-BSI) rates for antibiotic-impregnated (rifampin\\/minocycline) catheters (AIC) to non-impregnated catheters (NAIC) in a PICU. Interventions such as the use of maximum barrier precautions (1998), handwashing compliance campaign (2000\\/2001), and chlorohexidine prep (2003) prior to catheter insertion also occurred.METHODS:

M. Honeycutt; G. Schutze; A. Bhutta

2004-01-01

52

Identification and Characterization of Bacterial Pathogens Causing Bloodstream Infections by DNA Microarray  

Microsoft Academic Search

Bloodstream infections are potentially life-threatening and require rapid identification and antibiotic sus- ceptibility testing of the causative pathogen in order to facilitate specific antimicrobial therapy. We developed a prototype DNA microarray for the identification and characterization of three important bacteremia-causing species: Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. The array consisted of 120 species-specific gene probes 200 to 800 bp

Berit E. E. Cleven; Maria Palka-Santini; Salima Meembor; Martin Kronke; Oleg Krut

2006-01-01

53

Persistent Bloodstream Infection with Kocuria rhizophila Related to a Damaged Central Catheter  

PubMed Central

A case of persistent bloodstream infection with Kocuria rhizophila related to a damaged central venous catheter in a 3-year-old girl with Hirschsprung's disease is reported. The strain was identified as K. rhizophila by 16S rRNA gene sequencing and matrix-assisted laser desorption ionization–time of flight mass spectrometry. Arbitrarily primed PCR analysis showed a clonal strain. The repeated septic episodes were resolved with the catheter repair.

Becker, Karsten; Merens, Audrey; Ferroni, Agnes; Dubern, Beatrice; Vu-Thien, Hoang

2012-01-01

54

Risk factors for central venous catheter-related bloodstream infection: a 1073-patient study  

Microsoft Academic Search

We intended to evaluate the risk factors for catheter-related bloodstream infection (CR-BSI) with central venous (CV) catheters.\\u000a For the hub of the CV line, we used three-way stopcocks in the first year of the study and closed needleless connectors (NCs)\\u000a in the second year. Background factors included the age and sex of patients; the ward; the specialty service; the CV

Junichi Yoshida; Toshiyuki Ishimaru; Michiko Fujimoto; Noriko Hirata; Nobuo Matsubara; Nobuhiro Koyanagi

2008-01-01

55

Bloodstream infections in home infusion patients: The influence of race and needleless intravascular access devices  

Microsoft Academic Search

OBJECTIVES: To determine the cause of increased central venous catheter-associated (CVC) bloodstream infection (BSI) rates in a cohort of pediatric hematology\\/oncology patients receiving home health care (HHC). METHODS: A retrospective cohort study of hematology\\/oncology patients with CVCs receiving HHC from January 1992 through November 1994. RESULTS: Of 182 patients with CVCs identified during the study period, 58 (32%) acquired 90

Scott Kellerman; David K. Shay; Jean Howard; Connie Goes; James Feusner; Jon Rosenberg; Duc J. Vugia; William R. Jarvis

1996-01-01

56

Prospective evaluation of the epidemiology, microbiology, and outcome of bloodstream infections in adult surgical cancer patients  

Microsoft Academic Search

The aim of this study was to describe the epidemiology and microbiology of bloodstream infections (BSIs) among adult surgical cancer patients and to determine independent factors that influence in-hospital mortality. The study enrolled 112 consecutive episodes of BSIs in adult surgical cancer patients during a 26-month period. The median age of the patients was 64.5 years, and crude in-hospital mortality

E. Velasco; M. Soares; R. Byington; C. A. S. Martins; M. Schirmer; L. M. C. Dias; V. M. S. Gonçalves

2004-01-01

57

Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina  

Microsoft Academic Search

ObjectiveOur aim was to ascertain the effect of an infection control program, using education and performance feedback on intensive care units, for intravascular device (IVD)-associated bloodstream infection (BSI).

Victor Daniel Rosenthal; Sandra Guzman; Stella Maris Pezzotto; Crnich Christopher J

2003-01-01

58

New technologies to prevent intravascular catheter-related bloodstream infections.  

PubMed Central

Most intravascular catheter-related infections are associated with central venous catheters. Technologic advances shown to reduce the risk for these infections include a catheter hub containing an iodinated alcohol solution, short-term chlorhexidine-silver sulfadiazine- impregnated catheters, minocycline-rifampin-impregnated catheters, and chlorhexidine- impregnated sponge dressings. Nontechnologic strategies for reducing risk include maximal barrier precautions during catheter insertion, specialized nursing teams, continuing quality improvement programs, and tunneling of short-term internal jugular catheters.

Mermel, L. A.

2001-01-01

59

New Technologies to Prevent Intravascular Catheter-Related Bloodstream Infections  

Microsoft Academic Search

Most intravascular catheter-related infections are associated with central venous catheters. Technologic advances shown to reduce the risk for these infections include a catheter hub containing an iodinated alcohol solution, short-term chlorhexidine-silver sulfadiazine-impregnated catheters, minocycline- rifampin-impregnated catheters, and chlorhexidine-impregnated sponge dressings. Nontechnologic strategies for reducing risk include maximal barrier precautions during catheter insertion, specialized nursing teams, continuing quality improvement programs, and

Leonard A. Mermel

2001-01-01

60

Eosinopenia as a diagnostic marker of bloodstream infection in hospitalised paediatric and adult patients: a case-control study.  

PubMed

The objective of this study was to assess whether eosinopenia was a reliable diagnostic marker of bloodstream infection in hospitalised adult and paediatric patients. The design was a case-control study, set in a tertiary adult and paediatric hospital. A total of 157 adult and 85 paediatric patients with bloodstream infection ('cases') were compared to 195 and 94 randomly selected adult and paediatric patients who had clinical suspicion of bloodstream infection but with a negative blood culture ('controls') respectively. Patients with haematological or immunosuppressive disease and control patients who were treated with antibiotics within one week prior to the blood culture were excluded. Eosinopenia, or undetectable eosinophil count (<0.01 x 10(9) or <10/mm3), was more common among the cases than the controls (46.5% vs 21.5%, respectively). The specificity of eosinopenia to predict bloodstream infection in adult patients was reasonable (79%, 95% confidence interval [CI] 74 to 82), but its sensitivity was low (47%, 95% CI 41 to 52). The absolute eosinophil count only had a modest ability to discriminate bloodstream infections from controls in adult patients (area under receiver operating characteristic curve 0.349, 95% CI 0.288 to 0.411). Eosinophil counts had very little overall predictive ability (area under receiver operating characteristic curve 0.448, 95% CI 0.363 to 0.533, P=0.237), and the sensitivity (54%, 95% CI 47 to 61) and specificity (56%, 95% CI 49 to 63) of eosinopenia to predict bloodstream infection in paediatric patients were both low. In the multivariate analyses, only C-reactive protein concentrations and neutrophil counts, but not eosinopenia, were significantly associated with the presence of bloodstream infection in both adult and paediatric patients. The presence of eosinopenia can be considered as an inexpensive warning test for bloodstream infection in hospitalised adult patients so that further investigations can be initiated. An absence of eosinopenia is, however not sensitive enough to exclude bloodstream infection. C-reactive protein concentrations and neutrophil counts were both better markers of bloodstream infection than eosinopenia in hospitalised paediatric and adult patients. PMID:21485670

Wibrow, B A; Ho, K M; Flexman, J P; Keil, A D; Kohrs, D L

2011-03-01

61

Formulation of a model for automating infection surveillance: algorithmic detection of central-line associated bloodstream infection  

PubMed Central

Objective To formulate a model for translating manual infection control surveillance methods to automated, algorithmic approaches. Design We propose a model for creating electronic surveillance algorithms by translating existing manual surveillance practices into automated electronic methods. Our model suggests that three dimensions of expert knowledge be consulted: clinical, surveillance, and informatics. Once collected, knowledge should be applied through a process of conceptualization, synthesis, programming, and testing. Results We applied our framework to central vascular catheter associated bloodstream infection surveillance, a major healthcare performance outcome measure. We found that despite major barriers such as differences in availability of structured data, in types of databases used and in semantic representation of clinical terms, bloodstream infection detection algorithms could be deployed at four very diverse medical centers. Conclusions We present a framework that translates existing practice—manual infection detection—to an automated process for surveillance. Our experience details barriers and solutions discovered during development of electronic surveillance for central vascular catheter associated bloodstream infections at four hospitals in a variety of data environments. Moving electronic surveillance to the next level—availability at a majority of acute care hospitals nationwide—would be hastened by the incorporation of necessary data elements, vocabularies and standards into commercially available electronic health records.

Hota, Bala; Lin, Michael; Doherty, Joshua A; Borlawsky, Tara; Woeltje, Keith; Stevenson, Kurt; Khan, Yosef; Young, Jeremy; Weinstein, Robert A; Trick, William

2010-01-01

62

The Value of Combining Blood Culture and SeptiFast Data for Predicting Complicated Bloodstream Infections Caused by Gram-Positive Bacteria or Candida Species  

PubMed Central

Management of complicated bloodstream infections requires more aggressive treatment than uncomplicated bloodstream infections. We assessed the value of follow-up blood culture in bloodstream infections caused by Staphylococcus aureus, Enterococcus spp., Streptococcus spp., and Candida spp. and studied the value of persistence of DNA in blood (using SeptiFast) for predicting complicated bloodstream infections. Patients with bloodstream infections caused by these microorganisms were enrolled prospectively. After the first positive blood culture, samples were obtained every third day to perform blood culture and SeptiFast analyses simultaneously. Patients were followed to detect complicated bloodstream infection. The study sample comprised 119 patients. One-third of the patients developed complicated bloodstream infections. The values of persistently positive tests to predict complicated bloodstream infections were as follows: SeptiFast positive samples (sensitivity, 56%; specificity, 79.5%; positive predictive value, 54%; negative predictive value, 80.5%; accuracy, 72.3%) and positive blood cultures (sensitivity, 30.5%; specificity, 92.8%; positive predictive value, 64%; negative predictive value, 75.5%; accuracy, 73.9%). Multivariate analysis showed that patients with a positive SeptiFast result between days 3 and 7 had an almost 8-fold-higher risk of developing a complicated bloodstream infection. In S. aureus, the combination of both techniques to exclude endovascular complications was significantly better than the use of blood culture alone. We obtained a score with variables selected by the multivariate model. With a cutoff of 7, the negative predictive value for complicated bloodstream infection was 96.6%. Patients with a positive SeptiFast result between days 3 and 7 after a positive blood culture have an almost 8-fold-higher risk of developing complicated bloodstream infections. A score combining clinical data with the SeptiFast result may improve the exclusion of complicated bloodstream infections.

Marin, Mercedes; Kestler, Martha; Alcala, Luis; Rodriguez-Creixems, Marta; Bouza, Emilio

2013-01-01

63

Central line-associated bloodstream infection: not just an intensive care unit problem.  

PubMed

Central line-associated bloodstream infection (CLABSI) is an ongoing issue in health care, causing increased mortality and billions of dollars in healthcare costs. The majority of research and implementation has been done in the intensive care unit (ICU) setting. Although thousands of non-ICU patients are known to have CLABSI, adequate research has not been conducted in this population. This article explores the current literature on CLABSI and recommends additional research to focus on the non-ICU population and setting. PMID:23372092

Whited, Alyssa; Lowe, Janell M

2013-02-01

64

Efficacy of Ertapenem for Treatment of Bloodstream Infections Caused by Extended-Spectrum-?-Lactamase-Producing Enterobacteriaceae  

PubMed Central

Ertapenem is active against extended-spectrum-?-lactamase (ESBL)-producing Enterobacteriaceae organisms but inactive against Pseudomonas aeruginosa and Acinetobacter baumannii. Due to a lack of therapeutic data for ertapenem in the treatment of ESBL bloodstream infections (BSIs), group 2 carbapenems (e.g., imipenem or meropenem) are often preferred for treatment of ESBL-producing Enterobacteriaceae, although their antipseudomonal activity is unnecessary. From 2005 to 2010, 261 patients with ESBL BSIs were analyzed. Outcomes were equivalent between patients treated with ertapenem and those treated with group 2 carbapenems (mortality rates of 6% and 18%, respectively; P = 0.18).

Collins, Vicki L.; Pogue, Jason M.; Moshos, Judy; Bheemreddy, Suchitha; Sunkara, Bharath; Shallal, Alex; Chugh, Neelu; Eiseler, Sara; Bhargava, Pragati; Blunden, Christopher; Lephart, Paul R.; Memon, Babar Irfan; Hayakawa, Kayoko; Abreu-Lanfranco, Odaliz; Chopra, Teena; Munoz-Price, L. Silvia; Carmeli, Yehuda; Kaye, Keith S.

2012-01-01

65

Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality  

Microsoft Academic Search

Introduction  To estimate the incidence of intensive care unit (ICU)-acquired bloodstream infection (BSI) and its independent effect on\\u000a hospital mortality.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We retrospectively studied acquisition of BSI during admissions of >72 hours to adult ICUs from two university-affiliated\\u000a hospitals. We obtained demographics, illness severity and co-morbidity data from ICU databases and microbiological diagnoses\\u000a from departmental electronic records. We assessed survival at hospital

John R Prowle; Jorge E Echeverri; E Valentina Ligabo; Norelle Sherry; Gopal C Taori; Timothy M Crozier; Graeme K Hart; Tony M Korman; Barrie C Mayall; Rinaldo Bellomo

2011-01-01

66

Multiplex PCR for Rapid and Improved Diagnosis of Bloodstream Infections in Liver Transplant Recipients  

PubMed Central

This prospective study evaluated the utility of the SeptiFast (SF) test in detecting 25 clinically important pathogens in 225 blood samples from 170 intensive care unit (ICU) patients with suspected sepsis after liver transplantation (LTX) or after other major abdominal surgery (non-LTX). SF yielded a significantly higher positivity rate in the LTX group (52.3%) than in the non-LTX group (30.5%; P = 0.0009). SF may be a powerful tool for the early diagnosis of bloodstream infections in LTX patients.

Rath, Peter-Michael; Saner, Fuat; Paul, Andreas; Lehmann, Nils; Steinmann, Eike; Buer, Jan

2012-01-01

67

Group B streptococci causing neonatal bloodstream infection: Antimicrobial susceptibility and serotyping results from SENTRY centers in the Western Hemisphere  

Microsoft Academic Search

Objective: Group B streptococcal infection is a common cause of neonatal sepsis. Surveillance of antimicrobial susceptibility and serotype frequencies of invasive group B streptococci is important to ensure the effectiveness of therapeutic regimens and to guide vaccine development. Study Design: Prospective surveillance of neonatal bloodstream infection was performed at all Western Hemisphere sites participating in the SENTRY Program. From January

Janet I. Andrews; Daniel J. Diekema; Stephen K. Hunter; Paul R. Rhomberg; Michael A. Pfaller; Ronald N. Jones; Gary V. Doern

2000-01-01

68

A SacB Mutagenesis Strategy Reveals that the Bartonella quintana Variably Expressed Outer Membrane Proteins Are Required for Bloodstream Infection of the Host  

Microsoft Academic Search

Bartonella bacteria adhere to erythrocytes and persistently infect the mammalian bloodstream. We previ- ously identified four highly conserved Bartonella quintana adhesin genes that undergo phase variation during prolonged bloodstream infection. The variably expressed outer membrane proteins (Vomp) encoded by these genes are members of the trimeric autotransporter adhesin family. Each B. quintana Vomp appears to contribute a different adhesion phenotype,

Joanna K. MacKichan; Helen L. Gerns; Yu-Ting Chen; Peng Zhang; Jane E. Koehler

2008-01-01

69

Bacterial Bloodstream Infections in HIV-infected Adults Attending a Lagos Teaching Hospital  

PubMed Central

An investigation was carried out during October 2005–September 2006 to determine the prevalence of bloodstream infections in patients attending the outpatient department of the HIV/AIDS clinic at the Lagos University Teaching Hospital in Nigeria. Two hundred and one patients—86 males and 115 females—aged 14-65 years were recruited for the study. Serological diagnosis was carried out on them to confirm their HIV status. Their CD4 counts were done using the micromagnetic bead method. Twenty mL of venous blood sample collected from each patient was inoculated into a pair of Oxoid Signal blood culture bottles for 2-14 days. Thereafter, 0.1 mL of the sample was plated in duplicates on MacConkey, blood and chocolate agar media and incubated at 37 °C for 18-24 hours. The CD4+ counts were generally low as 67% of 140 patients sampled had <200 cells/?L of blood. Twenty-six bacterial isolates were obtained from the blood samples and comprised 15 (58%) coagulase-negative staphylococci as follows: Staphylococcus epidermidis (7), S. cohnii cohnii (1), S. cohnii urealyticum (2), S. chromogenes (1), S. warneri (2), S. scuri (1), and S. xylosus (1). Others were 6 (23%) Gram-negative non-typhoid Salmonella spp., S. Typhimurium (4), S. Enteritidis (2); Pseudomonas fluorescens (1), Escherichia coli (1), Ochrobactrum anthropi (1), Moraxella sp. (1), and Chryseobacterium meningosepticum. Results of antimicrobial susceptibility tests showed that coagulase-negative staphylococci had good sensitivities to vancomycin and most other antibiotics screened but were resistant mainly to ampicilin and tetracycline. The Gram-negative organisms isolated also showed resistance to ampicillin, tetracycline, chloramphenicol, and septrin. This study demonstrates that co-agulase-negative staphylococci and non-typhoidal Salmonellae are the most common aetiological agents of bacteraemia among HIV-infected adults attending the Lagos University Teaching Hospital, Nigeria. The organisms were resistant to older-generation antibiotics often prescribed in this environment but were sensitive to vancomycin, cefotaxime, cefuroxime, and other new-generation antibiotics.

Sulaiman, Akanmu A.; Solomon, Bamiro B.; Chinedu, Obosi A.; Victor, Inem A.

2010-01-01

70

Characteristics of catheter-related bloodstream infections in children with intestinal failure: implications for clinical management.  

PubMed

Catheter-related bloodstream infection is a major cause of mortality and morbidity in the intestinal-failure population. This study reports characteristics of CRBSI with implications for clinical management in parenteral nutrition-dependent children with intestinal failure. The researchers report the rate of central catheter infections, and the causative organisms, as well as identify risk factors in our intestinal-failure patients that would be amenable to preventive measures.The study is a retrospective review of the medical records of 101 patients with intestinal failure (IF), seen in the Intestinal Rehabilitation Clinic at Children's Medical Center of Dallas from May 2005 to March 2007. Catheter-related bloodstream infections (CRBSIs) were categorized as nosocomial or community-acquired. Data collected for each episode include microorganisms isolated from blood and potential risk factors. Z test was done to compare the infection rates.There were 92 episodes of CRBSIs in 45 parenteral nutrition (PN)-dependent patients with central venous catheters (CVC) in place for a total of 13,978 days. Eighty-three percent (n = 76) of CRBSIs developed in the community at a rate of 7.0 per 1,000 days. Seventeen percent (n = 16) nosocomial CRBSIs were observed at a rate of 5.5 per 1,000 catheter days. CRBSI rate was not statistically different between the two groups (7.0 vs. 5.5, p = .378).CRBSI in the intestinal-failure population is due to a wide variety of organisms with numerous risk factors. Education of CVC management with the practice of consistent guidelines may reduce CRBSI incidence, thus reducing the morbidity and mortality in the intestinal-failure patients. PMID:20010229

Drews, Barbara B; Sanghavi, Rinarani; Siegel, Jane D; Metcalf, Pat; Mittal, Naveen K

71

The Promise of Novel Technology for the Prevention of Intravascular Device–Related Bloodstream Infection. II. Long?Term Devices  

Microsoft Academic Search

Intravascular devices (IVDs) are widely used for vascular access but are associated with a substantial risk of IVD-related bloodstream infection (BSI). The development of novel technologies based on our understanding of pathogenesis promises a quantum reduction in IVD-related infections in an era of growing nursing shortage. Infections of long-term IVDs (most are in place for 10 days), including cuffed and

Christopher J. Crnich; Dennis G. Maki

2002-01-01

72

Catheter-related bloodstream infections: a prospective observational study of central venous and arterial catheters.  

PubMed

Abstract Background: Catheter-related bloodstream infections (CRBSIs) can lead to increased morbidity and length of stay (LOS) in the intensive care unit (ICU). The purpose of this study was to analyse the incidence of catheter-related bloodstream infection associated with central venous catheters (CVCs) and arterial catheters (ACs) and to identify risk factors for CRBSIs in our ICU. Methods: This was a prospective observational study in a 17-bed medical-surgical ICU of a 715-bed university hospital. Patients admitted to the ICU for ? 24 h between 1 September 2007 and 30 April 2008, who received a CVC or AC, were included in the study. Results: A total of 219 patients with 258 CVCs and 336 ACs were included in the study and observed for a combined total of 3172 catheter-days. The CRBSI incidence density was 1.2 per 1000 catheter-days for CVCs and 2.1 per 1000 catheter-days for ACs. The mean LOS (p = 0.003), the number of days a catheter remained in situ (p = 0.001), and the length of pre-ICU in-hospital stay (p = 0.031) were significantly higher in the CRBSI group. Risk factor analysis was not reliable due to the low number of CRBSIs. Conclusion: The incidence of AC- and CVC-related CRBSIs was comparable to the incidence reported in the literature. However, the incidence for ACs was higher than for CVCs. In addition to CVCs, ACs should be considered a possible cause of catheter-related infections and both should be replaced when CRBSI is suspected. PMID:23826790

Wittekamp, Bastiaan H; Chalabi, Myriam; van Mook, Walther N K A; Winkens, Bjorn; Verbon, Annelies; Bergmans, Dennis C J J

2013-07-05

73

Proteus mirabilis Bloodstream Infections: Risk Factors and Treatment Outcome Related to the Expression of Extended-Spectrum  -Lactamases  

Microsoft Academic Search

Bloodstream infection (BSI) due to Proteus mirabilis strains is a relatively uncommon clinical entity, and its significance has received little attention. This study was initiated to evaluate risk factors and treatment outcome of BSI episodes due to P. mirabilis producing extended-spectrum -lactamases (ESBLs). Twenty-five BSI episodes caused by P. mirabilis occurred at our hospital (Ospedale di Circolo e Fondazione Macchi,

Andrea Endimiani; Francesco Luzzaro; Gioconda Brigante; Mariagrazia Perilli; Gianluigi Lombardi; Gianfranco Amicosante; Gian Maria Rossolini; Antonio Toniolo

2005-01-01

74

Isolation of Staphylococcus epidermidis intermediately resistant to vancomycin in a case of central venous catheter-associated bloodstream infection.  

PubMed

The emergence and spread of vancomycin resistance among staphylococci, although rarely described in Japan to date, are major clinical concerns. We describe a case of central venous catheter-associated bloodstream infection in which Staphylococcus epidermidis intermediately resistant to vancomycin (minimum inhibitory concentration, 8 ?g/ml) was isolated. The patient fully recovered with removal of the intravenous catheter. PMID:23377556

Nakajima, Jun; Hitomi, Shigemi; Koganemaru, Hiroshi; Nakai, Yasunobu

2013-02-03

75

Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002)  

Microsoft Academic Search

The empiric treatment of patients with bloodstream infections (BSI) has become more complicated in an era of increasing antimicrobial resistance. The SENTRY Antimicrobial Surveillance Program has monitored BSI from patients in medical centers worldwide since 1997. During 1997–2002, a total of 81,213 BSI pathogens from North America, Latin America, and Europe were tested for antimicrobial susceptibility. S. aureus, E. coli,

Douglas J. Biedenbach; Gary J. Moet; Ronald N. Jones

2004-01-01

76

[Bloodstream infection in a neonatology unit of Medellín-Colombia, 2008-2009].  

PubMed

Bloodstream infection (BSI) is one of the main causes of sepsis and death in newborns. The relative importance of nosocomial and non-nosocomial agents in developing countries is not clear. We conducted a prospective study of newborns hospitalized with a first episode of BSI in order to classify it as early, late or nosocomial, describe the clinical and microbiological characteristics, and explore risk factors between hospital-acquired vs community-acquired BSI (HA-BSI vs CA-BSI). Twenty-seven newborns with a first episode of BSI were identified. Streptococcus agalactiae and coagulase negative Staphylococcus were the main agents in CA-BSI and HA-BSI, respectively. The only significant intrinsic risk factor between HA-BSI and CA-BSI was gestational age. The frequent finding of S. agalactiae warrants routine screening and prophylaxis in pregnant women. The risk factors for HA-BSI were mostly extrinsic, and thus, susceptible of being modified. PMID:21279285

Hoyos O, Alvaro; Suarez G, Margarita; Massaro C, Mónica; Ortiz M, Gloría; Aguirre C, José; Uribe M, Andrés

2011-01-07

77

Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit  

Microsoft Academic Search

Objective  Identification of catheter-related bloodstream infection (CR-BSI) risk factors and determination of whether intervention related\\u000a to identified risk factors would reduce CR-BSI rates.\\u000a \\u000a \\u000a \\u000a \\u000a Design  Prospective, observational, interventional and interrupted time-series study.\\u000a \\u000a \\u000a \\u000a Setting  Pediatric Intensive Care Unit (PICU) in a university hospital.\\u000a \\u000a \\u000a \\u000a Methods  During a 7-year period, 609 central venous catheters (CVC) were placed in 389 patients. CR-BSI risk factors were determined\\u000a by multivariate analysis

Corsino Rey; Francisco Álvarez; Victoria De-La-Rua; Andrés Concha; Alberto Medina; Juan-José Díaz; Sergio Menéndez; Marta Los-Arcos; Juan Mayordomo-Colunga

2011-01-01

78

Three cases of IMP-type metallo-?-lactamase-producing Enterobacter cloacae bloodstream infection in Japan.  

PubMed

We report three cases of IMP-type metallo-?-lactamase-producing Enterobacter cloacae bloodstream infection, which showed minimum inhibitory concentration values for imipenem with 2 ?g/ml in all isolates. Although carbapenems were initiated empirically in all cases, two of three cases died. The Clinical and Laboratory Standards Institute lowered the breakpoints of carbapenems for Enterobacteriaceae in 2010. However, the previous breakpoints are still used in many clinical laboratories, which can result in failure to detect carbapenem-resistant Enterobacteriaceae. Therefore, lower breakpoints of carbapenems should be used in clinical settings, and alternative tests for detecting metallo-?-lactamase such as polymerase chain reaction and immunochromatographic assays may contribute to better detection of carbapenem-resistant isolates. PMID:23160627

Hamada, Yohei; Watanabe, Koji; Tatsuya, Tada; Mezaki, Kazuhisa; Takeuchi, Sosuke; Shimizu, Toshio; Kirikae, Teruo; Ohmagari, Norio

2012-11-19

79

Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology, Epidemiology, and Clinical Features  

PubMed Central

Background Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. Methods We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (?16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project). Results In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (?16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. Conclusions In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.

Pereira, Carlos Alberto Pires; Marra, Alexandre R.; Camargo, Luis Fernando Aranha; Pignatari, Antonio Carlos Campos; Sukiennik, Teresa; Behar, Paulo Renato Petersen; Medeiros, Eduardo Alexandrino Servolo; Ribeiro, Julival; Girao, Evelyne; Correa, Luci; Guerra, Carla; Carneiro, Irna; Brites, Carlos; Reis, Marise; de Souza, Marta Antunes; Tranchesi, Regina; Barata, Cristina U.; Edmond, Michael B.

2013-01-01

80

Rapid Diagnosis of Bloodstream Infections with PCR Followed by Mass Spectrometry  

PubMed Central

Achieving a rapid microbiological diagnosis is crucial for decreasing morbidity and mortality of patients with a bloodstream infection, as it leads to the administration of an appropriate empiric antimicrobial therapy. Molecular methods may offer a rapid alternative to conventional microbiological diagnosis involving blood culture. In this study, the performance of a new technology that uses broad-spectrum PCR coupled with mass spectrometry (PCR/ESI-MS) was evaluated for the detection of microorganisms directly from whole blood. A total of 247 whole blood samples and paired blood cultures were prospectively obtained from 175 patients with a suspicion of sepsis. Both sample types were analyzed using the PCR/ESI-MS technology, and the results were compared with those obtained by conventional identification methods. The overall agreement between conventional methods and PCR/ESI-MS performed in blood culture aliquots was 94.2% with 96.8% sensitivity and 98.5% specificity for the molecular method. When comparing conventional methods with PCR/ESI-MS performed in whole blood specimens, the overall agreement was 77.1% with 50% sensitivity and 93.8% specificity for the molecular method. Interestingly, the PCR/ESI-MS technology led to the additional identification of 13 pathogens that were not found by conventional methods. Using the PCR/ESI-MS technology the microbiological diagnosis of bloodstream infections could be anticipated in about half of the patients in our setting, including a small but significant proportion of patients newly diagnosed. Thus, this promising technology could be very useful for the rapid diagnosis of sepsis in combination with traditional methods.

Jordana-Lluch, Elena; Carolan, Heather E.; Gimenez, Montserrat; Sampath, Rangarajan; Ecker, David J.; Quesada, M. Dolores; Modol, Josep M.; Armestar, Fernando; Blyn, Lawrence B.; Cummins, Lendell L.; Ausina, Vicente; Martro, Elisa

2013-01-01

81

An outbreak of Candida spp. bloodstream infection in a tertiary care center in Bogotá, Colombia.  

PubMed

Several cases of Candida bloodstream infections were documented from June to October 2004 at a tertiary care center in Bogotá, Colombia. Since no cases of candidemia had occurred during the preceding four months, an outbreak was declared. As a result, a microbiological study, a revision of infection control practices and a case-control study were performed. In all, 18 cases of candidemia were ascertained. Parenteral nutrition (p=0.04), presence of a central line (p=0.03), and severity of illness (p=0.03) were associated with candidemia in bivariate analysis. Diverse Candida species were observed. Candida parapsilosis contamination was found in plastic containers used for transient intravenous (IV) medication storage at the bedside, plastic bags reused for the transportation of IV medicines and cotton used for disinfection of IV ports. Poor infection control practices were widely observed. The outbreak was controlled after elimination of plastic bags used for transportation, instauration of daily disinfection of IV medication containers, acquisition of sterile alcohol swabs for port disinfection and staff education. It was concluded that candidemia was associated with previously-described risk factors and that poor infection-control practices were likely responsible for the outbreak. PMID:19219278

DiazGranados, Carlos A; Martinez, Adriana; Deaza, Ceneth; Valderrama, Sandra

2008-10-01

82

Decreasing central-line-associated bloodstream infections in connecticut intensive care units.  

PubMed

Central-line-associated bloodstream infections (CLABSIs) are a significant cause of preventable harm. A collaborative project involving a multifaceted intervention was used in the Michigan Keystone Project and associated with significant reductions in these infections. This intervention included the Comprehensive Unit-based Safety Program, a multifaceted approach to CLABSI prevention, and the monitoring and reporting of infections. The purpose of this study was to determine whether the multifaceted intervention from the Michigan Keystone program could be implemented in Connecticut and to evaluate the impact on CLABSI rates in intensive care units (ICUs). The primary outcome was the NHSN-defined rate of CLABSI. Seventeen ICUs, representing 14 hospitals and 104,695 catheter days were analyzed. The study period included up to four quarters (12 months) of baseline data and seven quarters (21 months) of postintervention data. The overall mean (median) CLABSI rate decreased from 1.8 (1.8) infections per 1,000 catheter days at baseline to 1.1 (0) at seven quarters postimplementation of the intervention. This study demonstrated that the multifaceted intervention used in the Keystone program could be successfully implemented in another state and was associated with a reduction in CLABSI rates in Connecticut. Moreover, even though the statewide baseline CLABSI rate in Connecticut was low, rates were reduced even further and well below national benchmarks. PMID:23347278

Hong, Alison L; Sawyer, Melinda D; Shore, Andrew; Winters, Bradford D; Masuga, Marie; Lee, Heewon; Mathews, Simon C; Weeks, Kristina; Goeschel, Christine A; Berenholtz, Sean M; Pronovost, Peter J; Lubomski, Lisa H

2013-01-24

83

Predictors of mortality in multidrug-resistant Klebsiella pneumoniae bloodstream infections.  

PubMed

The dramatic increase of antibiotic resistance in Klebsiella pneumoniae has been associated with fatal outcomes. First, bloodstream infections (BSIs) caused by extended-spectrum ?-lactamases (ESBL) Enterobacteriaceae have been associated with treatment failure, more recently BSIs caused by carbapenem-resistant K. pneumoniae (CR-KP) have been reported to be fatal in approximately 50% of cases. Severity of underlying disease, intensive care unit stay at infection onset, infection with ESBL or CR-KP strain and delay in administration of appropriate therapy are among the most common risk factors for mortality in patients with K. pneumoniae BSI, while infection source control and early appropriate antimicrobial treatment have been associated with survival. Thus, risk assessment for ESBL and/or CR-KP is mandatory in patients with suspicion of K. pneumoniae BSI. Here, we examine current evidence regarding risk factors for mortality in patients with K. pneumoniae BSI and address the issue of a risk prediction model for CR-KP BSI. PMID:24073806

Viale, Pierluigi; Giannella, Maddalena; Lewis, Russell; Trecarichi, Emanuele Maria; Petrosillo, Nicola; Tumbarello, Mario

2013-09-27

84

Multiplex PCR To Diagnose Bloodstream Infections in Patients Admitted from the Emergency Department with Sepsis ?  

PubMed Central

Sepsis is caused by a heterogeneous group of infectious etiologies. Early diagnosis and the provision of appropriate antimicrobial therapy correlate with positive clinical outcomes. Current microbiological techniques are limited in their diagnostic capacities and timeliness. Multiplex PCR has the potential to rapidly identify bloodstream infections and fill this diagnostic gap. We identified patients from two large academic hospital emergency departments with suspected sepsis. The results of a multiplex PCR that could detect 25 bacterial and fungal pathogens were compared to those of blood culture. The results were analyzed with respect to the likelihood of infection, sepsis severity, the site of infection, and the effect of prior antibiotic therapy. We enrolled 306 subjects with suspected sepsis. Of these, 43 were later determined not to have infectious etiologies. Of the remaining 263 subjects, 70% had sepsis, 16% had severe sepsis, and 14% had septic shock. The majority had a definite infection (41.5%) or a probable infection (30.7%). Blood culture and PCR performed similarly with samples from patients with clinically defined infections (areas under the receiver operating characteristic curves, 0.64 and 0.60, respectively). However, blood culture identified more cases of septicemia than PCR among patients with an identified infectious etiology (66 and 46, respectively; P = 0.0004). The two tests performed similarly when the results were stratified by sepsis severity or infection site. Blood culture tended to detect infections more frequently among patients who had previously received antibiotics (P = 0.06). Conversely, PCR identified an additional 24 organisms that blood culture failed to detect. Real-time multiplex PCR has the potential to serve as an adjunct to conventional blood culture, adding diagnostic yield and shortening the time to pathogen identification.

Tsalik, Ephraim L.; Jones, Daphne; Nicholson, Bradly; Waring, Lynette; Liesenfeld, Oliver; Park, Lawrence P.; Glickman, Seth W.; Caram, Lauren B.; Langley, Raymond J.; van Velkinburgh, Jennifer C.; Cairns, Charles B.; Rivers, Emanuel P.; Otero, Ronny M.; Kingsmore, Stephen F.; Lalani, Tahaniyat; Fowler, Vance G.; Woods, Christopher W.

2010-01-01

85

Daily cost of antimicrobial therapy in patients with Intensive Care Unit-acquired, laboratory-confirmed bloodstream infection  

Microsoft Academic Search

This study analysed daily antimicrobial costs of Intensive Care Unit (ICU)-acquired, laboratory-confirmed bloodstream infection (BSI) per patient admitted to the ICU of a university hospital, based on prospectively collected data over a 4-year period (2003–2006). Costs were calculated based on the price of the agent(s) initiated on the first day of appropriate treatment and according to: (i) focus of infection;

Dominique M. Vandijck; Mieke Depaemelaere; Sonia O. Labeau; Pieter O. Depuydt; Lieven Annemans; Franky M. Buyle; Sandra Oeyen; Kirsten E. Colpaert; Renaat P. Peleman; Stijn I. Blot; Johan M. Decruyenaere

2008-01-01

86

Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit  

Microsoft Academic Search

occurred in 31 (22.4%) participants. Bivariate Cox analysis re- vealed that receiving >25% of recommended calories compared with <25% was associated with significantly lower risk of blood- stream infection (relative hazard, 0.24; 95% confidence interval, 0.10 - 0.60). Simplified Acute Physiology Score II also was asso- ciated with risk of nosocomial bloodstream infection (relative hazard, 1.27; 95% confidence interval, 1.01-1.60).

Lewis Rubinson; Gregory B. Diette; Xiaoyan Song; Roy G. Brower; Jerry A. Krishnan

2004-01-01

87

Bloodstream infection following 217 consecutive systemic-enteric drained pancreas transplants  

PubMed Central

Background Combined kidney pancreas transplantation (PTx) evolved as excellent treatment for diabetic nephropathy. Infections remain common and serious complications. Methods 217 consecutive enteric drained PTxs performed from 1997 to 2004 were retrospectively analyzed with regard to bloodstream infection. Immunosuppression consisted of antithymocyteglobuline induction, tacrolimus, mycophenolic acid and steroids for the majority of cases. Standard perioperative antimicrobial prophylaxis consisted of pipercillin/tazobactam in combination with ciprofloxacin and fluconazole. Results One year patient, pancreas and kidney graft survival were 96.4%, 88.5% and 94.8%, surgical complication rate was 35%, rejection rate 30% and rate of infection 59%. In total 46 sepsis episodes were diagnosed in 35 patients (16%) with a median onset on day 12 (range 1–45) post transplant. Sepsis source was intraabdominal infection (IAI) (n = 21), a contaminated central venous line (n = 10), wound infection (n = 5), urinary tract infection (n = 2) and graft transmitted (n = 2). Nine patients (4%) experienced multiple episodes of sepsis. Overall 65 pathogens (IAI sepsis 39, line sepsis 15, others 11) were isolated from blood. Gram positive cocci accounted for 50 isolates (77%): Coagulase negative staphylococci (n = 28, i.e. 43%) (nine multi-resistant), Staphylococcus aureus (n = 11, i.e. 17%) (four multi-resistant), enterococci (n = 9, i.e. 14%) (one E. faecium). Gram negative rods were cultured in twelve cases (18%). Patients with blood borne infection had a two year pancreas graft survival of 76.5% versus 89.4% for those without sepsis (p = 0.036), patient survival was not affected. Conclusion Sepsis remains a serious complication after PTx with significantly reduced pancreas graft, but not patient survival. The most common source is IAI.

Berger, Natalie; Guggenbichler, Sigmund; Steurer, Wolfgang; Margreiter, Christian; Mayer, Gert; Kafka, Reinhold; Mark, Walter; Rosenkranz, Alexander R; Margreiter, Raimund; Bonatti, Hugo

2006-01-01

88

Bloodstream infections in very low birth weight infants with intestinal failure  

PubMed Central

Objective To examine pathogens and other characteristics associated with late-onset bloodstream infections (BSI) in infants with intestinal failure (IF) as a consequence of necrotizing enterocolitis (NEC). Study design Infants 401–1500 grams at birth who survived >72 hours and received care at NICHD Neonatal Research Network centers were studied. Frequency of culture positive BSI and pathogens were compared for infants with medical NEC, NEC managed surgically without IF, and surgical IF. Among infants with IF, duration of parenteral nutrition (PN) and other outcomes were evaluated. Results 932 infants were studied (IF, n=78; surgical NEC without IF, n=452; medical NEC, n=402). The proportion with BSI after NEC diagnosis was higher in infants with IF than with surgical NEC (p=0.007) or medical NEC (p<0.001). Gram positive pathogens were most frequent. Among infants with IF, increased number of infections was associated with longer hospitalization and duration on PN (0, 1, ?2 infections; median stay (days): 172, 188, 260, p=0.06; median days on PN: 90, 112, 115, p=0.003), and the proportion who achieved full feeds during hospitalization decreased (87%, 67%, 50%, p=0.03). Conclusion Recurrent BSIs are common in VLBW infants with IF. Gram positive bacteria were most commonly identified in these infants.

Cole, Conrad R.; Hansen, Nellie I.; Higgins, Rosemary D.; Bell, Edward F.; Shankaran, Seetha; Laptook, Abbot R.; Walsh, Michele C.; Hale, Ellen C.; Newman, Nancy S.; Das, Abhik; Stoll, Barbara J.

2011-01-01

89

Healthcare-associated Staphylococcus aureus bloodstream infection: length of stay, attributable mortality, and additional direct costs.  

PubMed

This study aimed to determine the excess length of stay, extra expenditures, and attributable mortality to healthcare-associated S. aureus bloodstream infection (BSI) at a teaching hospital in central Brazil. The study design was a matched (1:1) case-control. Cases were defined as patients >13 years old, with a healthcare-associated S. aureus BSI. Controls included patients without an S. aureus BSI, who were matched to cases by gender, age (± 7 years), morbidity, and underlying disease. Data were collected from medical records and from the Brazilian National Hospital Information System (Sistema de Informações Hospitalares do Sistema Único de Saúde - SIH/SUS). A Wilcoxon rank sum test was performed to compare length of stay and costs between cases and controls. Differences in mortality between cases and controls were compared using McNemar's tests. The Mantel-Haenzel stratified analysis was performed to compare invasive device utilization. Data analyses were conducted using Epi Info 6.0 and Statistical Package for Social Sciences (SPSS 13.0). 84 case-control pairs matched by gender, age, admission period, morbidity, and underlying disease were analyzed. The mean lengths of hospital stay were 48.3 and 16.2 days for cases and controls, respectively (p<0.01), yielding an excess hospital stay among cases of 32.1 days. The excess mortality among cases compared to controls that was attributable to S. aureus bloodstream infection was 45.2%. Cases had a higher risk of dying compared to controls (OR 7.3, 95% CI 3.1-21.1). Overall costs of hospitalization (SIH/SUS) reached US$ 123,065 for cases versus US$ 40,247 for controls (p<0.01). The cost of antimicrobial therapy was 6.7 fold higher for cases compared to controls. Healthcare-associated S. aureus BSI was associated with statistically significant increases in length of hospitalization, attributable mortality, and economic burden. Implementation of measures to minimize the risk of healthcare-associated bacterial infections is essential. PMID:23158266

Primo, Mariusa Gomes Borges; Guilarde, Adriana Oliveira; Martelli, Celina M Turchi; Batista, Lindon Johnson de Abreu; Turchi, Marília Dalva

2012-11-15

90

Incidence, Clinical, Microbiological Features and Outcome of Bloodstream Infections in Patients Undergoing Hemodialysis  

PubMed Central

Objectives: Infection is a common cause of death among hemodialysis patients. The study investigated incidence, risk factors, clinical features and outcome of bloodstream infections (BSIs) in haemodialysis patients. Methods: The records of haemodialysis patients from 1999 to 2005 were reviewed. Risk factors were investigated by multivariate analysis. Results: There were identified 148 bacteremic episodes, in 102 patients. The BSI rate was 0.52 per 1000 patient-days. Of the 148 episodes, 34 occurred in patients with permanent fistulae (0.18/1000 patient-days); 19 in patients with grafts (0.39/1000 patient-days); 28 in patients with permanent tunneled central catheters (1.03/1000 patient-days); and 67 in those with temporary-catheter (3.18/1000 patient-days). With fistula as reference, the BSI ratio was 1.84 with arteriovenous graft (P=.029), 4.85 with permanent central venous catheter (P<.001), and 14.88 with temporary catheter (P <.001). Catheter related were 41 episodes (28%). Gram positive organism were responsible for 96 episodes (65%), with S. aureus ( 55%) the most frequent, followed by S. epidermidis (26%) and Gram-negative for 36 (23%), with E. coli (39%) the most frequent. Infection was polymicrobial in 14 (9.5%). Diabetes (p<0.001), low serum albumin (p=0.040) and low hemoglobin (p<0.001) were significant risk factors. During hospitalization 18 patients (18%) died. Septic shock (p<0.001) and polymicrobial infection (p=0.041) were associated with in-hospital mortality. Conclusion: The risk of BSI in patients undergoing hemodialysis is related to the catheter type and vascular access. Septic shock and polymicrobial infection predispose to unfavourable outcome.

Fysaraki, Maria; Samonis, George; Valachis, Antonis; Daphnis, Eugenios; Karageorgopoulos, Drosos E.; Falagas, Matthew E.; Stylianou, Kostas; Kofteridis, Diamantis P.

2013-01-01

91

Nosocomial bloodstream infections: organisms, risk factors and resistant phenotypes in the Brazilian University Hospital.  

PubMed

Bacteremia is one of the most frequent and challenging hospital-acquired infection and it is associated with high attributable morbidity and mortality and additional use of healthcare resources. The objective of this work was to determine the frequencies of its occurrence, organisms and resistance phenotypes associated to nosocomial acquired bloodstream infections. A total number of 51 nosocomial bacteremia by Gram-negative and 99 by Gram-positive were evaluated and compared during a 15-month period. The risk factors associated with these bacteremias were analyzed and antibiotic use and surgery were associated with bacteremia by Gram-negative and > 2 invasive devices with Gram-positive. The resistance phenotypes ESBL (extended-spectrum beta-lactamases) (23.5%) and AmpC/others (17.6%) correspond to 41.2 % with predominance of E. agglomerans among AmpC (44.4%) and K. pneumoniae among ESBLs (38.5%). Among S. aureus bacteremia, approximately 40% were associated to MRSA (methicillin-resistant Staphylococcus aureus). PMID:17684638

Ribas, Rosineide M; Freitas, Claudete; Gontijo Filho, Paulo P

2007-06-01

92

Chryseomonas luteola bloodstream infection in a pediatric patient with pulmonary arterial hypertension receiving intravenous treprostinil therapy.  

PubMed

Treprostinil is a prostacyclin analogue approved for the treatment of pulmonary arterial hypertension (PAH). It is commonly administered through a central venous catheter (CVC). Treprostinil is associated with the incidence of Gram-negative bacterial bloodstream infections (BSI), a susceptibility that has been associated with a diluent used for treprostinil. We report the case of a 14-year-old boy with idiopathic PAH on continuous intravenous treprostinil therapy who presented with fever and fatigue. A blood culture drawn from his CVC was positive for the rare Gram-negative organism Chryseomonas luteola. The patient made a complete recovery with antibacterial treatment. This is the only documented case of a C. luteola BSI in a PAH patient receiving continuous intravenous treprostinil. We recommend maintaining a high index of suspicion for both common and rare Gram-negative pathogens and the early administration of appropriate antibiotic therapy in this population. The use of an alternate diluent solution, such as Sterile Diluent for Flolan, further decreases the infection risk. PMID:23329255

Wen, A Y; Weiss, I K; Kelly, R B

2013-01-18

93

Microbiological Profile of Organisms Causing Bloodstream Infection in Critically Ill Patients  

PubMed Central

Background Bloodstream infection (BSI) is the most frequent infection in critically ill patients. As BSI’s among patients in intensive care units (ICU’s) are usually secondary to intravascular catheters, they can be caused by both Gram-positive and Gram-negative microorganisms as well as fungi. Infection with multidrug-resistant (MDR) organisms is becoming more common, making the choice of empirical antimicrobial therapy challenging. The objective of this study is to evaluate the spectrum of microorganisms causing BSI’s in a Medical-Surgical Intensive Care Unit (MSICU) and their antimicrobial resistance patterns. Methods A prospective observational study among all adult patients with clinical signs of sepsis was conducted in a MSICU of an inner-city hospital in New York City between May 1, 2010 and May 30, 2011. Results A total of 722 adult patients with clinical signs of systemic inflammatory response syndrome (SIRS) and/or sepsis were admitted to the MSICU between May 1, 2010 and May 30, 2011. From those patients, 91 (12.6%) had one or more positive blood culture. A 122 isolates were identified: 72 (59%) were Gram-positive bacteria, 38 (31.1%) were Gram-negative organisms, and 12 (9.8%) were fungi. Thirteen (34.2%) Gram-negative organisms and 14 (19.4%) Gram-positive bacteria were classified as MDR. Conclusions Antimicrobial resistance, particularly among Gram-negative organisms, continues to increase at a rapid rate, especially in the ICU’s. Coordinated infection control interventions and antimicrobial stewardship policies are warranted in order to slow the emergence of resistance.

Orsini, Jose; Mainardi, Carlo; Muzylo, Eliza; Karki, Niraj; Cohen, Nina; Sakoulas, George

2012-01-01

94

First Case Report of Bloodstream Infection Due to a Candida Species Closely Related to the Novel Species Candida pseudorugosa  

PubMed Central

Candida pseudorugosa is a novel species closely related to Candida rugosa for which only one case has been reported. We report the first case of a bloodstream infection in humans caused by a Candida sp. closely related to C. pseudorugosa. We contribute evidence to show this organism as a potential human pathogen that may be misidentified by conventional methods, also pointing out its lower sensitivity to azoles and other antifungal agents.

Cordoba, Susana; Isla, Guillermina; Fernandez, Norma; Garcia, Susana; Mazza, Mariana; Murisengo, Omar Alejandro; Vivot, Walter; Szusz, Wanda; Davel, Graciela; Tiraboschi, Iris Nora; Bosco-Borgeat, Maria Eugenia

2012-01-01

95

Bloodstream Infections by Extended-Spectrum  -Lactamase-Producing Escherichia coli and Klebsiella pneumoniae in Children: Epidemiology and Clinical Outcome  

Microsoft Academic Search

To determine the epidemiologic features and clinical outcomes of bloodstream infections caused by extend- ed-spectrum -lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae isolates, cases of bac- teremia caused by these organisms in children were analyzed retrospectively. Among the 157 blood isolates recovered from 1993 to 1998 at the Seoul National University Children's Hospital, the prevalence of ESBL production was 17.9%

Yun-Kyung Kim; Hyunjoo Pai; Hoan-Jong Lee; Su-Eun Park; Eun-Hwa Choi; Jungmin Kim; Je-Hak Kim; Eui-Chong Kim

2002-01-01

96

Epidemiological Investigation of Bloodstream Infections by Extended Spectrum Cephalosporin-Resistant Escherichia coli in a Taiwanese Teaching Hospital  

PubMed Central

In an epidemiologic and case-control study including 30 case patients over a 3.5-year period in a Taiwanese university hospital, only ?-lactamase inhibitor use and extended-spectrum cephalosporin use were identified as independent risk factors for nosocomial CMY-2-producing Escherichia coli bloodstream infection, and CMY-2 producers were found more prevalent than extended-spectrum ?-lactamase-producing isolates.

Yan, Jing-Jou; Ko, Wen-Chien; Wu, Jiunn-Jong; Tsai, Shu-Huei; Chuang, Chin-Luan

2004-01-01

97

Nosocomial multi-drug resistant Acinetobacter baumannii bloodstream infection: risk factors and outcome with ampicillin-sulbactam treatment  

Microsoft Academic Search

The emergence of multidrug-resistant (MDR) Acinetobacter baumannii poses a therapeutic problem. The aim of this study was to assess the risk factors for nosocomial MDR-A. baumannii bloodstream infection (BSI) and the efficacy of ampicillin-sulbactam (A\\/S) in its treatment. Of 94 nosocomial A. baumannii BSI during the year 2000, 54% involved MDR strains, 81% of which were genetically related. Various risk

R Smolyakov; A Borer; K Riesenberg; F Schlaeffer; M Alkan; A Porath; D Rimar; Y Almog; J Gilad

2003-01-01

98

CC9 livestock-associated Staphylococcus aureus emerges in bloodstream infections in French patients unconnected with animal farming.  

PubMed

We report 4 bloodstream infections associated with CC9 agr type II Staphylococcus aureus in individuals without animal exposure. We demonstrate, by microarray analysis, the presence of egc cluster, fnbA, cap operon, lukS, set2, set12, splE, splD, sak, epiD, and can, genomic features associated with a high virulence potential in humans. PMID:23264362

Lamamy, Cindy; Berthelot, Aline; Bertrand, Xavier; Valentin, Anne-Sophie; Dos Santos, Sandra; Thiais, Sophie; Morange, Virginie; Girard, Nicole; Donnio, Pierre-Yves; Quentin, Roland; Schrenzel, Jacques; François, Patrice; van der Mee-Marquet, Nathalie

2012-12-21

99

Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit  

Microsoft Academic Search

The aim of this study was to identify risk factors for catheter-associated bloodstream infection (CABSI) in neonates. We undertook a prospective investigation of the potential risk factors for CABSI (patient-related, treatment-related and catheter-related) in a neonatal intensive care unit (NICU) using univariate and multivariate techniques. We also investigated the relationship between catheter hub and catheter exit site colonization with CABSI.Thirty-five

L. M. Mahieu; A. O. De Muynck; M. M. Ieven; J. J. De Dooy; H. J. Goossens; P. J. Van Reempts

2001-01-01

100

A Cluster of Bloodstream Infections and Pyrogenic Reactions among Hemodialysis Patients Traced to Dialysis Machine Waste-Handling Option Units  

Microsoft Academic Search

From June 17 through November 15, 1995, ten episodes of Enterobacter cloacae bloodstream infection and three pyrogenic reactions occurred in patients at a hospital-based hemodialysis center. In a case-control study limited to events occurring during October 1–31, 1995, seven dialysis sessions resulting in E. cloacae bacteremia or pyrogenic reaction without bacteremia were compared with 241 randomly selected control sessions. Dialysis

Elise M. Jochimsen; Charles Frenette; Monique Delorme; Matthew Arduino; Sonia Aguero; Loretta Carson; Johanne Ismaïl; Stephen Lapierre; Elizabeth Czyziw; Jerome I. Tokars; William R. Jarvis

1998-01-01

101

Bloodstream Infection after Umbilical Cord Blood Transplantation Using Reduced-Intensity Stem Cell Transplantation for Adult Patients  

Microsoft Academic Search

Bloodstream infection (BSI) is a significant problem after cord blood transplantation (CBT). However, little information has been reported on BSI after reduced-intensity CBT (RI-CBT). We retrospectively reviewed the medical records of 102 patients. The median age of the patients was 55 years (range, 17–79 years). Preparative regimens comprised fludarabine 125 to 150 mg\\/m2, melphalan 80 to 140 mg\\/m2, or busulfan

Hiroto Narimatsu; Tomoko Matsumura; Masahiro Kami; Shigesaburo Miyakoshi; Eiji Kusumi; Shinsuke Takagi; Yuji Miura; Daisuke Kato; Chiho Inokuchi; Tomohiro Myojo; Yukiko Kishi; Naoko Murashige; Koichiro Yuji; Kazuhiro Masuoka; Akiko Yoneyama; Atsushi Wake; Shinichi Morinaga; Yoshinobu Kanda; Shuichi Taniguchi

2005-01-01

102

Azithromycin and Ciprofloxacin Resistance in Salmonella Bloodstream Infections in Cambodian Adults  

PubMed Central

Background Salmonella enterica is a frequent cause of bloodstream infection (BSI) in Asia but few data are available from Cambodia. We describe Salmonella BSI isolates recovered from patients presenting at Sihanouk Hospital Centre of Hope, Phnom Penh, Cambodia (July 2007–December 2010). Methodology Blood was cultured as part of a microbiological prospective surveillance study. Identification of Salmonella isolates was performed by conventional methods and serotyping. Antibiotic susceptibilities were assessed using disk diffusion, MicroScan and E-test macromethod. Clonal relationships were assessed by Pulsed Field Gel Electrophoresis; PCR and sequencing for detection of mutations in Gyrase and Topoisomerase IV and presence of qnr genes. Principal Findings Seventy-two Salmonella isolates grew from 58 patients (mean age 34.2 years, range 8–71). Twenty isolates were identified as Salmonella Typhi, 2 as Salmonella Paratyphi A, 37 as Salmonella Choleraesuis and 13 as other non-typhoid Salmonella spp. Infection with human immunodeficiency virus (HIV) was present in 21 of 24 (87.5%) patients with S. Choleraesuis BSI. Five patients (8.7%) had at least one recurrent infection, all with S. Choleraesuis; five patients died. Overall, multi drug resistance (i.e., co-resistance to ampicillin, sulphamethoxazole-trimethoprim and chloramphenicol) was high (42/59 isolates, 71.2%). S. Typhi displayed high rates of decreased ciprofloxacin susceptibility (18/20 isolates, 90.0%), while azithromycin resistance was very common in S. Choleraesuis (17/24 isolates, 70.8%). Two S. Choleraesuis isolates were extended spectrum beta-lactamase producer. Conclusions and Significance Resistance rates in Salmonella spp. in Cambodia are alarming, in particular for azithromycin and ciprofloxacin. This warrants nationwide surveillance and revision of treatment guidelines.

Vlieghe, Erika R.; Phe, Thong; De Smet, Birgit; Veng, Chhun H.; Kham, Chun; Bertrand, Sophie; Vanhoof, Raymond; Lynen, Lut; Peetermans, Willy E.; Jacobs, Jan A.

2012-01-01

103

Trends in nosocomial bloodstream infections in a burn intensive care unit: an eight-year survey.  

PubMed

This study was designed to evaluate the frequency and profile of bloodstream infection (BSI) in a burn intensive care unit (BICU) in Tripoli, Libya, from 1st January 2000 to 31st December 2007 and to determine the prevalence of different bacteria involved in such infections and their antimicrobial susceptibilities. During the eight-year study period, 995 patients were admitted to the BICU. Blood cultures were collected from each septicaemic case and reviewed for age, sex, total body surface area burned, isolated micro-organisms, and antibiotic sensitivity. There were 430 episodes of BSI among 830 cases; the annual true positive rate varied between 40.0 and 59.4%, the majority (87.9%) being caused by one species only. However, 22% had two or more episodes with different pathogens during hospitalization. The leading isolate was Staphylococcusaureus (40.4%) (methicillinresistant, 55.7%). Pseudomonas spp ranked second (23.9%). Klebsiella spp were third, responsible for 7.4%; the rate of extended spectrum beta lactamase among Klebsiella isolates was 47%. Candida spp were the fourth most common pathogen (6.7%), the majority (55%) being C. albicans. Staphylococci were generally resistant to trimethoprim (91%) and fusidic acid (80%). Pseudomonas spp proved moderately resistant (38-43%) to tobramicin, ciprofloxacin, amikacin, and impenem but remained relatively susceptible to cefepime (72%). Klebsiella isolates demonstrated moderate resistance (46-58%) to most agents tested, and relatively low resistance (19-27%) to meropenem, impenem, and cefepime. We suggest that extra infection control measures should be implemented and antibiotic policy and guidelines introduced to reduce the high resistance rate among isolates such as Pseudomonas, Acinetobacter, and MRSA. PMID:21991204

Zorgani, A; Franka, R A; Zaidi, M M; Alshweref, U M; Elgmati, M

2010-06-30

104

Variations in catheter-related bloodstream infections rates based on local practices  

PubMed Central

Background Catheter-related bloodstream infection (CRBSI) surveillance serves as a quality improvement measure that is often used to assess performance. We reviewed the total number of microbiological samples collected in three Belgian intensive care units (ICU) in 2009–2010, and we described variations in CRBSI rates based on two factors: microbiological documentation rate and CRBSI definition which includes clinical criterion for coagulase-negative Staphylococcus (CNS) episode. Findings CRBSI rates were 2.95, 1.13 and 1.26 per 1,000 estimated catheter-days in ICUs A, B and C, respectively. ICU B cultured fewer microbiological samples and reported the lowest CRBSI rate. ICU C had the highest documentation rate but was assisted by support available from the laboratory for processing single CNS positive blood cultures. With the exclusion of clinical criterion, CRBSI rates would be reduced by 19%, 45% and 0% in ICUs A, B and C, respectively. Conclusion CRBSI rates may be biased by differences of blood culture sampling and CRBSI definition. These observations suggest that comparisons of CRBSI rates in different ICUs remain difficult to interpret without knowledge of local practices.

2013-01-01

105

Clinical and economic outcomes of decreased fluconazole susceptibility in patients with Candida glabrata bloodstream infections  

PubMed Central

Background The impact of reduced fluconazole susceptibility on clinical and economic outcomes in patients with Candida glabrata bloodstream infections (BSI) is unknown. Methods A retrospective cohort study was conducted to evaluate 30-day inpatient mortality and postculture hospital charges in patients with C glabrata BSI with decreased fluconazole susceptibility (minimum inhibitory concentration [MIC] ? 16 ?g/mL) versus fluconazole-susceptible C glabrata BSI (MIC ? 8 ?g/mL). These analyses were adjusted for demographics, comorbidities, and time at risk. Secondary analyses limited the C glabrata group with decreased fluconazole susceptibility to MIC ? 64 ?g/mL. Results There were 45 (31%) deaths among 144 enrolled patients: 19 deaths (25%) among 76 patients with C glabrata BSI with decreased fluconazole susceptibility and 26 deaths (38%) among 68 patients with fluconazole-susceptible C glabrata BSI. Decreased fluconazole susceptibility was not independently associated with increased 30-day inpatient mortality (adjusted odds ratio, .60; 95% confidence interval (CI): .26-1.35; P = 0.22) or hospital charges (multiplicative change in hospital charges, .93; 95% CI: .60-1.43; P = 0.73). Older age was associated with increased mortality and increased time at risk was associated with increased hospital charges. Conclusion Crude mortality rates remain high in patients with C glabrata BSI. However, decreased fluconazole susceptibility was not associated with increased mortality or hospital charges.

Lee, Ingi; Morales, Knashawn H.; Zaoutis, Theoklis E.; Fishman, Neil O.; Nachamkin, Irving; Lautenbach, Ebbing

2011-01-01

106

Defining the epidemiology of bloodstream infections: the 'gold standard' of population-based assessment.  

PubMed

Bloodstream infections (BSIs) are a major cause of morbidity and mortality. Although population-based studies have been proposed as an optimal means to define their epidemiology, the merit of these designs has not been well documented. This report investigated the potential value of using population-based designs in defining the epidemiology of BSIs. Population-based BSI surveillance was conducted in Calgary, Canada (population 1.24 million) and illustrative comparisons were made between the overall and selected subgroup cohorts within five main themes. The value of population denominator data, and age and gender standardization for calculation and comparison of incidence rates were demonstrated. In addition, a number of biases including those related to differential admission rates, selected hospital admission, and referral bias were highlighted in non-population-based cohorts. Due to their comprehensive nature and intrinsic minimization of bias, population-based designs should be considered the gold standard means of defining the epidemiology of an infectious disease. PMID:23218097

Laupland, K B

2012-12-06

107

Trends in nosocomial bloodstream infections following health care restructuring in Alberta between 1999 and 2005  

PubMed Central

OBJECTIVE: A previous study at the University of Alberta Hospital/Stollery Children’s Hospital in Edmonton, Alberta, revealed an increase in hospital-acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring. DESIGN: Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records. SETTING: The University of Alberta Hospital/Stollery Children’s Hospital (617 adult and 139 pediatric beds, respectively). PATIENTS: All pediatric and adult patients admitted during the above-specified period with one or more episodes of BSIs. RESULTS: There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital-wide and intensive care unit admissions, intensive care unit central venous catheter-days, total parenteral nutrition days and number of solid-organ transplants were either unchanged or increased. Gram-positive bacterial causes of BSIs showed significant downward trends, but Gram-negative bacterial and fungal etiologies were unchanged. CONCLUSIONS: These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.

Lee, Mao-Cheng; Saxinger, Lynora; Forgie, Sarah E; Taylor, Geoffrey

2010-01-01

108

Delays in Appropriate Antibiotic Therapy for Gram-Negative Bloodstream Infections: A Multicenter, Community Hospital Study  

PubMed Central

Background Gram-negative bacterial bloodstream infection (BSI) is a serious condition with estimated 30% mortality. Clinical outcomes for patients with severe infections improve when antibiotics are appropriately chosen and given early. The objective of this study was to estimate the association of prior healthcare exposure on time to appropriate antibiotic therapy in patients with gram-negative BSI. Method We performed a multicenter cohort study of adult, hospitalized patients with gram-negative BSI using time to event analysis in nine community hospitals from 2003-2006. Event time was defined as the first administration of an antibiotic with in vitro activity against the infecting organism. Healthcare exposure status was categorized as community-acquired, healthcare-associated, or hospital-acquired. Time to appropriate therapy among groups of patients with differing healthcare exposure status was assessed using Kaplan-Meier analyses and multivariate Cox proportional hazards models. Results The cohort included 578 patients with gram-negative BSI, including 320 (55%) healthcare-associated, 217 (38%) community-acquired, and 41 (7%) hospital-acquired infections. 529 (92%) patients received an appropriate antibiotic during their hospitalization. Time to appropriate therapy was significantly different among the groups of healthcare exposure status (log-rank p=0.02). Time to first antibiotic administration regardless of drug appropriateness was not different between groups (p=0.3). The unadjusted hazard ratios (HR) (95% confidence interval) were 0.80 (0.65-0.98) for healthcare-associated and 0.72 (0.63-0.82) for hospital-acquired, relative to patients with community-acquired BSI. In multivariable analysis, interaction was found between the main effect and baseline Charlson comorbidity index. When Charlson index was 3, adjusted HRs were 0.66 (0.48-0.92) for healthcare-associated and 0.57 (0.44-0.75) for hospital-acquired, relative to patients with community-acquired infections. Conclusions Patients with healthcare-associated or hospital-acquired BSI experienced delays in receipt of appropriate antibiotics for gram-negative BSI compared to patients with community-acquired BSI. This difference was not due to delayed initiation of antibiotic therapy, but due to the inappropriate choice of antibiotic.

Moehring, Rebekah W.; Sloane, Richard; Chen, Luke F.; Smathers, Emily C.; Schmader, Kenneth E.; Fowler, Vance G.; Weber, David J.; Sexton, Daniel J.; Anderson, Deverick J.

2013-01-01

109

Impact of Multiresistance of Gram-negative Bacteria in Bloodstream Infection on Mortality Rates and Length of Stay  

Microsoft Academic Search

Background:  Bloodstream infections (BSI) with gram-negative bacteria (GNB) are one of the most serious infections in the hospital setting,\\u000a a situation compounded by the increasing antibiotic resistance of gram-negative bacteria causing BSI. The aim of the study\\u000a was to assess the impact of antibiotic multiresistance of GNB in BSI on mortality rates and length of stay (LOS).\\u000a \\u000a \\u000a \\u000a Materials and Methods:  The setting

A. M. Sostarich; D. Zolldann; H. Haefner; R. Luetticken; R. Schulze-Roebecke; S. W. Lemmen

2008-01-01

110

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes  

PubMed Central

Our aims were to identify (i) risk factors associated with the acquisition of multidrug-resistant (MDR, to 3 or more classes of antimicrobials) Proteus mirabilis isolates responsible for bloodstream infections (BSIs) and (ii) the impact on mortality of such infections. Risk factors for acquiring MDR P. mirabilis BSIs were investigated in a case-case-control study; those associated with mortality were assessed by comparing survivors and nonsurvivors in a cohort study. The population consisted of 99 adult inpatients with P. mirabilis BSIs identified by our laboratory over an 11-year period (1999 to 2009), 36 (33.3%) of which were caused by MDR strains, and the overall 21-day mortality rate was 30.3%. Acquisition of an MDR strain was independently associated with admission from a long-term care facility (odds ratio [OR], 9.78; 95% confidence interval [CI], 1.94 to 49.16), previous therapy with fluoroquinolones (OR, 5.52; 95% CI, 1.30 to 23.43) or oxyimino-cephalosporins (OR, 4.72; 95% CI, 1.31 to 16.99), urinary catheterization (OR, 3.89; 95% CI, 1.50 to 10.09), and previous hospitalization (OR, 2.68; 95% CI, 10.4 to 6.89). Patients with MDR P. mirabilis BSIs received inadequate initial antimicrobial therapy (IIAT, i.e., treatment with drugs to which the isolate displayed in vitro resistance) more frequently than those with non-MDR infections; they also had increased mortality and (for survivors) longer post-BSI-onset hospital stays. In multivariate regression analysis, 21-day mortality was associated with septic shock at BSI onset (OR, 12.97; 95% CI, 32.2 to 52.23), P. mirabilis isolates that were MDR (OR, 6.62; 95% CI, 16.4 to 26.68), and IIAT (OR, 9.85; 95% CI, 26.7 to 36.25), the only modifiable risk factor of the 3. These findings can potentially improve clinicians' ability to identify P. mirabilis BSIs likely to be MDR, thereby reducing the risk of IIAT—a major risk factor for mortality in these cases—and facilitating the prompt implementation of appropriate infection control measures.

Trecarichi, Enrico Maria; Fiori, Barbara; Losito, Angela Raffaella; D'Inzeo, Tiziana; Campana, Lara; Ruggeri, Alberto; Di Meco, Eugenia; Liberto, Elvira; Fadda, Giovanni; Cauda, Roberto; Spanu, Teresa

2012-01-01

111

Surveillance of hospital-acquired central line-associated bloodstream infections in pediatric hematology-oncology patients: lessons learned, challenges ahead.  

PubMed

Across 36 US pediatric oncology centers, 576 central line-associated bloodstream infections (CLABSIs) were reported over a 21-month period. Most infections occurred in those with leukemia and/or profound neutropenia. The contribution of viridans streptococci infections was striking. Study findings depict the contemporary epidemiology of CLABSIs in hospitalized pediatric cancer patients. PMID:23388370

Gaur, Aditya H; Bundy, David G; Gao, Cuilan; Werner, Eric J; Billett, Amy L; Hord, Jeff D; Siegel, Jane D; Dickens, David; Winkle, Cindi; Miller, Marlene R

2013-01-22

112

Can Inpatient Hospital Experiences Predict Central Line-Associated Bloodstream Infections?  

PubMed Central

Background Factors that increase the risk of central line-associated bloodstream infections (CLABSIs) are not fully understood. Recently, Hospital Compare began compiling data from hospital-required reporting to the CDC's National Healthcare Safety Network on CLABSIs in intensive care units (ICUs), at over 4,000 Medicare-certified hospitals in the United States, and made this data accessible on a central website. Also available on the same website are results from the Hospital Consumer Assessment of Healthcare Providers and Systems survey of patients' hospital experiences. Utilizing both databases, our objective was to determine whether patients' hospital experiences were significantly associated with increased risk for reported ICU CLABSI. Methods and Findings We conducted a zero-inflated Poisson regression analysis at the hospital level on CLABSI-observed cases by ICUs in acute care hospitals (n?=?1987) in the United States between January 1, 2011, and December 31, 2011. During this period there were a total of 10,866 CLABSI cases and 9,543,765 central line days. In our final model, the percent of patients who reported that they “sometimes” or “never” received help as soon as they wanted was significantly associated with an increased risk for CLABSIs. Conclusions Using national datasets, we found that inpatients' hospital experiences were significantly associated with an increased risk of ICU reported CLABSIs. This study suggests that hospitals with lower staff responsiveness, perhaps because of an understaffing of nurse and supportive personnel, are at an increased risk for CLABSIs. This study bolsters the evidence that patient surveys may be a useful surrogate to predicting the incidence of hospital acquired conditions, including CLABSIs. Moreover, our study found that poor staff responsiveness may be indicative of greater hospital problems and generally poorly performing hospitals; and that this finding may be a symptom of hospitals with a multitude of problems, including patient safety problems, and not a direct cause.

Saman, Daniel M.; Kavanagh, Kevin T.; Johnson, Brian; Lutfiyya, M. Nawal

2013-01-01

113

Is the Volume of Blood Cultured Still a Significant Factor in the Diagnosis of Bloodstream Infections??  

PubMed Central

“The higher the volume of blood cultured the higher the yield of blood cultures” has been a well-accepted dictum since J. A. Washington II performed his classic work. This rule has not been questioned in the era of highly automated blood culture machines, nor has it been correlated with clinical variables. Our objective in this study was to complete a prospective analysis of the relationship between blood volume, the yield of blood cultures, and the severity of clinical conditions in adult patients with suspected bloodstream infections (BSI). During a 6-month period, random samples of blood cultures were weighed to determine the volume of injected blood (weight/density). Overall, 298 patients with significant BSI and 303 patients with sepsis and negative blood cultures were studied. The mean volume of blood cultured in patients with BSI (30.03 ± 14.96 ml [mean ± standard deviation]) was lower than in patients without BSI (32.98 ± 15.22 ml [P = 0.017]), and more episodes of bacteremia were detected with <20 ml (58.9%) than with >40 ml (40.2%) of blood cultured (P = 0.022). When patients were stratified according to the severity of their underlying condition, patients with BSI had higher APACHE II scores, and higher APACHE II scores were related to lower sample volumes (P < 0.001). A multivariate analysis showed that in the group of patients with APACHE II scores of ?18, higher volumes yielded higher rates of bacteremia (odds ratio, 1.04 per ml of blood; 95% confidence interval, 1.001 to 1.08). We conclude that the higher yield of blood cultures inoculated with lower volumes of blood reflects the conditions of the population cultured. Washington's dictum holds true today in the era of automated blood culture machines.

Bouza, Emilio; Sousa, Dolores; Rodriguez-Creixems, Marta; Lechuz, Juan Garcia; Munoz, Patricia

2007-01-01

114

Molecular detection of culture-confirmed bacterial bloodstream infections with limited enrichment time.  

PubMed

Conventional blood culturing using automated instrumentation with phenotypic identification requires a significant amount of time to generate results. This study investigated the speed and accuracy of results generated using PCR and pyrosequencing compared to the time required to obtain Gram stain results and final culture identification for cases of culture-confirmed bloodstream infections. Research and physician-ordered blood cultures were drawn concurrently. Aliquots of the incubating research blood culture fluid were removed hourly between 5 and 8 h, at 24 h, and again at 5 days. DNA was extracted from these 6 time point aliquots and analyzed by PCR and pyrosequencing for bacterial rRNA gene targets. These results were then compared to those of the physician-ordered blood culture. PCR and pyrosequencing accurately identified 92% of all culture-confirmed cases after a mean enrichment time of 5.8 ± 2.9 h. When the time needed to complete sample processing was included for PCR and pyrosequencing protocols, the molecular approach yielded results in 11.8 ± 2.9 h compared to means of 27.9 ± 13.6 h to obtain the Gram stain results and 81.6 ± 24.0 h to generate the final culture-based identification. The molecular approach enabled accurate detection of most bacteria present in incubating blood culture bottles on average about 16 h sooner than Gram stain results became available and approximately 3 days sooner than the phenotypic identification was entered in the Laboratory Information System. If implemented, this more rapid molecular approach could minimize the number of doses of unnecessary or ineffective antibiotics administered to patients. PMID:23985915

Moore, Miranda S; McCann, Chase D; Jordan, Jeanne A

2013-08-28

115

Central line-associated bloodstream infection in neonatal intensive care units.  

PubMed

Objective.?Describe the epidemiology of central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) participating in a standardized and mandatory CLABSI surveillance program. Design.?Retrospective cohort. Setting.?We included patients admitted (April 2007-March 2011) to 7 level II/III NICUs who developed a CLABSI (as defined by the National Healthcare Safety Network). Methods.?CLABSIs/1,000 central line-days and device utilization ratio were calculated; ?(2) test, Student t test, Kruskal-Wallis, and Poisson regression were used. Results.?Overall, 191 patients had 202 CLABSI episodes for a pooled mean rate of 4.0 CLABSIs/1,000 central line-days and a device utilization ratio of 0.20. Annual pooled mean CLABSI rates increased from 3.6 in 2007-2008 to 5.1 CLABSIs/1,000 central line-days in 2010-2011 ([Formula: see text]). The all-cause 30-day case fatality proportion was 8.9% ([Formula: see text]) and occurred a median of 8 days after CLABSI. Coagulase-negative Staphylococcus was identified in 112 (50.5%) cases. Staphylococcus aureus was identified in 22 cases, and 3 (13.6%) were resistant to methicillin. An underlying intra-abdominal pathology was found in 20% (40/202) of CLABSI cases, 50% of which were reported in the last year of study. When adjusted for mean birth weight, annual CLABSI incidence rates were independently associated with the proportion of intra-abdominal pathology ([Formula: see text]) and the proportion of pulmonary pathology ([Formula: see text]) reported. Conclusion.?The increase in CLABSI rates in Quebec NICUs seems to be associated with an increased proportion of cases with underlying intra-abdominal and pulmonary pathologies, which needs further investigation. PMID:24113600

Blanchard, Ana C; Fortin, Elise; Rocher, Isabelle; Moore, Dorothy L; Frenette, Charles; Tremblay, Claude; Quach, Caroline

2013-09-23

116

The Aetiology of the Bloodstream Infections in the Patients Who Presented to a Tertiary Care Teaching Hospital in Kathmandu, Nepal  

PubMed Central

Background: Bloodstream infections are associated with a significant patient morbidity and mortality. The detection of microorganisms in the patients’ blood has a great diagnostic and prognostic significance. The early positive results provide valuable diagnostic information, based on which the appropriate antimicrobial therapy can be initiated. Objective: To know the aetiology of the bloodstream infections in the Kathmandu Medical College, Nepal and the antibiotic sensitivity patterns of the causative organisms. Materials and Methods: The blood specimens which were received from May 2010 to October 2010 in Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal, were processed and all the positive isolates were included in the study. The isolates were identified by the standard laboratory procedures. The antibiotic susceptibility patterns were determined by the modified Kirby Bauer antibiotic sensitivity method. Result: Of the 1089 blood cultures which were received with the suspected cases of blood stream infections, 138 (12.6 %) were bacteriologically positive. Salmonella serotypes were isolated in 42.7% cases of blood stream infections, followed by Klebsiella pneumoniae in 19.5%, Staphylococcus aureus in 15.9% and others in the rest of the cases. All the gram-negative bacilli isolates showed lower degrees of resistance to amikacin and ofloxacin. All the gram positive isolates were sensitive to amikacin, oxacillin and vancomycin. Conclusion: This study stresses on the need for a continued screening and surveillance in the routine blood culture technique for starting with the empiric therapy for blood borne infections.

Pandey, Santwana; Raza, Shahid; Bhatta, Chandra Prakash

2013-01-01

117

Classification of positive blood cultures: computer algorithms versus physicians' assessment - development of tools for surveillance of bloodstream infection prognosis using population-based laboratory databases  

PubMed Central

Background Information from blood cultures is utilized for infection control, public health surveillance, and clinical outcome research. This information can be enriched by physicians’ assessments of positive blood cultures, which are, however, often available from selected patient groups or pathogens only. The aim of this work was to determine whether patients with positive blood cultures can be classified effectively for outcome research in epidemiological studies by the use of administrative data and computer algorithms, taking physicians’ assessments as reference. Methods Physicians’ assessments of positive blood cultures were routinely recorded at two Danish hospitals from 2006 through 2008. The physicians’ assessments classified positive blood cultures as: a) contamination or bloodstream infection; b) bloodstream infection as mono- or polymicrobial; c) bloodstream infection as community- or hospital-onset; d) community-onset bloodstream infection as healthcare-associated or not. We applied the computer algorithms to data from laboratory databases and the Danish National Patient Registry to classify the same groups and compared these with the physicians’ assessments as reference episodes. For each classification, we tabulated episodes derived by the physicians’ assessment and the computer algorithm and compared 30-day mortality between concordant and discrepant groups with adjustment for age, gender, and comorbidity. Results Physicians derived 9,482 reference episodes from 21,705 positive blood cultures. The agreement between computer algorithms and physicians’ assessments was high for contamination vs. bloodstream infection (8,966/9,482 reference episodes [96.6%], Kappa?=?0.83) and mono- vs. polymicrobial bloodstream infection (6,932/7,288 reference episodes [95.2%], Kappa?=?0.76), but lower for community- vs. hospital-onset bloodstream infection (6,056/7,288 reference episodes [83.1%], Kappa?=?0.57) and healthcare-association (3,032/4,740 reference episodes [64.0%], Kappa?=?0.15). The 30-day mortality in the discrepant groups differed from the concordant groups as regards community- vs. hospital-onset, whereas there were no material differences within the other comparison groups. Conclusions Using data from health administrative registries, we found high agreement between the computer algorithms and the physicians’ assessments as regards contamination vs. bloodstream infection and monomicrobial vs. polymicrobial bloodstream infection, whereas there was only moderate agreement between the computer algorithms and the physicians’ assessments concerning the place of onset. These results provide new information on the utility of computer algorithms derived from health administrative registries.

2012-01-01

118

Bloodstream Infections in Patients With Pulmonary Arterial Hypertension Treated With Intravenous Prostanoids: Insights From the REVEAL REGISTRY®  

PubMed Central

Objective To evaluate the rate of and potential risk factors for bloodstream infections (BSIs) using data from the REVEAL (Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension [PAH] Disease Management) REGISTRY®, which provides current information about patients with PAH. Patients and Methods Patients were enrolled from March 30, 2006, through December 8, 2009, and data on reported BSIs were collected through the third quarter of 2010. Bloodstream infection rates were calculated per 1000 patient-days of risk. Results Of 3518 patients enrolled, 1146 patients received intravenous (IV) prostanoid therapy for more than 1 day (no BSI, n=1023; ?1 BSI, n=123; total BSI episodes, n=166). Bloodstream infections rates were significantly increased in patients receiving IV treprostinil vs IV epoprostenol (0.36 vs 0.12 per 1000 treatment days; P<.001), primarily due to gram-negative organisms (0.20 vs 0.03 per 1000 treatment days; P<.001). Multivariate analysis adjusting for age, causes of PAH, and year of BSI found that treatment with IV treprostinil was associated with a 3.08-fold increase (95% confidence interval, 2.05-4.62; P<.001) in BSIs of any type and a 6.86-fold increase (95% confidence interval, 3.60-13.07; P<.001) in gram-negative BSIs compared with treatment with IV epoprostenol. Conclusion Compared with IV epoprostenol therapy, treatment with IV treprostinil is associated with a significantly higher rate of gram-negative BSIs; observed differences in BSI rate did not seem to be due to any other analyzed factors. Trial Registration clinicaltrials.gov Identifier: NCT00370214

Kitterman, Natalie; Poms, Abby; Miller, Dave P.; Lombardi, Sandra; Farber, Harrison W.; Barst, Robyn J.

2012-01-01

119

Lodderomyces elongisporus Masquerading as Candida parapsilosis as a Cause of Bloodstream Infections?  

PubMed Central

Ten yeast bloodstream isolates identified as Candida parapsilosis by conventional methods grew as turquoise blue colonies on Chromagar media. Subsequent sequence analysis showed that these isolates were the species Lodderomyces elongisporus. To our knowledge, this is the first published report of L. elongisporus as a cause of human disease.

Lockhart, Shawn R.; Messer, Shawn A.; Pfaller, Michael A.; Diekema, Daniel J.

2008-01-01

120

Rapid Real-Time Nucleic Acid Sequence-Based Amplification-Molecular Beacon Platform To Detect Fungal and Bacterial Bloodstream Infections  

Microsoft Academic Search

Bloodstream infections (BSIs) are a significant cause of morbidity and mortality. Successful patient out- comes are diminished by a failure to rapidly diagnose these infections and initiate appropriate therapy. A rapid and reliable diagnostic platform of high sensitivity is needed for the management of patients with BSIs. The combination of an RNA-dependent nucleic acid sequence-based amplification and molecular beacon (NASBA-

Yanan Zhao; Steven Park; Barry N. Kreiswirth; Christine C. Ginocchio; Raphael Veyret; Ali Laayoun; Alain Troesch; David S. Perlin

2009-01-01

121

Detecting risk and predicting patient mortality in patients with extended-spectrum ?-lactamase-producing Enterobacteriaceae bloodstream infections.  

PubMed

Extended-spectrum ?-lactamases (ESBLs) have been increasingly described worldwide, especially among Enterobacteriaceae isolates, and recently not only in the nosocomial, but also in the community setting. Bloodstream infections (BSIs) caused by ESBL-producing Enterobacteriaceae have been associated with increased rates of treatment failure, mortality and hospital costs. Any delay in the initiation of adequate antibiotic therapy is potentially lethal for patients with BSIs caused by ESBL-producing Enterobacteriaceae. The awareness of changes in bacterial resistance patterns, the careful knowledge of risk factors for ESBL infection and of factors facilitating adverse outcome, giving attention to local epidemiology, can improve the efficacy of empirical treatment protocols. The aim of this review is to focus on the main characteristics of BSIs caused by ESBL-producing Enterobacteriaceae, with particular emphasis on risk factors for these infections and factors related to mortality. PMID:23030423

Trecarichi, Enrico Maria; Cauda, Roberto; Tumbarello, Mario

2012-10-01

122

Epidemiology and Clinical Features of Bloodstream Infections Caused by AmpC-Type-?-Lactamase-Producing Klebsiella pneumoniae  

PubMed Central

Cases of bacteremia caused by AmpC-type-?-lactamase-producing Klebsiella pneumoniae isolates were retrospectively studied to determine the epidemiologic features and clinical outcomes of bloodstream infections. Among 389 blood isolates recovered from 1998 to 2002, 65 isolates (16.7%) were found to be extended-spectrum ?-lactamase (ESBL) or AmpC ?-lactamase producers. The ?-lactamases from 61 of the 65 isolates were characterized; 28 of 61 isolates produced AmpC-type enzymes (14 isolates each produced DHA-1 and CMY-1-like enzymes), 32 isolates produced TEM or SHV-related ESBLs, and 1 isolate produced a CTX-M-14-like enzyme. To compare the clinical features and outcomes of bloodstream infections caused by AmpC producers with those caused by TEM- or SHV-related ESBL producers, 27 patients infected with isolates producing AmpC-type enzymes (AmpC group) and 25 patients infected with isolates producing TEM- or SHV-related enzymes (ESBL group) were analyzed. There was no significant difference between the AmpC and the ESBL groups in terms of risk factors. When the initial response was assessed at 72 h after antimicrobial therapy, the treatment failure rate for the AmpC group was 51.9% (14 of 27 patients) and the 7- and 30-day mortality rates were 14.8 and 29.6%, respectively, which were similar to those for the ESBL group. When the mortality rate for the patients who received extended-spectrum cephalosporins as definitive treatment was assessed, all four patients in the DHA-1 group and one of three patients in the CMY-1-like group died. In summary, the prevalence of AmpC enzyme-producing K. pneumoniae was high at the Seoul National University Hospital, and the clinical features and outcomes for the patients infected with AmpC-producing organisms were similar to those for the patients infected with TEM- or SHV-related ESBL producers.

Pai, Hyunjoo; Kang, Cheol-In; Byeon, Jeong-Hum; Lee, Ki-Deok; Park, Wan Beom; Kim, Hong-Bin; Kim, Eui-Chong; Oh, Myoung-don; Choe, Kang-Won

2004-01-01

123

A Trypanosoma brucei bloodstream form mutant deficient in ornithine decarboxylase can protect against wild-type infection in mice.  

PubMed

A Trypanosoma brucei bloodstream mutant in which both copies of the ornithine decarboxylase (ODC) gene were knocked out (ODC mutant) was used to determine the biological functions of ODC in T. brucei. Growth of the mutant cells ceased within 12-24 h in regular culture medium deficient in polyamines, but could be rescued by supplementation with 1 mM putrescine. A mouse model of T. brucei infection was used to determine whether the mutant was still infective and was found to develop either extremely low or undetectable levels of parasitemia, suggesting that in T. brucei, ODC activity is essential for establishing an infection. Furthermore, when these mice were subsequently challenged with wild-type T. brucei cells expressing the same variant surface glycoprotein (VSG), they did not develop any parasitemia, indicating that inoculating the mice with the attenuated ODC mutant had conferred protection against challenge by wild-type cells. These results were reproduced in C57BL/6J mice deficient in alpha-beta and gamma-delta T-cell receptors. However, no protection was observed in rag-2 knockout mice deficient in both B and T lymphocytes or in C57BL/10J mice deficient only in B lymphocytes. The results thus suggest that the ODC mutant could induce a T-lymphocyte-independent but B-lymphocyte-dependent immunity against wild-type cells of the same VSG. Such a mechanism of immunity has been elicited only by live T. brucei cells, but not by isolated VSGs or radiation-killed trypanosomes. This ODC mutant may thus represent a genuinely attenuated T. brucei bloodstream form capable of immunizing mammals against infections by African trypanosomes of the same VSG subtype without causing detectable infection by itself. The observation also raises the interesting likelihood that the in vivo treatment of T. brucei bloodstream forms with alpha-DL-difluoromethylornithine is a de facto attenuation of the parasitic organisms, which may very well result in B-lymphocyte-dependent host immune responses to subsequent infections by parasites of the same VSG subtypes. PMID:9990346

Mutomba, M C; Li, F; Gottesdiener, K M; Wang, C C

1999-02-01

124

Prediction of Failure in Vancomycin-Treated Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: a Clinically Useful Risk Stratification Tool?†  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of bloodstream infection (BSI) and is often associated with invasive infections and high rates of mortality. Vancomycin has remained the mainstay of therapy for serious Gram-positive infections, particularly MRSA BSI; however, therapeutic failures with vancomycin have been increasingly reported. We conducted a comprehensive evaluation of the factors (patient, strain, infection, and treatment) involved in the etiology and management of MRSA BSI to create a risk stratification tool for clinicians. This study included consecutive patients with MRSA BSI treated with vancomycin over 2 years in an inner-city hospital in Detroit, MI. Classification and regression tree analysis (CART) was used to develop a risk prediction model that characterized vancomycin-treated patients at high risk of clinical failure. Of all factors, the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, with a cutoff point of 14, was found to be the strongest predictor of failure and was used to split the population into two groups. Forty-seven percent of the population had an APACHE-II score < 14, a value that was associated with low rates of clinical failure (11%) and mortality (4%). Fifty-four percent of the population had an APACHE-II score ? 14, which was associated with high rates of clinical failure (35%) and mortality (23%). The risk stratification model identified the interplay of three other predictors of failure, including the vancomycin MIC as determined by Vitek 2 analysis, the risk level of the source of BSI, and the USA300 strain type. This model can be a useful tool for clinicians to predict the likelihood of success or failure in vancomycin-treated patients with MRSA bloodstream infection.

Moore, Carol L.; Lu, Mei; Cheema, Faiqa; Osaki-Kiyan, Paola; Perri, Mary Beth; Donabedian, Susan; Haque, Nadia Z.; Zervos, Marcus J.

2011-01-01

125

The Promise of Novel Technology for the Prevention of Intravascular Device–Related Bloodstream Infection. I. Pathogenesis and Short?Term Devices  

Microsoft Academic Search

Intravascular devices (IVDs) are widely used for vascular access but are associated with substantial risk of development of IVD-related bloodstream infection (BSI). The development of novel technologies, which are based on an understanding of pathogenesis, promises a quantum reduction in IVD-related infections in an era of growing nursing shortages. Infections of short-term IVDs (that is, those in place !10 days),

Christopher J. Crnich; Dennis G. Maki

2002-01-01

126

Beyond the Bundle: A Survey of Central Line-Associated Bloodstream Infection Prevention Practices Used in US and Canadian Pediatric Hospitals.  

PubMed

We surveyed US and Canadian pediatric hospitals about their use of central line-associated bloodstream infection (CLABSI) prevention strategies beyond typical insertion and maintenance bundles. We found wide variation in supplemental strategies across hospitals and in their penetration within hospitals. Future studies should assess specific adjunctive prevention strategies and CLABSI rates. PMID:24113607

Klieger, Sarah B; Potter-Bynoe, Gail; Quach, Caroline; Sandora, Thomas J; Coffin, Susan E

2013-09-23

127

Oral health, dental prophylaxis and catheter related bloodstream infections in home parenteral nutrition patients: results of a UK survey and cohort study  

Microsoft Academic Search

Background Concern that some catheter related bloodstream infections (CRBSI) arise from dental treatment in home parenteral nutrition (HPN) patients results in recommendation of antibiotic prophylaxis. Clinical guideline 64 is widely recognised and observed. There is a lack of consistent guidance for other patient groups viewed at risk from procedural bacteraemia.Methods 1. An email survey of the British Association for Parenteral

S. M. Gabe; J. M. Nightingale; M. Burke; A. M. Lee

2012-01-01

128

Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum ?-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence  

Microsoft Academic Search

BACKGROUND: The frequency of ESBL producing Klebsiella pneumoniae bloodstream infections (BSI) is high in Brazilian hospitals, however little is known regarding what role, if any, resistance plays in the expected outcome in hospitals with a high prevalence of these pathogens. METHODS: From 1996 to 2001, hospital acquired K. pneumoniae BSI were evaluated retrospectively. Each patient was included only once at

Alexandre R Marra; Sérgio B Wey; Adauto Castelo; Ana Cristina Gales; Ruy Guilherme R Cal; José R do Carmo Filho; Michael B Edmond; Carlos Alberto P Pereira

2006-01-01

129

Delaying the Empiric Treatment of Candida Bloodstream Infection until Positive Blood Culture Results Are Obtained: a Potential Risk Factor for Hospital Mortality  

Microsoft Academic Search

Fungal bloodstream infections are associated with significant patient mortality and health care costs. Nevertheless, the relationship between a delay of the initial empiric antifungal treatment until blood culture results are known and the clinical outcome is not well established. A retrospective cohort analysis with automated patient medical records and the pharmacy database at Barnes-Jewish Hospital was conducted. One hundred fifty-seven

Matthew Morrell; Victoria J. Fraser; Marin H. Kollef

2005-01-01

130

Value of superficial cultures for prediction of catheter-related bloodstream infection in long-term catheters: a prospective study.  

PubMed

Cultures taken from the skin and from the hubs of short-term central venous catheters can help us to predict catheter-related bloodstream infections (C-RBSIs). The value of these cultures for such predictions has not been assessed in long-term catheters. Our objective was to assess the value of superficial cultures for the prediction of C-RBSI among patients with long-term catheters. Over a 2-year period, we prospectively obtained cultures from the skin overlying reservoir ports (group A) and from the skin insertion site and hubs of all tunneled catheters (group B). This routine was performed by vascular and interventional radiologists immediately before catheter removal (irrespective of the reason for withdrawal). Swabs were processed semiquantitatively. Catheter tips from both groups were cultured using Maki's semiquantitative technique and sonication. We also performed cultures of the reservoir ports at different sites. C-RBSI was defined as the isolation of the same species of microorganism(s) both in the colonized catheter and in at least 1 peripheral blood culture. We included 372 catheters (group A, 223; group B, 149) during the study period. The catheter colonization rate was 23.4% (87/372), and 28 patients had C-RBSI. Validity index values for the capacity of surface cultures to predict C-RBSI in groups A and B were, respectively, as follows: sensitivity, 23.5% and 45.5%; specificity, 59.7% and 63.0%; positive predictive value, 4.6% and 8.9%; and negative predictive value, 90.4% and 93.5%. Superficial cultures of patients with long-term catheters could help us to rule out the catheter as the portal of entry of bloodstream infections. Superficial cultures (from skin and hubs) proved to be a useful conservative diagnostic tool for ruling out C-RBSI among patients with long-term tunneled catheters and totally implantable venous access ports. PMID:23850957

Guembe, M; Martín-Rabadán, P; Echenagusia, A; Camúñez, F; Rodríguez-Rosales, G; Simó, G; Echenagusia, M; Bouza, E

2013-07-12

131

Molecular analysis and frequency of Staphylococcus aureus virulence genes isolated from bloodstream infections in a teaching hospital in Tianjin, China.  

PubMed

Staphylococcus aureus is an important cause of bloodstream infections worldwide. We examined the prevalence of genes that encode erythromycin ribosome methylase and bacterial toxins in S. aureus collected from bloodstream infections. Sixty different S. aureus isolates were obtained from blood cultures of patients who were admitted to a Teaching Hospital in Tianjin from January 2006 to August 2011. The susceptibility of the isolates to 16 antibiotics was tested. Methicillin-resistant S. aureus (MRSA) was identified using the disk diffusion method with cefoxitin. PCR was used to detect genes that encode the staphylococcal enterotoxins, Panton-Valentine leukocidin, toxic shock syndrome toxin 1 and erythromycin ribosome methylase. Molecular analysis of the MRSA strains was done using pulsed-field gel electrophoresis (PFGE) and staphylococcal cassette chromosome mec (SCCmec) typing. The positivity rates of mecA, ermA, ermB, and ermC in the isolates were 13/60, 10/60, 18/60, and 18/60, respectively. Among the 60 isolates, 30 harbored enterotoxin genes, with sea as the most frequent toxin gene (33%), followed by sec (15%), sed (12%), and seb (5%). The see and tst genes were not found in any of the isolates. The pvl gene was detected in four strains. Eleven MRSA isolates were of the SCCmec type III; two MRSA isolates could not be determined through SCCmec typing. PFGE analysis of the 13 MRSA isolates produced 8 distinct pulsotypes. Virulence genes and erythromycin ribosome methylase genes were highly prevalent in these isolates. The PFGE results demonstrated that the MRSA spread through cloning, mainly involving SCCmec type III. PMID:23546946

Wang, L X; Hu, Z D; Hu, Y M; Tian, B; Li, Jing; Wang, F X; Yang, H; Xu, H R; Li, Y C; Li, J

2013-03-11

132

UTILIZATION OF FLUORANTHENE BY PSEUDOMONAS PAUCIMOBILIS STRAIN EPA505  

EPA Science Inventory

Pseudomonas paucimobilis strain EPA505, was previously purified from a 7-membered bacterial community originally isolated from a creosote-contaminated soil for its ability to degrade polycyclic aromatic hydrocarbon (PAH) components of creosote. The unique ability of this organism...

133

Frequency of Isolation of Pathogens from Bloodstream, Nosocomial Pneumonia, Skin and Soft Tissue, and Urinary Tract Infections Occurring in European Patients  

Microsoft Academic Search

The frequency of isolation of pathogens that cause different types of infections is an important guide for empiric therapy.\\u000a As part of the SENTRY Antimicrobial Surveillance Program, the frequency of isolation of different bacterial species from bloodstream,\\u000a nosocomial pneumonia, skin and soft tissue, and urinary tract infections occurring in European patients was determined. A\\u000a total of 15,704 isolates were collected

A. C. Fluit; F.-J. Schmitz; J. Verhoef

2001-01-01

134

[Manifestation, distribution of pathogen, and resistance of bloodstream infections after renal transplantation: clinical anylasis of 71 patients].  

PubMed

Objective: To investigate the clinical manifestation and determine the distribution of pathogens and their characteristics of drug susceptibility to bloodstream infections (BSIs), and provide evidence for clinical anti-infection treatments after renal transplantation. Methods: Totally 81 episodes of BSIs occurred in 71 patients between July 2003 and June 2013. We retrospectively analyzed the pathogens and their drug susceptibility characteristics with BD microbiological assay system. We also collected the clinical and laboratory data of the patients . Results: The main pathogens were gram negative bacteria (67.90%), followed by gram positive bacteria (28.40%) and fungi (3.70%). The most common gram negative bacillus was Escherichia coli. While for gram positive bacteria, the main bacillus was coagulase-negative staphylococci. The gram negative bacteria were relatively sensitive to aminoglycosides and carbapenem. The gram positive bacteria were sensitive to glycopeptides and oxazolidone. Conclusion: The clinical manifestations included high body temperature, onset in the early period after kidney transplantation and high mortality. Though gram positive coccus plays an important role, most infections are caused by gram negative bacteria in BSIs after the renal transplantation. The antibiotic resistant rate for gram negative bacteria is very high as well as gram positive bacteria. PMID:24071703

Wan, Qiquan; Li, Jingle; Ye, Qifa; Zhou, Jiandang

2013-09-01

135

Virulence gene profiling and molecular characterization of hospital-acquired Staphylococcus aureus isolates associated with bloodstream infection.  

PubMed

A better understanding of virulence gene profiling and molecular characterization of Staphylococcus aureus isolates associated with bloodstream infection (BSI) may provide further insights related to clinical outcomes with these infections. We analyzed 89 S. aureus isolates including 37 MRSA isolates (41.6%) recovered from 89 adult patients with BSI from 4 hospitals in Zhejiang province, eastern China. Thirty-five (94.6%) of MRSA isolates and 4 (7.7%) of methicillin-sensitive S. aureus (MSSA) isolates were resistant to multiple antimicrobials. All isolates harbored at least 2 of 22 possible virulence genes, including sdrC (92.1%), icaA (89.9%), hla (80.9%), clf (69.7%), sea (68.5%), sdrD (67.4%), hlb (67.4%), sdrE (65.2%), sei (51.7%), seg (50.6%), and cna (50.6%). Forty-four (49.4%) of all S. aureus BSI isolates, including 23 (62.2%) of MRSA isolates, harbored ?10 of the virulence genes evaluated in this study. Sixteen (43.2%) MRSA isolates and 5 (9.6%) MSSA isolates harbored the gene encoding Panton-Valentine leukocidin (PVL). Collective genes for pvl, sdrE, sed, seg, and sei among MRSA isolates were significantly more frequent relative to MSSA isolates (P < 0.05). A total of 22 sequence types (STs), including novel ST2184, ST2199, and ST2200, and 33 spa types, including novel spa types t9530 and t9532, were identified among S. aureus BSI isolates, among which ST188 (15.7%) and ST7 (15.7%), and t091 (12.4%) and t189 (12.4%), seldom noted for Chinese isolates previously, were major STs and spa types, respectively. In contrast to previous reports, no predominant clones were found in the present study. Among the MRSA isolates, although ST239-MRSA-SCCmecIII, predominant clone in China, still represented the most common clone, it only accounted for 18.9%. However, ST188-MRSA- SCCmecIV seldom reported before accounted for 10.8%. Among the MSSA isolates, ST7-MSSA represented the most common clone (23.1%), followed by ST188-MSSA and ST630-MSSA (9.6% each). In conclusion, simultaneous carriage of multiple virulence genes and genetically considerable diversity were common among S. aureus BSI isolates. Furthermore, MRSA isolates exhibited more frequent carriage of superantigen genes and pvl relative to MSSA isolates. Taken together, there are distinctive virulence gene profiling and molecular characteristic among S. aureus isolates associated with bloodstream infection in China. PMID:23021064

Yu, Fangyou; Li, Tingjian; Huang, Xiaoying; Xie, Juan; Xu, Yuanyuan; Tu, Jinjing; Qin, Zhiqiang; Parsons, Chris; Wang, Jinwei; Hu, Longhua; Wang, Liangxing

2012-09-26

136

Outbreak of Multi-Drug Resistant Pseudomonas aeruginosa Bloodstream Infection in the Haematology Unit of a South African Academic Hospital  

PubMed Central

Objective To describe an outbreak of multi-resistant Pseudomonas aeruginosa bloodstream infections (MRPA-BSI) that occurred in the haematology ward of a tertiary academic hospital in Cape Town, South Africa, and determine risk factors for acquisition of MRPA-BSI. Methods The outbreak investigation included a search for additional cases, review of patient records, environmental and staff screening, molecular typing using pulsed-field gel electrophoresis (PFGE) and Multi-locus sequencing (MLST) and a retrospective case-control study. Results Ten MRPA-BSI cases occurred in the haematology ward between January 2010 and January 2011. The case fatality rate was 80%. Staff screening specimens were negative for MRPA and an environmental source was not identified. PFGE showed that 9/10 isolates were related. MLST showed that 3 of these 9 isolates belonged to Sequence type (ST) 233 while the unrelated isolate belonged to ST260. Conclusion We have described an outbreak of MRPA-BSI occurring over an extended period of time among neutropenic haematology patients. Molecular typing confirms that the outbreak was predominantly due to a single strain. The source of the outbreak was not identified, but the outbreak appears to have been controlled following intensive infection control measures.

Mudau, Maanda; Jacobson, Rachael; Minenza, Nadia; Kuonza, Lazarus; Morris, Vida; Engelbrecht, Heather; Nicol, Mark P.; Bamford, Colleen

2013-01-01

137

Rapid and reliable MALDI-TOF mass spectrometry identification of Candida non-albicans isolates from bloodstream infections.  

PubMed

Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) fingerprinting has recently become an effective instrument for rapid microbiological diagnostics and in particular for identification of micro-organisms directly in a positive blood culture. The aim of the study was to evaluate a collection of 82 stored yeast isolates from bloodstream infection, by MALDI-TOF MS; 21 isolates were identified also directly from positive blood cultures and in the presence of other co-infecting micro-organisms. Of the 82 isolates grown on plates, 64 (76%) were correctly identified by the Vitek II system and 82 (100%) by MALDI-TOF MS; when the two methods gave different results, the isolate was identified by PCR. MALDI-TOF MS was unreliable in identifying two isolates (Candida glabrata and Candida parapsilosis) directly from blood culture; however, direct analysis from positive blood culture samples was fast and effective for the identification of yeast, which is of great importance for early and adequate treatment. PMID:23845229

Pulcrano, Giovanna; Iula, Dora Vita; Vollaro, Antonio; Tucci, Alessandra; Cerullo, Monica; Esposito, Matilde; Rossano, Fabio; Catania, Maria Rosaria

2013-07-09

138

Intravascular catheter-related bloodstream infection caused by Abiotrophia defectiva in a neutropenic child.  

PubMed

Bacteraemia and endocarditis are the most frequently reported clinical infections due to Abiotrophia defectiva species. This species has been rarely implicated in infections in neutropenic patients. We report a rare case of long-term venous catheter-related infection caused by A. defectiva that occurred in a febrile child who had neutropenia and Langerhans' cell histiocytosis. PMID:23378563

Phulpin-Weibel, A; Gaspar, N; Emirian, A; Chachaty, E; Valteau-Couanet, D; Gachot, B

2013-02-01

139

Is diabetes a risk factor for central venous access port-related bloodstream infection in oncological patients?  

PubMed

It was a dogma that patients with diabetes mellitus (DM) are at increased risk of infection or death associated with an infection. However, in cancer patients, this has not been well investigated. The aim was to investigate whether diabetic patients with cancer are at high risk of central venous access port (CVAP)-related bloodstream infection (BSI), and to analyse mortality after CVAP-BSI. A total of 17 patients with type 1 DM (T1DM), 66 with type 2 DM (T2DM) and 307 non-diabetic patients were included. Each patient was followed up until the first late CVAP-BSI or for a maximum for 1 year in the absence of a CVAP-BSI. Fifty-three CVAP-BSIs occurred in 66,528 catheter-days. The cumulative incidence of CVAP-BSI was not higher in T1DM (5.9 %; p = 0.17) and T2DM (19.7 %; p = 0.70) compared with the non-diabetic patients (12.7 %). However, in patients with CVAP-BSI, the 1-month crude mortality rate was higher in DM patients (42.9 % vs. 15.4 %; p = 0.04), whereas the mortality in patients without CVAP-BSI was similar in both groups of patients (19.8 % vs. 17.1 %; p = 0.58). Of the 12 deaths that occurred within 1 month of CVAP-BSI, 16.66 % was attributable to CVAP-BSI. The predictive factor of 1-month mortality was DM (p = 0.04). Parenteral nutrition (PN) was independently associated with CVAP-BSI in diabetic patients (p = 0.001). In this study, diabetes did not increase the risk of CVAP-BSI, but mortality was higher in diabetic patients who had a CVAP-BSI. This suggests, in addition to medical treatment, CVAP should be withdrawn after infection onset. PMID:22930406

Touré, A; Vanhems, P; Lombard-Bohas, C; Souquet, J-C; Lauverjat, M; Chambrier, C

2012-08-22

140

Preventing catheter-associated bloodstream infections: A survey of policies for insertion and care of central venous catheters from hospitals in the prevention epicenter program  

Microsoft Academic Search

objective. To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care. design. A 9-page written survey of practices and policies for nontunneled

David K. Warren; Deborah S. Yokoe; Michael W. Climo; Loreen A. Herwaldt; Gary A. Noskin; Gianna Zuccotti; Jermone I Tokars; Trish M. Perl; Victoria J. Fraser

2006-01-01

141

Ventilator-associated pneumonia in very low–birth-weight infants at the time of nosocomial bloodstream infection and during airway colonization with Pseudomonas aeruginosa  

Microsoft Academic Search

Purpose: To study retrospectively the incidence of ventilator-associated pneumonia (VAP) at the time of Pseudomonas aeruginosa nosocomial bloodstream infection (BSI) and at the time of P aeruginosa airway colonization. Materials and Methods: Fifteen very low–birth-weight infants who had P aeruginosa BSI and 33 others who did not but who had P aeruginosa airway-colonization were studied. We correlated clinical data, blood

Leandro Cordero; Mercedes Sananes; Brian Coley; Mark Hogan; Miguel Gelman; Leona W. Ayers

2000-01-01

142

National Epidemiology of Mycoses Survey (NEMIS): Variations in Rates of Bloodstream Infections Due to Candida Species in Seven Surgical Intensive Care Units and Six Neonatal Intensive Care Units  

Microsoft Academic Search

Candida species are the fourth most frequent cause of nosocomial bloodstream infections, and 25%-50% occur in critical care units. During an 18-month prospective study period, all patients admitted for ˜72 hours to the surgical (SICUs) or neonatal intensive care units (NICUs) at each of the participant institutions were followed daily. Among 4,276 patients admitted to the seven SICUs in six

Todd Wiblin; Lisa Saiman; Jan Patterson; Michael Rinaldi; Michael Pfaller; William Jarvis; Jeffrey Dawson

1999-01-01

143

Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy  

Microsoft Academic Search

OBJECTIVES: The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI) and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass) infusion containers. METHODS: A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases) and patients without

Rosanna Tarricone; Aleksandra Torbica; Fabio Franzetti; Victor D Rosenthal

2010-01-01

144

Proteus mirabilis Bloodstream Infections: Risk Factors and Treatment Outcome Related to the Expression of Extended-Spectrum ?-Lactamases  

PubMed Central

Bloodstream infection (BSI) due to Proteus mirabilis strains is a relatively uncommon clinical entity, and its significance has received little attention. This study was initiated to evaluate risk factors and treatment outcome of BSI episodes due to P. mirabilis producing extended-spectrum ?-lactamases (ESBLs). Twenty-five BSI episodes caused by P. mirabilis occurred at our hospital (Ospedale di Circolo e Fondazione Macchi, Varese, Italy) over a 7.5-year period. Phenotypic and molecular methods were used to assess ESBL production. Clinical records of BSI patients were examined retrospectively. Demographic data, underlying diseases (according to McCabe and Jackson classification and Charlson weighted index), risk factors, and treatment outcome were investigated by comparing cases due to ESBL-positive strains to cases due to ESBL-negative strains. Eleven isolates were found to express ESBLs (TEM-52 or TEM-92). The remaining 14 isolates were ESBL negative and were uniformly susceptible to extended-spectrum cephalosporins and monobactams. Comparison of the two groups showed that previous hospitalization in a nursing home (P = 0.04) and use of bladder catheter (P = 0.01) were significant risk factors for infections due to ESBL-positive strains. In addition, cases due to ESBL-positive strains showed a significantly higher mortality attributable to BSI (P = 0.04). BSI cases due to ESBL-negative isolates uniformly responded to therapy, whereas 5/11 cases due to ESBL-positive isolates failed to respond (P < 0.01). Use of carbapenems was associated with complete response independently of ESBL production. Therapeutic failure and mortality may occur in BSI episodes caused by ESBL-positive P. mirabilis isolates. Thus, recognition of ESBL-positive strains appears to be critical for the clinical management of patients with systemic P. mirabilis infections.

Endimiani, Andrea; Luzzaro, Francesco; Brigante, Gioconda; Perilli, Mariagrazia; Lombardi, Gianluigi; Amicosante, Gianfranco; Rossolini, Gian Maria; Toniolo, Antonio

2005-01-01

145

The clinical diagnostic accuracy of rapid detection of healthcare-associated bloodstream infection in intensive care using multipathogen real-time PCR technology  

PubMed Central

Background There is growing interest in the potential utility of real-time PCR in diagnosing bloodstream infection by detecting pathogen DNA in blood samples within a few hours. SeptiFast is a multipathogen probe-based real-time PCR system targeting ribosomal DNA sequences of bacteria and fungi. It detects and identifies the commonest pathogens causing bloodstream infection and has European regulatory approval. The SeptiFast pathogen panel is suited to identifying healthcare-associated bloodstream infection acquired during complex healthcare, and the authors report here the protocol for the first detailed health-technology assessment of multiplex real-time PCR in this setting. Methods/design A Phase III multicentre double-blinded diagnostic study will determine the clinical validity of SeptiFast for the rapid detection of healthcare-associated bloodstream infection, against the current service standard of microbiological culture, in an adequately sized population of critically ill adult patients. Results from SeptiFast and standard microbiological culture procedures in each patient will be compared at study conclusion and the metrics of clinical diagnostic accuracy of SeptiFast determined in this population setting. In addition, this study aims to assess further the preliminary evidence that the detection of pathogen DNA in the bloodstream using SeptiFast may have value in identifying the presence of infection elsewhere in the body. Furthermore, differences in circulating immune-inflammatory markers in patient groups differentiated by the presence/absence of culturable pathogens and pathogen DNA will help elucidate further the patho-physiology of infection developing in the critically ill. Ethics and dissemination Ethical approval has been granted by the North West 6 Research Ethics Committee (09/H1003/109). Based on the results of this first non-commercial study, independent recommendations will be made to The Department of Health (open-access health technology assessment report) as to whether SeptiFast has sufficient clinical diagnostic accuracy to move forward to efficacy testing during the provision of routine clinical care.

Dunn, Graham; Chadwick, Paul; Young, Duncan; Bentley, Andrew; Carlson, Gordon; Warhurst, Geoffrey

2011-01-01

146

Beyond the bundle - journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections.  

PubMed

INTRODUCTION: We set a goal to reduce the incidence rate of catheter-related bloodstream infections to rate of <1 per 1,000 central line days in a two-year period. METHODS: This is an observational cohort study with historical controls in a 25-bed intensive care unit at a tertiary academic hospital. All patients admitted to the unit from January 2008 to December 2011 (31,931 patient days) were included. A multidisciplinary team consisting of hospital epidemiologist/infectious diseases physician, infection preventionist, unit physician and nursing leadership was convened. Interventions included: central line insertion checklist, demonstration of competencies for line maintenance and access, daily line necessity checklist, and quality rounds by nursing leadership, heightened staff accountability, follow-up surveillance by epidemiology with timely unit feedback and case reviews, and identification of noncompliance with evidence-based guidelines. Molecular epidemiologic investigation of a cluster of vancomycin-resistant Enterococcus faecium (VRE) was undertaken resulting in staff education for proper acquisition of blood cultures, environmental decontamination and daily chlorhexidine gluconate (CHG) bathing for patients. RESULTS: Center for Disease Control/National Health Safety Network (CDC/NHSN) definition was used to measure central line-associated bloodstream infection (CLA-BSI) rates during the following time periods: baseline (January 2008 to December 2009), intervention year (IY) 1 (January to December 2010), and IY 2 (January to December 2011). Infection rates were as follows: baseline: 2.65 infections per 1,000 catheter days; IY1: 1.97 per 1,000 catheter days; the incidence rate ratio (IRR) was 0.74 (95% CI = 0.37 to 1.65, P = 0.398); residual seven CLA-BSIs during IY1 were VRE faecium blood cultures positive from central line alone in the setting of findings explicable by noninfectious conditions. Following staff education, environmental decontamination and CHG bathing (IY2): 0.53 per 1,000 catheter days; the IRR was 0.20 (95% CI = 0.06 to 0.65, P = 0.008) with 80% reduction compared to the baseline. Over the two-year intervention period, the overall rate decreased by 53% to 1.24 per 1,000 catheter-days (IRR of 0.47 (95% CI = 0.25 to 0.88, P = 0.019) with zero CLA-BSI for a total of 15 months. CONCLUSIONS: Residual CLA-BSIs, despite strict adherence to central line bundle, may be related to blood culture contamination categorized as CLA-BSIs per CDC/NHSN definition. Efforts to reduce residual CLA-BSIs require a strategic multidisciplinary team approach focused on epidemiologic investigations of practitioner- or unit-specific etiologies. PMID:23497591

Exline, Matthew C; Ali, Naeem A; Zikri, Nancy; Mangino, Julie E; Torrence, Kelly; Vermillion, Brenda; St Clair, Jamie; Lustberg, Mark E; Pancholi, Preeti; Sopirala, Madhuri M

2013-03-01

147

Methicillin-Susceptible ST398 Staphylococcus aureus Responsible for Bloodstream Infections: An Emerging Human-Adapted Subclone?  

PubMed Central

In the course of an annual 3-month bloodstream infections (BSI) survey conducted during a four-year period in 31 healthcare institutions located in three noncontiguous French regions, we report 18 ST398 Staphylococcus aureus BSI. ST398 BSI incidence showed a seven-fold increase during the study period (0.002 per 1,000 patient days in 2007 vs. 0.014 in 2010). ST398 BSI isolates differed from the pig-borne multiresistant clone: 17/18 BSI isolates were methicillin susceptible and none was of t011, t034 or t108 pig-borne spa-types. ST398 BSI isolates had homogenous resistance patterns (15/18 with only Eryr) and prophagic content (all harboured the hlb-converting Sau3int phage). The clustering of BSI and pig-borne isolates by spa-typing and MLVA, the occurrence of Sau3int phage in BSI isolates and the lack of this phage in pig-borne isolates suggest that the emergence of BSI isolates could have arisen from horizontal transfer, at least of the Sau3int phage, in genetically diverse MSSA ST398 isolates. The acquisition of the phage likely plays a role in the increasing ability of the lysogenic ST398 isolates to colonize human. The mode of acquisition of the non pig-borne ST398 isolates by our 18 patients remains unclear. ST398 BSI were diagnosed in patients lacking livestock exposure and were significantly associated with digestive portals of entry (3/18 [16.7%] for ST398 vs. 19/767 [2.5%] for non ST398 BSI; p?=?.012). This raises the question of possible foodborne human infections. We suggest the need for active surveillance to study and control the spread of this human-adapted subclone increasingly isolated in the hospital setting.

Valentin-Domelier, Anne-Sophie; Girard, Myriam; Bertrand, Xavier; Violette, Jeremie; Francois, Patrice; Donnio, Pierre-Yves; Talon, Daniel; Quentin, Roland; Schrenzel, Jacques; van der Mee-Marquet, Nathalie

2011-01-01

148

Increase in Bloodstream Infection Due to Vancomycin-Susceptible Enterococcus faecium in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes  

PubMed Central

We conducted a prospective study to assess the risk factors, molecular epidemiology and outcome of bloodstream infection (BSI) due to Enterococcus faecium in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible E. faecium BSI was observed among cancer patients. Comparison of 54 episodes of BSI due to E. faecium with 38 episodes of BSI due to E. faecalis showed that previous use of carbapenems was the only independent risk factor for E. faecium acquisition (OR 10.24; 95% CI, 1.35-77.66). All E. faecium isolates were susceptible to glycopeptides, whereas 97% showed high-level resistance to ampicillin and ciprofloxacin. All 30 isolates available for genotyping belonged to the hospital-associated E. faecium lineages 17, 18 and 78. After 2009, most of the isolates belonged to ST117 (lineage 78). Patients with E. faecium BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with E. faecalis BSI, and time to adequate empirical antibiotic therapy was also longer in the former group. No significant differences were found between the two groups regarding early and overall case-fatality rates. Independent risk factors for overall case-fatality were current corticosteroids (OR 4.18; 95% CI, 1.34-13.01) and intensive care unit admission (OR 9.97; 95% CI, 1.96-50.63). The emergence of E. faecium among cancer patients is a concern since there are limited treatment options and it may presage the emergence of vancomycin-resistant enterococci. A rationale approach that combines infection control with antimicrobial stewardship.

Gudiol, Carlota; Ayats, Josefina; Camoez, Mariana; Dominguez, M. Angeles; Garcia-Vidal, Carolina; Bodro, Marta; Ardanuy, Carmen; Obed, Mora; Arnan, Montserrat; Antonio, Maite; Carratala, Jordi

2013-01-01

149

Methicillin-susceptible ST398 Staphylococcus aureus responsible for bloodstream infections: an emerging human-adapted subclone?  

PubMed

In the course of an annual 3-month bloodstream infections (BSI) survey conducted during a four-year period in 31 healthcare institutions located in three noncontiguous French regions, we report 18 ST398 Staphylococcus aureus BSI. ST398 BSI incidence showed a seven-fold increase during the study period (0.002 per 1,000 patient days in 2007 vs. 0.014 in 2010). ST398 BSI isolates differed from the pig-borne multiresistant clone: 17/18 BSI isolates were methicillin susceptible and none was of t011, t034 or t108 pig-borne spa-types. ST398 BSI isolates had homogenous resistance patterns (15/18 with only Ery(r)) and prophagic content (all harboured the hlb-converting Sau3int phage). The clustering of BSI and pig-borne isolates by spa-typing and MLVA, the occurrence of Sau3int phage in BSI isolates and the lack of this phage in pig-borne isolates suggest that the emergence of BSI isolates could have arisen from horizontal transfer, at least of the Sau3int phage, in genetically diverse MSSA ST398 isolates. The acquisition of the phage likely plays a role in the increasing ability of the lysogenic ST398 isolates to colonize human. The mode of acquisition of the non pig-borne ST398 isolates by our 18 patients remains unclear. ST398 BSI were diagnosed in patients lacking livestock exposure and were significantly associated with digestive portals of entry (3/18 [16.7%] for ST398 vs. 19/767 [2.5%] for non ST398 BSI; p?=?.012). This raises the question of possible foodborne human infections. We suggest the need for active surveillance to study and control the spread of this human-adapted subclone increasingly isolated in the hospital setting. PMID:22163008

Valentin-Domelier, Anne-Sophie; Girard, Myriam; Bertrand, Xavier; Violette, Jérémie; François, Patrice; Donnio, Pierre-Yves; Talon, Daniel; Quentin, Roland; Schrenzel, Jacques; van der Mee-Marquet, Nathalie

2011-12-05

150

Molecular diagnosis of bloodstream infections with a new dual-priming oligonucleotide-based multiplex PCR assay.  

PubMed

Mortality from bloodstream infections (BSIs) correlates with diagnostic delay and the use of inappropriate empirical treatment. Early PCR-based diagnosis could decrease inappropriate treatment, improving patient outcome. The aim of the present study was to assess the clinical utility of this molecular technology to diagnose BSIs. We assessed a new dual-priming oligonucleotide-based multiplex PCR assay, the Magicplex Sepsis Test (MST) (Seegene), along with blood culture (BC). A total of 267 patients from the intensive care unit and haematology and emergency departments were enrolled. Clinical data were also used by physicians to determine the likelihood of infection. Ninety-eight (37?%) specimens were positive: 29 (11?%) by both the MST and BC, 29 (11?%) by the MST only, and 40 (15?%) by BC only. The proportion of agreement between the two methods was 73?% (Cohen's ?: 0.45; 0.28-0.6; indicating fair to moderate agreement). According to clinical assessment, 63 (64?%) positive specimens were considered BSIs: 23 (36?%) were positive by both the MST and BC, 22 (35?%) were positive only by BC, and 18 (29?%) were positive only by the MST. Thirty-eight (14?%) positive specimens by the MST and/or BC were considered as contaminants. Of 101 specimens collected from patients receiving antibiotics, 20 (20?%) were positive by the MST and 32 (32?%) by BC. Sensitivity and specificity were 65?% and 92?%, respectively, for the MST and 71?% and 88?%, respectively for BC. We concluded that the MST shows a high specificity but changes in design are needed to increase bacteraemia detection. For viability in clinical laboratories, technical improvements are also required to further automate the process. PMID:23924662

Carrara, Lucrecia; Navarro, Ferran; Turbau, Miquel; Seres, Montse; Morán, Indalecio; Quintana, Isabel; Martino, Rodrigo; González, Yesica; Brell, Albert; Cordon, Oscar; Diestra, Karol; Mata, Caterina; Mirelis, Beatriz; Coll, Pere

2013-08-07

151

Risk Factors for the Development of Catheter-Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition.  

PubMed

BACKGROUND: Risk factors for development of catheter-related bloodstream infections (CRBSI) were studied in 125 adults and 18 children who received home parenteral nutrition (HPN). Methods: Medical records from a national home care pharmacy were reviewed for all patients that had HPN infused at least twice weekly for a minimum of two years from January 1, 2006-December 31, 2011. Infection and risk factor data were collected during this time period on all patients although those patients who received HPN for a longer period had data collected since initiation of HPN. RESULTS: In adults, 331 central venous catheters (CVCs) were placed. Total catheter years were 1157. Median CVC dwell time was 730 days. In children, there were 53 CVCs placed. Total catheter years were 113.1. Median CVC dwell time was 515 days. There were 147 CRBSIs (0.13/catheter year;0.35/1000 catheter days). In children there were 33 CRBSIs (0.29/catheter year;0.80/1000 days; P < .001 versus adults). In adults, univariate analysis showed use of subcutaneous infusion ports instead of tunneled catheters (P = .001), multiple lumen catheters (P = .001), increased frequency of lipid emulsion infusion (P = .001), obtaining blood from the CVC (P < 0.001), and infusion of non-PN medications via the CVC (P < .001) were significant risk factors for CRBSI. Increased PN frequency was associated with increased risk of CRBSI (P = .001) in children, but not in adults. Catheter disinfection with povidone-iodine was more effective than isopropyl alcohol alone. There were insufficient patients to evaluate chlorhexidine-containing regimens. Conclusion: Numerous risk factors for CRBSI were identified for which simple and current countermeasures already exist. PMID:23744839

Buchman, Alan L; Opilla, Marianne; Kwasny, Mary; Diamantidis, Thomas G; Okamoto, Rodney

2013-06-01

152

Increase in Bloodstream Infection Due to Vancomycin-Susceptible Enterococcus faecium in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes.  

PubMed

We conducted a prospective study to assess the risk factors, molecular epidemiology and outcome of bloodstream infection (BSI) due to Enterococcus faecium in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible E. faecium BSI was observed among cancer patients. Comparison of 54 episodes of BSI due to E. faecium with 38 episodes of BSI due to E. faecalis showed that previous use of carbapenems was the only independent risk factor for E. faecium acquisition (OR 10.24; 95% CI, 1.35-77.66). All E. faecium isolates were susceptible to glycopeptides, whereas 97% showed high-level resistance to ampicillin and ciprofloxacin. All 30 isolates available for genotyping belonged to the hospital-associated E. faecium lineages 17, 18 and 78. After 2009, most of the isolates belonged to ST117 (lineage 78). Patients with E. faecium BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with E. faecalis BSI, and time to adequate empirical antibiotic therapy was also longer in the former group. No significant differences were found between the two groups regarding early and overall case-fatality rates. Independent risk factors for overall case-fatality were current corticosteroids (OR 4.18; 95% CI, 1.34-13.01) and intensive care unit admission (OR 9.97; 95% CI, 1.96-50.63). The emergence of E. faecium among cancer patients is a concern since there are limited treatment options and it may presage the emergence of vancomycin-resistant enterococci. A rationale approach that combines infection control with antimicrobial stewardship. PMID:24069339

Gudiol, Carlota; Ayats, Josefina; Camoez, Mariana; Domínguez, M Ángeles; García-Vidal, Carolina; Bodro, Marta; Ardanuy, Carmen; Obed, Mora; Arnan, Montserrat; Antonio, Maite; Carratalà, Jordi

2013-09-19

153

Virulence Attenuation of Candida albicans Genetic Variants Isolated from a Patient with a Recurrent Bloodstream Infection  

PubMed Central

The incidence of Candida albicans infections and the relapse episodes after antifungal treatment have increased in recent decades. Recurrences are mainly due to the persistence of the original infecting strain that may present genetic and genomic rearrangements during interaction with the host, reflecting strain adaptation. In this study, four isolates recovered from a patient during recurrent candidemia episodes were genotyped by microsatellite length polymorphism (MLP) and by multilocus sequence typing (MLST) and found to be genetic variants of the same strain. Using experimental mouse infections, a progressive reduction in the virulence of the four isolates was observed, with the first two isolates more virulent than the third and fourth. Additionally, in the mouse model, the first isolate resisted host control more efficiently, resulting in higher kidney fungal burdens and necrosis as compared to the third isolate. The resolution of inflammation was delayed in mice challenged with the first isolate and the message for IFN-? and TNF-? in the spleen was lower within the first few hours post-infection. Original and recurrent isolates also displayed different phenotypes regarding activity of secreted enzymes and response to stress agents. Overall, the comparative analysis indicated that the virulence decrease of these isolates was related to a lower ability to resist to the host anticandida effector mechanisms. We showed for the first time that C. albicans genetic variants of the same strain, sequentially isolated from an immunocompromised patient, underwent adaptations in the human host that resulted in virulence attenuation when tested in mice.

Sampaio, Paula; Santos, Marlene; Correia, Alexandra; Amaral, Fabio E.; Chavez-Galarza, Julio; Costa-de-Oliveira, Sofia; Castro, Antonio G.; Pedrosa, Jorge; Pais, Celia

2010-01-01

154

Survey of State Hospital Associations: Practices to Prevent Hospital-Associated Bloodstream Infections.  

National Technical Information Service (NTIS)

According to the Centers for Disease Control and Prevention (CDC), hospital-associated infections are one of the top ten causes of death in this country. CDC researchers estimated that in 2002 there were approximately 1.7 million hospital-associated infec...

2008-01-01

155

Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting.  

PubMed

The influence of infection-control practices on bloodstream infection (BSI) risk was examined in a home health care setting in which three needleless devices were used consecutively. A case-control study and a retrospective cohort study were conducted. Risk factors for BSI included lower education level, younger age, having a central venous catheter (CVC) with multiple ports, or having a tunneled CVC. Among patients with a tunneled CVC, those at greatest risk had been allowed to shower rather than bathe and to get their exit site wet (P<.01). A high proportion (49%) of isolates were hydrophilic gram-negative bacteria, suggesting water sources of infection. In the cohort study, the BSI rate decreased as the frequency of changing the needleless device end cap increased from once weekly up to every 2 days, suggesting that the mechanism for BSI may involve contamination from the end cap. These findings may help to develop infection-control measures specific to home health care. PMID:9878029

Do, A N; Ray, B J; Banerjee, S N; Illian, A F; Barnett, B J; Pham, M H; Hendricks, K A; Jarvis, W R

1999-02-01

156

Ten-year surveillance of nosocomial bloodstream infections: trends of aetiology and antimicrobial resistance in a comprehensive cancer centre  

PubMed Central

Background: Bloodstream infections (BSIs) are one of the major life-threatening infectious conditions in cancer patients and are responsible for prolonged hospital stays, high healthcare costs and significant mortality. Several clinical trials have reported an improved survival in patients treated with appropriate empirical broad-spectrum antibiotic therapy. Early detection of pathogens and determination of their susceptibility are essential for the optimization of treatment. Variability between hospitals is substantial and requires the individual analysis of local trends. The aim of this study is to assess the local epidemiology of BSI in a single cancer centre over a 10-year period. Methods: Retrospective microbiological surveillance of all febrile/infective episodes occurring in oncological and surgical patients in a high-volume cancer centre between January 1999 and December 2008 were considered. Patients’ data were collected, processed and analyzed using the epidemiological resource of the Virtuoso Plus software (Metafora Informatica Srl, Milano, Italy). Spearman’s rank correlation coefficient, including the two-tailed test of significance, was used to investigate trends of incidence and rate of antibiotic resistance over the 10-year period. Results: A total of 13,058 blood cultures (BCs) were performed in 2,976 patients. BCs were positive in 2,447 tests, representing 740 infective/febrile episodes: 358 (48%) in medical oncology and 382 (52%) in surgical wards. Gram-positives were responsible for the majority of episodes in oncological and surgical divisions (about 63% and 55%, respectively). Gram-positives were also the most common organism in non-catheter-related BSIs (CRBSIs) both in medical oncology (75%) and in surgical divisions (50%). Enterococci showed an increased resistance to levofloxacin, from 5.6% to 25.7% (p = 0.02) and to erythromycin, from 41.7% to 61.4%, (p = 0.05). Similarly, coagulase negative staphylococci (CoNS) developed resistance to levofloxacin and ciprofloxacin, passing from 33.9% to 67.4% (p = 0.01) and from 5.6% to 25.7% (p = 0.01), respectively. Conclusions: Gram-positives are the main pathogens of BSIs; there is no difference in aetiology of CRBSIs between surgical and oncological patients. The lower incidence of gram-positive non-CRBSIs in surgical patients was probably due to gram-negative infections secondary to surgical complications.

Passerini, R; Ghezzi, TL; Sandri, MT; Radice, D; Biffi, R

2011-01-01

157

Patients with Acinetobacter baumannii bloodstream infections are colonized in the gastrointestinal tract with identical strains  

PubMed Central

In this study, we identified critically ill patients with Acinetobacter baumannii bacteremia and examined perirectal surveillance cultures for the presence of genetically related A baumannii strains using pulsed-field gel electrophoresis to determine whether gut colonization preceded clinical infection. Seven patients with imipenem-resistant A baumannii bacteremia were identified from January to June of 2008. Six of 7 (86%) patients were colonized in the gastrointestinal tract with genetically similar strains preceding their bacteremia.

Thom, Kerri A.; Hsiao, William W. L.; Harris, Anthony D.; Stine, O. Colin; Rasko, David A.; Johnson, J. Kristie

2010-01-01

158

Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea  

PubMed Central

Background Healthcare-associated (HCA) infection has emerged as a new epidemiological category. The aim of this study was to evaluate the impact of HCA infection on mortality in community-onset Klebsiella pneumoniae bloodstream infection (KpBSI). Methods We conducted a retrospective study in two tertiary-care hospitals over a 6-year period. All adult patients with KpBSI within 48 hours of admission were enrolled. We compared the clinical characteristics of HCA and community-acquired (CA) infection, and analyzed risk factors for mortality in patients with community-onset KpBSI. Results Of 553 patients with community-onset KpBSI, 313 (57%) were classified as HCA- KpBSI and 240 (43%) as CA-KpBSI. In patients with HCA-KpBSI, the severity of the underlying diseases was higher than in patients with CA-KpBSI. Overall the most common site of infection was the pancreatobiliary tract. Liver abscess was more common in CA-KpBSI, whereas peritonitis and primary bacteremia were more common in HCA-KpBSI. Isolates not susceptible to extended-spectrum cephalosporin were more common in HCA- KpBSI than in CA-KpBSI (9% [29/313] vs. 3% [8/240]; p = 0.006). Overall 30-day mortality rate was significantly higher in HCA-KpBSI than in CA-KpBSI (22% [70/313] vs. 11% [27/240]; p = 0.001). In multivariate analysis, high Charlson’s weighted index of co-morbidity, high Pitt bacteremia score, neutropenia, polymicrobial infection and inappropriate empirical antimicrobial therapy were significant risk factors for 30-day mortality. Conclusions HCA-KpBSI in community-onset KpBSI has distinctive characteristics and has a poorer prognosis than CA-KpBSI, but HCA infection was not an independent risk factor for 30-day mortality.

2012-01-01

159

Nosocomial Bloodstream Infections in Brazilian Hospitals: Analysis of 2,563 Cases from a Prospective Nationwide Surveillance Study?  

PubMed Central

Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. Data from a nationwide, concurrent surveillance study, Brazilian SCOPE (Surveillance and Control of Pathogens of Epidemiological Importance), were used to examine the epidemiology and microbiology of nBSIs at 16 Brazilian hospitals. In our study 2,563 patients with nBSIs were included from 12 June 2007 to 31 March 2010. Ninety-five percent of BSIs were monomicrobial. Gram-negative organisms caused 58.5% of these BSIs, Gram-positive organisms caused 35.4%, and fungi caused 6.1%. The most common pathogens (monomicrobial) were Staphylococcus aureus (14.0%), coagulase-negative staphylococci (CoNS) (12.6%), Klebsiella spp. (12.0%), and Acinetobacter spp. (11.4%). The crude mortality was 40.0%. Forty-nine percent of nBSIs occurred in the intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 622 patients (24.3%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (70.3%). Methicillin resistance was detected in 157 S. aureus isolates (43.7%). Of the Klebsiella sp. isolates, 54.9% were resistant to third-generation cephalosporins. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 55.9% and 36.8%, respectively, were resistant to imipenem. In our multicenter study, we found high crude mortality and a high proportion of nBSIs due to antibiotic-resistant organisms.

Marra, Alexandre R.; Camargo, Luis Fernando Aranha; Pignatari, Antonio Carlos Campos; Sukiennik, Teresa; Behar, Paulo Renato Petersen; Medeiros, Eduardo Alexandrino Servolo; Ribeiro, Julival; Girao, Evelyne; Correa, Luci; Guerra, Carla; Brites, Carlos; Pereira, Carlos Alberto Pires; Carneiro, Irna; Reis, Marise; de Souza, Marta Antunes; Tranchesi, Regina; Barata, Cristina U.; Edmond, Michael B.

2011-01-01

160

Comparison of pathogen DNA isolation methods from large volumes of whole blood to improve molecular diagnosis of bloodstream infections.  

PubMed

For patients suffering from bloodstream infections (BSI) molecular diagnostics from whole blood holds promise to provide fast and adequate treatment. However, this approach is hampered by the need of large blood volumes. Three methods for pathogen DNA isolation from whole blood were compared, i.e. an enzymatic method (MolYsis, 1-5 ml), the novel non-enzymatic procedure (Polaris, 1-5 ml), and a method that does not entail removal of human DNA (Triton-Tris-EDTA EasyMAG, 200 µl). These methods were evaluated by processing blood spiked with 0-1000 CFU/ml of Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans. Downstream detection was performed with real-time PCR assays. Polaris and MolYsis processing followed by real-time PCRs enabled pathogen detection at clinically relevant concentrations of 1-10 CFU/ml blood. By increasing sample volumes, concurrent lower cycle threshold (Ct) values were obtained at clinically relevant pathogen concentrations, demonstrating the benefit of using larger blood volumes. A 100% detection rate at a concentration of 10 CFU/ml for all tested pathogens was obtained with the Polaris enrichment, whereas comparatively lower detection rates were measured for MolYsis (50-67%) and EasyMAG (58-79%). For the samples with a concentration of 1 CFU/ml Polaris resulted in most optimal detection rates of 70-75% (MolYsis 17-50% and TTE-EasyMAG 20-36%). The Polaris method was more reproducible, less labour intensive, and faster (45 minutes (including Qiagen DNA extraction) vs. 2 hours (MolYsis)). In conclusion, Polaris and MolYsis enrichment followed by DNA isolation and real-time PCR enables reliable and sensitive detection of bacteria and fungi from 5 ml blood. With Polaris results are available within 3 hours, showing potential for improved BSI diagnostics. PMID:23977288

Loonen, Anne J M; Bos, Martine P; van Meerbergen, Bart; Neerken, Sigi; Catsburg, Arnold; Dobbelaer, Irene; Penterman, Roel; Maertens, Geert; van de Wiel, Paul; Savelkoul, Paul; van den Brule, Adriaan J C

2013-08-15

161

A central venous line protocol decreases bloodstream infections and length of stay in a trauma intensive care unit population.  

PubMed

We evaluated the benefit of a central venous line (CVL) protocol on bloodstream infections (BSIs) and outcome in a trauma intensive care unit (ICU) population. We prospectively compared three groups: Group 1 (January 2003 to June 2004) preprotocol; Group 2 (July 2004 to June 2005) after the start of the protocol that included minimizing CVL use and strict universal precautions; and Group 3 (July 2005 to December 2006) after the addition of a line supply cart and nursing checklist. There were 1622 trauma patients admitted to the trauma ICU during the study period of whom 542 had a CVL. Group 3 had a higher Injury Severity Score (ISS) compared with both Groups 2 and 1 (28.3 +/- 13.0 vs 23.5 +/- 11.7 vs 22.8 +/- 12.0, P = 0.0002) but had a lower BSI rate/1000 line days (Group 1: 16.5; Group 2: 15.0; Group 3: 7.7). Adjusting for ISS group, three had shorter ICU length of stay (LOS) compared with Group 1 (12.11 +/- 1.46 vs 18.16 +/- 1.51, P = 0.01). Logistic regression showed ISS (P = 0.04; OR, 1.025; CI, 1.001-1.050) and a lack of CVL protocol (P = 0.01; OR, 0.31; CI, 0.13-0.76) to be independent predictors of BSI. CVL protocols decrease both BSI and LOS in trauma patients. Strict enforcement by a nurse preserves the integrity of the protocol. PMID:19999905

Duane, Therèse M; Brown, Holly; Borchers, C Todd; Wolfe, Luke G; Malhotra, Ajai K; Aboutanos, Michel B; Ivatury, Rao R

2009-12-01

162

Systematic review and meta-analysis of linezolid and daptomycin for treatment of vancomycin-resistant enterococcal bloodstream infections.  

PubMed

Bloodstream infections due to vancomycin-resistant enterococci (VRE-BSI) result in substantial patient mortality and cost. Daptomycin and linezolid are commonly prescribed for VRE-BSI, but there are no clinical trials to determine optimal antibiotic selection. We conducted a systematic review for investigations that compared daptomycin and linezolid for VRE-BSI. We searched Medline from 1966 through 2012 for comparisons of linezolid and daptomycin for VRE-BSI. We included searches of EMBASE, clinicaltrials.gov, and national meetings. Data were extracted using a standardized instrument. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using a fixed-effects model. Our search yielded 4,243 publications, of which 482 contained data on VRE treatment. Most studies (452/482) did not present data on BSI or did not provide information on linezolid or daptomycin. Among the remaining 30 studies, 9 offered comparative data between the two agents. None were randomized clinical trials. There was no difference in microbiologic (n = 5 studies, 517 patients; OR, 1.0; 95% CI, 0.4 to 1.7; P = 0.95) and clinical (n = 3 studies, 357 patients; OR, 1.2; 95% CI, 0.7 to 2.0; P = 0.7) cures between the two antibiotics. There was a trend toward increased survival with linezolid compared to daptomycin treatment (n = 9 studies, 1,074 patients; OR, 1.3; 95% CI, 1.1 to 1.8; I(2) = 0 [where I(2) is a measure of inconsistency]), but this did not reach statistical significance (P = 0.054). There are limited data to inform clinicians on optimal antibiotic selection for VRE-BSI. Available studies are limited by small sample size, lack of patient-level data, and inconsistent outcome definitions. Additional research, including randomized clinical trials, is needed before conclusions can be drawn about treatment options for VRE therapy. PMID:23896468

Whang, Donald W; Miller, Loren G; Partain, Neil M; McKinnell, James A

2013-07-29

163

Prevention of catheter-related bloodstream infections: an appraisal of developments in designing an infection-resistant 'dream dialysis-catheter'.  

PubMed

With the increasing number of elderly, diabetics and debilitated patients being accepted for haemodialysis (HD), the use of central venous catheters (CVCs) as vascular access has become more widespread, with an inevitable inherent risk of catheter-related bloodstream infections (CRBSI) and ensuing mortality. No reliable plans for the effective management of CRBSI without actually sacrificing vascular access sites are presently available. Therefore, the onus really falls on renal physicians to make effective use of the established supportive guiding principles, practices, policies and programs to prevent CRBSI among HD patients. A huge body of research in polymer industry has aimed at alterations of physical, chemical, biological and immunological properties of CVCs to prevent the bacterial colonization of catheters. Developing an infection-resistant dialysis catheter has been an elusive dream. This article analyses the current state-of-the-art strategies aimed at preventing CRBSI and also reviews the progress made to date, in the direction of development of a 'bioactive' thrombosis and infection-resistant dialysis catheter. PMID:15958036

Saxena, Anil K; Panhotra, Bodh R

2005-06-01

164

Nationwide Sentinel Surveillance of Bloodstream Candida Infections in 40 Tertiary Care Hospitals in Spain? †  

PubMed Central

Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Spain to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for acquiring a Candida infection. Prospective laboratory-based surveillance was conducted from June 2008 to June 2009 in 40 medical centers located around the country. A case of candidemia was defined as the isolation of a Candida species from a blood culture. Incidence rates were calculated per 1,000 admissions. Antifungal susceptibility tests were performed by using broth microdilution assay according to the guidelines of the Clinical and Laboratory Standards Institute. We detected 984 cases, for an overall incidence of 1.09 cases per 1,000 admissions. The crude mortality was 20.20%. Candida albicans was the most common species (49.08%), followed by C. parapsilosis (20.73%), C. glabrata (13.61%), and C. tropicalis (10.77%). Overall, decreased susceptibility to fluconazole occurred in 69 (7.01%) incident isolates. Antifungal resistance was rare, and a moderate linear correlation between fluconazole and voriconazole MICs was observed. This is the largest multicenter candidemia study conducted to date and shows the substantial morbidity and mortality of candidemia in Spain.

Cisterna, R.; Ezpeleta, G.; Telleria, O.; Guinea, J.; Regueiro, B.; Garcia-Rodriguez, J.; Esperalba, J.

2010-01-01

165

Admission to hospital with community-onset bloodstream infection during the 'after hours' is not associated with an increased risk for death.  

PubMed

Several studies conducted in diverse patient populations have found that patients presenting with acute illness during weekends or evening/nights are at increased risk for death. This study was conducted to examine whether patients with community-onset bloodstream infections who are admitted during evenings, nights, and weekends suffer increased mortality rates. All residents within the Calgary area who had first admissions with community-onset bloodstream infections during 2000-2008 were included. One thousand eight hundred and seventy-eight (27%) patients were admitted on a weekend. Among all admissions, 2753 (40%) were during the hours of 08:00-17:59, 1996 (29%) during 18:00-22:59, and 2174 (31%) during 23:00-07:59. More than two-thirds (n = 4867; 70%) of cases were admitted during the 'after hours' (evenings, nights, and/or weekends). The 30-day case-fatality rate was 13% (882/6923) and did not significantly vary between daytime (364/2753; 13%), evening (246/1996; 12%), and night (272/2174; 13%) admissions (p = 0.6), or with patients admitted on weekends as compared to weekdays (252/1878 (13%) vs. 630/5045 (12%); p = 0.3). Admission during the after hours (weekends and evenings/nights) was not associated with increased risk for death in logistic regression analysis (odds ratio 0.99, 95% confidence interval 0.83-1.16; p = 0.88). Admission with community-onset bloodstream infection during the after hours is not associated with adverse outcome in this region. PMID:20662617

Laupland, Kevin B

2010-07-22

166

Impact of changes in CLSI and EUCAST breakpoints for susceptibility in bloodstream infections due to extended-spectrum ?-lactamase-producing Escherichia coli.  

PubMed

The impact of recent changes in and discrepancies between the breakpoints for cephalosporins and other antimicrobials, as determined by CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST), was analysed in patients with bloodstream infections caused by extended-spectrum ?-lactamase (ESBL) producing Escherichia coli in Spain, was analysed. We studied a cohort of 191 episodes of bloodstream infection caused by ESBL-producing E. coli in 13 Spanish hospitals; the susceptibility of isolates to different antimicrobials was investigated by microdilution and interpreted according to recommendations established in 2009 and 2010 by CLSI, and in 2011 by EUCAST. Overall, 58.6% and 14.7% of isolates were susceptible to ceftazidime, and 35.1% and 14.7% to cefepime using the CLSI-2010 and EUCAST-2009/2011 recommendations, respectively (all isolates would have been considered resistant using the previous guidelines). Discrepancies between the CLSI-2010 and the EUCAST-2011 recommendations were statistically significant for other antimicrobials only in the case of amikacin (98.4% versus 75.9% of susceptible isolates; p <0.01). The results varied depending on the ESBL produced. No significant differences were found in the percentage of patients classified as receiving appropriate therapy, following the different recommendations. Four out of 11 patients treated with active cephalosporins according to CLSI-2010 guidelines died (all had severe sepsis or shock); these cases would have been considered resistant according to EUCAST-2011. In conclusion, by using current breakpoints, extended-spectrum cephalosporins would be regarded as active agents for treating a significant proportion of patients with bloodstream infections caused by ESBL-producing E. coli. PMID:21985560

Rodríguez-Baño, J; Picón, E; Navarro, M D; López-Cerero, L; Pascual, A

2011-10-10

167

Direct MALDI-TOF Mass Spectrometry Assay of Blood Culture Broths for Rapid Identification of Candida Species Causing Bloodstream Infections: an Observational Study in Two Large Microbiology Laboratories  

PubMed Central

We evaluated the reliability of the Bruker Daltonik's MALDI Biotyper system in species-level identification of yeasts directly from blood culture bottles. Identification results were concordant with those of the conventional culture-based method for 95.9% of Candida albicans (187/195) and 86.5% of non-albicans Candida species (128/148). Results were available in 30 min (median), suggesting that this approach is a reliable, time-saving tool for routine identification of Candida species causing bloodstream infection.

Posteraro, Brunella; Fiori, Barbara; D'Inzeo, Tiziana; Campoli, Serena; Ruggeri, Alberto; Tumbarello, Mario; Canu, Giulia; Trecarichi, Enrico Maria; Parisi, Gabriella; Tronci, Mirella; Sanguinetti, Maurizio; Fadda, Giovanni

2012-01-01

168

Incidence of catheter-associated bloodstream infection after introduction of minocycline and rifampin antimicrobial-coated catheters in a pediatric burn population.  

PubMed

The Centers for Disease Control and Prevention guidelines for prevention of intravascular catheter-related infections suggest that antimicrobial-coated catheters can decrease the risk of developing catheter-related bloodstream infection in a variety of adult patient populations. There are limited data on their efficacy in the pediatric population, particularly among children with burn injuries. A study was conducted at Shriners Hospitals for Children®, Boston, to determine whether minocycline/rifampin (MR)-coated catheters could decrease the incidence of catheter-associated bloodstream infection (CABSI) in a pediatric burn population. A historical control group included all patients with double- or triple-lumen catheters inserted in the 18-month period from January 2006 to June 2007. The study group included all patients with MR antimicrobial double- or triple-lumen catheters inserted in the subsequent 18-month period, July 2007 to December 2008. Data collected included name, age, date of burn/injury, date of admission, percent TBSA area burn injury or other diagnosis, catheter site (subclavian, internal jugular, or femoral), method of insertion (new percutaneous stick or guidewire), type of catheter (double or triple lumen), date inserted, duration of catheter placement (days), and positive blood cultures recovered while the central venous catheter was in place. CABSI was defined using the Centers for Disease Control and Prevention definition of laboratory-confirmed bloodstream infection. There were a total of 66 patients with 252 catheters (1780 catheter days) in the control group and 75 patients with 263 catheters (1633 catheter days) in the study group. Age, percent burn injury, catheter site, and method of insertion were not statistically different between the two groups. The percentage of infected catheters and the rate of infection were significantly different for the two groups, with the MR antimicrobial catheters only half as likely to become infected. In a subset of these patients with catheters in place for more than 4 days, the percentage of infected catheters and rate of infection were also significantly different with results similar to those in the entire group. MR antimicrobial-coated catheters significantly reduced the incidence of CABSI in this pediatric burn population compared with noncoated catheters. PMID:22210071

Weber, Joan M; Sheridan, Robert L; Fagan, Shawn; Ryan, Colleen M; Pasternack, Mark S; Tompkins, Ronald G

169

Concurrent Epidemics of Skin and Soft Tissue Infection and Bloodstream Infection Due to Community-Associated Methicillin-Resistant Staphylococcus aureus  

PubMed Central

Background.?Since its emergence in 2000, epidemic spread of the methicillin-resistant Staphylococcus aureus (MRSA) clone USA300 has led to a high burden of skin and soft tissue infections (SSTIs) in the United States, yet its impact on MRSA bloodstream infections (BSIs) is poorly characterized. Methods.?To assess clonality of the MRSA isolates causing SSTI and BSI during the epidemic period, a stratified, random sample of 1350 unique infection isolates (from a total of 7252) recovered at the Community Health Network of San Francisco from 2000 to 2008 were selected for genotyping. Risk factors and outcomes for 549 BSI cases caused by the USA300 epidemic clone and non-USA300 MRSA clones were assessed by retrospective review of patient medical records. Results.?From 2000 to 2008, secular trends of USA300 SSTI and USA300 BSI were strongly correlated (Pearson r = 0.953). USA300 accounted for 55% (304/549) of BSIs as it was the predominant MRSA clone that caused community-associated (115/160), healthcare-associated community-onset (125/207), and hospital-onset (64/182) BSIs. Length of hospitalization after BSI diagnosis and mortality rates for USA300 and non-USA300 were similar. Two independent risk factors for USA300 BSI were identified: concurrent SSTI (adjusted relative risk, 1.4 [95% confidence interval {CI}, 1.2–1.6]) and anti-MRSA antimicrobial use in the preceding 30 days (0.7 [95% CI, .6–.8]). Isolates from concurrent SSTI were indistinguishable genotypically from the USA300 isolates that caused BSI. Conclusions.?USA300 SSTIs serve as a source for BSI. Strategies to control the USA300 SSTI epidemic may lessen the severity of the concurrent USA300 BSI epidemic.

Tattevin, Pierre; Schwartz, Brian S.; Graber, Christopher J.; Volinski, Joann; Bhukhen, Akta; Bhukhen, Arti; Mai, Thuy T.; Vo, Nhung H.; Dang, Denise N.; Phan, Tiffany HaiVan; Basuino, Li; Perdreau-Remington, Francoise; Chambers, Henry F.; Diep, Binh An

2012-01-01

170

Antibiotic treatment duration for bloodstream infections in critically ill patients: a national survey of Canadian infectious diseases and critical care specialists.  

PubMed

An optimum duration of antibiotic therapy would eradicate infection whilst minimising adverse drug reactions, resistance and costs. However, there is a paucity of evidence guiding the duration of therapy for bloodstream infections. Canadian infectious diseases (ID) and critical care specialists were surveyed regarding their recommended antibiotic treatment durations for five common bacteraemic syndromes. A descriptive analysis was performed to assess: (i) practice heterogeneity; (ii) equipoise for a trial of shorter versus longer therapy; and (iii) the influence of pathogen and host characteristics on recommendations. In total, 172 clinicians responded to the survey (60% ID, 39% critical care and 1% combined specialists). For each syndrome, the most common recommendation was 14 days, yet the majority of respondents recommended durations of ? 10 days. Median durations were similar for each syndrome: central vascular catheter-related bloodstream infection, 10 ± 3.6 days; bacteraemic pneumonia, 10 ± 2.8 days; bacteraemic urinary tract infection, 10 ± 3.8 days; bacteraemic intra-abdominal infection, 10 ± 4.1 days; and bacteraemic skin and soft-tissue infection, 14 ± 3.2 days. Respondents recommended the longest durations for Staphylococcus aureus and the shortest durations for coagulase-negative staphylococci. Most respondents would not modify duration based on host characteristics or measures of clinical response. ID physicians recommended longer durations than critical care physicians for all five syndromes, but the majority of both specialist groups would enrol patients in a trial of shorter (7 day) versus longer (14 day) antibiotic therapy. In conclusion, significant practice variation exists amongst clinicians' recommended durations of antibiotic treatment for bacteraemia. There is equipoise for a randomised trial comparing shorter versus longer courses of antibiotics for most bacteraemic syndromes and pathogens. PMID:21982833

Daneman, Nick; Shore, Kevin; Pinto, Ruxandra; Fowler, Rob

2011-10-07

171

Catheter-related bloodstream infectio  

Microsoft Academic Search

Central venous catheters are associated with the vast majority of nosocomial, catheter-related bloodstream infections (CR-BSI).\\u000a Despite identification of multiple effective methods for preventing CR-BSI, it remains an important clinical problem. Catheters\\u000a coated with anti-infective substances, such as chlorhexidine and silver sulfadiazine or rifampin and minocycline, have shown\\u000a promising results in recent clinical trials, but confirmatory studies by different investigators are

David P. Calfee; Barry M. Farr

1999-01-01

172

Impact of Hospital Care on Incidence of Bloodstream Infection: The Evaluation of Processes and Indicators in Infection Control Study  

Microsoft Academic Search

The Evaluation of Processes and Indicators in Infection Control (EPIC) study assesses the relationship between hospital care and rates of central venous catheter-associated primary bacteremia in 54 intensive- care units (ICUs) in the United States and 14 other countries. Using ICU rather than the patient as the primary unit of statistical analysis permits evaluation of factors that vary at the

Stephen B. Kritchevsky; Barbara I. Braun; Edward S. Wong; Steven L. Solomon; Lynn Steele; Cheryl Richards

2001-01-01

173

The decline of typhoid and the rise of non-typhoid salmonellae and fungal infections in a changing HIV landscape: bloodstream infection trends over 15 years in southern Vietnam.  

PubMed

The etiological spectrum of bloodstream infections is variable between industrialized and developing countries and even within a defined location over time. We investigated trends in bloodstream infections at an infectious disease hospital in Ho Chi Minh City, Vietnam, from 1994-2008. Amongst 66,111 blood cultures performed, a clinically relevant pathogen was isolated in 7645 episodes (positivity rate; 116/1000 cultures). Salmonella Typhi was the predominant pathogen until 2002; however, a considerable annual decline in the proportion of S. Typhi was observed (OR 0.6993, 95% CI [0.6885, 0.7103], p<0.0001). Conversely, there was a significant increase in the proportions of non-typhoidal Salmonella (NTS), Cryptococcus neoformans and Penicillium marneffei, concurrent with increasing HIV prevalence. These data document a substantial longitudinal shift in bloodstream infection etiology in southern Vietnam. We propose such changes are related to increasing economic prosperity and HIV prevalence, and this pattern marks a substantial change in the epidemiology of invasive salmonellosis in Southeast Asia. PMID:22137537

Nga, Tran Vu Thieu; Parry, Christopher M; Le, Thuy; Lan, Nguyen Phu Huong; Diep, To Song; Campbell, James I; Hoang, Nguyen Van Minh; Dung, Le Thi; Wain, John; Dolecek, Christiane; Farrar, Jeremy J; Chau, Nguyen Van Vinh; Hien, Tran Tinh; Day, Jeremy N; Baker, Stephen

2012-01-01

174

Biodegradation of triphenylmethane dye Malachite Green by Sphingomonas paucimobilis  

Microsoft Academic Search

Triphenylmethane dyes belong to the most important group of synthetic colorants and are used extensively in the textile industries\\u000a for dying cotton, wool, silk, nylon, etc. They are generally considered as the xenobiotic compounds, which are very recalcitrant\\u000a to biodegradation. Sphingomonas paucimobilis, was isolated from the soil sample collected from contaminated sites of textile industry located in KsarHellal, Tunisia,\\u000a and

Lamia Ayed; Kamel Chaieb; Abdelkarim Cheref; Amina Bakhrouf

2009-01-01

175

Regiospecific oxidoreductions catalyzed by a new Pseudomonas paucimobilis hydroxysteroid dehydrogenase  

Microsoft Academic Search

The preparative-scale regio- and stereo-specific oxidation of hydroxy groups and reduction of keto functions at C(3) of several C21 bile acids, catalyzed by a new 3?-hydroxysteroid dehydrogenase (3?-HSDH), is reported. The crude enzyme, isolated from the cells of Pseudomonas paucimobilis, revealed the presence of a further enzymatic fraction containing a secondary alcohol dehydrogenase (SADH), that has been used to recycle

Ercolina Bianchini; Nicola Chinaglia; Mariangela Dean; Pier Paolo Giovannini; Alessandro Medici; Paola Pedrini; Silvia Poli

1999-01-01

176

Costs of bloodstream infections caused by Escherichia coli and influence of extended-spectrum-beta-lactamase production and inadequate initial antibiotic therapy.  

PubMed

Escherichia coli is the leading cause of bloodstream infections (BSIs) caused by Gram-negative bacteria. The increasing prevalence of antibiotic-resistant E. coli strains, particularly those producing extended-spectrum ?-lactamases (ESBLs), increases the odds that empirically prescribed antimicrobial therapy for these infections will be inadequate, but the economic impact of this risk has not been fully evaluated. In the present retrospective 1-year analysis of 134 consecutive E. coli BSIs in our hospital, we explored the clinical and economic impacts of (i) inadequate initial antimicrobial treatment (IIAT) (i.e., empirical treatment with drugs to which the isolate had displayed in vitro resistance) of these infections and (ii) ESBL production by the bloodstream isolate. Cost data were obtained from the hospital accounting system. Compared with the 107 (79.8%) adequately treated patients, the 27 (20.1%) who received IIAT had a higher proportion of ESBL BSIs (74.0% versus 15.8%), longer (+6 days) and more costly (+EUR 4,322.00) post-BSI-onset hospital stays, and higher 21-day mortality rates (40.7% versus 5.6%). Compared with the 97 non-ESBL infections, the 37 (27.6%) ESBL BSIs were also associated with longer (+7 days) and more costly (+EUR 5,026.00) post-BSI-onset hospital stays and increased 21-day mortality (29.7% versus 6.1%). These findings confirm that the hospital costs and mortality associated with E. coli BSIs are significantly increased by ESBL production and by IIAT. PMID:20660675

Tumbarello, Mario; Spanu, Teresa; Di Bidino, Rossella; Marchetti, Marco; Ruggeri, Matteo; Trecarichi, Enrico Maria; De Pascale, Gennaro; Proli, Enrica Maria; Cauda, Roberto; Cicchetti, Americo; Fadda, Giovanni

2010-07-26

177

Costs of Bloodstream Infections Caused by Escherichia coli and Influence of Extended-Spectrum-?-Lactamase Production and Inadequate Initial Antibiotic Therapy?  

PubMed Central

Escherichia coli is the leading cause of bloodstream infections (BSIs) caused by Gram-negative bacteria. The increasing prevalence of antibiotic-resistant E. coli strains, particularly those producing extended-spectrum ?-lactamases (ESBLs), increases the odds that empirically prescribed antimicrobial therapy for these infections will be inadequate, but the economic impact of this risk has not been fully evaluated. In the present retrospective 1-year analysis of 134 consecutive E. coli BSIs in our hospital, we explored the clinical and economic impacts of (i) inadequate initial antimicrobial treatment (IIAT) (i.e., empirical treatment with drugs to which the isolate had displayed in vitro resistance) of these infections and (ii) ESBL production by the bloodstream isolate. Cost data were obtained from the hospital accounting system. Compared with the 107 (79.8%) adequately treated patients, the 27 (20.1%) who received IIAT had a higher proportion of ESBL BSIs (74.0% versus 15.8%), longer (+6 days) and more costly (+EUR 4,322.00) post-BSI-onset hospital stays, and higher 21-day mortality rates (40.7% versus 5.6%). Compared with the 97 non-ESBL infections, the 37 (27.6%) ESBL BSIs were also associated with longer (+7 days) and more costly (+EUR 5,026.00) post-BSI-onset hospital stays and increased 21-day mortality (29.7% versus 6.1%). These findings confirm that the hospital costs and mortality associated with E. coli BSIs are significantly increased by ESBL production and by IIAT.

Tumbarello, Mario; Spanu, Teresa; Di Bidino, Rossella; Marchetti, Marco; Ruggeri, Matteo; Trecarichi, Enrico Maria; De Pascale, Gennaro; Proli, Enrica Maria; Cauda, Roberto; Cicchetti, Americo; Fadda, Giovanni

2010-01-01

178

Clinical Characteristics of Bloodstream Infections Due to Ampicillin-Sulbactam-Resistant, Non-Extended- Spectrum-?-Lactamase-Producing Escherichia coli and the Role of TEM-1 Hyperproduction?  

PubMed Central

Ampicillin-sulbactam is commonly used as an empirical therapy for invasive infections where Escherichia coli is a potential pathogen. We evaluated the clinical and microbiologic characteristics of bloodstream infection due to E. coli, with focus on cases that were nonsusceptible to ampicillin-sulbactam and not producing extended-spectrum ?-lactamase (ESBL). Of a total of 357 unique bacteremic cases identified between 2005 and 2008, 111 (31.1%) were intermediate or resistant to ampicillin-sulbactam by disk testing. In multivariate analysis, a history of liver disease, organ transplant, peptic ulcer disease, and prior use of ampicillin-sulbactam were independent risk factors for bloodstream infection with ampicillin-sulbactam-nonsusceptible E. coli. Among cases that received ampicillin-sulbactam as an empirical therapy, an early clinical response was observed in 65% (22/34) of susceptible cases but in only 20% (1/5) of nonsusceptible cases. Among 50 ampicillin-sulbactam-resistant isolates examined, there was no clonal relatedness and no evidence of production of inhibitor-resistant TEM (IRT). Instead, the resistance was attributed to hyperproduction of TEM-1 ?-lactamase in the majority of isolates. However, promoter sequences of blaTEM-1 did not predict resistance to ampicillin-sulbactam. While the plasmid copy number did not differ between representative resistant and susceptible isolates, the relative expression of blaTEM-1 was significantly higher in two of three resistant isolates than in three susceptible isolates. These results suggest high-level blaTEM-1 expression as the predominant cause of ampicillin-sulbactam resistance and also the presence of yet-unidentified factors promoting overexpression of blaTEM-1 in these isolates.

Waltner-Toews, Rebecca I.; Paterson, David L.; Qureshi, Zubair A.; Sidjabat, Hanna E.; Adams-Haduch, Jennifer M.; Shutt, Kathleen A.; Jones, Mark; Tian, Guo-Bao; Pasculle, Anthony W.; Doi, Yohei

2011-01-01

179

Rapid Real-Time Nucleic Acid Sequence-Based Amplification-Molecular Beacon Platform To Detect Fungal and Bacterial Bloodstream Infections ?  

PubMed Central

Bloodstream infections (BSIs) are a significant cause of morbidity and mortality. Successful patient outcomes are diminished by a failure to rapidly diagnose these infections and initiate appropriate therapy. A rapid and reliable diagnostic platform of high sensitivity is needed for the management of patients with BSIs. The combination of an RNA-dependent nucleic acid sequence-based amplification and molecular beacon (NASBA-MB) detection system in multiplex format was developed to rapidly detect medically important BSI organisms. Probes and primers representing pan-gram-negative, pan-gram-positive, pan-fungal, pan-Candida, and pan-Aspergillus organisms were established utilizing 16S and 28S rRNA targets for bacteria and fungi, respectively. Two multiplex panels were developed to rapidly discriminate bacterial or fungal infections at the subkingdom/genus level with a sensitivity of 1 to 50 genomes. A clinical study was performed to evaluate the accuracy of this platform by evaluating 570 clinical samples from a tertiary-care hospital group using blood bottle samples. The sensitivity, specificity, and Youden's index values for pan-gram-positive detection and pan-gram-negative detection were 99.7%, 100%, 0.997 and 98.6%, 95.9%, 0.945, respectively. The positive predictive values (PPV) and the negative predictive values (NPV) for these two probes were 100, 90.7, and 99.4, 99.4, respectively. Pan-fungal and pan-Candida probes showed 100% sensitivity, specificity, PPV, and NPV, and the pan-Aspergillus probe showed 100% NPV. Robust signals were observed for all probes in the multiplex panels, with signal detection in <15 min. The multiplex real-time NASBA-MB assay provides a valuable platform for the rapid and specific diagnosis of bloodstream pathogens, and reliable pathogen identification and characterization can be obtained in under 3 h.

Zhao, Yanan; Park, Steven; Kreiswirth, Barry N.; Ginocchio, Christine C.; Veyret, Raphael; Laayoun, Ali; Troesch, Alain; Perlin, David S.

2009-01-01

180

Clinical characteristics of bloodstream infections due to ampicillin-sulbactam-resistant, non-extended- spectrum-beta-lactamase-producing Escherichia coli and the role of TEM-1 hyperproduction.  

PubMed

Ampicillin-sulbactam is commonly used as an empirical therapy for invasive infections where Escherichia coli is a potential pathogen. We evaluated the clinical and microbiologic characteristics of bloodstream infection due to E. coli, with focus on cases that were nonsusceptible to ampicillin-sulbactam and not producing extended-spectrum ?-lactamase (ESBL). Of a total of 357 unique bacteremic cases identified between 2005 and 2008, 111 (31.1%) were intermediate or resistant to ampicillin-sulbactam by disk testing. In multivariate analysis, a history of liver disease, organ transplant, peptic ulcer disease, and prior use of ampicillin-sulbactam were independent risk factors for bloodstream infection with ampicillin-sulbactam-nonsusceptible E. coli. Among cases that received ampicillin-sulbactam as an empirical therapy, an early clinical response was observed in 65% (22/34) of susceptible cases but in only 20% (1/5) of nonsusceptible cases. Among 50 ampicillin-sulbactam-resistant isolates examined, there was no clonal relatedness and no evidence of production of inhibitor-resistant TEM (IRT). Instead, the resistance was attributed to hyperproduction of TEM-1 ?-lactamase in the majority of isolates. However, promoter sequences of bla(TEM-1) did not predict resistance to ampicillin-sulbactam. While the plasmid copy number did not differ between representative resistant and susceptible isolates, the relative expression of bla(TEM-1) was significantly higher in two of three resistant isolates than in three susceptible isolates. These results suggest high-level bla(TEM-1) expression as the predominant cause of ampicillin-sulbactam resistance and also the presence of yet-unidentified factors promoting overexpression of bla(TEM-1) in these isolates. PMID:21135189

Waltner-Toews, Rebecca I; Paterson, David L; Qureshi, Zubair A; Sidjabat, Hanna E; Adams-Haduch, Jennifer M; Shutt, Kathleen A; Jones, Mark; Tian, Guo-Bao; Pasculle, Anthony W; Doi, Yohei

2010-12-06

181

An Association Between Bacterial Genotype Combined With a High-Vancomycin Minimum Inhibitory Concentration and Risk of Endocarditis in Methicillin-Resistant Staphylococcus aureus Bloodstream Infection  

PubMed Central

Introduction.?Antimicrobial resistance and bacterial virulence factors may increase the risk of hematogenous complications during methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI). This study reports on the impact of increasing vancomycin minimum inhibitory concentrations (V-MICs) and MRSA clone type on risk of hematogenous complications from MRSA BSI during implementation of an effective MRSA control program. Methods.?In sum, spa typing, staphylococcal cassette chromosome mec allotyping, and vancomycin and teicoplanin MICs were performed on 821 consecutive MRSA bloodstream isolates from 1999 to 2009. Prospectively collected data, including focus of infection, were available for 695 clinically significant cases. Logistic and multinomial logistic regression was used to determine the association between clone type, vancomycin MIC (V-MIC), and focus of infection. Results.?MRSA BSIs decreased by ?90% during the 11 years. Typing placed isolates into 3 clonal complex (CC) groups that had different population median V-MICs (CC30, 0.5 ?g/mL [n = 349]; CC22, 0.75 ?g/mL [n = 272]; non-CC22/30, 1.5 ?g/mL [n = 199]). There was a progressive increase in the proportion of isolates with a V-MIC above baseline median in each clonal group and a disproportionate fall in the clone group with lowest median V-MIC (CC30). In contrast, there were no increases in teicoplanin MICs. High V-MIC CC22 isolates (1.5–2 ?g/mL) were strongly associated with endocarditis (odds ratio, 12; 95% confidence interval, 3.72–38.9) and with a septic metastasis after catheter-related BSI (odds ratio, 106; 95% confidence interval, 12.6–883) compared with other clone type/V-MIC combinations. Conclusions.?An interaction between clone type and V-MIC can influence the risk of endocarditis associated with MRSA BSI, implying involvement of both therapeutic and host-pathogen factors.

Miller, Clare E.; Batra, Rahul; Cooper, Ben S.; Patel, Amita K.; Klein, John; Otter, Jonathan A.; Kypraios, Theodore; French, Gary L.

2012-01-01

182

International Surveillance of Bloodstream Infections Due to Candida Species: Frequency of Occurrence and In Vitro Susceptibilities to Fluconazole, Ravuconazole, and Voriconazole of Isolates Collected from 1997 through 1999 in the SENTRY Antimicrobial Surveillance Program  

Microsoft Academic Search

A surveillance program (SENTRY) of bloodstream infections (BSI) in the United States, Canada, Latin America, and Europe from 1997 through 1999 detected 1,184 episodes of candidemia in 71 medical centers (32 in the United States, 23 in Europe, 9 in Latin America, and 7 in Canada). Overall, 55% of the yeast BSIs were due to Candida albicans, followed by Candida

M. A. Pfaller; D. J. Diekema; R. N. Jones; H. S. Sader; A. C. Fluit; R. J. Hollis; S. A. Messer

2001-01-01

183

Uptake of Cr (VI) by Sphingomonas paucimobilis Biomass from Aqueous Solutions  

Microsoft Academic Search

The Sphingomonas paucimobilis biomass has been successfully utilized to degrade several persistent organic pollutants (POPs). However, few studies have been conducted to use it to remove heavy metals from aqueous solutions. In the present study, biosorption experiments for Cr (VI) were investigated using nonliving biomass of S. paucimobilis isolated from activated sludge, Lianyungang Dapu sewage treatment plant, China. The effects

Xue Song Wang; Li Ping Huang; Yuan Li; Jing Chen; Wen He; Hua Hua Miao

2010-01-01

184

Outbreaks of gram-negative bacterial bloodstream infections traced to probable contamination of hemodialysis machines--Canada, 1995; United States, 1997; and Israel, 1997.  

PubMed

During 1996, approximately 236,000 persons received hemodialysis in the United States; of these, an estimated 183,000 (78%) received chronic hemodialysis. Patients who receive chronic hemodialysis are at increased risk for bloodstream infections (BSIs) because of the need for repeated vascular access. Reported BSI rates for hemodialysis patients have ranged from 8.4 to 16.8 episodes per 100 patient-years, and BSI has been identified as the cause of death in 6%-18% of hemodialysis patients. Outbreaks of BSIs in hemodialysis units usually have been caused by inadequate disinfection of 1) water treatment or distribution systems and 2) reprocessed dialyzers. This report summarizes the investigations of three clusters of gram-negative bacterial BSIs at hemodialysis centers in Canada, the United States, and Israel. The findings indicate that all three outbreaks probably resulted from contamination of the waste drain ports in the same model of hemodialysis machine. PMID:9461047

1998-01-30

185

Carriage of virulence factors and molecular characteristics of Staphylococcus aureus isolates associated with bloodstream, and skin and soft tissue infections in children.  

PubMed

We investigated the virulence gene carriage and molecular type characteristics of Staphylococcus aureus isolates from bloodstream infections (BSIs) and skin and soft tissue infections (SSTIs) in children. A total of 71 isolates, 16 of which were methicillin-resistant S. aureus (MRSA), were investigated by PCR for virulence-associated gene profiles, sequence type and spa type. This revealed that 76.7% and 53.7% of the SSTI and BSI isolates, respectively, exhibited simultaneous carriage of o10 virulence genes. Compared to BSI isolates, carriage rates for hla, hlb, cna, clfA, seb, sec and pvl genes were significantly higher in SSTI isolates. By contrast, carriage of eta, etb and sea was significantly higher for BSI isolates. Thirty-four sequence types (STs) and 36 spa types were identified in the 71 isolates and included 14 novel STs and four novel spa types. ST59-MRSA-IV/V-t437 was the most common clone in the MRSA isolates. We concluded that virulence determinants are widely distributed in isolates of S. aureus strains from children with BSIs and SSTIs, with an unexpectedly high rate in SSTI isolates. Future profiling of S. aureus virulence determinants may allow the prediction of severity and outcome for children with these infections. PMID:23217217

Li, T; Yu, X; Xie, J; Xu, Y; Shang, Y; Liu, Y; Huang, X; Qin, Z; Parsons, C; Hu, L; Salgado, C; Wang, L; Yu, F

2012-12-10

186

Central venous catheter-associated bloodstream infection and colonisation of insertion site and catheter tip. What are the rates and risk factors in haematology patients?  

PubMed

Skin colonisation is an important source for central venous catheter (CVC) colonisation and infection. This study intended to identify risk factors for skin colonisation prior to CVC placement (baseline colonisation) and within 10 days after CVC insertion (subsequent colonisation), for CVC-tip colonisation and for bloodstream infection (BSI). Within a randomised clinical trial, data of 219 patients with haematological malignancies and inserted CVC (with a total of 5,501 CVC-days and 4,275 days at risk) in two university hospitals were analysed. Quantitative skin cultures were obtained from the insertion site before CVC placement and at regular intervals afterwards. CVC-tip cultures were taken on CVC removal and data collection was performed. Statistical analysis included linear and logistic regression models. Age was an independent risk factor for colonisation prior to CVC placement (baseline colonisation). Independent risk factors for subsequent colonisation were baseline colonisation and male gender. High level of subsequent skin colonisation at the insertion site was a predictor of CVC-tip colonisation, and a predictor of BSI. High level of skin colonisation predicts catheter tip colonisation and possibly subsequent infection. Sustained reduction of bacterial growth at the CVC insertion site is therefore indispensable. Male patients are at particular risk for skin colonisation and may be a target population for additional insertion-site care before and during catheterisation. PMID:20532506

Luft, Dirk; Schmoor, Claudia; Wilson, Christine; Widmer, Andreas F; Bertz, Hartmut; Frei, Reno; Heim, Dominik; Dettenkofer, Markus

2010-06-08

187

Educational interventions to reduce the rate of central catheter-related bloodstream infections in the NICU: a review of the research literature.  

PubMed

Catheter-related bloodstream infections (CR-BSIs) are a significant cause of morbidity and mortality in the NICU, occurring at rates ranging from 11.3 per 1,000 catheter days in infants <1,000 g to 4 per 1,000 catheter days in infants >2,500 g. Cost-effective and successful educational interventions aimed at nurses have been shown to decrease CR-BSIs with adults, but no such studies address neonatal nurses. This literature review examined how educational interventions could help neonatal nurses reduce infection rates in patients with central venous catheters. Four databases were searched: PubMed, CINAHL, Cochrane, and OVID. Of ten studies that measured CR-BSIs before and after educational interventions, nine showed a postintervention reduction in the rate of CR-BSIs of 40 percent or greater (eight demonstrating statistically significant reductions), and the tenth reported a reduction rate of 21 percent. All of the educational programs had additional intervention components, so it is not possible to ascribe all the success to the education, but this review suggests that this topic needs to be studied with the NICU population. PMID:19892637

Semelsberger, Carrie F

188

Doing Well by Doing Good: Assessing the Cost Savings of an Intervention to Reduce Central Line-Associated Bloodstream Infections in a Hawaii Hospital.  

PubMed

A complete understanding of the financial impact of patient safety interventions must consider the economic incentives of both payers and providers within the current fee-for-service payment model. This study evaluated the impact of a central line-associated bloodstream infection (CLABSI) initiative on costs, reimbursements, and margins for 1 Hawaii hospital and its payers. Intensive care unit patients (January 2009-December 2011) who developed a CLABSI were compared to matched controls. Mean hospital cost, reimbursement, and margin was $222 692 versus $80 144 (P = .01), $259 433 versus $72 543 (P < .01), and $54 906 versus $6506 (P < .01), respectively. Although hospitals and payers reduce costs by preventing CLABSIs, hospitals also would decrease their margins, which creates a perverse incentive to have more line infections. An optimal reimbursement system must reward hospitals and payers for preventing harm rather than treating illness. This study highlights the critical role that health care payers have as patient safety advocates, financial sponsors, and facilitators. PMID:23652336

Hsu, Eugene; Lin, Della; Evans, Samuel J; Hamid, Kamran S; Frick, Kevin D; Yang, Ting; Pronovost, Peter J; Pham, Julius Cuong

2013-05-01

189

Suitability of initial antibiotic therapy for the treatment of bloodstream infections and the potential role of antibiotic management teams in improving it.  

PubMed

Hospital antibiotic management teams (AMTs) have been recommended, but, in France, their concrete implementation remains scarce and their effectiveness largely unevaluated. The objective of this investigation was to evaluate the appropriateness of antibiotic therapy (AT) for bloodstream infections (BSIs) at a 950-bed university teaching hospital, and assess the role of an AMT in improving it. A prospective analysis of all significant BSIs occurring outside of the intensive care unit (ICU) during an 18-month period was carried out. AT was deemed effective if at least one prescribed antibiotic was effective in vitro, and appropriate if it was consistent with local recommendations. Out of 574 BSIs, 512 were evaluated: 231 community-acquired, 206 nosocomial, and 75 healthcare-associated. For 219 (42.8%) BSIs, the AT initiated prior to AMT intervention proved to be effective and appropriate, inappropriate but effective in 136 (26.5%), and ineffective or absent in 157 (30.7%). In the multivariate analysis, hospital-acquired and other healthcare-associated BSIs, as well as catheter-borne (CB) infections, were associated with inappropriate or absent AT. A recommendation from the AMT was given and followed in 233 (94%) out of 249 BSIs requiring intervention. Initially, two-thirds of BSIs outside the ICU did not receive appropriate AT. Healthcare-associated BSIs should, therefore, be the priority target of AMTs. PMID:22134774

Diamantis, S; Rioux, C; Bonnal, C; Farfour, É; Papy, E; Andremont, A; Yeni, P; Bouvet, É; Lucet, J-C

2011-12-02

190

Overexpression of AmpC and Efflux Pumps in Pseudomonas aeruginosa Isolates from Bloodstream Infections: Prevalence and Impact on Resistance in a Spanish Multicenter Study?  

PubMed Central

The prevalence and impact of the overexpression of AmpC and efflux pumps were evaluated with a collection of 190 Pseudomonas aeruginosa isolates recovered from bloodstream infections in a 2008 multicenter study (10 hospitals) in Spain. The MICs of a panel of 13 antipseudomonal agents were determined by microdilution, and the expressions of ampC, mexB, mexY, mexD, and mexF were determined by real-time reverse transcription (RT)-PCR. Up to 39% of the isolates overexpressed at least one of the mechanisms. ampC overexpression (24.2%) was the most prevalent mechanism, followed by mexY (13.2%), mexB (12.6%), mexF (4.2%), and mexD (2.2%). The overexpression of mexB plus mexY, documented for 5.3% of the isolates, was the only combination showing a significantly (P = 0.02) higher prevalence than expected from the frequencies of the individual mechanisms (1.6%). Additionally, all imipenem-resistant isolates studied (25 representative isolates) showed inactivating mutations in oprD. Most of the isolates nonsusceptible to piperacillin-tazobactam (96%) and ceftazidime (84%) overexpressed ampC, while mexB (25%) and mexY (29%) overexpressions gained relevance among cefepime-nonsusceptible isolates. Nevertheless, the prevalence of mexY overexpression was highest among tobramycin-nonsusceptible isolates (37%), and that of mexB was highest among meropenem-nonsusceptible isolates (33%). Regarding ciprofloxacin-resistant isolates, besides the expected increased prevalence of efflux pump overexpression, a highly significant link to ampC overexpression was documented for the first time: up to 52% of ciprofloxacin-nonsusceptible isolates overexpressed ampC, sharply contrasting with the 24% documented for the complete collection (P < 0.001). In summary, mutation-driven resistance was frequent in P. aeruginosa isolates from bloodstream infections, whereas metallo-?-lactamases, detected in 2 isolates (1%) producing VIM-2, although with increasing prevalences, were still uncommon.

Cabot, Gabriel; Ocampo-Sosa, Alain A.; Tubau, Fe; Macia, Maria D.; Rodriguez, Cristina; Moya, Bartolome; Zamorano, Laura; Suarez, Cristina; Pena, Carmen; Martinez-Martinez, Luis; Oliver, Antonio

2011-01-01

191

The rate of bloodstream infection is high in infants with short bowel syndrome: Relationship with small bowel bacterial overgrowth, enteral feeding and inflammatory and immune responses  

PubMed Central

Objective This pilot study in parenteral nutrition (PN) dependent infants with short bowel syndrome (SBS) evaluated the impact of feeding route and intestinal permeability on bloodstream infection (BSI), small bowel bacterial overgrowth (SBBO) and systemic immune responses, and fecal calprotectin as a biomarker for SBBO. Study design 10 infants (ages 4.2-15.4 months) with SBS due to necrotizing enterocolitis were evaluated. Nutritional assessment, breath hydrogen testing, intestinal permeability, fecal calprotectin, serum flagellin- and LPS- specific antibody titers, and proinflammatory cytokine concentrations (TNF-?, IL-1 ?, IL-6, IL-8) were performed at baseline, 60 and 120 days. Healthy, age-matched controls (n=5) were recruited. Results BSI incidence was high (80%) and SBBO was common (50%). SBBO increased the odds for BSI (> 7-fold; p=0.009). Calprotectin levels were higher in children with SBS and SBBO versus those without SBBO and healthy controls (p<0.05). Serum TNF-?, was elevated at baseline versus controls. Serum TNF-?, IL-1 ?, IL-6 and IL-8 levels diminished with increased enteral nutrition. Anti-flagellin and anti-LPS IgG levels in children with SBSwere lower versus controls and rose over time. Conclusion In children with SBS, SBBO increases the risk for BSI and systemic proinflammatory response decreases with increasing enteral feeding and weaning PN.

Cole, Conrad R.; Frem, Juliana C.; Schmotzer, Brian; Gewirtz, Andrew T.; Meddings, Jonathan B.; Gold, Benjamin D.; Ziegler, Thomas R.

2009-01-01

192

Diagnosis by real-time polymerase chain reaction of pathogens and antimicrobial resistance genes in bone marrow transplant patients with bloodstream infections  

PubMed Central

Background Early identification of pathogens and antimicrobial resistance in bloodstream infections (BSIs) decreases morbidity and mortality, particularly in immunocompromised patients. The aim of the present study was to compare real-time polymerase chain reaction (PCR) with commercial kits for detection of 17 pathogens from blood culture (BC) and 10 antimicrobial resistance genes. Methods A total of 160 BCs were taken from bone marrow transplant patients and screened with Gram-specific probes by multiplex real-time PCR and 17 genus-specific sequences using TaqMan probes and blaSHV, blaTEM, blaCTX, blaKPC, blaIMP, blaSPM, blaVIM, vanA, vanB, and mecA genes by SYBR Green. Results Twenty-three of 33 samples identified by phenotypic testing were concordantly positive by BC and real-time PCR. Pathogen identification was discordant in 13 cases. In 12 of 15 coagulase-negative staphylococci, the mecA gene was detected and four Enterococcus spp. were positive for vanA. Two blaCTX and three blaSHV genes were found by quantitative PCR. The blaKPC and metallo-?-lactamase genes were not detected. Five fungal species were identified only by real-time PCR. Conclusions Real-time PCR could be a valuable complementary tool in the management of BSI in bone marrow transplants patients, allowing identification of pathogens and antimicrobial resistance genes.

2013-01-01

193

Prognosis of patients with methicillin-resistant Staphylococcus aureus bloodstream infection treated with teicoplanin: a retrospective cohort study investigating effect of teicoplanin minimum inhibitory concentrations  

PubMed Central

Background The present study was designed to investigate whether teicoplanin minimum inhibitory concentrations (MICs) of methicillin-resistant Staphylococcus aureus (MRSA) isolates play a role in the prognosis of patient with teicoplanin-treated MRSA bloodstream infection (BSI). Methods Between 1 January 2006 and 31 December 2009, adult patients with teicoplanin-treated MRSA BSI in two Taiwan medical centers were retrospectively enrolled. Their blood MRSA isolates were submitted for determination of MICs to various antibiotics and multi-locus sequence types. All-cause mortalities on Days 14 and 30, as well as clinical response at the end of teicoplanin therapy were treated as endpoints. Results Two hundred seventy adult patients were enrolled and 210 blood MRSA isolates were available. Independent risk factors for un-favorable outcome at the end of teicoplanin therapy included septic shock (p?

2013-01-01

194

Trends in Antifungal Susceptibility of Candida spp. Isolated from Pediatric and Adult Patients with Bloodstream Infections: SENTRY Antimicrobial Surveillance Program, 1997 to 2000  

PubMed Central

From 1 January 1997 through 31 December 2000, 2,047 bloodstream infections (BSIs) due to Candida spp. were reported from hospitals in the United States, Canada, Latin America, and Europe participating in the SENTRY Antifungal Surveillance Program. Among individuals in four age groups (?1, 2 to 15, 16 to 64, and ?65 years) Candida albicans was the most common species, causing 60, 55, 55, and 50% of infections, respectively. C. glabrata caused 17 to 23% of BSIs in those ages 16 to 64 and ?65 years, whereas it caused only 3% of BSIs in the individuals in the two younger age groups (P < 0.001). C. parapsilosis (which caused 21 to 24% of BSIs) and C. tropicalis (which caused 7 to 10% of BSIs) were more common than C. glabrata in individuals ages ?1 year and 2 to 15 years. Isolates of Candida spp. showed a trend of decreasing susceptibility to fluconazole, itraconazole, and amphotericin B with increasing patient age (P ? 0.01). None of the C. glabrata isolates from individuals ?1 year old were resistant to fluconazole, whereas they made up 5 to 9% of isolates from individuals ages 16 to 64 and ?65 years. Isolates of C. tropicalis from patients ?1 year old were more susceptible to flucytosine (MIC at which 90% of isolates are inhibited [MIC90], 0.5 ?g/ml; 0% resistant isolates) than those from patients ?65 years old (MIC90, 32 ?g/ml; 11% resistant isolates). The investigational triazoles posaconazole, ravuconazole, and voriconazole were all highly active against all species of Candida from individuals in all age groups. These data demonstrate differences in the species distributions of pathogens and differences in antifungal resistance among isolates from individuals in the pediatric and adult age groups. Ongoing surveillance will enhance efforts to limit the extent of antifungal resistance in individuals in various age groups.

Pfaller, M. A.; Diekema, D. J.; Jones, R. N.; Messer, S. A.; Hollis, R. J.

2002-01-01

195

The impact of staffing on central venous catheter-associated bloodstream infections in preterm neonates - results of nation-wide cohort study in Germany  

PubMed Central

Background Very low birthweight (VLBW) newborns on neonatal intensive care units (NICU) are at increased risk for developing central venous catheter-associated bloodstream infections (CVC BSI). In addition to the established intrinsic risk factors of VLBW newborns, it is still not clear which process and structure parameters within NICUs influence the prevalence of CVC BSI. Methods The study population consisted of VLBW newborns from NICUs that participated in the German nosocomial infection surveillance system for preterm infants (NEO-KISS) from January 2008 to June 2009. Structure and process parameters of NICUs were obtained by a questionnaire-based enquiry. Patient based date and the occurrence of BSI derived from the NEO-KISS database. The association between the requested parameters and the occurrance of CVC BSI and laboratory-confirmed BSI was analyzed by generalized estimating equations. Results We analyzed data on 5,586 VLBW infants from 108 NICUs and found 954 BSI cases in 847 infants. Of all BSI cases, 414 (43%) were CVC-associated. The pooled incidence density of CVC BSI was 8.3 per 1,000 CVC days. The pooled CVC utilization ratio was 24.3 CVC-days per 100 patient days. A low realized staffing rate lead to an increased risk of CVC BSI (OR 1.47; p=0.008) and also of laboratory-confirmed CVC BSI (OR 1.78; p=0.028). Conclusions Our findings show that low levels of realized staffing are associated with increased rates of CVC BSI on NICUs. Further studies are necessary to determine a threshold that should not be undercut.

2013-01-01

196

Catheter-related bloodstream infections caused by rapidly growing nontuberculous mycobacteria: a case series including rare species.  

PubMed

Rapidly growing nontuberculous mycobacteria (RGMs) are responsible for a variety of clinical syndromes in humans including catheter-related blood stream infections (CRBSIs). Recently, we identified a cluster of RGM-associated CRBSI at our institution. We describe the epidemiologic and clinical patterns associated with these infections. We conducted a retrospective single-center review of RGM CRBSI between May 2004 and June 2005. RGMs isolated from blood cultures of 6 patients included Mycobacterium mucogenicum (2), Mycobacterium fortuitum (2), and the rare RGM species, Mycobacterium neoaurum (1) and Mycobacterium septicum (1). All of the patients had a long-term intravascular catheter (mean duration, 6.5 months). Bacteremia was resolved in all patients after catheter removal and appropriate antibiotics. None of the patients suffered a relapse of RGM CRBSI, and all survived to 1 year. RGMs are causative pathogens in both immunosuppressed and immunocompetent individuals with long-term intravascular catheters and blood stream infections. Recent trends at our center suggest that infections with these pathogens are rising. PMID:18294801

Hawkins, Claudia; Qi, Chao; Warren, John; Stosor, Valentina

2008-02-21

197

Impact of bloodstream infections on outcome and the influence of prophylactic oral antibiotic regimens in allogeneic hematopoietic SCT recipients  

Microsoft Academic Search

This study aimed to determine the impact of blood stream infections (BSIs) on outcome of allogeneic hematopoietic SCT (HSCT), and to examine the influence of old (non-levofloxacin-containing) and new (levofloxacin-based) prophylactic antibiotic protocols on the pattern of BSIs. We retrospectively enrolled 246 allogeneic HSCT recipients between January 1999 and June 2006, dividing patients into BSI (within 6 months post-HSCT, n=61)

C-Y Liu; Y-C Lai; L-J Huang; Y-W Yang; T-L Chen; L-T Hsiao; J-H Liu; J-P Gau; P-M Chen; C-H Tzeng; T-J Chiou

2011-01-01

198

A Trypanosoma bruceiBloodstream Form Mutant Deficient in Ornithine Decarboxylase Can Protect against Wild-Type Infection in Mice  

Microsoft Academic Search

Mutomba, M. C., Li, F., Gottesdiener, K. M., and Wang, C. C. 1999. ATrypanosoma bruceibloodstream form mutant deficient in ornithine decarboxylase can protect against wild-type infection in mice.Experimental Parasitology91,176–184. ATrypanosoma bruceibloodstream mutant in which both copies of the ornithine decarboxylase (ODC) gene were knocked out (ODC mutant) was used to determine the biological functions of ODC inT. brucei.Growth of the

Martha C. Mutomba; Fengsheng Li; Keith M. Gottesdiener; Ching C. Wang

1999-01-01

199

Concordance of Gastrointestinal Tract Colonization and Subsequent Bloodstream Infections with Gram-negative Bacilli in Very Low Birthweight Infants in the Neonatal Intensive Care Unit  

PubMed Central

BACKGROUND Gram-negative bacilli (GNB) cause as many as 20% of episodes of late-onset sepsis among very low birth weight (VLBW, birth weight < or =1500 g) infants in the neonatal intensive care unit. As the gastrointestinal (GI) tract can serve as a reservoir for GNB, we hypothesized that VLBW infants with prior GI tract colonization with gentamicin-susceptible GNB who developed bloodstream infections (BSI) would do so with gentamicin-susceptible GNB. METHODS A prospective cohort study of VLBW infants was performed in 2 level III neonatal intensive care units from September 2004 to October 2007. GI tract surveillance cultures were obtained weekly. Risk factors for GNB BSI and for GI tract colonization with GNB were assessed. RESULTS Fifty-one (7.3%) of 698 subjects experienced 59 GNB BSIs of which 34 occurred by 6 weeks of life and 625 (90%) of 698 subjects were colonized with GNB. Overall, 25% of BSI and 16% of GI tract isolates were nonsusceptible to gentamicin and colonization with the same species and same gentamicin susceptibility profile preceded 98% of GNB BSIs. Vaginal delivery, birth weight < or =750 g, GI tract pathology, increased use of central venous catheters, use of vancomycin, mechanical ventilation, and H2 blockers/proton pump inhibitors were associated with GNB BSI. Vaginal delivery, birth weight >1000 g, and treatment with carbapenem agents were associated with GNB colonization. CONCLUSIONS These data support the use of empiric gentamicin to treat late-onset sepsis in infants colonized with gentamicin-susceptible GNB. Targeted GI tract surveillance cultures of infants with specific risk factors during weeks 2 to 6 of life could be used to guide empiric therapy for late-onset sepsis.

Smith, Ann; Saiman, Lisa; Zhou, Juyan; Della-Latta, Phyllis; Jia, Haomiao; Graham, Philip L.

2010-01-01

200

Use of Universal 16S rRNA Gene PCR as a Diagnostic Tool for Venous Access Port-Related Bloodstream Infections  

PubMed Central

Amplification of the universal 16S rRNA gene using PCR has improved the diagnostic yield of microbiological samples. However, no data have been reported on the reliability of this technique with venous access ports (VAPs). We assessed the utility of 16S rRNA PCR for the prediction of VAP-related bloodstream infection (VAP-RBSI). During a 2-year period, we prospectively received all VAPs removed by interventional radiologists. PCR and conventional cultures were performed using samples from the different VAP sites. We compared the results of PCR with those of conventional culture for patients with confirmed VAP-RBSI. We collected 219 VAPs from 219 patients. Conventional VAP culture revealed 15 episodes of VAP-RBSI. PCR revealed a further 4 episodes in patients undergoing antibiotic therapy which would have gone undetected using conventional culture. Moreover, it had a negative predictive value of 97.8% for the prediction of VAP-RBSI when it was performed using biofilm from the internal surface of the port. In conclusion, universal 16S rRNA PCR performed with samples from the inside of VAPs proved to be a useful tool for the diagnosis of VAP-RBSI. It increased detection of VAP-RBSI episodes by 21.1% in patients undergoing antibiotic therapy whose episodes would have gone undetected using conventional culture. Therefore, we propose a new application of 16S rRNA PCR as a useful tool for the diagnosis of VAP-RBSI in patients receiving antibiotic therapy.

Marin, M.; Martin-Rabadan, P.; Echenagusia, A.; Camunez, F.; Rodriguez-Rosales, G.; Simo, G.; Echenagusia, M.; Bouza, E.

2013-01-01

201

Predictive factors for mortality in patients with methicillin-resistant Staphylococcus aureus bloodstream infection: impact on outcome of host, microorganism and therapy.  

PubMed

Mortality related to methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) remains high, despite changes in the epidemiology. To analyze the current predictive factors for mortality we conducted a prospective study in a large cohort of patients with MRSA-BSI from 21 Spanish hospitals. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed, including susceptibility to antibiotics and molecular characterization. Vancomycin MICs (V-MIC) were tested by the E-test and microdilution methods. Time until death was the dependent variable in a Cox regression analysis. Overall, 579 episodes were included. Acquisition was nosocomial in 59% and vascular catheter was the most frequent source (38%). A dominant PFGE genotype was found in 368 (67%) isolates, which belonged to Clonal Complex (CC)5 and carried SCCmecIV and agr2. Microdilution V-MIC50 and V-MIC90 were 0.7 and 1.0 mg/L, respectively. Initial therapy was appropriate in 66% of episodes. Overall mortality was observed in 179 (32%) episodes. The Cox-regression analysis identified age >70 years (HR 1.88), previous fatal disease (HR 2.16), Pitt score >1 (HR 3.45), high-risk source (HR 1.85) and inappropriate initial treatment (HR 1.39) as independent predictive factors for mortality. CC5 and CC22 (HR 0.52 and 0.45) were associated with significantly lower mortality rates than CC8. V-MIC ?1.5 did not have a significant impact on mortality, regardless of the method used to assess it. PMID:23331461

Gasch, O; Camoez, M; Dominguez, M A; Padilla, B; Pintado, V; Almirante, B; Molina, J; Lopez-Medrano, F; Ruiz, E; Martinez, J A; Bereciartua, E; Rodriguez-Lopez, F; Fernandez-Mazarrasa, C; Goenaga, M A; Benito, N; Rodriguez-Baño, J; Espejo, E; Pujol, M

2012-11-22

202

Diagnosis of catheter-related bloodstream infection in a total parenteral nutrition population: inclusion of sepsis defervescence after removal of culture-positive central venous catheter.  

PubMed

Defervescence of sepsis after removal of culture-positive central venous catheters (CVCs) has been advocated for diagnosis of catheter-related bloodstream infection (CRBSI) even without positive blood culture. However, most studies report CRBSI incidence only when blood cultures, and CVC tip, are positive (standard definition). We examined the effect of inclusion of defervescence criteria on CRBSI incidence in a total parenteral nutrition (TPN) population. The study was carried out in a 525 bed tertiary referral hospital for a period of 12 years. CRBSI incidence was compared between standard definition (positive CVC tip culture and positive blood culture) and when 'defervescence criteria' were included. Sepsis defervescence was defined as a fall in temperature, white cell count and sepsis resolution after CVC removal, with positive CVC tip culture, but negative blood cultures. CRBSI episodes in which a blood culture was omitted were excluded. The study population included 1365 patients in whom 2536 CVCs were used over a period of 15 234 CVC-days. There were 192 CRBSI episodes in 165 patients. In all, 152 CRBSI episodes met only the standard criteria for CRBSI whereas 40 episodes met the defervescence criteria. The standard definition alone resulted in a mean (+/- SD) incidence of 10.6+/-5.8 per 1000 CVC-days. This increased to 13+/-6.4 per 1000 CVC-days when defervescence criteria were included. Inclusion of defervescence criteria increased CRBSI incidence by a mean of 2.5+/-1.4 episodes per 1000 days or 27% (95% CI: 1.61-3.339; P<0.001). This study implies that the scale of CRBSI may be higher than is currently recognised and that the blood culture positivity rate for CRBSI is 79% (152/192). PMID:20554348

Walshe, C M; Boner, K S; Bourke, J; Hone, R; Phelan, D

2010-06-16

203

Characterisation and clinical features of Enterobacter cloacae bloodstream infections occurring at a tertiary care university hospital in Switzerland: is cefepime adequate therapy?  

PubMed

Despite many years of clinical experience with cefepime, data regarding the outcome of patients suffering from bloodstream infections (BSIs) due to Enterobacter cloacae (Ecl) are scarce. To address the gap in our knowledge, 57 Ecl responsible for 51 BSIs were analysed implementing phenotypic and molecular methods (microarrays, PCRs for bla and other genes, rep-PCR to analyse clonality). Only two E. cloacae (3.5%) were ESBL-producers, whereas 34 (59.6%) and 18 (31.6%) possessed inducible (Ind-Ecl) or derepressed (Der-Ecl) AmpC enzymes, respectively. All isolates were susceptible to imipenem, meropenem, gentamicin and ciprofloxacin. Der-Ecl were highly resistant to ceftazidime and piperacillin/tazobactam (both MIC???256 ?g/mL), whereas cefepime retained its activity (MIC?? of 3 ?g/mL). rep-PCR indicated that the isolates were sporadic, but Ecl collected from the same patients were indistinguishable. In particular, three BSIs initially due to Ind-Ecl evolved (under ceftriaxone or piperacillin/tazobactam treatment) into Der-Ecl because of mutations or a deletion in ampD or insertion of IS4321 in the promoter. These last two mechanisms have never been described in Ecl. Mortality was higher for BSIs due to Der-Ecl than Ind-Ecl (3.8% vs. 29.4%; P=0.028) and was associated with the Charlson co-morbidity index (P=0.046). Using the following directed treatments, patients with BSI showed a favourable treatment outcome: cefepime (16/18; 88.9%); carbapenems (12/13; 92.3%); ceftriaxone (4/7; 57.1%); piperacillin/tazobactam (5/7; 71.4%); and ciprofloxacin (6/6; 100%). Cefepime represents a safe therapeutic option and an alternative to carbapenems to treat BSIs due to Ecl when the prevalence of ESBL-producers is low. PMID:23313399

Hilty, Markus; Sendi, Parham; Seiffert, Salome N; Droz, Sara; Perreten, Vincent; Hujer, Andrea M; Bonomo, Robert A; Mühlemann, Kathrin; Endimiani, Andrea

2013-01-10

204

Significance of Mannose-Binding Lectin Deficiency and Nucleotide-Binding Oligomerization Domain 2 Polymorphisms in Staphylococcus aureus Bloodstream Infections: A Case-Control Study  

PubMed Central

Background Pathways coordinated by innate pattern recognition receptors like mannose-binding lectin (MBL) and nucleotide-binding oligomerization domain 2 (NOD2) are among the first immune responses to Staphylococcus aureus (S. aureus) bloodstream infections (BSI) in animal models, but human data are limited. Here, we investigated the role of MBL deficiency and NOD2 mutations in the predisposition to and severity of S. aureus BSI. Patients and Methods A matched case-control study was undertaken involving 70 patients with S. aureus BSI and 70 age- and sex-matched hospitalized controls. MBL levels, MBL2 and NOD2 polymorphisms were analyzed. Results After adjusting for potential confounders, MBL deficiency (<0.5 µg/ml) was found less frequently in cases than controls (26 vs. 41%, OR 0.4, 95% confidence interval (CI) 0.20-0.95, p=0.04) as were low producing MBL genotypes (11 vs. 23%, OR 0.2, 95% CI 0.08-0.75, p=0.01), whereas NOD2 polymorphisms were similarly distributed. Cases with NOD2 polymorphisms had less organ dysfunction as shown by a lower SOFA score (median 2.5 vs. 4.5, p=0.02), whereas only severe MBL deficiency (<0.1 µg/ml) was associated with life-threatening S. aureus BSI (OR 5.6, 95% CI 1.25-24.85, p=0.02). Conclusions Contrary to animal model data, our study suggests MBL deficiency may confer protection against acquiring S. aureus BSI. NOD2 mutations were less frequently associated with multi-organ dysfunction. Further human studies of the innate immune response in S. aureus BSI are needed to identify suitable host targets in sepsis treatment.

Osthoff, Michael; Au Yong, Hue Mun; Dean, Melinda M.; Eisen, Damon P.

2013-01-01

205

Pseudomonas aeruginosa bloodstream infections: risk factors and treatment outcome related to expression of the PER-1 extended-spectrum beta-lactamase  

PubMed Central

Background Bloodstream infection (BSI) due to Pseudomonas aeruginosa (Pa) has relevant clinical impact especially in relation to drug resistance determinants. The PER-1 extended-spectrum beta-lactamase (ESBL) is a common enzyme conferring high-level resistance to anti-pseudomonal cephalosporins. Risk factors and treatment outcome of BSI episodes caused by PER-1-positive Pa (PER-1-Pa) strains were compared to those caused by ESBL-negative Pa isolates (ESBL-N-Pa). Methods Twenty-six BSI cases due to ceftazidime-resistant Pa strains have been investigated. MIC values of anti-pseudomonal drugs were determined by the Etest method (AB Biodisk, Solna, Sweden). The double-disk synergy test was used to detect ESBL production. PCR amplification and DNA sequencing were used to characterize ESBL types. Clinical records of BSI-patients were examined retrospectively. Demographic data, underlying diseases (McCabe-Jackson classification and Charlson weighted index), risk factors, antimicrobial therapy, and treatment outcome were evaluated in cases due to ESBL-positive and cases due to ESBL-N-Pa isolates. Unpaired Student's t-test, Mann-Whitney U-test, Fisher's exact test and the ?2 test were used for statistical analysis. Results Nine Pa isolates expressed the PER-1 ESBL; the remaining 17 isolates did not produce ESBLs. Severe sepsis (P = 0.03), bladder and intravascular catheters (both P = 0.01), immunosuppressive therapy (P = 0.04), and mechanical ventilation (P = 0.03) were significantly associated with BSI due to PER-1-Pa. Empirical treatment (P = 0.02) and treatment after ID/AST (P < 0.01) were rarely adequate in PER-1-Pa cases. With regard to treatment outcome, 77.8% BSI cases due to PER-1-Pa vs. 28.6% cases due to ESBL-N-Pa isolates failed to respond (P < 0.03). All cases due to PER-1-Pa that were treated with carbapenems (alone or in combination with amikacin) failed to respond. In contrast, 7/8 cases due to ESBL-N-Pa given carbapenems were responders. Conclusion Therapeutic failure and increased hospital costs are associated with BSI episodes caused by PER-1-Pa strains. Thus, recognition and prompt reporting of ESBL-production appears a critical factor for the management of patients with serious P. aeruginosa infections.

Endimiani, Andrea; Luzzaro, Francesco; Pini, Beatrice; Amicosante, Gianfranco; Maria Rossolini, Gian; Toniolo, Antonio Q

2006-01-01

206

Catheter-Associated Bloodstream Infections  

MedlinePLUS Videos and Cool Tools

... To Listen to the Audio or Read/Print/Save the Handout, Click on a Picture Below To ... These Files, Right Click the Mouse and Choose "Save link as...." Audio not available Mobile Video Handout ...

207

Cloning and Sequencing of the Sphingomonas (Pseudomonas) paucimobilis Gene Essential for the O Demethylation of Vanillate and Syringate  

Microsoft Academic Search

Sphingomonas (Pseudomonas) paucimobilis SYK-6 is able to grow on 5,5*-dehydrodivanillic acid (DDVA), syringate, vanillate, and other dimeric model compounds of lignin as a sole carbon source. Nitrosoguanidine mutagenesis of S. paucimobilis SYK-6 was performed, and two mutants with altered DDVA degradation pathways were isolated. The mutant strain NT-1 could not degrade DDVA, but could degrade syringate, vanillate, and 2,2*,3*-trihydroxy-3-methoxy-5,5*-dicarboxybiphenyl (OH-DDVA).

SEIJI NISHIKAWA; TOMONORI SONOKI; TATSUHIDE KASAHARA; TAKAHIRO OBI; SHOKO KUBOTA; SHINYA KAWAI; NORIYUKI MOROHOSHI; YOSHIHIRO KATAYAMA

1998-01-01

208

Biochemical and Molecular Characterization of Strontium-resistant Environmental Isolates of Pseudomonas fluorescens and Sphingomonas paucimobilis  

Microsoft Academic Search

Strontium resistance was investigated in strains isolated from the river K?z?l?rmak which has been affected by industrial and agricultural heavy metal pollution from the surrounding facilities and domestic effluents from the city K?r?kkale, Turkey. Strontium-resistant isolates with a minimal inhibitory concentration of 2000 mg L were isolated and identified as Pseudomonas fluorescens and Sphingomonas paucimobilis. Both isolates were shown to be

Ozer Gamze; Aysun Ergene; Bulent Icgen

2012-01-01

209

Structures and Properties of Gellan Polymers Produced by Sphingomonas paucimobilis ATCC 31461 from Lactose Compared with Those Produced from Glucose and from Cheese Whey  

Microsoft Academic Search

The dairy industry produces large quantities of whey as a by-product of cheese production and is increas- ingly looking for new ways to utilize this waste product. Gellan gum is reliably produced by Sphingomonas paucimobilis in growth media containing lactose, a significant component of cheese whey, as a carbon source. We studied and compared polysaccharide biosynthesis by S. paucimobilis ATCC

ARSENIO M. FIALHO; LIGIA O. MARTINS; MARIE-LUCIE DONVAL; JORGE H. LEITAO; MICHAEL J. RIDOUT; ANDREW J. JAY; VICTOR J. MORRIS; ISABEL SA ´-CORREIA

1999-01-01

210

Triphenylmethanes, malachite green and crystal violet dyes decolourisation by Sphingomonas paucimobilis  

Microsoft Academic Search

In this study, Gram negative bacterium,Sphingomonas paucimobilis, was used to test its ability to decolourise two triphenylmethane dyes: malachite green (MG) and crystal violet (CV) in mineral\\u000a salts medium (MSM). Decolourisation was examined with dye concentrations (2.5, 5, 15, 25, 30 and 50 mg\\/l), glucose (0, 1.4,\\u000a 2.8, 4.2, 5.6 and 7 mM) and yeast extract concentrations (0, 0.05, 0.10,

Jihane Cheriaa; Amina Bakhrouf

2009-01-01

211

Bone Infections  

MedlinePLUS

... of the body, bones can get infected. The infections are usually bacterial, but can also be fungal. ... bloodstream. People who are at risk for bone infections include those with diabetes, poor circulation, or recent ...

212

Catheter-related bloodstream infections in children receiving parenteral nutrition: considerations about the experience of the Pediatric Nutritional Team of the Tuscany Region, Italy  

Microsoft Academic Search

Infection is the most important clinical complication associated with the use of cen- tral venous catheters, both in terms of incidence and gravity. This study aims to assess the inci- dence of these infections in children receiving parenteral nutrition in a tertiary children's hospital and at home. A prospective cohort survey was carried out in a consecutive series of 671

B. ABBATE; C. MENICOCCI; G. L. NANNETTI

213

Bloodstream Infections Caused by Antibiotic-Resistant Gram-Negative Bacilli: Risk Factors for Mortality and Impact of Inappropriate Initial Antimicrobial Therapy on Outcome  

Microsoft Academic Search

The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial antimicrobial therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with

Cheol-In Kang; Sung-Han Kim; Wan Beom Park; Ki-Deok Lee; Hong-Bin Kim; Eui-Chong Kim; Myoung-don Oh; Kang-Won Choe

2005-01-01

214

[Impact of clinical practice guidelines on the incidence of bloodstream infections related to peripherally inserted central venous catheter in preterm infants].  

PubMed

In our neonatal intensive care unit, the incidence density of infections related to central catheters, assessed retrospectively over 2 years, exceeded that described in the literature. To reduce this incidence density, clinical practice guidelines were implemented for the insertion and maintenance of central lines. The purpose of this study was to evaluate the impact of the protocol on the incidence density and the incidence rate of nosocomial bloodborne infections. This was a prospective study in a neonatal intensive care unit of the Fort-de-France University Hospital over 17 months, which included all premature infants with a central line. We studied the adherence to the protocol, possible complications related to the protocol, the characteristics of the population, the incidence rate, and the density of specific central catheter-related infections. There were 111 children, 122 catheters, and 2575 catheter days during period 1 and 101 children, 125 catheters, and 1631 catheter days during period 2. Gestational age and birth weight were significantly lower in period 2 (29.6±2.3 GW vs 27.3±1.9, P=0.001; 1239±379g vs 915±175g, P<0.001) and the catheterization duration differed between the 2 periods (20±11 days vs 13±6 days, P<0.0001). A trend for a lower incidence density of infection was observed in the second period (16 per 1000 catheter days vs 10 per 1000 catheter days, P=0.06). Although the 2 groups' baseline characteristics were different, this study suggests a positive impact of clinical practice guidelines for the insertion and maintenance of central venous catheters on the incidence of nosocomial infections related to central catheters. PMID:23245862

Boutaric, E; Gilardi, M; Cécile, W; Fléchelles, O

2012-12-13

215

Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units  

Microsoft Academic Search

Objective  Nosocomial infections remain a major problem in intensive care units. Several authorities have recommended housing patients\\u000a in single rooms to prevent cross-transmission of potential pathogens, but this issue is currently debated. The aim of the\\u000a present study was to compare the rate of nosocomial cross-contamination between patients hosted in single rooms versus bay\\u000a rooms.\\u000a \\u000a \\u000a \\u000a Design  Prospective observational data acquisition over 2.5 years.

David Bracco; Marc-Jacques Dubois; Redouane Bouali; Philippe Eggimann

2007-01-01

216

Epidemiology and clinical outcomes of bloodstream infections caused by extended-spectrum ?-lactamase-producing Escherichia coli in patients with cancer.  

PubMed

Patients with cancer can be vulnerable to infection with antimicrobial-resistant pathogens such as extended-spectrum ?-lactamase (ESBL)-producing Enterobacteriaceae. A cohort study was performed to evaluate the epidemiology and impact of ESBL-producing Escherichia coli (ESBL-EC) bacteraemia on the outcomes of adult patients with cancer. During the 2.5-year study period, a total of 350 cases of E. coli bacteraemia were documented in cancer patients, of which 95 (27.1%) were due to ESBL-EC. Significant factors associated with ESBL-EC bacteraemia were liver disease, immunosuppressant use, recent surgery, and prior use of cephalosporins or fluoroquinolones. The overall 30-day mortality rate was 14.9% (52/350), and the mortality rate was higher in patients with ESBL-EC than in those without ESBL-EC (22.1% vs.12.2%; P=0.02). Multivariate analysis showed that ESBL-EC was an independent risk factor for mortality (odds ratio=3.01, 95% confidence interval 1.45-6.28; P=0.003), along with the presence of septic shock, mechanical ventilation, the severity of underlying diseases, and pneumonia as a source of bacteraemia. Of the 69 isolates in which ESBLs and their molecular relationships were studied, 68 (98.6%) produced CTX-M-type and 51 (73.9%) produced CTX-M-14 and/or CTX-M-15. Twenty-four sequence types (STs) were identified among CTX-M-14- and CTX-M-15-producing E. coli isolates, with ST131 being the most prevalent (12/51; 23.5%). In conclusion, this study confirms that CTX-M-producing E. coli and ST131, which have been shown to be an emerging public health threat, are widely prevalent in cancer patients and can adversely affect the outcome of E. coli bacteraemia in these patients. PMID:24071027

Ha, Young Eun; Kang, Cheol-In; Cha, Min Kyeong; Park, So Yeon; Wi, Yu Mi; Chung, Doo Ryeon; Peck, Kyong Ran; Lee, Nam Yong; Song, Jae-Hoon

2013-09-07

217

Improvement in Production and Quality of Gellan Gum by Sphingomonas paucimobilis Under High Dissolved Oxygen Tension Levels  

Microsoft Academic Search

The effect of agitation rate and dissolved oxygen tension (DOT) on growth and gellan production by Sphingomonas paucimobilis was studied. Higher cell growth of 5.4 g l?1 was?obtained at 700 rpm but maximum gellan (15 g l?1) was produced at 500 rpm. DOT levels above 20% had no effect on cell growth but gellan yield was increased to 23 g l?1 with increase in DOT level to 100%.

R. M. Banik; A. Santhiagu

2006-01-01

218

Comparative Genotyping of Candida albicans Bloodstream and Nonbloodstream Isolates at a Polymorphic Microsatellite Locus  

PubMed Central

Molecular typing studies have shown that the predominant form of reproduction of Candida albicans is clonal and that, in a majority of situations, persistent or recurrent infections are due to a unique strain. Characterization of distinct subpopulations and correlation with clinical features may thus be important to understanding the pathogenesis of candidiasis. In a clonal model, a unique polymorphic marker may identify populations with different biological properties. We therefore compared 48 bloodstream isolates and 48 nonbloodstream matched strains of C. albicans at the elongation factor 3-encoding gene (CEF3) polymorphic microsatellite locus of C. albicans. Sizing of the alleles was performed by automated capillary electrophoresis. A new, 137-bp allele was characterized, and seven nondescribed combinations were observed, resulting in 15 and 11 distinct CEF3 profiles in bloodstream and control strains, respectively. Genotypes 126-135, 130-136, and 131-131 accounted for 60.4% of both bloodstream and control strains. Four bloodstream isolates but no control strains displayed the 135-135 combination. None of the other genotypes was present at an increased frequency in bloodstream isolates. Bloodstream and nonbloodstream strains of C. albicans thus have a heterogeneous structure at the CEF3 locus, with three major and multiple minor allelic combinations.

Dalle, Frederic; Franco, Norelie; Lopez, Jose; Vagner, Odile; Caillot, Denis; Chavanet, Pascal; Cuisenier, Bernadette; Aho, Serge; Lizard, Sarab; Bonnin, Alain

2000-01-01

219

International Surveillance of Bloodstream Infections Due to Candida Species: Frequency of Occurrence and In Vitro Susceptibilities to Fluconazole, Ravuconazole, and Voriconazole of Isolates Collected from 1997 through 1999 in the SENTRY Antimicrobial Surveillance Program  

PubMed Central

A surveillance program (SENTRY) of bloodstream infections (BSI) in the United States, Canada, Latin America, and Europe from 1997 through 1999 detected 1,184 episodes of candidemia in 71 medical centers (32 in the United States, 23 in Europe, 9 in Latin America, and 7 in Canada). Overall, 55% of the yeast BSIs were due to Candida albicans, followed by Candida glabrata and Candida parapsilosis (15%), Candida tropicalis (9%), and miscellaneous Candida spp. (6%). In the United States, 45% of candidemias were due to non-C. albicans species. C. glabrata (21%) was the most common non-C. albicans species in the United States, and the proportion of non-C. albicans BSIs was highest in Latin America (55%). C. albicans accounted for 60% of BSI in Canada and 58% in Europe. C. parapsilosis was the most common non-C. albicans species in Latin America (25%), Canada (16%), and Europe (17%). Isolates of C. albicans, C. parapsilosis, and C. tropicalis were all highly susceptible to fluconazole (97 to 100% at ?8 ?g/ml). Likewise, 97 to 100% of these species were inhibited by ?1 ?g/ml of ravuconazole (concentration at which 50% were inhibited [MIC50], 0.007 to 0.03 ?g/ml) or voriconazole (MIC50, 0.007 to 0.06 ?g/ml). Both ravuconazole and voriconazole were significantly more active than fluconazole against C. glabrata (MIC90s of 0.5 to 1.0 ?g/ml versus 16 to 32 ?g/ml, respectively). A trend of increased susceptibility of C. glabrata to fluconazole was noted over the three-year period. The percentage of C. glabrata isolates susceptible to fluconazole increased from 48% in 1997 to 84% in 1999, and MIC50s decreased from 16 to 4 ?g/ml. A similar trend was documented in both the Americas (57 to 84% susceptible) and Europe (22 to 80% susceptible). Some geographic differences in susceptibility to triazole were observed with Canadian isolates generally more susceptible than isolates from the United States and Europe. These observations suggest susceptibility patterns and trends among yeast isolates from BSI and raise additional questions that can be answered only by continued surveillance and clinical investigations of the type reported here (SENTRY Program).

Pfaller, M. A.; Diekema, D. J.; Jones, R. N.; Sader, H. S.; Fluit, A. C.; Hollis, R. J.; Messer, S. A.

2001-01-01

220

Cloning and Characterization of the Ferulic Acid Catabolic Genes of Sphingomonas paucimobilis SYK-6  

PubMed Central

Sphingomonas paucimobilis SYK-6 degrades ferulic acid to vanillin, and it is further metabolized through the protocatechuate 4,5-cleavage pathway. We obtained a Tn5 mutant of SYK-6, FA2, which was able to grow on vanillic acid but not on ferulic acid. A cosmid which complemented the growth deficiency of FA2 on ferulic acid was isolated. The 5.2-kb BamHI-EcoRI fragment in this cosmid conferred the transformation activity of ferulic acid to vanillin on Escherichia coli host cells. A sequencing analysis revealed the genes ferB and ferA in this fragment; these genes consist of 852- and 2,127-bp open reading frames, respectively. The deduced amino acid sequence of ferB showed 40 to 48% identity with that of the feruloyl-coenzyme A (CoA) hydratase/lyase genes of Pseudomonas and Amycolatopsis ferulic acid degraders. On the other hand, the deduced amino acid sequence of ferA showed no significant similarity to the feruloyl-CoA synthetase genes of other ferulic acid degraders. However, the deduced amino acid sequence of ferA did show 31% identity with pimeloyl-CoA synthetase of Pseudomonas mendocina 35, which has been classified as a new superfamily of acyl-CoA synthetase (ADP forming) with succinyl-CoA synthetase (L. B. Sánchez, M. Y. Galperin, and M. Müller, J. Biol. Chem. 275:5794-5803, 2000). On the basis of the enzyme activity of E. coli carrying each of these genes, ferA and ferB were shown to encode a feruloyl-CoA synthetase and feruloyl-CoA hydratase/lyase, respectively. p-coumaric acid, caffeic acid, and sinapinic acid were converted to their corresponding benzaldehyde derivatives by the cell extract containing FerA and FerB, thereby indicating their broad substrate specificities. We found a ferB homolog, ferB2, upstream of a 5-carboxyvanillic acid decarboxylase gene (ligW) involved in the degradation of 5,5?-dehydrodivanillic acid. The deduced amino acid sequence of ferB2 showed 49% identity with ferB, and its gene product showed feruloyl-CoA hydratase/lyase activity with a substrate specificity similar to that of FerB. Insertional inactivation of each fer gene in S. paucimobilis SYK-6 suggested that the ferA gene is essential and that ferB and ferB2 genes are involved in ferulic acid degradation.

Masai, Eiji; Harada, Kyo; Peng, Xue; Kitayama, Hirotaka; Katayama, Yoshihiro; Fukuda, Masao

2002-01-01

221

Kinetics of degradation of surfactant-solubilized fluoranthene by a Sphingomonas paucimobilis  

SciTech Connect

To achieve a better quantitative understanding of the stimulating or inhibiting effect of surfactants on the metabolism of polycyclic aromatic hydrocarbons (PAHs), a biodegradation model describing solubilization, bioavailability, and biodegradation of crystalline fluoranthene is proposed and used to model experimental data. The degradation was investigated in batch systems containing the PAH-degrading bacterium Sphingomonas paucimobilis strain EPA505, the nonionic surfactant Triton X-100, and a fluoranthene-amended liquid mineral salts medium. Surfactant-enhanced biodegradation is complex; however, the biodegradation model predicted fluoranthene disappearance and the initial mineralization well. Surfactant-amendment did increase fluoranthene mineralization rates by strain EPA505; however, the increases were not proportional to the rates of fluoranthene solubilization. The surfactant clearly influenced the microbial PAH metabolism as indicated by a rapid accumulation of colored products and by a surfactant -related decreased in the overall extent of fluoranthene mineralization. Model estimations of the bioavailability of micelle-solubilized fluoranthene, the relatively fast fluoranthene disappearance, and the accumulation of extracellular compounds in the degradation system suggest that low availability of micellar fluoranthene is not the only factor controlling surfactant-enhanced biodegradation. Also factors such as the extent of accumulation and bioavailability of the PAH metabolites and the crystalline solubilization rate in the presence of surfactants may determine the overall effect of surfactant-enhanced biodegradation of high molecular weight PAHs.

Willumsen, P.A. (National Environmental Research Institute, Roskilde (Denmark). Dept. of Marine Ecology and Microbiology); Arvin, E. (Technical Univ. of Denmark, Lyngby (Denmark). Dept. of Environmental Science and Engineering)

1999-08-01

222

Isolation and characterization of a fluoranthene-utilizing strain of pseudomonas paucimobilis  

SciTech Connect

A soil bacterium capable of utilizing fluoranthene as the sole source of carbon and energy for growth was purified from a seven-member bacterial community previously isolated from a creosote waste site for its ability to degrade polycyclic aromatic hydrocarbons. By standard bacteriological methods, this bacterium was characterized taxonomically as a strain of Pseudomonas paucimobilis and was designated strain EPA505. Utilization of fluoranthene by strain EPA505 was demonstrated by increase in bacterial biomass, decrease in aqueous fluoranthene concentration, and transient formation of transformation products in liquid cultures where fluoranthene was supplied as the sole carbon source. Resting cells grown in complex medium showed activity toward anthraquinone, benzo(b)fluorene, biphenyl, chrysene, and pyrene as demonstrated by the disappearance of parent compounds or changes in their UV absorption spectra. Fluoranthene-grown resting cells were active against these compounds as well as 2,3-dimethylnaphthalene, anthracene, fluoranthene, fluorene, naphthalene, and phenanthrene. These studies demonstrate that organic compounds not previously reported to serve as growth substrates can be utilized by axenic cultures of microorganisms. Such organisms may possess novel degradative systems that are active toward other compounds whose biological degradation has been limited because inherent structural considerations or because of low aqueous solubility.

Mueller, J.G.; Chapman, P.J.; Pritchard, P.H.; Blattmann, B.O. (Environmental Protection Agency Environmental Research Laboratory, Gulf Breeze, FL (USA))

1990-04-01

223

Cultivation of bloodstream forms of Trypanosoma carassii , a common parasite of freshwater fish  

Microsoft Academic Search

Trypanosoma carassii (syn. T. danilewskyi) is a widespread parasite of carp and other cyprinid as well as some noncyprinid freshwater fish. It lives extracellularly\\u000a in the blood and tissues of its hosts, causing chronic infections. In this paper the isolation of T. carassii from fish blood and the propagation and cloning of bloodstream forms in vitro are described. By several

Peter Overath; Jens Ruoff; York-Dieter Stierhof; Jochen Haag; Herbert Tichy; Iva Dyková; Jiri Lom

1998-01-01

224

Molecular cloning of a Pseudomonas paucimobilis gene encoding a 17-kilodalton polypeptide that eliminates HCl molecules from gamma-hexachlorocyclohexane.  

PubMed Central

Pseudomonas paucimobilis UT26 is capable of growing on gamma-hexachlorocyclohexane (gamma-HCH). A genomic library of P. paucimobilis UT26 was constructed in Pseudomonas putida by using the broad-host-range cosmid vector pKS13. After 2,300 clones were screened by gas chromatography, 3 clones showing gamma-HCH degradation were detected. A 5-kb fragment from one of the cosmid clones was subcloned into pUC118, and subsequent deletion and gas chromatography-mass spectrometry analyses revealed that a fragment of ca. 500 bp was responsible for the conversion of gamma-HCH to 1,2,4-trichlorobenzene via gamma-pentachlorocyclohexene. Nucleotide sequence analysis revealed an open reading frame (linA) of 465 bp within the fragment. The nucleotide sequence of the linA gene and the deduced amino acid sequence showed no similarity to any known sequences. The product of the linA gene was 16.5 kDa according to sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Images FIG. 3 FIG. 6

Imai, R; Nagata, Y; Fukuda, M; Takagi, M; Yano, K

1991-01-01

225

Distribution of fluconazole-resistant Candida bloodstream isolates among hospitals and inpatient services in Israel.  

PubMed

The emergence of fluconazole-resistant Candida (FRC) is worrisome, but little is known about susceptibility patterns in different nosocomial settings. We prospectively analysed Candida bloodstream isolates in 18 medical centres in Israel (six tertiary-care and 12 community hospitals). The study included 444 episodes of candidaemia (450 patient-specific isolates, 8.5% fluconazole-resistant). Institutional FRC bloodstream infection rates correlated with annual inpatient days, and were strongly associated with the presence and activity of haematology/oncology services. Infection with Candida krusei and fluconazole-resistant Candida glabrata occurred exclusively in hospitals with >600 beds. These findings suggest that empirical antifungal strategies should be tailored to the nosocomial setting. PMID:23005038

Ben-Ami, R; Rahav, G; Elinav, H; Kassis, I; Shalit, I; Gottesman, T; Megged, O; Weinberger, M; Ciobotaro, P; Shitrit, P; Weber, G; Paz, A; Miron, D; Oren, I; Bishara, J; Block, C; Keller, N; Kontoyiannis, D P; Giladi, M

2012-09-25

226

Hospital Specificity, Region Specificity, and Fluconazole Resistance of Candida albicans Bloodstream Isolates  

Microsoft Academic Search

In a survey of bloodstream infection (BSI) isolates across the continental United States, 162 Candida albicans isolates were fingerprinted with the species-specific probe Ca3 and the patterns were analyzed for relatedness with a computer-assisted system. The results demonstrate that particular BSI strains are more highly con- centrated in particular geographic locales and that established BSI strains are endemic in some,

M. A. PFALLER; S. R. LOCKHART; C. PUJOL; J. A. SWAILS-WENGER; S. A. MESSER; M. B. EDMOND; R. N. JONES; R. P. WENZEL; D. R. SOLL

1998-01-01

227

Cloning and Sequencing of a Novel meta-Cleavage Dioxygenase Gene Whose Product Is Involved in Degradation of g-Hexachlorocyclohexane in Sphingomonas paucimobilis  

Microsoft Academic Search

Sphingomonas (formerly Pseudomonas) paucimobilis UT26 utilizes g-hexachlorocyclohexane (g-HCH), a halogenated organic insecticide, as a sole source of carbon and energy. In a previous study, we showed that g-HCH is degraded to chlorohydroquinone (CHQ) and then to hydroquinone (HQ), although the rate of reaction from CHQ to HQ was slow (K. Miyauchi, S. K. Suh, Y. Nagata, and M. Takagi, J.

KEISUKE MIYAUCHI; YUGO ADACHI; YUJI NAGATA; MASAMICHI TAKAGI

1999-01-01

228

Candida dubliniensis: an appraisal of its clinical significance as a bloodstream pathogen.  

PubMed

A nine-year prospective study (2002-2010) on the prevalence of Candida dubliniensis among Candida bloodstream isolates is presented. The germ tube positive isolates were provisionally identified as C. dubliniensis by presence of fringed and rough colonies on sunflower seed agar. Subsequently, their identity was confirmed by Vitek2 Yeast identification system and/or by amplification and sequencing of the ITS region of rDNA. In all, 368 isolates were identified as C. dubliniensis; 67.1% came from respiratory specimens, 11.7% from oral swabs, 9.2% from urine, 3.8% from blood, 2.7% from vaginal swabs and 5.4% from other sources. All C. dubliniensis isolates tested by Etest were susceptible to voriconazole and amphotericin B. Resistance to fluconazole (?8 µg/ml) was observed in 2.5% of C. dubliniensis isolates, 7 of which occurred between 2008-2010. Of note was the diagnosis of C. dubliniensis candidemia in 14 patients, 11 of them occurring between 2008-2010. None of the bloodstream isolate was resistant to fluconazole, while a solitary isolate showed increased MIC to 5-flucytosine (>32 µg/ml) and belonged to genotype 4. A review of literature since 1999 revealed 28 additional cases of C. dubliniensis candidemia, and 167 isolates identified from blood cultures since 1982. In conclusion, this study highlights a greater role of C. dubliniensis in bloodstream infections than hitherto recognized. PMID:22396802

Khan, Ziauddin; Ahmad, Suhail; Joseph, Leena; Chandy, Rachel

2012-03-02

229

Biochemical characterization of the beta-1,4-glucuronosyltransferase GelK in the gellan gum-producing strain Sphingomonas paucimobilis A.T.C.C. 31461.  

PubMed Central

Biosynthesis of bacterial polysaccharide-repeat units proceeds by sequential transfer of sugars, from the appropriate sugar donor to an activated lipid carrier, by committed glycosyltransferases (GTs). Few studies on the mechanism of action for this type of GT are available. Sphingomonas paucimobilis A.T.C.C. 31461 produces the industrially important polysaccharide gellan gum. We have cloned the gelK gene from S. paucimobilis A.T.C.C. 31461. GelK belongs to family 1 of the GT classification [Campbell, Davies, Bulone, Henrissat (1997) Biochem. J. 326, 929-939]. Sequence similarity studies suggest that GelK consists of two protein modules corresponding to the -NH(2) and -CO(2)H halves, the latter possibly harbouring the GT activity. The gelK gene and the open reading frames coding for the -NH(2) (GelK(NH2)) and -CO(2)H (GelK(COOH)) halves were overexpressed in Escherichia coli. GelK and GelK(NH2) were present in both the soluble and membrane fractions of E. coli, whereas GelK(COOH) was only present in the soluble fraction. GelK catalysed the transfer of [(14)C]glucuronic acid from UDP-[(14)C]glucuronic acid into a glycolipid extracted from S. paucimobilis or E. coli, even in the presence of EDTA, and the radioactive sugar was released from the glycolipid by beta-1,4-glucuronidase. GelK was not able to use synthetic glucosyl derivatives as acceptors, indicating that the PP(i)-lipid moiety is needed for enzymic activity. Recombinant GelK(NH2) and GelK(COOH) did not show detectable activity. Based on the biochemical characteristics of GelK and on sequence similarities with N-acetylglucosaminyltransferase, we propose that GT families 1 and 28 form a superfamily.

Videira, P; Fialho, A; Geremia, R A; Breton, C; Sa-Correia, I

2001-01-01

230

JAMA Patient Page: Wound Infections  

MedlinePLUS

... infection to the bloodstream, involving other organs • Septic shock , a critical illness involving the whole body, which ... antibiotics. In the case of sepsis or septic shock, intensive care and life support may be needed. ...

231

Characterizing the Promiscuity of LigAB, a Lignin Catabolite Degrading Extradiol Dioxygenase from Sphingomonas paucimobilis SYK-6.  

PubMed

LigAB from Sphingomonas paucimobilis SYK-6 is the only structurally characterized dioxygenase of the largely uncharacterized superfamily of Type II extradiol dioxygenases (EDO). This enzyme catalyzes the oxidative ring-opening of protocatechuate (3,4-dihydroxybenzoic acid or PCA) in a pathway allowing the degradation of lignin derived aromatic compounds (LDACs). LigAB has also been shown to utilize two other LDACs from the same metabolic pathway as substrates, gallate, and 3-O-methyl gallate; however, kcat/KM had not been reported for any of these compounds. In order to assess the catalytic efficiency and get insights into the observed promiscuity of this enzyme, steady-state kinetic analyses were performed for LigAB with these and a library of related compounds. The dioxygenation of PCA by LigAB was highly efficient, with a kcat of 51 s(-1) and a kcat/KM of 4.26 × 10(6) M(-1)s(-1). LigAB demonstrated the ability to use a variety of catecholic molecules as substrates beyond the previously identified gallate and 3-O-methyl gallate, including 3,4-dihydroxybenzamide, homoprotocatechuate, catechol, and 3,4-dihydroxybenzonitrile. Interestingly, 3,4-dihydroxybenzamide (DHBAm) behaves in a manner similar to that of the preferred benzoic acid substrates, with a kcat/Km value only ?4-fold lower than that for gallate and ?10-fold higher than that for 3-O-methyl gallate. All of these most active substrates demonstrate mechanistic inactivation of LigAB. Additionally, DHBAm exhibits potent product inhibition that leads to an inactive enzyme, being more highly deactivating at lower substrate concentration, a phenomena that, to our knowledge, has not been reported for another dioxygenase substrate/product pair. These results provide valuable catalytic insight into the reactions catalyzed by LigAB and make it the first Type II EDO that is fully characterized both structurally and kinetically. PMID:23977959

Barry, Kevin P; Taylor, Erika A

2013-09-11

232

Water: the bloodstream of the biosphere.  

PubMed Central

Water, the bloodstream of the biosphere, determines the sustainability of living systems. The essential role of water is expanded in a conceptual model of energy dissipation, based on the water balance of whole landscapes. In this model, the underlying role of water phase changes--and their energy-dissipative properties--in the function and the self-organized development of natural systems is explicitly recognized. The energy-dissipating processes regulate the ecological dynamics within the Earth's biosphere, in such a way that the development of natural systems is never allowed to proceed in an undirected or random way. A fundamental characteristic of self-organized development in natural systems is the increasing role of cyclic processes while loss processes are correspondingly reduced. This gives a coincidental increase in system efficiency, which is the basis of growing stability and sustainability. Growing sustainability can be seen as an increase of ecological efficiency, which is applicable at all levels up to whole landscapes. Criteria for necessary changes in society and for the design of the measures that are necessary to restore sustainable landscapes and waters are derived.

Ripl, Wilhelm

2003-01-01

233

Streptococcus pneumoniae Causes Experimental Meningitis following Intranasal and Otitis Media Infections via a Nonhematogenous Route  

Microsoft Academic Search

Using two different animal models of Streptococcus pneumoniae infection, we have demonstrated that this organism is able to spread to the central nervous system and cause meningitis by bypassing the bloodstream. Following respiratory tract infection induced via intranasal inoculation, bacteria were rapidly found in the bloodstream and brains in the majority of infected mice. A similar pattern of dissemination occurred

ANDREA MARRA; DANIEL BRIGHAM

2001-01-01

234

Bloodstream Infection Due to Mycoplasma arginini in an Immunocompromised Patient  

PubMed Central

Mycoplasma arginini, an organism usually recovered from mammals, was isolated from the blood of a febrile patient with advanced non-Hodgkin lymphoma. The patient's condition improved without administration of antimycoplasmal drugs. Simulation of blood culture showed that automated blood culture instruments may fail to detect the organism.

Watanabe, Mayumi; Goto, Miki; Hasegawa, Yuichi

2012-01-01

235

Circulating inflammatory mediators in patients with fever: Predicting bloodstream infection  

Microsoft Academic Search

and 0.59 (P < 0.01) for peak WBC count, 0.60 (P < 0.005) for peak C3a, 0.63 (P < 0.001) for peak IL-6, and 0.61 (P < 0.001) for peak sPLA2. The AUC under the ROC curve for prediction of positive blood cultures was 0.68 (P < 0.001) for peak temperature and 0.56 for peak WBC count (P < 0.05).

A. B. JOHAN GROENEVELD; AILKO W. J. BOSSINK; GERARD J. VAN MIERLO; C. ERIK HACK

2001-01-01

236

Bloodstream infection due to Mycoplasma arginini in an immunocompromised patient.  

PubMed

Mycoplasma arginini, an organism usually recovered from mammals, was isolated from the blood of a febrile patient with advanced non-Hodgkin lymphoma. The patient's condition improved without administration of antimycoplasmal drugs. Simulation of blood culture showed that automated blood culture instruments may fail to detect the organism. PMID:22785195

Watanabe, Mayumi; Hitomi, Shigemi; Goto, Miki; Hasegawa, Yuichi

2012-07-11

237

New developments in the diagnosis of bloodstream infections  

Microsoft Academic Search

New techniques have emerged for the detection of bacteria in blood, because the blood culture as gold standard is slow and insufficiently sensitive when the patient has previously received antibiotics or in the presence of fastidious organisms. DNA-based techniques, hybridisation probes, and PCR-based detection or protein-based detection by mass spectroscopy are aimed at rapid identification of bacteria and provide results

Remco PH Peters; Michiel A van Agtmael; Sven A Danner; Paul HM Savelkoul; Christina MJE Vandenbroucke-Grauls

2004-01-01

238

Pyrimidine Biosynthesis Is Not an Essential Function for Trypanosoma brucei Bloodstream Forms  

PubMed Central

Background African trypanosomes are capable of both pyrimidine biosynthesis and salvage of preformed pyrimidines from the host, but it is unknown whether either process is essential to the parasite. Methodology/Principal Findings Pyrimidine requirements for growth were investigated using strictly pyrimidine-free media, with or without single added pyrimidine sources. Growth rates of wild-type bloodstream form Trypanosoma brucei brucei were unchanged in pyrimidine-free medium. The essentiality of the de novo pyrimidine biosynthesis pathway was studied by knocking out the PYR6-5 locus that produces a fusion product of orotate phosphoribosyltransferase (OPRT) and Orotidine Monophosphate Decarboxylase (OMPDCase). The pyrimidine auxotroph was dependent on a suitable extracellular pyrimidine source. Pyrimidine starvation was rapidly lethal and non-reversible, causing incomplete DNA content in new cells. The phenotype could be rescued by addition of uracil; supplementation with uridine, 2?deoxyuridine, and cytidine allowed a diminished growth rate and density. PYR6-5?/? trypanosomes were more sensitive to pyrimidine antimetabolites and displayed increased uracil transport rates and uridine phosphorylase activity. Pyrimidine auxotrophs were able to infect mice although the infection developed much more slowly than infection with the parental, prototrophic trypanosome line. Conclusions/Significance Pyrimidine salvage was not an essential function for bloodstream T. b. brucei. However, trypanosomes lacking de novo pyrimidine biosynthesis are completely dependent on an extracellular pyrimidine source, strongly preferring uracil, and display reduced infectivity. As T. brucei are able to salvage sufficient pyrimidines from the host environment, the pyrimidine biosynthesis pathway is not a viable drug target, although any interruption of pyrimidine supply was lethal.

Munday, Jane C.; Donachie, Anne; Morrison, Liam J.; de Koning, Harry P.

2013-01-01

239

Nosocomial Infections in Intensive Care Units  

Microsoft Academic Search

The prevalence of nosocomial infections is higher in intensive care units (ICUs) than in general hospital wards. Catheter-related bloodstream infections, ventilator-associated pneumonias, and surgical site infections cause the majority of these infections, which result in a considerable increase of morbidity, mortality, and cost. Overall length of stay, stay in the ICU, and duration of mechanical ventilation are prolonged among surviving

C. Ruef

2005-01-01

240

Hospital Specificity, Region Specificity, and Fluconazole Resistance of Candida albicans Bloodstream Isolates  

PubMed Central

In a survey of bloodstream infection (BSI) isolates across the continental United States, 162 Candida albicans isolates were fingerprinted with the species-specific probe Ca3 and the patterns were analyzed for relatedness with a computer-assisted system. The results demonstrate that particular BSI strains are more highly concentrated in particular geographic locales and that established BSI strains are endemic in some, but not all, hospitals in the study and undergo microevolution in hospital settings. The results, however, indicate no close genetic relationship among fluconazole-resistant BSI isolates in the collection, either from the same geographic locale or the same hospital. This study represents the first of three fingerprinting studies designed to analyze the origin, genetic relatedness, and drug resistance of Candida isolates responsible for BSI.

Pfaller, M. A.; Lockhart, S. R.; Pujol, C.; Swails-Wenger, J. A.; Messer, S. A.; Edmond, M. B.; Jones, R. N.; Wenzel, R. P.; Soll, D. R.

1998-01-01

241

Azaanthraquinone inhibits respiration and in vitro growth of long slender bloodstream forms of Trypanosoma congolense.  

PubMed

An ethanolic extract of Mitracarpus scaber was found to possess in vitro and in vivo trypanocidal activity against Trypanosoma congolense. At a dosage of 50 mg kg(-1) day(-1) in normal saline for 5 days, the extract cured Balbc mice infected with T. congolense without any relapse. The isolated active component benz(g)isoquinoline 5,10 dione (Azaanthraquinone) (AQ) purified from the extract was found to inhibit glucose-dependent cellular respiration and glycerol-3-phosphate-dependent mitochondrial O(2) assimilation of the long bloodstream forms of Trypanosoma congolense. On account of the pattern of inhibition, the target could be the mitochondrial electron transport system composed of glyceraldehyde 3-phosphate dehydrogenase (G3PDH). The azaanthraquinone specifically inhibited the reduced coenzyme Q(1)-dependent O(2) uptake of the mitochondria with respect to ubiquinone. The susceptible site could be due to ubiquinone redox system which links the two enzyme activities. PMID:12125096

Nok, Andrew Jonathan

2002-09-01

242

Lipidomic analysis of bloodstream and procyclic form Trypanosoma brucei  

PubMed Central

Summary The biological membranes of Trypanosoma brucei contain a complex array of phospholipids that are synthesized de novo from precursors obtained either directly from the host, or as catabolised endocytosed lipids. This paper describes the use of nanoflow electrospray tandem mass spectrometry and high resolution mass spectrometry in both positive and negative ion modes, allowing the identification of ~500 individual molecular phospholipids species from total lipid extracts of cultured bloodstream and procyclic form T. brucei. Various molecular species of all of the major subclasses of glycerophospholipids were identified including phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, and phosphatidylinositol as well as phosphatidic acid, phosphatidylglycerol and cardolipin, and the sphingolipids sphingomyelin, inositol phosphoceramide and ethanolamine phosphoceramide. The lipidomic data obtained in this study will aid future biochemical phenotyping of either genetically or chemically manipulated commonly used bloodstream and procyclic strains of Trypanosoma brucei. Hopefully this will allow a greater understanding of the bizarre world of lipids in this important human pathogen.

RICHMOND, GREGORY S.; GIBELLINI, FEDERICA; YOUNG, SIMON A.; MAJOR, LOUISE; DENTON, HELEN; LILLEY, ALISON; SMITH, TERRY K.

2013-01-01

243

Streptococci isolated from the bloodstream and gingival crevice of man  

Microsoft Academic Search

SUMMARY. One hundred and twenty six strains of streptococci isolated from the bloodstreams of 123 hospital in-patients-55 with endocardi- tis-and 255 strains isolated from the gingival crevices of 66 volunteers were characterised. Species isolated were Streptococcus mitior, S. sanguis, undifferentiated viridans streptococci, S. salivarius, S. milleri, S. mutans, S. bovis and S. faecalis. There was no significant difference between the

I. CRAWFORD; C. RUSSELL

1983-01-01

244

Purification and characterization of a haloalkane dehalogenase of a new substrate class from a gamma-hexachlorocyclohexane-degrading bacterium, Sphingomonas paucimobilis UT26.  

PubMed Central

The linB gene product (LinB), 1,3,4,6-tetrachloro-1,4-cyclohexadiene halidohydrolase, which is involved in the degradation of gamma-hexachlorocyclohexane in Sphingomonas paucimobilis UT26 (Y. Nagata, T. Nariya, R. Ohtomo, M. Fukuda, K. Yano, and M. Takagi, J. Bacteriol. 175:6403-6410, 1993), was overproduced in E. coli and purified to homogeneity. The molecular mass of LinB was deduced to be 30 kDa by gel filtration chromatography and 32 kDa by electrophoresis on sodium dodecyl sulfate-polyacrylamide gel, indicating that LiuB is a monomeric enzyme. The optimal pH for activity was 8.2. Not only monochloroalkanes (C3 to C10) but also dichloroalkanes, bromoalkanes, and chlorinated allphatic alcohols were good substrates for LinB, suggesting that LinB shares properties with another haloalkane dehalogenase, DhlA (S. Keuning, D.B. Janssen, and B. Witholt, J. Bacteriol. 163:635-639, 1985), which shows significant similarity to LinB in primary structure (D. B. Janssen, F. Pries, J. van der Ploeg, B. Kazemier, P. Terpstra, and B. Witholt, J. Bacteriol. 171:6791-6799, 1989) but not in substrate specificity. Principal component analysis of substrate activities of various haloalkane dehalogenases suggested that LinB probably constitutes a new substrate specificity class within this group of enzymes.

Nagata, Y; Miyauchi, K; Damborsky, J; Manova, K; Ansorgova, A; Takagi, M

1997-01-01

245

Identification of the pgmG Gene, Encoding a Bifunctional Protein with Phosphoglucomutase and Phosphomannomutase Activities, in the Gellan Gum-Producing Strain Sphingomonas paucimobilis ATCC 31461  

PubMed Central

The pgmG gene of Sphingomonas paucimobilis ATCC 31461, the industrial gellan gum-producing strain, was cloned and sequenced. It encodes a 50,059-Da polypeptide that has phosphoglucomutase (PGM) and phosphomannomutase (PMM) activities and is 37 to 59% identical to other bifunctional proteins with PGM and PMM activities from gram-negative species, including Pseudomonas aeruginosa AlgC. Purified PgmG protein showed a marked preference for glucose-1-phosphate (G1P); the catalytic efficiency was about 50-fold higher for G1P than it was for mannose-1-phosphate (M1P). The estimated apparent Km values for G1P and M1P were high, 0.33 and 1.27 mM, respectively. The pgmG gene allowed the recovery of alginate biosynthetic ability in a P. aeruginosa mutant with a defective algC gene. This result indicates that PgmG protein can convert mannose-6-phosphate into M1P in the initial steps of alginate biosynthesis and, together with other results, suggests that PgmG may convert glucose-6-phosphate into G1P in the gellan pathway.

Videira, Paula A.; Cortes, Luisa L.; Fialho, Arsenio M.; Sa-Correia, Isabel

2000-01-01

246

Nosocomial infections in pediatric intensive care units  

Microsoft Academic Search

Nosocomial infections are a significant problem in pediatric intensive care units. While Indian estimates are not available,\\u000a western PICUs report incidence of 6–8%. The common nosocomial infections in PICU are bloodstream infections (20–30% of all\\u000a infections), lower respiratory tract infections (20–35%), and urinary tract infections (15–20%); there may be some differences\\u000a in their incidence in different PICUs. The risk of

Rakesh Lodha; Uma Chandra; Mouli Natchu; Mrinal Nanda; S. K. Kabra

2001-01-01

247

Antimicrobial treatment for Intensive Care Unit (ICU) infections including the role of the infectious disease specialist  

Microsoft Academic Search

Between 5 and 10% of patients admitted to acute care hospitals acquire one or more infections, and the risks have steadily increased during recent decades. Three types of infection account for more than 60% of all nosocomial infections: pneumonia, urinary tract infection and primary bloodstream infection, all of them associated with the use of medical devices. Nearly 70% of infections

Silvano Esposito; Sebastiano Leone

2007-01-01

248

Triazole Cross-Resistance among Candida spp.: Case Report, Occurrence among Bloodstream Isolates, and Implications for Antifungal Therapy  

PubMed Central

Candida spp. are common causes of bloodstream infections among hospitalized patients. Fluconazole (FLC) remains a first-line therapy for candidemia; and voriconazole (VRC), an expanded-spectrum triazole, was recently approved for the treatment of candidemia in nonneutropenic patients. In vitro studies have suggested that VRC has potent activity against Candida spp. with reduced susceptibilities to FLC. We present a case report of invasive candidiasis and candidemia due to a Candida glabrata isolate that developed resistance to all currently available triazole antifungals after a course of FLC treatment. This case prompted us to determine the frequency of cross-resistance among bloodstream Candida isolates collected during a recent 12-month period at a large, academic medical center. FLC MICs were determined for 125 of 153 isolates (81.7%). Thirty of 125 isolates (24%) were resistant or showed reduced susceptibilites to FLC (MICs ? 16 ?g/ml). When 28 of these 30 isolates were tested for their VRC susceptibilities, 9 (32%) had MICs that were ?2 ?g/ml. Five of these nine isolates were C. glabrata, two isolates were Candida tropicalis, one isolate was Candida albicans, and one isolate was Candida parapsilosis. All five Candida krusei isolates tested had VRC MICs ?0.5 ?g/ml. These data have prompted the introduction of reflexive FLC susceptibility testing of first bloodstream Candida isolates at our institution. The case report and our data also suggest that VRC should be avoided as initial therapy in unstable patients with invasive candidiasis, particularly in the setting of prior azole exposure. Studies are needed to define the clinical significance of in vitro resistance to the newer antifungal agents.

Magill, Shelley S.; Shields, Christine; Sears, Cynthia L.; Choti, Michael; Merz, William G.

2006-01-01

249

Characterization of the 5-Carboxyvanillate Decarboxylase Gene and Its Role in Lignin-Related Biphenyl Catabolism in Sphingomonas paucimobilis SYK-6  

PubMed Central

Sphingomonas paucimobilis SYK-6 degrades a lignin-related biphenyl compound, 5,5?-dehydrodivanillate (DDVA), to 5-carboxyvanillate (5CVA) by the enzyme reactions catalyzed by the DDVA O-demethylase (LigX), the ring cleavage oxygenase (LigZ), and the meta-cleavage compound hydrolase (LigY). In this study we examined the degradation step of 5CVA. 5CVA was transformed to vanillate, O-demethylated, and further degraded via the protocatechuate 4,5-cleavage pathway by this strain. A cosmid clone which conferred the 5CVA degradation activity to a host strain was isolated. In the 7.0-kb EcoRI fragment of the cosmid we found a 1,002-bp open reading frame responsible for the conversion of 5CVA to vanillate, and we designated it ligW. The gene product of ligW (LigW) catalyzed the decarboxylation of 5CVA to produce vanillate along with the specific incorporation of deuterium from deuterium oxide, indicating that LigW is a nonoxidative decarboxylase of 5CVA. LigW did not require any metal ions or cofactors for its activity. The decarboxylase activity was specific to 5CVA. Inhibition experiments with 5CVA analogs suggested that two carboxyl groups oriented meta to each other in 5CVA are important to the substrate recognition by LigW. Gene walking analysis indicated that the ligW gene was located on the 18-kb DNA region with other DDVA catabolic genes, including ligZ, ligY, and ligX.

Peng, Xue; Masai, Eiji; Kitayama, Hirotaka; Harada, Kyo; Katayama, Yoshihiro; Fukuda, Masao

2002-01-01

250

Differentiation of a culture-adapted mutant bloodstream form of Trypanosoma brucei into the procyclic form results in growth arrest of the cells.  

PubMed

The bloodstream forms of Trypanosoma brucei monomorphic strain 427 serially passaged in rats can differentiate in vitro equally well in HMI-9, HMI-10, SDM-79 or Cunningham's medium into the insect (procyclic) forms by a simple temperature shift from 37 to 26 degrees C in the presence of citrate and cis-aconitate. The procyclic forms thus generated can also continue to multiply at 26 degrees C without replacing the culture medium. The same strain of T. brucei pre-adapted to grow as bloodstream forms in HMI-10 medium at 37 degrees C is also capable of differentiating showing a similar rate of variant surface glycoprotein (VSG) disappearance and appearance of phosphoenolpyruvate carboxykinase (PEPCK) under the same experimental conditions. However, appearance of both procyclin mRNA and procyclin protein is much delayed and the resulting procyclic forms cannot multiply. The culture-adapted bloodstream forms are capable of infecting rats, and the cells thus harvested from the rats can differentiate but cannot multiply in the same manner as the original culture-adapted bloodstream forms. Apparently, a certain variant has been selected during the adaptation of T. brucei bloodstream forms from rat blood to the culture medium. This variant could be a useful tool for identifying the genes involved in differentiation of T. brucei and multiplication of the procyclic forms. Comparison of the protein profiles between the wild-type and the variant during differentiation showed that a major protein band of about 70 kDa remained in the non-dividing variant procyclic forms but vanished in the rapidly dividing wild type procyclic forms. N-terminal determinations indicated that the 70-kDa protein band consists of bovine serum albumin and fetuin. Presumably these two serum proteins are actively taken up by the bloodstream forms via endocytosis. Since the procyclic forms are incapable of endocytosis, the serum proteins may be rapidly diluted in the growing wild type procyclic cells but remain unchanged in the non-dividing procyclic cells of the variant. Further studies are underway in trying to identify the key distinctions between these two lines of cells at the molecular level. PMID:8538691

Mutomba, M C; Wang, C C

1995-06-01

251

Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Volume 6. Prevention of Healthcare-Associated Infections. Evidence Report/Technology Assessment Number 9.  

National Technical Information Service (NTIS)

To determine the effects of quality improvement strategies on promoting adherence to interventions for prevention of selected (surgical site infections (SSI), central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), ...

2007-01-01

252

Cell-cycle synchronisation of bloodstream forms of Trypanosoma brucei using Vybrant DyeCycle Violet-based sorting.  

PubMed

Studies on the cell-cycle of Trypanosoma brucei have revealed several unusual characteristics that differ from the model eukaryotic organisms. However, the inability to isolate homogenous populations of parasites in distinct cell-cycle stages has limited the analysis of trypanosome cell division and complicated the understanding of mutant phenotypes with possible impact on cell-cycle related events. Although hydroxyurea-induced cell-cycle arrest in procyclic and bloodstream forms has been applied recently with success, such block-release protocols can complicate the analysis of cell-cycle regulated events and have the potential to disrupt important cell-cycle checkpoints. An alternative approach based on flow cytometry of parasites stained with Vybrant DyeCycle Orange circumvents this problem, but is restricted to procyclic form parasites. Here, we apply Vybrant Dyecycle Violet staining coupled with flow cytometry to effectively select different cell-cycle stages of bloodstream form trypanosomes. Moreover, the sorted parasites remain viable, although synchrony is rapidly lost. This method enables cell-cycle enrichment of populations of trypanosomes in their mammal infective stage, particularly at the G1 phase. PMID:19729042

Kabani, Sarah; Waterfall, Martin; Matthews, Keith R

2009-09-01

253

Cellular and Molecular Remodeling of the Endocytic Pathway during Differentiation of Trypanosoma brucei Bloodstream Forms ? †  

PubMed Central

During the course of mammalian infection, African trypanosomes undergo extensive cellular differentiation, as actively dividing long slender (SL) forms progressively transform into intermediate (I) forms and finally quiescent G1/G0-locked short stumpy (ST) forms. ST forms maintain adaptations compatible with their survival in the mammalian bloodstream, such as high endocytic activity, but they already show preadaptations to the insect midgut conditions. The nutritional requirements of ST forms must differ from those of SL forms because the ST forms stop multiplying. We report that the uptake of several ligands was reduced in ST forms compared with that in SL forms. In particular, the haptoglobin-hemoglobin (Hp-Hb) complex was no longer taken up due to dramatic downregulation of its cognate receptor, TbHpHbR. As this receptor also allows uptake of trypanolytic particles from human serum, ST forms were resistant to trypanolysis by human serum lipoproteins. These observations allowed both flow cytometry analysis of SL-to-ST differentiation and the generation of homogeneous ST populations after positive selection upon exposure to trypanolytic particles. In addition, we observed that in ST forms the lysosome relocates anterior to the nucleus. Altogether, we identified novel morphological and molecular features that characterize SL-to-ST differentiation.

Vanhollebeke, Benoit; Uzureau, Pierrick; Monteyne, Daniel; Perez-Morga, David; Pays, Etienne

2010-01-01

254

A Tetrahydrofolate-Dependent O-Demethylase, LigM, Is Crucial for Catabolism of Vanillate and Syringate in Sphingomonas paucimobilis SYK-6  

PubMed Central

Vanillate and syringate are converted into protocatechuate (PCA) and 3-O-methylgallate (3MGA), respectively, by O-demethylases in Sphingomonas paucimobilis SYK-6. PCA is further degraded via the PCA 4,5-cleavage pathway, while 3MGA is degraded through multiple pathways in which PCA 4,5-dioxygenase (LigAB), 3MGA 3,4-dioxygenase (DesZ), and an unidentified 3MGA O-demethylase and gallate dioxygenase are participants. For this study, we isolated a 4.7-kb SmaI fragment that conferred on Escherichia coli the activity required for the conversion of vanillate to PCA. The nucleotide sequence of this fragment revealed an open reading frame of 1,413 bp (ligM), the deduced amino acid sequence of which showed 49% identity with that of the tetrahydrofolate (H4folate)-dependent syringate O-demethylase gene (desA). The metF and ligH genes, which are thought to be involved in H4folate-mediated C1 metabolism, were located just downstream of ligM. The crude LigM enzyme expressed in E. coli converted vanillate and 3MGA to PCA and gallate, respectively, with similar specific activities, and only in the presence of H4folate; however, syringate was not a substrate for LigM. The disruption of ligM led to significant growth retardation on both vanillate and syringate, indicating that ligM is involved in the catabolism of these substrates. The ability of the ligM mutant to transform vanillate was markedly decreased, and this mutant completely lost the 3MGA O-demethylase activity. A ligM desA double mutant completely lost the ability to transform vanillate, thus indicating that desA also contributes to vanillate degradation. All of these results indicate that ligM encodes vanillate/3MGA O-demethylase and plays an important role in the O demethylation of vanillate and 3MGA, respectively.

Abe, Tomokuni; Masai, Eiji; Miyauchi, Keisuke; Katayama, Yoshihiro; Fukuda, Masao

2005-01-01

255

Prevalence of blaZ Gene Types and the Inoculum Effect with Cefazolin among Bloodstream Isolates of Methicillin-Susceptible Staphylococcus aureus  

PubMed Central

We sought to define the prevalence of blaZ gene types and the inoculum effect to cefazolin among methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections. The blaZ gene was present in 142/185 (77%) isolates. A total of 50 (27%) isolates had a ?4-fold increase in the cefazolin MIC from a standard to a high inoculum, and 8 (4%) demonstrated a nonsusceptible cefazolin MIC, all type A blaZ strains. The efficacy of cefazolin in the presence of the inoculum effect requires further study.

Crispell, E.; Satola, S. W.; Burd, E. M.; Jerris, R.; Wang, Y. F.; Farley, M. M.

2012-01-01

256

Rabbit Model of Candida albicans Biofilm Infection: Liposomal Amphotericin B Antifungal Lock Therapy  

Microsoft Academic Search

Catheter-related infections due to Candida albicans biofilms are a leading cause of fungal nosocomial bloodstream infection. In this paper, we describe the development of a model of catheter-associated infection with C. albicans biofilms and show that antifungal lock therapy with liposomal amphotericin B is an effective treatment strategy for these infections. Silicone catheters surgically placed in New Zealand White rabbits

Matthew K. Schinabeck; Lisa A. Long; Mohammad A. Hossain; Jyotsna Chandra; Pranab K. Mukherjee; Sotohy Mohamed; Mahmoud A. Ghannoum

2004-01-01

257

Intravascular Catheter-Associated Infections  

Microsoft Academic Search

Serious infections associated with intravascular catheters are common. The available data suggests there are likely to be\\u000a more than 500 000 cases of catheter-associated bloodstream infections occurring annually in Western Europe and the USA. These\\u000a may be associated with as many as 100?000 deaths. The pathophysiology of this common condition is still not fully elucidated.\\u000a With catheters that are in

J. A. Crump; P. J. Collignon

2000-01-01

258

Characterization of sialidase from bloodstream forms of Trypanosoma vivax.  

PubMed

Sialidase (EC: 3.2.1.18) from Trypanosoma vivax (Agari Strain) was isolated from bloodstream forms of the parasite and purified to apparent electrophoretic homogeneity. The enzyme was purified 77-fold with a yield of 32% and co-eluted as a 66-kDa protein from a Sephadex G 110 column. The T. vivax sialidase was optimally active at 37 degrees C with an activation energy (E(a)) of 26.2 kJ mole(-1). The pH activity profile was broad with optimal activity at 6.5. The enzyme was activated by dithiothreitol and strongly inhibited by para-hydroxy mercuricbenzoate thus implicating a sulfhydryl group as a possible active site residue of the enzyme. Theenzyme hydrolysed Neu5Ac2,3lac and fetuin. It was inactive towards Neu5Ac2,6lac, colomic acid and the gangliosides GM1, and GDI. Initial velocity studies, for the determination of kinetic constants with fetuin as substrate gave a V(max) of 142.86 micromol h(-1) mg(-1) and a K(M) of 0.45 mM. The K(M) and V(max) with Neu5Ac-2,3lac were 0.17 mM and 840 micromole h(-1) mg(-1) respectively. The T. vivax sialidase was inhibited competitively by both 2,3 dideoxy neuraminic acid (Neu5Ac2,3en) and para-hydroxy oxamic acid. When ghost RBCs were used as substrates, the enzyme desialylated the RBCs from camel, goat, and zebu bull. The RBCs from dog, mouse and ndama bull were resistant to hydrolysis. PMID:15898128

Buratai, L B; Nok, A J; Ibrahim, S; Umar, I A; Esievo, K A N

259

Comparison of US and non-US central venous catheter infection rates: Evaluation of processes and indicators in infection control study  

Microsoft Academic Search

Objective: We sought to identify the presence or absence of international variation in central venous catheter-associated bloodstream infection (BSI) rates and to examine associated infection control practices that might underlie the differences. Design: The Evaluation of Processes and Indicators in Infection Control (EPIC) study was conducted as a prospective surveillance study. Settings: The study took place in intensive care units

Ziad A. Memish; Yaseen Arabi; Gwen Cunningham; Stephen Kritchevsky; Barbara Braun; Cheryl Richards; Stefan Weber; Crèsio Romeu Pereira

2003-01-01

260

Infection!  

NSDL National Science Digital Library

Play Infection! the game where you're the germ. And while you play, learn about the way your body fights infections.The game works best in Netscape 4 and Internet Explorer 4 or later. You will need to download Shockwave, but don't worry, you can do that right from the site.

York, Amercian M.

261

Infections  

MedlinePLUS

... Fever and Taking Your Child's Temperature Flu Center Head Lice Is It a Cold or the Flu? Middle ... Worms, Lice, etc.) Amebiasis Ascariasis Bedbugs Chiggers Giardiasis Head Lice Infections That Pets Carry Malaria Pinworm Pubic Lice ...

262

Infection prevention in the intensive care unit.  

PubMed

Hospital-acquired infections have profound social, economic, and personal costs to patients in the intensive care unit (ICU). Numerous risk factors, such as poor nutrition and hyperglycemia, directly involve patients. Meanwhile, hand hygiene, environmental cleaning, and appropriate hospital staffing can impact ICU infection rates. A multidirectional approach-including continuing staff education, minimizing risk factors, and implementing guidelines established by national committees-is necessary to decrease infections such as catheter-related bloodstream infections, urinary tract infections, ventilator-associated pneumonia, and Clostridium difficile. Infection-control committees can assist in implementing policies. This is an active area of research and we anticipate continued advancements to improve patient care. PMID:19665091

Barsanti, Mary C; Woeltje, Keith F

2009-09-01

263

The role of proteolysis during differentiation of Trypanosoma brucei from the bloodstream to the procyclic form  

Microsoft Academic Search

The in vitro differentiation of Trypanosoma brucei from bloodstream to procyclic (insect) forms is accompanied by diminishing variant surface glycoprotein (VSG) and increasing levels of procyclin and phosphoenolpyruvate carboxykinase (PEPCK). In this study, we examined the fate of several glycolytic enzymes of T. brucei during differentiation. We observed a down-regulation of glycosomal phosphoglycerate kinase (gPGK) during differentiation. In contrast, intracellular

Martha C Mutomba; Ching C Wang

1998-01-01

264

Effects of aphidicolin and hydroxyurea on the cell cycle and differentiation of Trypanosoma brucei bloodstream forms  

Microsoft Academic Search

The effects of aphidicolin (APH) and hydroxyurea (HU) on the cell cycle and differentiation of Trypanosoma brucei bloodstream forms were studied. APH (0.1 ?g ml?1) inhibited cell division, but did not inhibit DNA synthesis. Most of the cells were arrested in the G2 phase of the cell cycle, with each cell containing two kinetoplasts, but only one nucleus. Recovery of

Martha C. Mutomba; Ching C. Wang

1996-01-01

265

Infection!  

NSDL National Science Digital Library

This activity from the American Museum of Natural History's family magazine series is a board game in which kids learn how germs spread and infections take hold. The online activity begins with an overview of the many ways germs can enter your body and the body's first and second lines of defense. Kids then go to a page of directions for playing the online game, where they are also asked to select a microbe playing piece. As they move through the playing board, kids gain insight into how the body fights infection.

266

Effect of topical emollient treatment of preterm neonates in Bangladesh on invasion of pathogens into the bloodstream.  

PubMed

Topical emollient therapy may reduce the incidence of serious infections and mortality of preterm infants in developing countries. We tested whether emollient therapy reduced the burden of pathogens on skin and/or prevented bacterial translocation. Neonates <33 wk gestational age were randomized to treatment with sunflower seed oil (SSO) or Aquaphor or the untreated control group. Skin condition score and skin cultures were obtained at enrollment and on d 3, 7, and weekly thereafter, and blood cultures were obtained for episodes of suspected nosocomial sepsis. For analysis, blood cultures were paired with skin cultures obtained 0-3 d before the blood culture. Skin condition scores at 3 d were better in patients treated with either emollient compared with untreated controls; however, skin flora was similar across the groups. The SSO group showed a 72% elevated odds of having a false-positive (FP) skin culture associated with a negative blood culture (i.e. skin flora blocked from entry into blood) compared with the control group. Topical therapy with SSO reduced the passage of pathogens from the skin surface into the bloodstream of preterm infants. PMID:17413870

Darmstadt, Gary L; Saha, Samir K; Ahmed, A S M Nawshad Uddin; Choi, Yoonjoung; Chowdhury, M A K Azad; Islam, Maksuda; Law, Paul A; Ahmed, Saifuddin

2007-05-01

267

A lytic monoclonal antibody to Trypanosoma cruzi bloodstream trypomastigotes which recognizes an epitope expressed in tissues affected in Chagas' disease.  

PubMed Central

It has been suggested that molecular mimicry between the antigens of Trypanosoma cruzi and the host could have a role in the onset of the chronic stage of Chagas' disease. In this article, we report on a monoclonal antibody (MAb), CAK20.12 (immunoglobulin G2b), which reacts with a polypeptidic epitope of a 150-kDa antigen expressed on the surface of several strains of T. cruzi. This MAb also causes lysis of bloodstream trypomastigotes. Serum samples from 30 of 30 patients with chronic and 11 of 13 patients with acute Chagas' disease present specific antibodies to this antigen. MAb CAK20.12 reacts, by indirect immunofluorescence, with human and syngeneic murine striated muscle tissue, with the smooth muscle layer of cardiac arteries, with the lamina muscularis mucosae and the external striated muscle layer of the esophagus, and with the smooth muscle cells of the colon from normal syngeneic mice. Reactivity with the small intestine was very weak, and no reactivity with ventricle or atrium tissue was detected. Adsorption with an antigenic fraction from normal murine striated muscle or from T. cruzi epimastigotes confirmed that MAb CAK20.12 recognizes a common epitope present in parasites and host tissues. MAb CAK20.12, lytic for the infective form of T. cruzi, recognizes an epitope expressed in striated and smooth muscle cells of the host tissues affected in the chronic stage of Chagas' disease. Images

Zwirner, N W; Malchiodi, E L; Chiaramonte, M G; Fossati, C A

1994-01-01

268

Use of PCR coupled with electrospray ionization mass spectrometry for rapid identification of bacterial and yeast bloodstream pathogens from blood culture bottles.  

PubMed

Sepsis is among the top 10 causes of mortality in the United States. Rapid administration of antibiotics is one of the most important contributors to patient survival, yet only a limited number of methods exist for rapid identification of microbes cultivated from bloodstream infections, which can lead to sepsis. While traditional single-target molecular methods have been shown to greatly improve survival for septic patients by enabling rapid deescalation of broad-spectrum antibiotics, multiplex methods offer even greater possibilities. A novel multiplex method, PCR coupled to electrospray ionization mass spectrometry (PCR/ESI-MS), was used to identify the genus and species of microorganisms found to cause human bloodstream infections. DNA was directly extracted from 234 BacT-Alert blood culture bottles, and results were compared to those obtained by clinical reference standard methods. The study results demonstrated 98.7% and 96.6% concordance at the genus and species levels, respectively. Mixtures of microbes were identified in 29 blood culture bottles, including mixed species of the same genus, as well as mixtures containing Gram-positive and Gram-negative organisms, exemplifying the PCR/ESI-MS capability to identify multiple organisms simultaneously without the need for cultivation. This study demonstrates high analytical accuracy in comparison to routine subculture of blood culture bottles and phenotypic identification of microbes. Without foreknowledge of the microorganisms potentially present, the PCR/ESI-MS methods can deliver accurate results in as little as 5 to 6 h after a positive alarm from the automated blood culture system; however, current batch mode testing limits the method's clinical utility at this time. PMID:21048006

Kaleta, Erin J; Clark, Andrew E; Johnson, Desiree R; Gamage, Dulini C; Wysocki, Vicki H; Cherkaoui, Abdessalam; Schrenzel, Jacques; Wolk, Donna M

2010-11-03

269

Use of PCR Coupled with Electrospray Ionization Mass Spectrometry for Rapid Identification of Bacterial and Yeast Bloodstream Pathogens from Blood Culture Bottles ?  

PubMed Central

Sepsis is among the top 10 causes of mortality in the United States. Rapid administration of antibiotics is one of the most important contributors to patient survival, yet only a limited number of methods exist for rapid identification of microbes cultivated from bloodstream infections, which can lead to sepsis. While traditional single-target molecular methods have been shown to greatly improve survival for septic patients by enabling rapid deescalation of broad-spectrum antibiotics, multiplex methods offer even greater possibilities. A novel multiplex method, PCR coupled to electrospray ionization mass spectrometry (PCR/ESI-MS), was used to identify the genus and species of microorganisms found to cause human bloodstream infections. DNA was directly extracted from 234 BacT-Alert blood culture bottles, and results were compared to those obtained by clinical reference standard methods. The study results demonstrated 98.7% and 96.6% concordance at the genus and species levels, respectively. Mixtures of microbes were identified in 29 blood culture bottles, including mixed species of the same genus, as well as mixtures containing Gram-positive and Gram-negative organisms, exemplifying the PCR/ESI-MS capability to identify multiple organisms simultaneously without the need for cultivation. This study demonstrates high analytical accuracy in comparison to routine subculture of blood culture bottles and phenotypic identification of microbes. Without foreknowledge of the microorganisms potentially present, the PCR/ESI-MS methods can deliver accurate results in as little as 5 to 6 h after a positive alarm from the automated blood culture system; however, current batch mode testing limits the method's clinical utility at this time.

Kaleta, Erin J.; Clark, Andrew E.; Johnson, Desiree R.; Gamage, Dulini C.; Wysocki, Vicki H.; Cherkaoui, Abdessalam; Schrenzel, Jacques; Wolk, Donna M.

2011-01-01

270

Comparative evaluation of three commercial identification systems using common and rare bloodstream yeast isolates.  

PubMed

The commercial yeast identification systems API ID32C, Auxacolor, and Vitek were evaluated using 251 molecularly identified bloodstream isolates and 2 reference strains, representing a total of 35 species (6 common and 29 rare). Correct identification rates were higher for common species (Auxacolor, 95%; API ID32C, 94%; Vitek, 92%) than for rare species (Auxacolor, 43%; API ID32C, 56%; Vitek, 64%). All systems performed equally among the former, and Vitek performed best among the latter. PMID:21543578

Meletiadis, Joseph; Arabatzis, Michael; Bompola, Maria; Tsiveriotis, Konstantinos; Hini, Stavroula; Petinaki, Efthymia; Velegraki, Aristea; Zerva, Loukia

2011-05-04

271

Cytokinesis in Bloodstream Stage Trypanosoma brucei Requires a Family of Katanins and Spastin  

Microsoft Academic Search

Microtubule severing enzymes regulate microtubule dynamics in a wide range of organisms and are implicated in important cell cycle processes such as mitotic spindle assembly and disassembly, chromosome movement and cytokinesis. Here we explore the function of several microtubule severing enzyme homologues, the katanins (KAT80, KAT60a, KAT60b and KAT60c), spastin (SPA) and fidgetin (FID) in the bloodstream stage of the

Corinna Benz; Caroline Clucas; Jeremy C. Mottram; Tansy C. Hammarton

2012-01-01

272

Efflux-Related Resistance to Norfloxacin, Dyes, and Biocides in Bloodstream Isolates of Staphylococcus aureus  

Microsoft Academic Search

Efflux is an important resistance mechanism in Staphylococcus aureus, but its frequency in patients with bacteremia is unknown. Nonreplicate bloodstream isolates were collected over an 8-month period, and MICs of four common efflux pump substrates, with and without the broad-spectrum efflux pump inhibitor reserpine, were determined (n 232). A reserpine-associated fourfold decrease in MIC was considered indicative of efflux. Strains

Carmen E. DeMarco; Laurel A. Cushing; Emmanuel Frempong-Manso; Susan M. Seo; Tinevimbo A. A. Jaravaza; Glenn W. Kaatz

2007-01-01

273

Epidemiologic surveillance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country  

Microsoft Academic Search

BACKGROUND: Nosocomial Infections (NI) are a frequent and relevant problem. The purpose of this study was to determine the epidemiology of the three most common NI in a Pediatric Intensive Care Unit from a developing country. METHODS: We performed a prospective study in a single Pediatric Intensive Care Unit during 12 months. Children were assessed for 3 NI: bloodstream infections

María R Becerra; José A Tantaleán; Víctor J Suárez; Margarita C Alvarado; Jorge L Candela; Flor C Urcia

2010-01-01

274

Severe Fusobacteria infections (Lemierre syndrome) in two boys  

Microsoft Academic Search

Abscess formation is a rare cause of febrile illness in childhood but always has to be considered in such clinical presentations. Belonging to the resident flora of the oropharyngeal region, Fusobacteria are known to cause local infections; from here they may extend to other sites via the bloodstream or are aspirated into the lung (Lemierre disease). We report on two

Lars Klinge; Udo Vester; Jörg Schaper; Peter F. Hoyer

2002-01-01

275

Ochrobactrum anthropi catheter-related bloodstream infection: the first case report in malaysia.  

PubMed

A 60-year old Malay man presented with an intermittent lowgrade fever for 3 days and worsening of right ankle ulcers. He was known to have ischaemic heart disease, diabetes mellitus type 2, hypertension and end stage renal failure and was on regular haemodialysis. The organisms isolated from the peripheral and central blood specimens were identified as Ochrobactrum anthropi, a rarely encountered gramnegative bacillus with a unique antibiotic susceptibility profile. His condition improved after removal of the catheters and administration of antibiotic therapy. This case report highlights the importance of being wary of such rare, opportunistic pathogens and good communication between the microbiologists and the clinicians. PMID:23749021

Siti Rohani, A H; Tzar, M N

2013-06-01

276

Histopathological study on experimental endophthalmitis induced by bloodstream infection with Candida albicans.  

PubMed

To investigate the details of the pathophysiology of endogenous fungal endophthalmitis (EFE), we performed sequential histological and ophthalmoscopic examination on a rabbit model comparing immunocompromised EFE developed using a steroid with an immunocompetent one intravenously inoculated with Candida albicans. The ophthalmoscopic examination and histological analysis of the retina in both groups demonstrated that lesions appear on the equator of the eyeball and then spread toward the posterior pole. It has been speculated that, because of the unique innate vasculature system of the equator, there is a sudden, decrease of shear stress in rheologically, resulting in adhesion of yeast cells to the endothelial cells. Histological examination revealed that the degree of polymorphonuclear leukocyte (PMN) infiltration was equivalent in the two groups. However, the appearance of PMN was delayed and the number of fungi was higher in the state of hyphae and/or pseudohyphae in the steroid-treated group. Furthermore, the eyeball was found to be the second earliest organ involved in candidemia. Our results indicate that ophthalmic examination is useful to monitor the development and systemic involvement of endophthalmitis in patients with candidemia. PMID:17314423

Omuta, Junko; Uchida, Katsuhisa; Yamaguchi, Hideyo; Shibuya, Kazutoshi

2007-02-01

277

Prospective Multicenter Study of the Impact of Carbapenem Resistance on Mortality in Pseudomonas aeruginosa Bloodstream Infections  

PubMed Central

The impact of antimicrobial resistance on clinical outcomes is the subject of ongoing investigations, although uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bacteremia in a prospective multicenter (10 teaching hospitals) observational study of patients with monomicrobial bacteremia followed up for 30 days after the onset of bacteremia. The adjusted influence of carbapenem resistance on mortality was studied by using Cox regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptible P. aeruginosa (CSPA) isolates, and 145 (23%) were caused by carbapenem-resistant P. aeruginosa (CRPA) isolates. The median incidence density of nosocomial CRPA bacteremia was 2.3 episodes per 100,000 patient-days (95% confidence interval [CI], 1.9 to 2.8). The regression demonstrated a time-dependent effect of carbapenem resistance on mortality as well as a significant interaction with the Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson index scores. The impact of resistance on mortality was statistically significant only from the fifth day after the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratio for a Charlson score of 0 at day 30, 9.9 [95% CI, 3.3 to 29.4]; adjusted hazard ratio for a Charlson score of 5 at day 30, 2.6 [95% CI, 0.8 to 8]). This study clarifies the relationship between carbapenem resistance and mortality in patients with P. aeruginosa bacteremia. Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious effect may not be as great during the first days of the bacteremia or in the presence of comorbidities.

Suarez, Cristina; Gozalo, Monica; Murillas, Javier; Almirante, Benito; Pomar, Virginia; Aguilar, Manuela; Granados, Ana; Calbo, Esther; Rodriguez-Bano, Jesus; Rodriguez, Fernando; Tubau, Fe; Martinez-Martinez, Luis; Oliver, Antonio

2012-01-01

278

Ceftazidime-resistant Klebsiella pneumoniae bloodstream infection in children with febrile neutropenia  

Microsoft Academic Search

Objectives: To evaluate prevalence of ceftazidime-resistant Klebsiella pneumoniae (CRKP) in the pediatric oncology unit of University Hospital, Kuala, Lumpur, and to identify differences between febrile neutropenic pediatric patients with CRKP and ceftazidime-sensitive K. pneumoniae (CSKP) bacteremia.Materials and Methods: Febrile neutropenic patients treated between January 1996 and December 1997 at the pediatric oncology unit of University Hospital, Kuala Lumpur, were prospectively

Hany Ariffin; Parasakthi Navaratnam; Mahfuzah Mohamed; Anusha Arasu; Wan Ariffin Abdullah; Chan Lee Lee; Lin Hai Peng

2000-01-01

279

Relationship between Quinolone Use and Emergence of Ciprofloxacin-ResistantEscherichia coli in Bloodstream Infections  

Microsoft Academic Search

From 1988 to 1992, 27 of 855 cases ofEscherichia colibacteremia in nonneutropenic adult patients observed at our hospital were due to ciprofloxacin-resistant (CIPRO-R) strains. Eighteen episodes (67%) were commu- nity acquired, and nine (33%) were nosocomially acquired. Overall, the rates ofE. colibacteremia caused by CIPRO-R strains increased steadily from 0% in 1988 to 7.5% in 1992 (P < 0.01). There

CARMEN PENA; JOSE M. ALBAREDA; ROMAN PALLARES; MIGUEL PUJOL; FE TUBAU; ANDJAVIER ARIZA

280

Epidemiology and Prognostic Determinants of Bloodstream Infections in Surgical Intensive Care  

Microsoft Academic Search

Main Outcome Measures: Clinical variables, organ dysfunctions, and outcome. Results: Among 4530 admissions to the surgical inten- sive care unit, 224 clinically significant episodes of BSI were recorded (incidence, 4.9%), with a 28-day fatality of 36%. A total of 110 patients had primary bacteremia, of which 39 (35%) were catheter related. Although gram- positive organisms were the most frequently isolated

Stephan Harbarth; Karin Ferriere; Stephane Hugonnet; Bara Ricou; Peter Suter; Didier Pittet

2002-01-01

281

Management and outcome of bloodstream infections due to Candida species in England and Wales  

Microsoft Academic Search

This two-year prospective hospital population-based study of candidaemia is the first to be conducted in the UK. It was carried out on behalf on the British Society for Medical Mycology (BSMM) as part of the European Confederation of Medical Mycology (ECMM) epidemiological survey of candidaemia. Six hospitals in England and Wales acted as sentinel hospitals. Main outcome measures were hospital

C. C Kibbler; S Seaton; R. A Barnes; W. R Gransden; R. E Holliman; E. M Johnson; J. D Perry; D. J Sullivan; J. A Wilson

2003-01-01

282

Using a Microfluidic--Microelectric Device to Directly Separate Serum/Blood Cells from a Continuous Whole Bloodstream Flow  

NASA Astrophysics Data System (ADS)

To make the rapid separation of serum/blood cells possible in a whole bloodstream flow without centrifugation and Pasteur pipette suction, the first step is to use a microchannel to transport the whole bloodstream into a microdevice. Subsequently, the resulting serum/blood cell is separated from the whole bloodstream by applying other technologies. Creating the serum makes this subsequent separation possible. To perform the actual separation, a microchannel with multiple symmetric curvilinear microelectrodes has been designed on a glass substrate and fabricated with micro-electromechanical system technology. The blood cells can be observed clearly by black-field microscopy imaging. A local dielectrophoretic (DEP) force, obtained from nonuniform electric fields, was used for manipulating and separating the blood cells from a continuous whole bloodstream. The experimental studies show that the blood cells incur a local dielectrophoretic field when they are suspended in a continuous flow (v = 0.02{--}0.1 cm/s) and exposed to AC fields at a frequency of 200 kHz. Using this device, the symmetric curvilinear microelectrodes provide a local dielectrophoretic field that is sufficiently strong for separating nearby blood cells and purifying the serum in a continuous whole bloodstream flow.

Wang, Ming-Wen; Jeng, Kuo-Shyang; Yu, Ming-Che; Su, Jui-Chih

2012-03-01

283

The cell cycle as a therapeutic target against Trypanosoma brucei: Hesperadin inhibits Aurora kinase-1 and blocks mitotic progression in bloodstream forms  

PubMed Central

Summary Aurora kinase family members coordinate a range of events associated with mitosis and cytokinesis. Anti-cancer therapies are currently being developed against them. Here, we evaluate whether Aurora kinase-1 (TbAUK1) from pathogenic Trypanosoma brucei might be targeted in anti-parasitic therapies as well. Conditional knockdown of TbAUK1 within infected mice demonstrated its essential contribution to infection. An in vitro kinase assay was developed which used recombinant trypanosome histone H3 (rTbH3) as a substrate. Tandem MS identified a novel phosphorylation site in the carboxyl-tail of rTbH3. Hesperadin, an inhibitor of human Aurora B, prevented the phosphorylation of substrate with IC50 of 40 nM. Growth of cultured bloodstream forms (BF) was also sensitive to Hesperadin (IC50 of 50 nM). Hesperadin blocked nuclear division and cytokinesis, but not other aspects of the cell cycle. Consequently, growth arrested cells accumulated multiple kinetoplasts, flagella and nucleoli; similar to the effects of RNAi-dependent knockdown of TbAUK1 in cultured BF cells. Molecular models predicted high affinity binding of Hesperadin to both conserved and novel sites in TbAUK1. Collectively, these data demonstrate that cell cycle progression is essential for infections with T. brucei, and that parasite Aurora kinases can be targeted with small-molecule inhibitors.

Jetton, Neal; Rothberg, Karen G.; Hubbard, James G.; Wise, John; Li, Yan; Ball, Haydn L.; Ruben, Larry

2009-01-01

284

Frequency of decreased susceptibility and resistance to echinocandins among fluconazole-resistant bloodstream isolates of Candida glabrata.  

PubMed

The echinocandin class of antifungal agents is considered to be the first-line treatment of bloodstream infections (BSI) due to Candida glabrata. Recent reports of BSI due to strains of C. glabrata resistant to both fluconazole and the echinocandins are of concern and prompted us to review the experience of two large surveillance programs, the SENTRY Antimicrobial Surveillance Program for the years 2006 through 2010 and the Centers for Disease Control and Prevention population-based surveillance conducted in 2008 to 2010. The in vitro susceptibilities of 1,669 BSI isolates of C. glabrata to fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin were determined by CLSI broth microdilution methods. Fluconazole MICs of ?64 ?g/ml were considered resistant. Strains for which anidulafungin and caspofungin MICs were ?0.5 ?g/ml and for which micafungin MICs were ?0.25 ?g/ml were considered resistant. A total of 162 isolates (9.7%) were resistant to fluconazole, of which 98.8% were nonsusceptible to voriconazole (MIC > 0.5 ?g/ml) and 9.3%, 9.3%, and 8.0% were resistant to anidulafungin, caspofungin, and micafungin, respectively. There were 18 fluconazole-resistant isolates that were resistant to one or more of the echinocandins (11.1% of all fluconazole-resistant isolates), all of which contained an acquired mutation in fks1 or fks2. By comparison, there were no echinocandin-resistant strains detected among 110 fluconazole-resistant isolates of C. glabrata tested in 2001 to 2004. These data document the broad emergence of coresistance over time to both azoles and echinocandins in clinical isolates of C. glabrata. PMID:22278842

Pfaller, M A; Castanheira, M; Lockhart, S R; Ahlquist, A M; Messer, S A; Jones, R N

2012-01-25

285

Expression of SAP5 and SAP9 in Candida albicans biofilms: comparison of bloodstream isolates with isolates from other sources.  

PubMed

Abstract Secreted aspartic proteases (Sap), encoded by a family of 10 SAP genes, are key virulence determinants in Candida albicans. Although biofilm-associated bloodstream infections (BSIs) are frequently caused by C. albicans, SAP gene expression in C. albicans biofilms formed by BSI isolates has not been evaluated. We compared the expression of two SAP genes, SAP5 and SAP9, in C. albicans biofilms formed by BSI isolates with those formed by isolates from other body sites. Sixty-three C. albicans isolates were analyzed, comprising 35 BSI isolates and 28 from other sites. A denture-strip biofilm model was used, and expression of the two SAP genes was quantified by real-time RT-PCR during planktonic or biofilm growth. Mean SAP5 expression levels of the BSI isolates were 3.59-fold and 3.86-fold higher in 24-h and 48-h biofilms, respectively, than in planktonic cells. These results did not differ from those for isolates from other sites (2.71-fold and 2.8-fold for 24-h and 48-h biofilms, respectively). By contrast, mean SAP9 expression during biofilm formation was higher in BSI isolates (2.89-fold and 3.29-fold at 24 and 48 h, respectively) than in isolates from other sites (1.27-fold and 1.32-fold at 24 and 48 h, respectively; both, P < 0.001). These results show, for the first time, that both SAP5 and SAP9 are upregulated in C. albicans biofilms formed by BSI isolates, and that BSI isolates may have a greater capacity to express SAP9 under biofilm conditions than isolates from other sites. PMID:23971863

Joo, Min Young; Shin, Jong Hee; Jang, Hee-Chang; Song, Eun Song; Kee, Seung Jung; Shin, Myung Geun; Suh, Soon Pal; Ryang, Dong Wook

2013-08-23

286

Effects of aphidicolin and hydroxyurea on the cell cycle and differentiation of Trypanosoma brucei bloodstream forms.  

PubMed

The effects of aphidicolin (APH) and hydroxyurea (HU) on the cell cycle and differentiation of Trypanosoma brucei bloodstream forms were studied. APH (0.1 microgram ml-1) inhibited cell division, but did not inhibit DNA synthesis. Most of the cells were arrested in the G2 phase of the cell cycle, with each cell containing two kinetoplasts, but only one nucleus. Recovery of the arrested cells showed a 24-h lag period compared to controls. Higher concentrations of APH (1 and 10 micrograms ml-1) were required to inhibit DNA synthesis, but the cells failed to resume growth after removal of the drug. Incubation of cells with HU (7.5 micrograms ml-1) did not inhibit DNA synthesis, but arrested cells after duplicating both the kinetoplast and the nucleus. Recovery from drug arrest also showed a 24-h lag period. We therefore conclude that neither APH nor HU arrests T. brucei at the G1/S phase boundary as anticipated. The mechanisms of cell cycle arrest by APH and HU are not through inhibition of DNA synthesis, but rather through unidentified pathways, leading to growth arrest prior to nuclear division and cytokinesis respectively. Since the arrested cells do not resume normal development immediately following drug removal, APH and HU should be regarded as unsuitable agents for synchronizing T. brucei bloodstream forms. T. brucei bloodstream forms arrested with either APH or HU differentiated normally into procyclic forms in vitro, indicating that a cycle of cell division is not required for initiation of differentiation, and that the process can be initiated and completed when cells are arrested at the G2/M and M/G1 phase boundaries. PMID:8885225

Mutomba, M C; Wang, C C

1996-09-01

287

JBP2, a SWI2/SNF2-like protein, regulates de novo telomeric DNA glycosylation in bloodstream form Trypanosoma brucei.  

PubMed

Synthesis of the modified thymine base, beta-d-glucosyl-hydroxymethyluracil or J, within telomeric DNA of Trypanosoma brucei correlates with the bloodstream form specific epigenetic silencing of telomeric variant surface glycoprotein genes involved in antigenic variation. In order to analyze the function of base J in the regulation of antigenic variation, we are characterizing the regulatory mechanism of J biosynthesis. We have recently proposed a model in which chromatin remodeling by a SWI2/SNF2-like protein (JBP2) regulates the developmental and de novo site-specific localization of J synthesis within bloodstream form trypanosome DNA. Consistent with this model, we now show that JBP2 (-/-) bloodstream form trypanosomes contain five-fold less base J and are unable to stimulate de novo J synthesis in newly generated telomeric arrays. PMID:17706299

Kieft, Rudo; Brand, Verena; Ekanayake, Dilrukshi K; Sweeney, Kate; DiPaolo, Courtney; Reznikoff, William S; Sabatini, Robert

2007-06-28

288

Guidelines for the prevention of intravascular catheter-related infections  

Microsoft Academic Search

Background: Although many catheter-related bloodstream infections (CR-BSIs) are preventable, measures to reduce these infections are not uniformly implemented. Objective: To update an existing evidenced-based guideline that promotes strategies to prevent CR-BSIs. Data Sources: The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. Studies Included: Laboratory-based studies, controlled clinical trials, prospective interventional

Naomi P. O'Grady; Mary Alexander; E. Patchen Dellinger; Julie L. Gerberding; Stephen O. Heard; Dennis G. Maki; Henry Masur; Rita D. McCormick; Leonard A. Mermel; Michele L. Pearson; Issam I. Raad; Adrienne Randolph; Robert A. Weinstein

2002-01-01

289

Trypanosoma brucei: Two mitogen activated protein kinase kinases are dispensable for growth and virulence of the bloodstream form  

PubMed Central

Mitogen activated protein kinase cascades function in eukaryotic responses to the environment and stress. Trypanosomatid parasites possess protein kinases with sequences characteristic of kinases in such cascades. In this report we use gene knockouts to demonstrate that two mitogen activated kinase kinase genes, MKK1 (Tb927.3.4860) and MKK5 (Tb927.10.5270), are not essential in the pathogenic bloodstream stage of Trypanosoma brucei, either in vitro or in vivo. Bloodstream forms lacking MKK1 showed decreased growth at 39°C as compared to the parental line. However, unlike its Leishmania orthologue, T. brucei MKK1 does not appear to play a significant role in flagellar biogenesis.

Jensen, Bryan C.; Kifer, Charles T.; Parsons, Marilyn

2011-01-01

290

The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison  

Microsoft Academic Search

BackgroundNosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing these infections. However, hand hygiene compliance among healthcare professionals remains low despite the well-known effect on infection reduction.

Onno K. Helder; Johannes Brug; Caspar W. N. Looman; Johannes B. van Goudoever; René F. Kornelisse

2010-01-01

291

Cell density-dependent ectopic expression in bloodstream form Trypanosoma brucei  

PubMed Central

Ectopic expression of either wild type or mutant proteins is a standard method in cell biology, and a vital part of the tool kit of molecular parasitology. During study of protein expression levels mediating intracellular trafficking, we became aware of highly variable expression between experiments. When investigated systematically it became apparent that ectopic expression of proteins from a ribosomal promoter diminished at high cell culture density in bloodstream form Trypanosoma brucei. This phenomenon was not restricted to expression of a specific protein or cell line or the vector backbone. While procyclic form cells did not exhibit detectable density-related expression changes, bloodstream form cells manifest significant reduction in expression at high density, confirmed by qRT PCR, Western blotting and fluorescence microscopy. Culturing in conditioned media unveiled a similar reduction in expression at lower cell densities. Taken together we concluded that this effect is likely related to the influence of a diffusible factor present in conditioned media and has implications for accurate quantification of ectopic expression using transgenic expression systems.

Ali, Moazzam; Field, Mark C.

2013-01-01

292

Flagellar motility is required for the viability of the bloodstream trypanosome.  

PubMed

The 9 + 2 microtubule axoneme of flagella and cilia represents one of the most iconic structures built by eukaryotic cells and organisms. Both unity and diversity are present among cilia and flagella on the evolutionary as well as the developmental scale. Some cilia are motile, whereas others function as sensory organelles and can variously possess 9 + 2 and 9 + 0 axonemes and other associated structures. How such unity and diversity are reflected in molecular repertoires is unclear. The flagellated protozoan parasite Trypanosoma brucei is endemic in sub-Saharan Africa, causing devastating disease in humans and other animals. There is little hope of a vaccine for African sleeping sickness and a desperate need for modern drug therapies. Here we present a detailed proteomic analysis of the trypanosome flagellum. RNA interference (RNAi)-based interrogation of this proteome provides functional insights into human ciliary diseases and establishes that flagellar function is essential to the bloodstream-form trypanosome. We show that RNAi-mediated ablation of various proteins identified in the trypanosome flagellar proteome leads to a rapid and marked failure of cytokinesis in bloodstream-form (but not procyclic insect-form) trypanosomes, suggesting that impairment of flagellar function may provide a method of disease control. A postgenomic meta-analysis, comparing the evolutionarily ancient trypanosome with other eukaryotes including humans, identifies numerous trypanosome-specific flagellar proteins, suggesting new avenues for selective intervention. PMID:16525475

Broadhead, Richard; Dawe, Helen R; Farr, Helen; Griffiths, Samantha; Hart, Sarah R; Portman, Neil; Shaw, Michael K; Ginger, Michael L; Gaskell, Simon J; McKean, Paul G; Gull, Keith

2006-03-01

293

Cell density-dependent ectopic expression in bloodstream form Trypanosoma brucei.  

PubMed

Ectopic expression of either wild type or mutant proteins is a standard method in cell biology, and a vital part of the tool kit of molecular parasitology. During study of protein expression levels mediating intracellular trafficking, we became aware of highly variable expression between experiments. When investigated systematically it became apparent that ectopic expression of proteins from a ribosomal promoter diminished at high cell culture density in bloodstream form Trypanosoma brucei. This phenomenon was not restricted to expression of a specific protein or cell line or the vector backbone. While procyclic form cells did not exhibit detectable density-related expression changes, bloodstream form cells manifest significant reduction in expression at high density, confirmed by qRT PCR, Western blotting and fluorescence microscopy. Culturing in conditioned media unveiled a similar reduction in expression at lower cell densities. Taken together we concluded that this effect is likely related to the influence of a diffusible factor present in conditioned media and has implications for accurate quantification of ectopic expression using transgenic expression systems. PMID:23538029

Ali, Moazzam; Field, Mark C

2013-03-26

294

Isolation and characterization of glycosylphosphatidylinositol-anchored, mucin-like surface glycoproteins from bloodstream forms of the freshwater-fish parasite Trypanosoma carassii.  

PubMed Central

Wild and farmed freshwater fishes are widely and heavily parasitized by the haemoflagellate Trypanosoma carassii. In contrast, common carp, a natural host, can effectively control experimental infections by the production of specific anti-parasite antibodies. In this study we have identified and partially characterized mucin-like glycoproteins which are expressed in high abundance [(6. 0+/-1.7)x10(6) molecules.cell(-1)] at the surface of the bloodstream trypomastigote stage of the parasite. The polypeptide backbone of these glycoproteins is dominated by threonine, glycine, serine, alanine, valine and proline residues, and is modified at its C-terminus by a glycosylphosphatidylinositol membrane anchor. On average, each polypeptide carries carbohydrate chains composed of about 200 monosaccharide units (galactose, N-acetylglucosamine, xylose, sialic acid, fucose, mannose and arabinose), which are most probably O-linked to hydroxy amino acids. The mucin-like molecules are the target of the fish's humoral immune response, but do not undergo antigenic variation akin to that observed for the variant surface glycoprotein in salivarian trypanosomes. The results are discussed with reference to the differences between natural and experimental infections, and in relation to the recently delineated molecular phylogeny of trypanosomes.

Lischke, A; Klein, C; Stierhof, Y D; Hempel, M; Mehlert, A; Almeida, I C; Ferguson, M A; Overath, P

2000-01-01

295

The International Nosocomial Infection Control Consortium (INICC): Goals and objectives, description of surveillance methods, and operational activities  

Microsoft Academic Search

We have shown that intensive care units (ICUs) in countries with limited resources have rates of device-associated health care-as- sociated infection (HAI), including central line-related bloodstream infection (CLAB), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI), 3 to 5 times higher than rates reported from North American, Western Euro- pean, and Australian ICUs. The International Nosocomial Infection Control Consortium

Victor D. Rosenthal; Dennis G. Maki; Nicholas Graves

296

Listeria monocytogenes-Infected Phagocytes Can Initiate Central Nervous System Infection in Mice  

PubMed Central

Listeria monocytogenes-infected phagocytes are present in the bloodstream of experimentally infected mice, but whether they play a role in central nervous system (CNS) invasion is unclear. To test whether bacteria within infected leukocytes could establish CNS infection, experimentally infected mice were treated with gentamicin delivered by surgically implanted osmotic pumps. Bacterial inhibitory titers in serum and plasma ranged from 1:16 to 1:256, and essentially all viable bacteria in the bloodstream of treated mice were leukocyte associated. Nevertheless, CNS infection developed in gentamicin-treated animals infected intraperitoneally or by gastric lavage, suggesting that intracellular bacteria could be responsible for neuroinvasion. This was supported by data showing that 43.5% of bacteria found with blood leukocytes were intracellular and some colocalized with F-actin, indicating productive intracellular parasitism. Experiments using an L. monocytogenes strain containing a chromosomal actA-gfpuv-plcB transcriptional fusion showed that blood leukocytes were associated with intracellular and extracellularly bound green fluorescent protein-expressing (GFP+) bacteria. Treatment with gentamicin decreased the numbers of extracellularly bound GFP+ bacteria significantly but did not affect the numbers of intracellular GFP+ bacteria, suggesting that the latter were the result of intercellular spread of GFP+ bacteria to leukocytes. These data demonstrate that infected leukocytes and the intracellular L. monocytogenes harbored within them play key roles in neuroinvasion. Moreover, they suggest that phagocytes recruited to infected organs such as the liver or spleen are themselves parasitized by intercellular spread of L. monocytogenes and then reenter the bloodstream and contribute to the systemic dissemination of bacteria.

Drevets, Douglas A.; Jelinek, Todd A.; Freitag, Nancy E.

2001-01-01

297

Severe nosocomial infections with imipenem-resistant Acinetobacter baumannii treated with ampicillin\\/sulbactam  

Microsoft Academic Search

Forty consecutive patients with nosomial infections caused by multidrug-resistant Acinetobacter baumannii were treated with intravenous ampicillin\\/sulbactam. The infections were primary bloodstream (32.5%), pneumonia (30%), urinary tract (15%), peritonitis (7.5%), surgical site (7.5%), meningitis (5%) and sinusitis (2.5%). Most were severe infections with underlying conditions (median APACHE II score: 14.5) and 72.5% occurred in the ICU. Twenty-seven (67.5%) were improved\\/cured, seven

Anna S Levin; Carlos E Levy; A. Edison I Manrique; Eduardo A. S Medeiros; Silvia F Costa

2003-01-01

298

Deep sternal wound infection due to Pasteurella multocida : the first case report and review of literature  

Microsoft Academic Search

Pasteurella multocida is a Gram-negative bacterium recovered from a wide variety of wild and domestic animals and has mostly been associated with\\u000a infection following animal bites. We present the first reported case of a patient who developed a postoperative sternal wound\\u000a infection due to P. multocida complicated by bloodstream infection. The outcome was favorable following surgical debridement and antimicrobial therapy.

R. Baillot; P. Voisine; L. M. E. G. Côté; Y. Longtin

299

Nosocomial Infections and Multidrug-Resistant Bacterial Organisms in the Pediatric Intensive Care Unit  

Microsoft Academic Search

Nosocomial infections in Pediatric Intensive Care Units (PICUs) caused by multidrug-resistant bacterial organisms are increasing.\\u000a This review attempts to report on significant findings in the current literature related to nosocomial infections in PICU\\u000a settings with an international perspective. The types of nosocomial infections are addressed, including catheter-related bloodstream\\u000a infections, ventilator-associated pneumonia, urinary tract infections, gastrointestinal infections and post-surgical wound\\u000a infections.

Eric J. McGrath; Basim I. Asmar

2011-01-01

300

Antiproliferative Effect of Dihydroxyacetone on Trypanosoma brucei Bloodstream Forms: Cell Cycle Progression, Subcellular Alterations, and Cell Death  

Microsoft Academic Search

We evaluated the effects of dihydroxyacetone (DHA) on Trypanosoma brucei bloodstream forms. DHA is considered an energy source for many different cell types. T. brucei takes up DHA readily due to the presence of aquaglyceroporins. However, the parasite is unable to use it as a carbon source because of the absence of DHA kinase (DHAK). We could not find a

Nestor L. Uzcategui; Didac Carmona-Gutierrez; Viola Denninger; Caroline Schoenfeld; Florian Lang; Katherine Figarella; Michael Duszenko

2007-01-01

301

Biofilm Production by Isolates of Candida Species Recovered from Nonneutropenic Patients: Comparison of Bloodstream Isolates with Isolates from Other Sources  

Microsoft Academic Search

Biofilm production has been implicated as a potential virulence factor of some Candida species responsible for catheter-related fungemia in patients receiving parenteral nutrition. We therefore compared clinical bloodstream isolates representing seven different Candida species to each other and to those from other anatomical sites for the capacity to form biofilms in glucose-containing medium. Potential associations between the capacity to form

Jong Hee Shin; Seung Jung Kee; Myung Geun Shin; Soo Hyun Kim; Dong Hyeon Shin; Sang Ku Lee; Soon Pal Suh; Dong Wook Ryang

2002-01-01

302

Invasive Fungal Infection Due to Triadelphia pulvinata in a Patient with Acute Myeloid Leukemia.  

PubMed

Triadelphia pulvinata is a rare dematiaceous fungus found in soil. We report the first case of invasive disease in a patient with acute myeloid leukemia who had a bloodstream infection with possibly both lung and brain involvement. Identification was by combined phenotypic features and fungal ribosomal DNA sequence analysis. PMID:23863568

Edathodu, Jameela; Al-Abdely, Hail M; Althawadi, Sahar; Wickes, Brian L; Thompson, Elizabeth H; Wiederhold, Nathan P; Madrid, Hugo; Guarro, Josep; Sutton, Deanna A

2013-07-17

303

Carbohydrade Recognition at Infection Site  

NSDL National Science Digital Library

The recognition of cell-surface carbohydrate on neutrophils is the first stage of their migration out of the blood at sites of infection. Specialized transmembrane proteins (called lectins) are made by the cells lining the blood vessel (called endothelial cells) in response to chemical signals emanating from the site of infection. These proteins recognize particular groups of sugars carried by glycolipids and glycoproteins on the surface of neutrophils circulating in the blood. The neutrophils consequently stick to the blood vessel wall. This association is not very strong, but it leads to another, much stronger protein-protein interaction (not shown) that helps the neutrophil migrate out of the bloodstream between the endothelial cells into the tissue at the site of infection.

Alberts, Bruce; Johnson, Alexander; Lewis, Julian; Raff, Martin; Roberts, Keith; Walter, Peter

1998-07-01

304

Genetic Diversity among Korean Candida albicans Bloodstream Isolates: Assessment by Multilocus Sequence Typing and Restriction Endonuclease Analysis of Genomic DNA by Use of BssHII?†  

PubMed Central

Multilocus sequence typing (MLST) has been successfully applied to the epidemiology of Candida albicans isolates not only within the hospital setting but also in multiple locations nationwide. We performed MLST to investigate the genetic relatedness among bloodstream infection (BSI) isolates of C. albicans recovered from 10 Korean hospitals over a 12-month period. The 156 isolates yielded 112 unique diploid sequence types (DSTs). While 95 DSTs were each derived from a single isolate, 17 DSTs were shared by 61 isolates (39.1%). Interestingly, 111 (71.1%) isolates clustered within previously known clades, and 29 (18.6%) clustered within a new clade that includes strains of Asian origin previously typed as singletons. This MLST study was complemented by restriction endonuclease analysis of genomic DNA using BssHII (REAG-B) in order to evaluate whether strains with identical DSTs and originating from the same hospital corresponded to nosocomial clusters. Importantly, only those isolates with a strong epidemiological relationship showed ?95% identical REAG-B types. Our results indicate that REAG-B typing can be complementary to MLST but should be limited to the investigation of isolates of identical DSTs and when interhuman transmission is suspected.

Shin, Jong Hee; Bougnoux, Marie-Elisabeth; d'Enfert, Christophe; Kim, Soo Hyun; Moon, Chang-Jin; Joo, Min Young; Lee, Kyungwon; Kim, Mi-Na; Lee, Hye Soo; Shin, Myung Geun; Suh, Soon Pal; Ryang, Dong Wook

2011-01-01

305

Genetic diversity among Korean Candida albicans bloodstream isolates: assessment by multilocus sequence typing and restriction endonuclease analysis of genomic DNA by use of BssHII.  

PubMed

Multilocus sequence typing (MLST) has been successfully applied to the epidemiology of Candida albicans isolates not only within the hospital setting but also in multiple locations nationwide. We performed MLST to investigate the genetic relatedness among bloodstream infection (BSI) isolates of C. albicans recovered from 10 Korean hospitals over a 12-month period. The 156 isolates yielded 112 unique diploid sequence types (DSTs). While 95 DSTs were each derived from a single isolate, 17 DSTs were shared by 61 isolates (39.1%). Interestingly, 111 (71.1%) isolates clustered within previously known clades, and 29 (18.6%) clustered within a new clade that includes strains of Asian origin previously typed as singletons. This MLST study was complemented by restriction endonuclease analysis of genomic DNA using BssHII (REAG-B) in order to evaluate whether strains with identical DSTs and originating from the same hospital corresponded to nosocomial clusters. Importantly, only those isolates with a strong epidemiological relationship showed ?95% identical REAG-B types. Our results indicate that REAG-B typing can be complementary to MLST but should be limited to the investigation of isolates of identical DSTs and when interhuman transmission is suspected. PMID:21562112

Shin, Jong Hee; Bougnoux, Marie-Elisabeth; d'Enfert, Christophe; Kim, Soo Hyun; Moon, Chang-Jin; Joo, Min Young; Lee, Kyungwon; Kim, Mi-Na; Lee, Hye Soo; Shin, Myung Geun; Suh, Soon Pal; Ryang, Dong Wook

2011-05-11

306

RNA Interference Mutant Induction In Vivo Demonstrates the Essential Nature of Trypanosome Flagellar Function during Mammalian Infection?  

PubMed Central

We demonstrate that trypanosomes compromised in flagellar function are rapidly cleared from infected mice. Analysis of the PFR2 bloodstream RNA interference mutant revealed that defective cell motility occurred prior to cytokinesis failure. This validation provides a paradigm for the flagellum as a target for future assays and interventions against this human pathogen.

Griffiths, Samantha; Portman, Neil; Taylor, Philip R.; Gordon, Siamon; Ginger, Michael L.; Gull, Keith

2007-01-01

307

Healthcare-associated infections in a neonatal intensive care unit  

PubMed Central

Introduction Healthcare-associated infection is a common problem in patients from neonatal intensive care units and it is one of the leading causes of death in this group of patients. Healthcare-associated infections are associated with increases in mortality, morbidity, and prolonged length of hospital stay. The aim of the study was to assess the incidence, clinical presentation, mortality and aetiology of healthcare-associated infections in newborns in a neonatal intensive care unit between 2005 and 2010. Material and methods The research involved documentation of 2610 neonates hospitalized in this period in the Neonatal Intensive Care Unit, Dr Jan Biziel University Hospital No. 2 in Bydgoszcz. The incidence, clinical presentation, mortality and causative factors of healthcare-associated infections were assessed. Results The prevalence of healthcare-associated infections was 7.32%. The most frequent healthcare-associated infections were bloodstream infection (65.4%) and urinary tract infection (22.5%). The mortality rate was 2.1%. The most frequent pathogens were coagulase-negative staphylococci (36.1%) and Klebsiella pneumoniae (29.3%). Conclusions The rate of healthcare-associated bloodstream infections in the analysed department is low, taking into consideration the specificity of the department. There is a necessity to establish convenient definitions of various kinds of healthcare-associated infecions in neonates, especially those born preterm.

Jankowska, Aldona; Kurylak, Andrzej

2012-01-01

308

Virus infections in the nervous system.  

PubMed

Virus infections usually begin in peripheral tissues and can invade the mammalian nervous system (NS), spreading into the peripheral (PNS) and more rarely the central (CNS) nervous systems. The CNS is protected from most virus infections by effective immune responses and multilayer barriers. However, some viruses enter the NS with high efficiency via the bloodstream or by directly infecting nerves that innervate peripheral tissues, resulting in debilitating direct and immune-mediated pathology. Most viruses in the NS are opportunistic or accidental pathogens, but a few, most notably the alpha herpesviruses and rabies virus, have evolved to enter the NS efficiently and exploit neuronal cell biology. Remarkably, the alpha herpesviruses can establish quiescent infections in the PNS, with rare but often fatal CNS pathology. Here we review how viruses gain access to and spread in the well-protected CNS, with particular emphasis on alpha herpesviruses, which establish and maintain persistent NS infections. PMID:23601101

Koyuncu, Orkide O; Hogue, Ian B; Enquist, Lynn W

2013-04-17

309

Chlamydia trachomatis Infection and Anti-Hsp60 Immunity: The Two Sides of the Coin  

Microsoft Academic Search

Chlamydia trachomatis (CT) infection is one of the most common causes of reproductive tract diseases and infertility. CT-Hsp60 is synthesized during infection and is released in the bloodstream. As a consequence, immune cells will produce anti-CT-Hsp60 antibodies. Hsp60, a ubiquitous and evolutionarily conserved chaperonin, is normally sequestered inside the cell, particularly into mitochondria. However, upon cell stress, as well as

Francesco Cappello; Everly Conway de Macario; Valentina Di Felice; Giovanni Zummo; Alberto J. L. Macario

2009-01-01

310

Chlamydia trachomatis Infection and Anti-Hsp60 Immunity: The Two Sides of the Coin  

Microsoft Academic Search

Chlamydia trachomatis (CT) infection is one of the most common causes of reproductive tract diseases and infertility. CT-Hsp60 is synthesized during infection and is released in the bloodstream. As a consequence, immune cells will produce anti-CT-Hsp60 antibodies. Hsp60, a ubiquitous and evolutionarily conserved chaper- onin, is normally sequestered inside the cell, particularly into mitochondria. However, upon cell stress, as well

Francesco Cappello; Everly Conway de Macario; Valentina Di Felice; Giovanni Zummo; Alberto J. L. Macario

2009-01-01

311

Prospective assessment of hospital-acquired bloosdstream infections: how many may be preventable?  

Microsoft Academic Search

ObjectiveTo determine the proportion of preventable hospital-acquired bloodstream infections (HA-BSIs), the authors prospectively examined consecutive cases in a large university hospital over an 18-month period.Patients and methodsMedical charts were assessed with the physician in charge of the patient within 4 days after HA-BSI diagnosis to determine whether the infection was healthcare-related. Preventability was assessed using a validated tool. Results of

Christine Bonnal; Bruno Mourvillier; Régis Bronchard; Danielle de Paula; Laurence Armand-Lefevre; François Lheriteau; Jean-Luc Quenon; Jean-Christophe Lucet

2010-01-01

312

Probing the bioinorganic chemistry of toxic metals in the mammalian bloodstream to advance human health.  

PubMed

The etiology of numerous grievous human diseases, including Alzheimer's and Parkinson's Disease is not well understood. Conversely, the concentration toxic metals and metalloids, such as As, Cd, Hg and Pb in human blood of the average population is well established, yet we know strikingly little about the role that they might play in the etiology of disease processes. Establishing functional connections between the chronic exposure of humans to these and other inorganic pollutants and the etiology of certain human diseases is therefore viewed by many as one of the greatest challenges in the post-genomic era. Conceptually, this task requires us to uncover hitherto unknown biomolecular mechanisms which must explain how small doses of a toxic metal/metalloid compound (low ?g per day) - or mixtures thereof - may eventually result in a particular human disease. The biological complexity that is inherently associated with mammals, however, makes the discovery of these mechanisms a truly monumental task. Recent findings suggest that a better understanding of the bioinorganic chemistry of inorganic pollutants in the mammalian bloodstream represents a fruitful strategy to unravel relevant biomolecular mechanisms. The adverse effect(s) that toxic metals/metalloid compounds exert on the transport of essential ultratrace elements to internal organs appear particularly pertinent. A brief overview of the effect that arsenite and Hg(2+) exert on the mammalian metabolism of selenium is presented. PMID:22209021

Gailer, Jürgen

2011-12-13

313

Bitter melon extract inhibits proliferation of Trypanosoma brucei bloodstream forms in vitro.  

PubMed

Trypanosoma brucei is the causative agent of sleeping sickness, a fatal disease prevalent in sub-Saharan Africa. The few currently available drug treatments are dated and face problems with toxicity and resistance. For these reasons, there is an urgent need for the development of new chemotherapies for the treatment of sleeping sickness. In this study, we investigated the trypanocidal activity of bitter melon extract. Recently, it has been shown that bitter melon extracts display cytotoxic activity towards different cancer cell lines. However, agents exhibiting anti-tumour activity are usually also inhibiting the growth of T. brucei. Treatment of bloodstream forms of T. brucei with extracts prepared from Chinese and Indian bitter melon varieties resulted in a decrease in cell proliferation. In contrast, human myeloid leukaemia HL-60 cells were 3-6 times less sensitive to the extracts than trypanosomes. Initial fractionation of bitter melon extracts indicated that the trypanocidal activity of the extract is associated with at least two different classes of substances: one class of larger molecular weight compounds (>3 kDa) causing rapid lysis of trypanosomes and one class of smaller molecular weight compounds (<3 kDa) inducing accumulation of the parasites in the G(2)-M phase of the cell cycle. Together, the results suggest that bitter melon is a promising source for trypanocidal agents which could be used as lead compounds for the development of novel anti-sleeping sickness drugs. PMID:23266484

Phillips, Elizabeth A; Sexton, Darren W; Steverding, Dietmar

2012-12-22

314

In vitro lysis of the bloodstream forms of Trypanosoma brucei gambiense by stearylamine-bearing liposomes.  

PubMed Central

Cytolytic activity of liposomes consisting of stearylamine and phosphatidylcholine (SA/PC-liposomes) was examined in vitro against the bloodstream forms of Trypanosoma brucei gambiense. More than 99% of the cells (2 X 10(6)/ml) were killed within 30 min by treatment with 15 mol% SA/PC-liposomes (100 microM total lipids). As few as 1.2 X 10(12) liposomes per ml (equivalent to 2 nM liposome) showed trypanocidal activity. Fluorescence microscopy of cells treated with the dansylated SA/PC-liposomes suggested that the liposomes bound to and accumulated on the cell surface, eventually damaging the plasma membrane. SA/PC-liposomes showed no significant hemolysis when incubated with human and mouse erythrocytes under conditions that killed greater than 99.9% of the T. b. gambiense trypomastigotes. Human leukocytes were also shown to be less susceptible to SA/PC-liposomes than T. b. gambiense. These results may point to a new direction in strategy for therapy of African trypanosomiasis. Images

Tachibana, H; Yoshihara, E; Kaneda, Y; Nakae, T

1988-01-01

315

Antifungal Susceptibility Survey of 2,000 Bloodstream Candida Isolates in the United States  

PubMed Central

Candida bloodstream isolates (n = 2,000) from two multicenter clinical trials carried out by the National Institute of Allergy and Infectious Diseases Mycoses Study Group between 1995 and 1999 were tested against amphotericin B (AMB), flucytosine (5FC), fluconazole (FLU), itraconazole (ITR), voriconazole (VOR), posaconazole (POS), caspofungin (CFG), micafungin (MFG), and anidulafungin (AFG) using the NCCLS M27-A2 microdilution method. All drugs were tested in the NCCLS-specified RPMI 1640 medium except for AMB, which was tested in antibiotic medium 3. A sample of isolates was also tested in RPMI 1640 supplemented to 2% glucose and by using the diluent polyethylene glycol (PEG) in lieu of dimethyl sulfoxide for those drugs insoluble in water. Glucose supplementation tended to elevate the MIC, whereas using PEG tended to decrease the MIC. Trailing growth occurred frequently with azoles. Isolates were generally susceptible to AMB, 5FC, and FLU. Rates of resistance to ITR approached 20%. Although no established interpretative breakpoints are available for the candins (CFG, MFG, and AFG) and the new azoles (VOR and POS), they all exhibited excellent antifungal activity, even for those strains resistant to the other aforementioned agents.

Ostrosky-Zeichner, Luis; Rex, John H.; Pappas, Peter G.; Hamill, Richard J.; Larsen, Robert A.; Horowitz, Harold W.; Powderly, William G.; Hyslop, Newton; Kauffman, Carol A.; Cleary, John; Mangino, Julie E.; Lee, Jeannette

2003-01-01

316

The cooperative roles of two kinetoplastid-specific kinesins in cytokinesis and in maintaining cell morphology in bloodstream trypanosomes.  

PubMed

The cytoskeleton of Trypanosoma brucei, a unicellular eukaryote and a parasitic protozoan, is defined by the subpellicular microtubule corset that is arranged underneath the plasma membrane. We recently identified two orphan kinesins, TbKIN-C and TbKIN-D, that cooperate to regulate the organization of the subpellicular microtubule corset and thereby maintain cell morphology in the procyclic form of T. brucei. In this report, we characterize the function of TbKIN-C and TbKIN-D in the bloodstream form of T. brucei and investigate their functional cooperation in both the bloodstream and procyclic forms. TbKIN-C and TbKIN-D form a tight complex in vivo in the bloodstream form. TbKIN-C is strongly enriched at the posterior tip of the cell, whereas TbKIN-D is distributed throughout the cell body at all cell cycle stages. RNAi of TbKIN-C or TbKIN-D in the bloodstream form inhibits cell proliferation and leads to cell death, due to cytokinesis defects. RNAi of TbKIN-C and TbKIN-D also results in defects in basal body segregation, but does not affect the synthesis and segregation of the flagellum and the flagellum attachment zone (FAZ) filament. Knockdown of TbKIN-C and TbKIN-D does not disrupt the organization of the subpellicular microtubule corset, but produces multinucleated cells with an enlarged flagellar pocket and misplaced flagella. Interestingly, depletion of TbKIN-C results in rapid degradation of TbKIN-D and, similarly, knockdown of TbKIN-C destabilizes TbKIN-D, suggesting that formation of TbKIN-C/TbKIN-D complex stabilizes both kinesins and is required for the two kinesins to execute their essential cellular functions. Altogether, our results demonstrate the essential role of the two kinesins in cell morphogenesis and cytokinesis in the bloodstream form and the requirement of heteromeric complex formation for maintaining the stability of the two kinesins. PMID:24069240

Wei, Ying; Hu, Huiqing; Lun, Zhao-Rong; Li, Ziyin

2013-09-12

317

The Cooperative Roles of Two Kinetoplastid-Specific Kinesins in Cytokinesis and in Maintaining Cell Morphology in Bloodstream Trypanosomes  

PubMed Central

The cytoskeleton of Trypanosoma brucei, a unicellular eukaryote and a parasitic protozoan, is defined by the subpellicular microtubule corset that is arranged underneath the plasma membrane. We recently identified two orphan kinesins, TbKIN-C and TbKIN-D, that cooperate to regulate the organization of the subpellicular microtubule corset and thereby maintain cell morphology in the procyclic form of T. brucei. In this report, we characterize the function of TbKIN-C and TbKIN-D in the bloodstream form of T. brucei and investigate their functional cooperation in both the bloodstream and procyclic forms. TbKIN-C and TbKIN-D form a tight complex in vivo in the bloodstream form. TbKIN-C is strongly enriched at the posterior tip of the cell, whereas TbKIN-D is distributed throughout the cell body at all cell cycle stages. RNAi of TbKIN-C or TbKIN-D in the bloodstream form inhibits cell proliferation and leads to cell death, due to cytokinesis defects. RNAi of TbKIN-C and TbKIN-D also results in defects in basal body segregation, but does not affect the synthesis and segregation of the flagellum and the flagellum attachment zone (FAZ) filament. Knockdown of TbKIN-C and TbKIN-D does not disrupt the organization of the subpellicular microtubule corset, but produces multinucleated cells with an enlarged flagellar pocket and misplaced flagella. Interestingly, depletion of TbKIN-C results in rapid degradation of TbKIN-D and, similarly, knockdown of TbKIN-C destabilizes TbKIN-D, suggesting that formation of TbKIN-C/TbKIN-D complex stabilizes both kinesins and is required for the two kinesins to execute their essential cellular functions. Altogether, our results demonstrate the essential role of the two kinesins in cell morphogenesis and cytokinesis in the bloodstream form and the requirement of heteromeric complex formation for maintaining the stability of the two kinesins.

Wei, Ying; Hu, Huiqing; Lun, Zhao-Rong; Li, Ziyin

2013-01-01

318

Dalbavancin compositions for treatment of bacterial infections  

US Patent & Trademark Office Database

The invention provides methods and compositions for treatment of bacterial infections. The composition may be a combination of factors, which include A.sub.0, A.sub.1, B.sub.1, B.sub.2, C.sub.0, C.sub.1, isoB.sub.0, and MAG, in the presence of low level solvent. Methods of the invention include administration of dalbavancin formulations for treatment of a bacterial infection, in particular a Gram-positive bacterial infection of skin and soft tissue. Dosing regimens include multiple dose administration of dalbavancin, which often remains at therapeutic levels in the bloodstream for at least one week, providing prolonged therapeutic action against a bacterial infection. Dosing regimens for renal patients are also included.

Stogniew; Martin (Blue Bell, PA); Colombo; Luigi (Malnate, IT); Ciabatti; Romeo (Novate Milanese, IT)

2012-03-27

319

Trypanosome Motion Represents an Adaptation to the Crowded Environment of the Vertebrate Bloodstream  

PubMed Central

Blood is a remarkable habitat: it is highly viscous, contains a dense packaging of cells and perpetually flows at velocities varying over three orders of magnitude. Only few pathogens endure the harsh physical conditions within the vertebrate bloodstream and prosper despite being constantly attacked by host antibodies. African trypanosomes are strictly extracellular blood parasites, which evade the immune response through a system of antigenic variation and incessant motility. How the flagellates actually swim in blood remains to be elucidated. Here, we show that the mode and dynamics of trypanosome locomotion are a trait of life within a crowded environment. Using high-speed fluorescence microscopy and ordered micro-pillar arrays we show that the parasites mode of motility is adapted to the density of cells in blood. Trypanosomes are pulled forward by the planar beat of the single flagellum. Hydrodynamic flow across the asymmetrically shaped cell body translates into its rotational movement. Importantly, the presence of particles with the shape, size and spacing of blood cells is required and sufficient for trypanosomes to reach maximum forward velocity. If the density of obstacles, however, is further increased to resemble collagen networks or tissue spaces, the parasites reverse their flagellar beat and consequently swim backwards, in this way avoiding getting trapped. In the absence of obstacles, this flagellar beat reversal occurs randomly resulting in irregular waveforms and apparent cell tumbling. Thus, the swimming behavior of trypanosomes is a surprising example of micro-adaptation to life at low Reynolds numbers. For a precise physical interpretation, we compare our high-resolution microscopic data to results from a simulation technique that combines the method of multi-particle collision dynamics with a triangulated surface model. The simulation produces a rotating cell body and a helical swimming path, providing a functioning simulation method for a microorganism with a complex swimming strategy.

Heddergott, Niko; Kruger, Timothy; Babu, Sujin B.; Wei, Ai; Stellamanns, Erik; Uppaluri, Sravanti; Pfohl, Thomas; Stark, Holger; Engstler, Markus

2012-01-01

320

Human Parathyroid Hormone Is Secreted Primarily into the Bloodstream After Rat Parotid Gland Gene Transfer  

PubMed Central

Abstract Hypoparathyroidism is a hormone deficiency syndrome that leads to low blood calcium levels and for which current replacement therapy is inadequate. Gene transfer to salivary glands leads to safe and abundant secretion of therapeutic protein into either saliva or the bloodstream. We previously reported the successful transduction of rat submandibular glands with an adenoviral vector encoding human parathyroid hormone (Ad.hPTH), but unfortunately most of the hPTH was secreted into saliva. Because submandibular and parotid glands are morphologically and functionally different, we hypothesized that hPTH sorting might be different in parotid glands. After 2 days, the pattern of hPTH secretion from transduced parotid glands of intact rats was reversed from that of transduced submandibular glands, that is, most transgenic hPTH was detected in serum (5?×?1010 viral particles per gland; the saliva-to-serum ratio of total hPTH secreted was 0.04). Vector copies were localized to the targeted parotid glands, with none detected in liver or spleen. Ad.hPTH next was administered to parotid glands of parathyroidectomized rats. Two days after delivery no hPTH was detectable in saliva, but high levels were found in serum, leading to normalization of serum calcium and a significant increase in the urinary phosphorus-to-creatinine ratio. This study demonstrates for the first time differential sorting of transgenic hPTH between submandibular and parotid glands, suggesting that hPTH may be a valuable model protein for understanding the molecular basis of transgenic secretory protein sorting in these exocrine glands. We also show the clinical potential of salivary gland hPTH gene therapy for patients with hypoparathyroidism.

Adriaansen, J.; Perez, P.; Zheng, C.; Collins, M.T.

2011-01-01

321

The role of proteolysis during differentiation of Trypanosoma brucei from the bloodstream to the procyclic form.  

PubMed

The in vitro differentiation of Trypanosoma brucei from bloodstream to procyclic (insect) forms is accompanied by diminishing variant surface glycoprotein (VSG) and increasing levels of procyclin and phosphoenolpyruvate carboxykinase (PEPCK). In this study, we examined the fate of several glycolytic enzymes of T. brucei during differentiation. We observed a down-regulation of glycosomal phosphoglycerate kinase (gPGK) during differentiation. In contrast, intracellular levels of glycosomal glyceraldehyde-3-phosphate dehydrogenase (gGAPDH), aldolase (ALD), and phosphoglucoisomerase (PGI) remained unchanged during differentiation and apparently continued to be synthesized in the procyclic form. To determine the potential role of proteasomes and other proteases during the differentiation process, we tested the effect of lactacystin, a specific inhibitor of proteasome activity, and morpholinourea-Phe-homoPhe-benz-alpha-pyrone (P27), a selective inhibitor of cysteine proteases, on the in vitro differentiation of T. brucei. Cells differentiated normally in the presence of 1 microM lactacystin, which confirmed our previous observation that this differentiation does not require crossing any phase boundaries in the cell cycle (Mutomba and Wang, Mol Biochem Parasitol 1996;80:89-102). But the cells thus differentiated did not increase in number and retained gPGK. Cells differentiated under 2 microM P27 also proceeded at a normal rate but failed to multiply and retained gPGK. However, most of the differentiated cells under 2 microM P27 also retained VSG on the cell membrane surface and expressed higher levels of procyclin suggesting that a cysteine protease(s) may be involved in releasing VSG and partially reducing procyclin during differentiation. This cysteine protease(s) has been tentatively identified in the procyclic cells as a 48 kDa protein through labeling of cysteine protease(s) with a biotinylated P27 homolog K02 (morpholinourea-Phe-homoPhe-vinylsulfone). PMID:9662024

Mutomba, M C; Wang, C C

1998-05-15

322

Novel sterol metabolic network of Trypanosoma brucei procyclic and bloodstream forms  

PubMed Central

Trypanosoma brucei is the protozoan parasite that causes African trypanosomiasis, a neglected disease of people and animals. Co-metabolite analysis, labelling studies using [methyl-2H3]-methionine and substrate/product specificities of the cloned 24-SMT (sterol C24-methyltransferase) and 14-SDM (sterol C14-demethylase) from T. brucei afforded an uncommon sterol metabolic network that proceeds from lanosterol and 31-norlanosterol to ETO [ergosta-5,7,25(27)-trien-3?-ol], 24-DTO [dimethyl ergosta-5,7,25(27)-trienol] and ergosterol [ergosta-5,7,22(23)-trienol]. To assess the possible carbon sources of ergosterol biosynthesis, specifically 13C-labelled specimens of lanosterol, acetate, leucine and glucose were administered to T. brucei and the 13C distributions found were in accord with the operation of the acetate–mevalonate pathway, with leucine as an alternative precursor, to ergostenols in either the insect or bloodstream form. In searching for metabolic signatures of procyclic cells, we observed that the 13C-labelling treatments induce fluctuations between the acetyl-CoA (mitochondrial) and sterol (cytosolic) synthetic pathways detected by the progressive increase in 13C-ergosterol production (control <[2-13C]leucine<[2-13C]acetate<[1-13C]glucose) and corresponding depletion of cholesta-5,7,24-trienol. We conclude that anabolic fluxes originating in mitochondrial metabolism constitute a flexible part of sterol synthesis that is further fluctuated in the cytosol, yielding distinct sterol profiles in relation to cell demands on growth.

Nes, Craigen R.; Singha, Ujjal K.; Liu, Jialin; Ganapathy, Kulothungan; Villalta, Fernando; Waterman, Michael R.; Lepesheva, Galina I.; Chaudhuri, Minu; Nes, W. David

2012-01-01

323

Nuclear DBF-2-related Kinases Are Essential Regulators of Cytokinesis in Bloodstream Stage Trypanosoma brucei*  

PubMed Central

Nuclear DBF-2-related (NDR) kinases are essential regulators of cell cycle progression, growth, and development in many organisms and are activated by the binding of an Mps One Binder (MOB) protein partner, autophosphorylation, and phosphorylation by an upstream STE20 family kinase. In the protozoan parasite, Trypanosoma brucei, the causative agent of human African trypanosomiasis, the NDR kinase, PK50, is expressed in proliferative life cycle stages and was shown to complement a yeast NDR kinase mutant cell line. However, the function of PK50 and a second NDR kinase, PK53, in T. brucei has not been determined to date, although trypanosome MOB1 is known to be essential for cytokinesis, suggesting the NDR kinases may also be involved in this process. Here, we show that specific depletion of PK50 or PK53 from bloodstream stage trypanosomes resulted in the rapid accumulation of cells with two nuclei and two kinetoplasts, indicating that cytokinesis was specifically inhibited. This led to a deregulation of the cell cycle and cell death and provides genetic validation of these kinases as potential novel drug targets for human African trypanosomiasis. Recombinant active PK50 and PK53 were produced and biochemically characterized. Both enzymes autophosphorylated, were able to trans-phosphorylate generic kinase substrates in vitro, and were active in the absence of phosphorylation by an upstream kinase. Additionally, both enzymes were active in the absence of MOB1 binding, which was also demonstrated to likely be a feature of the kinases in vivo. Biochemical characterization of recombinant PK50 and PK53 has revealed key kinetic differences between them, and the identification of in vitro peptide substrates in this study paves the way for high throughput inhibitor screening of these kinases.

Ma, Jiangtao; Benz, Corinna; Grimaldi, Raffaella; Stockdale, Christopher; Wyatt, Paul; Frearson, Julie; Hammarton, Tansy C.

2010-01-01

324

Antecedent Hyperglycemia Is Associated With an Increased Risk of Neutropenic Infections During Bone Marrow Transplantation  

PubMed Central

OBJECTIVE—To use bone marrow transplantation (BMT) as a model for testing the association between hyperglycemia and infection. RESEARCH DESIGN AND METHODS—This cohort study included 382 adults (6.5% with diabetes) who had no evidence of infection before neutropenia during BMT. Mean glucose was calculated from central laboratory and bedside measurements taken before neutropenia; the primary outcome was neutropenic infections. RESULTS—Eighty-four patients (22%) developed at least one neutropenic infection, including 51 patients (13%) with bloodstream infections. In patients who did not receive glucocorticoids during neutropenia, each 10 mg/dl increase in mean preneutropenia glucose was associated with an odds ratio of 1.08 (95% CI 0.98–1.19) (P = 0.14) for any infection and 1.15 (1.03–1.28) (P = 0.01) for bloodstream infections, after adjusting for age, sex, race, year, cancer diagnosis, transplant type, and total glucocorticoid dose before neutropenia. In those who received glucocorticoids during neutropenia (n = 71), the adjusted odds ratio associated with a 10 mg/dl increase in mean glucose was 1.21 (1.09–1.34) (P < 0.0001) for any infection and 1.24 (1.11–1.38) (P < 0.0001) for bloodstream infections. There was no association between mean glycemia and long length of hospital stay, critical status designation, or mortality. CONCLUSIONS—In a BMT population highly susceptible to infection, there was a continuous positive association between mean antecedent glycemia and later infection risk, particularly in patients who received glucocorticoids while neutropenic. Tight glycemic control during BMT and glucocorticoid treatment may reduce infections.

Derr, Rachel L.; Hsiao, Victoria C.; Saudek, Christopher D.

2008-01-01

325

Declining cephalosporin and fluoroquinolone non-susceptibility among bloodstream Enterobacteriaceae from the UK: links to prescribing change?  

PubMed

OBJECTIVES: The UK saw major increases in cephalosporin and quinolone resistance amongst Enterobacteriaceae from 2001 to 2006, with cephalosporin resistance largely reflecting dissemination of CTX-M extended-spectrum ?-lactamases (ESBLs). We review subsequent trends. METHODS: Data were extracted from Public Health England's national database (LabBase), which collects susceptibility results for bloodstream isolates from hospital microbiology laboratories in England, Wales and Northern Ireland, and from the BSAC Bacteraemia Resistance Surveillance System, which centrally tests bloodstream isolates from 25-40 sentinel UK and Irish laboratories. Reference laboratory submissions were also reviewed. RESULTS: LabBase and BSAC data showed that rates of non-susceptibility to cephalosporins and quinolones rose amongst Escherichia coli and Klebsiella spp. until mid-decade (2004-07) before plateauing or falling; similar falls in non-susceptibility began slightly earlier in Enterobacter spp. These reversals in trend occurred whilst the incidence of E. coli bacteraemias was rising, the incidence of Klebsiella bacteraemias was stable and the incidence of Enterobacter bacteraemias was falling; they were not paralleled in EARS-Net data for continental Europe and did not reflect the displacement of single mechanisms. They coincided with large reductions in hospital cephalosporin and quinolone use, owing to concern about Clostridium difficile, with replacement by penicillin/?-lactamase inhibitor combinations, which have borderline activity against ESBL producers, but consistently lack activity against carbapenemase producers. CONCLUSIONS: Non-susceptibility to cephalosporins and quinolones has declined among bloodstream Enterobacteriaceae in the UK, probably reflecting prescribing shifts. The penicillin/?-lactamase inhibitor combinations that have largely replaced cephalosporins and quinolones may add to selection for carbapenemase producers. PMID:23766490

Livermore, David M; Hope, Russell; Reynolds, Rosy; Blackburn, Ruth; Johnson, Alan P; Woodford, Neil

2013-06-13

326

Structure-function analysis of dynein light chain 1 identifies viable motility mutants in bloodstream-form Trypanosoma brucei.  

PubMed

The flagellum of Trypanosoma brucei is an essential and multifunctional organelle that is receiving increasing attention as a potential drug target and as a system for studying flagellum biology. RNA interference (RNAi) knockdown is widely used to test the requirement for a protein in flagellar motility and has suggested that normal flagellar motility is essential for viability in bloodstream-form trypanosomes. However, RNAi knockdown alone provides limited functional information because the consequence is often loss of a multiprotein complex. We therefore developed an inducible system that allows functional analysis of point mutations in flagellar proteins in T. brucei. Using this system, we identified point mutations in the outer dynein light chain 1 (LC1) that allow stable assembly of outer dynein motors but do not support propulsive motility. In procyclic-form trypanosomes, the phenotype of LC1 mutants with point mutations differs from the motility and structural defects of LC1 knockdowns, which lack the outer-arm dynein motor. Thus, our results distinguish LC1-specific functions from broader functions of outer-arm dynein. In bloodstream-form trypanosomes, LC1 knockdown blocks cell division and is lethal. In contrast, LC1 point mutations cause severe motility defects without affecting viability, indicating that the lethal phenotype of LC1 RNAi knockdown is not due to defective motility. Our results demonstrate for the first time that normal motility is not essential in bloodstream-form T. brucei and that the presumed connection between motility and viability is more complex than might be interpreted from knockdown studies alone. These findings open new avenues for dissecting mechanisms of flagellar protein function and provide an important step in efforts to exploit the potential of the flagellum as a therapeutic target in African sleeping sickness. PMID:21378260

Ralston, Katherine S; Kisalu, Neville K; Hill, Kent L

2011-03-04

327

Reducing haemodialysis access infection rates.  

PubMed

Infections are the second most common cause of vascular access loss in the long-term haemodialysis patient, and recent years have seen an increase in healthcare-associated infections (HCAIs) associated with vascular access (Suhail, 2009). There have been a number of drivers including publication guidelines (Department of Health, 2006; 2007) and local protocols providing evidence-based recommendations that, when implemented, can reduce the risk of these infections. In England, the selection of bloodstream infections caused by methicillin resistant staphylococcus aureus (MRSA) as a significant clinical outcome has led to a vast amount of work in this area. Root cause analysis of individual infections (by the clinical teams when these occur) in many specialities identified areas where practice could be improved, including practice relating to vascular access within the renal setting. Manufacturers have also supported this work by focusing on developing products that are designed to reduce the likelihood of infections occurring. One product identified and used within the NHS is Chloraprep. PMID:21646994

Dorman, Amanda; Dainton, Marissa

328

Evaluation of Clinical Outcomes in Patients with Bloodstream Infections Due to Gram-Negative Bacteria According to Carbapenem MIC Stratification  

PubMed Central

Predictive modeling suggests that actual carbapenem MIC results are more predictive of clinical patient outcomes than categorical classification of the MIC as susceptible, intermediate, or resistant. Some have speculated that current CLSI guidelines' suggested thresholds are too high and that clinical success is more likely if the MIC value is ?1 mg/liter for certain organisms. Patients treated with carbapenems and with positive blood cultures for Pseudomonas aeruginosa, Acinetobacter baumannii, or extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria were considered for evaluation in this clinical retrospective cohort study. Relevant patient demographics and microbiologic variables were collected, including carbapenem MIC. The primary objective was to define a risk-adjusted all-cause hospital mortality breakpoint for carbapenem MICs. Secondarily, we sought to determine if a similar breakpoint existed for indirect outcomes (e.g., time to mortality and length of stay [LOS] postinfection for survivors). Seventy-one patients met the criteria for study inclusion. Overall, 52 patients survived, and 19 died. Classification and regression tree (CART) analysis determined a split of organism MIC between 2 and 4 mg/liter and predicted differences in mortality (16.1% versus 76.9%; P < 0.01). Logistic regression controlling for confounders identified each imipenem MIC doubling dilution as increasing the probability of death 2-fold (adjusted odds ratio [aOR] 2.0; 95% confidence interval [CI], 1.3 to 3.2). Secondary outcomes were similar between groups. This study revealed that patients with organisms that had a MIC of ?4 mg/liter had worse outcomes than patients whose isolates had a MIC of ?2 mg/liter, even after adjustment for confounding variables. We recommend additional clinical studies to better understand the susceptibility breakpoint for carbapenems.

Esterly, John S.; Wagner, Jamie; McLaughlin, Milena M.; Postelnick, Michael J.; Qi, Chao

2012-01-01

329

Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome  

Microsoft Academic Search

Objectives. To study the risk factor for nosocomial bacteremia caused by Escherichia coli or Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL) and the influence on patient outcome. Design. Retrospective, single-center study of consecutive bacteremic patients. Settings. A university-affiliated teaching hospital. Patients. A total of 85 patients with nosocomial bacteremia due to E. coli or K. pneumoniae were enrolled. Intervention. None. Measurements

Bin Du; Yun Long; Hongzhong Liu; Dechang Chen; Dawei Liu; Yingchun Xu; Xiuli Xie

2002-01-01

330

Mycobacterium neoaurum infection in a patient with renal failure.  

PubMed

Mycobacterium neoaurum, a member of the Mycobacterium parafortuitum complex, has only rarely been reported as a pathogen of human infections. We report a case of catheter-related bloodstream infection (CRBSI) due to M. neoaurum in a patient on hemodialysis. The isolate was identified by conventional methods as well as by 16S rRNA gene analysis. The patient was successfully treated with intravenous antibiotics (meropenem and amikacin) for three weeks and the catheter was removed. M. neoaurum should be considered as a possible cause of CRBSI in patients with renal failure. Combination antimicrobial therapy and catheter removal can lead to a favorable clinical outcome. PMID:19119036

Lai, Chih-Cheng; Tan, Che-Kim; Chen, Chung-Chih; Hsueh, Po-Ren

2008-12-31

331

Quantitative Image Analysis of HIV-1 Infection in Lymphoid Tissue  

NASA Astrophysics Data System (ADS)

Tracking human immunodeficiency virus-type 1 (HIV-1) infection at the cellular level in tissue reservoirs provides opportunities to better understand the pathogenesis of infection and to rationally design and monitor therapy A quantitative technique was developed to determine viral burden in two important cellular compartments in lymphoid tissues. Image analysis and in situ hybridization were combined to show that in the presymptomatic stages of infection there is a large, relatively stable pool of virions on the surfaces of follicular dendritic cells and a smaller pool of productively infected cells Despite evidence of constraints on HIV-1 replication in the infected cell population in lymphoid tissues, estimates of the numbers of these cells and the virus they could produce are consistent with the quantities of virus that have been detected in the bloodstream. The cellular sources of virus production and storage in lymphoid tissues can now be studied with this approach over the course of infection and treatment.

Haase, Ashley T.; Henry, Keith; Zupancic, Mary; Sedgewick, Gerald; Faust, Russell A.; Melroe, Holly; Cavert, Winston; Gebhard, Kristin; Staskus, Katherine; Zhang, Zhi-Qiang; Dailey, Peter J.; Balfour, Henry H., Jr.; Erice, Alejo; Perelson, Alan S.

1996-11-01

332

Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients  

PubMed Central

Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive.

2012-01-01

333

The cAMP-specific phosphodiesterase TbPDE2C is an essential enzyme in bloodstream form Trypanosoma brucei  

PubMed Central

Chemotherapy of human sleeping sickness, a fatal disease caused by the protozoan parasite Trypanosoma brucei, is in a dismal state, and the identification and characterization of new drug targets is an urgent prerequisite for an improvement of the dramatic situation in the field. Over the last several years, inhibitors of cyclic nucleotide-specific phosphodiesterases have proven to be highly successful drug candidates for an assortment of clinical conditions. Their potential as antiparasitic drugs has not been explored so far. This study reports the characterization of a cAMP-specific phosphodiesterase from T. brucei, TbPDE2C. This enzyme is a class I phosphodiesterase, and it is a member of a small enzyme family in T. brucei, TbPDE2. Inhibitors of this enzyme block the proliferation of bloodstream form trypanosomes in culture. RNA interference experiments demonstrated that the TbPDE2 family, and in particular TbPDE2C, are essential for maintaining intracellular cAMP concentrations within a physiological range. Bloodstream form trypanosomes are exquisitely sensitive to elevated concentrations of intracellular cAMP, and a disruption of TbPDE2C function quickly leads to the disruption of nuclear and cellular cell division, and to cell death. TbPDE2C might represent a novel drug target for the development of new and effective trypanocidal drugs.

Zoraghi, Roya; Seebeck, Thomas

2002-01-01

334

Automated Extraction Improves Multiplex Molecular Detection of Infection in Septic Patients  

Microsoft Academic Search

Sepsis is one of the leading causes of morbidity and mortality in hospitalized patients worldwide. Molecular technologies for rapid detection of microorganisms in patients with sepsis have only recently become available. LightCycler SeptiFast test Mgrade (Roche Diagnostics GmbH) is a multiplex PCR analysis able to detect DNA of the 25 most frequent pathogens in bloodstream infections. The time and labor

Benito J. Regueiro; Eduardo Varela-Ledo; Lucia Martinez-Lamas; Javier Rodriguez-Calviño; Antonio Aguilera; Antonio Santos; Antonio Gomez-Tato; Julian Alvarez-Escudero

2010-01-01

335

Rhodococcus equi venous catheter infection: a case report and review of the literature  

PubMed Central

Introduction Rhodococcus equi is an animal pathogen that was initially isolated from horses and is being increasingly reported as a cause of infection in humans with impaired cellular immunity. However, this pathogen is underestimated as a challenging antagonist and is frequently considered to be a mere contaminant despite the potential for life-threatening infections. Most case reports have occurred in immunocompromised patients who have received organ transplants (for example kidney, heart, bone marrow) or those with human immunodeficiency virus infection. Infections often manifest as pulmonary involvement or soft tissue abscesses. Bacteremia related to R. equi infections of tunneled central venous catheters has rarely been described. Case presentation We report the case of a 63-year-old non-transplant recipient, non-HIV infected Caucasian woman with endometrial carcinoma who developed recurrent bloodstream infections and septic shock due to R. equi and ultimately required the removal of her port catheter, a subcutaneous implantable central venous catheter. We also review the medical literature related to human infections with R. equi. Conclusion R. equi should be considered a serious pathogen, not a contaminant, particularly in an immunocompromised patient who presents with a central venous catheter-related bloodstream infection. Counseling patients with central venous catheters who participate in activities involving exposure to domesticated animals is recommended.

2011-01-01

336

Genome-wide expression profiling of in vivo-derived bloodstream parasite stages and dynamic analysis of mRNA alterations during synchronous differentiation in Trypanosoma brucei  

Microsoft Academic Search

BACKGROUND: Trypanosomes undergo extensive developmental changes during their complex life cycle. Crucial among these is the transition between slender and stumpy bloodstream forms and, thereafter, the differentiation from stumpy to tsetse-midgut procyclic forms. These developmental events are highly regulated, temporally reproducible and accompanied by expression changes mediated almost exclusively at the post-transcriptional level. RESULTS: In this study we have examined,

Sarah Kabani; Katelyn Fenn; Alan Ross; Al Ivens; Terry K Smith; Peter Ghazal; Keith Matthews

2009-01-01

337

Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement  

Microsoft Academic Search

BackgroundElimination of hospital-acquired infections is an important patient safety goal.SettingAll 174 medical, cardiac, surgical and mixed Veterans Administration (VA) intensive care units (ICUs).InterventionA centralised infrastructure (Inpatient Evaluation Center (IPEC)) supported the practice bundle implementation (handwashing, maximal barriers, chlorhexidinegluconate site disinfection, avoidance of femoral catheterisation and timely removal) to reduce central line-associated bloodstream infections (CLABSI). Support included recruiting leadership, benchmarked feedback,

Marta L Render; Rachael Hasselbeck; Ron W Freyberg; Timothy P Hofer; Anne E Sales; Peter L Almenoff

2011-01-01

338

The carbapenem-resistant Enterobacteriaceae score: a bedside score to rule out infection with carbapenem-resistant Enterobacteriaceae among hospitalized patients.  

PubMed

Patients infected with carbapenem-resistant Enterobacteriaceae often experience delays in initiation of appropriate antimicrobial therapy and increased mortality. A score was developed to differentiate bloodstream infections caused by carbapenem-resistant Enterobacteriaceae (16 patients) versus extended-spectrum ?-lactamase-producing Enterobacteriaceae (166 patients). A score of ? 32 demonstrated high area under the curve of 0.80 (95% confidence interval: 0.68-0.92) and a negative predictive value of 97%. PMID:22939417

Martin, Emily T; Tansek, Ryan; Collins, Vicki; Hayakawa, Kayoko; Abreu-Lanfranco, Odaliz; Chopra, Teena; Lephart, Paul R; Pogue, Jason M; Kaye, Keith S; Marchaim, Dror

2012-08-30

339

Late-onset group B streptococcal disease by infected mother's milk detected by polymerase chain reaction.  

PubMed

Late-onset Group B streptococcal (GBS) disease is a cause of illness, death and neurological sequelae in infancy. The epidemiology and pathogenesis of late-onset GBS disease is poorly defined. Infected breast-milk has been suggested as a source of postnatal infection and invasive disease. We describe a late-onset GBS disease by infected mother's milk in a term newborn in which the detection of GBS in neonatal bloodstream (confirmed by culture) and in the mother's milk was performed by PCR. PMID:17802903

Lanari, Marcello; Serra, Laura; Cavrini, Francesca; Liguori, Giovanna; Sambri, Vittorio

2007-07-01

340

Advances in the Diagnosis and Management of Central Venous Access Device Infections in Children  

Microsoft Academic Search

\\u000a Infection is a well-known complication of central venous access device (CVAD) use, with an incidence of 3–6 bloodstream infections\\u000a per 1,000 catheter days in children. Prevention of CVAD infections has improved with new strategies including the use of chlorhexidine\\u000a antisepsis, bundles, maximal sterile barriers for insertion, prophylactic locks, antibiotic impregnated catheters and tunnelling\\u000a of long-term devices. Despite these strategies, catheter-related

Asha Bowen; Jonathan Carapetis

341

The mevalonate pathway in the bloodstream form of Trypanosoma brucei. Identification of dolichols containing 11 and 12 isoprene residues.  

PubMed

The major surface antigen of the bloodstream form of Trypanosoma brucei, the variant surface glycoprotein, is attached to the plasma membrane via a glycosylphosphatidylinositol anchor. The biosynthesis of the glycosylphosphatidylinositol anchor, as well as the assembly of the asparagine-linked oligosaccharide chains found on the variant surface glycoproteins, involves polyisoprenoid lipids that act as sugar carriers. Preliminary observations (Menon, A.K., Schwarz, R.T., Mayor, and Cross, G.A.M. (1990) J. Biol. Chem. 265, 9033-9042) suggested that the sugar carriers in T. brucei were short-chain polyisoprenoids containing substantially fewer isoprene residues than polyisoprenols in mammalian cells. In this paper we describe metabolic labeling experiments with [3H]mevalonate, as well as chromatographic and mass spectrometric analyses of products of the mevalonate pathway in T. brucei. We report that cells of the bloodstream form of T. brucei contain a limited spectrum of short chain dolichols and dolichol phosphates (11 and 12 isoprene residues). The total dolichol content was estimated to be 0.28 nmol/10(9) cells; the dolichyl phosphate content was 0.07 nmol/10(9) cells. The same spectrum of dolichol chain lengths was also found in a polar lipid that could be labeled with [3H]mevalonate, [3H]glucosamine, and [3H]mannose, and which was characterized as Man5GlcNAc2-PP-dolichol. The most abundant product of the mevalonate pathway identified in T. brucei was cholesterol (140 nmol/10(9) cells). Ubiquinone (0.09 nmol/10(9) cells) with a solanesol side chain was also identified. PMID:1918042

Löw, P; Dallner, G; Mayor, S; Cohen, S; Chait, B T; Menon, A K

1991-10-15

342

Blood-brain barrier and retroviral infections  

PubMed Central

Homeostasis in the central nervous system (CNS) is maintained by active interfaces between the bloodstream and the brain parenchyma. The blood-brain barrier (BBB) constitutes a selective filter for exchange of water, solutes, nutrients, and controls toxic compounds or pathogens entry. Some parasites, bacteria, and viruses have however developed various CNS invasion strategies, and can bypass the brain barriers. Concerning viruses, these strategies include transport along neural pathways, transcytosis, infection of the brain endothelial cells, breaching of the BBB, and passage of infected-leukocytes. Moreover, neurotropic viruses can alter BBB functions, thus compromising CNS homeostasis. Retroviruses have been associated to human neurological diseases: HIV (human immunodeficiency virus 1) can induce HIV-associated dementia, and HTLV-1 (human T lymphotropic virus 1) is the etiological factor of tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM). The present review focuses on how the different retroviruses interact with this structure, bypass it and alter its functions.

Miller, Florence; Afonso, Philippe V.; Gessain, Antoine; Ceccaldi, Pierre-Emmanuel

2012-01-01

343

Comparison of the Vitek Gram-Positive Susceptibility 106 Card and the MRSA-Screen Latex Agglutination Test for Determining Oxacillin Resistance in Clinical Bloodstream Isolates of Staphylococcus aureus  

PubMed Central

The Vitek automated susceptibility testing system with a modified Gram-Positive Susceptibility (GPS) 106 Card (bioMerieux Vitek, Inc., Hazelwood, Mo.) and a rapid slide latex agglutination test (MRSA-Screen; Denka Seiken Co., Ltd., Tokyo, Japan) were evaluated for their ability to detect oxacillin resistance in Staphylococcus aureus. The oxacillin-salt agar screen (OS) test, the reference broth microdilution method, and the detection of the mecA gene by PCR were compared with the commercial products. A total of 200 contemporary (1999) bloodstream infection isolates were collected from the SENTRY Antimicrobial Surveillance Program, representing diverse geographic areas throughout the world. Among the 99 mecA-positive isolates, 3 isolates were found negative by the MRSA-Screen. Another two isolates did not grow on OS plates and had MICs of 0.5 and 2 ?g/ml with the Vitek GPS card. All 101 mecA-negative isolates were also found negative by the MRSA-Screen and were categorized as susceptible by the GPS card. Overall, the MRSA-Screen, GPS card, and OS test had sensitivities of 96.9, 98.0, and 98.0% and specificities of 100.0, 100.0, and 98.0%, respectively. MRSA-Screen was a rapid (?15 min) and simple test to perform, and the GPS card provided results in <8 h. Both methods were sensitive and specific for detecting staphylococcal oxacillin resistance in the clinical microbiology laboratory.

Yamazumi, T.; Marshall, S. A.; Wilke, W. W.; Diekema, D. J.; Pfaller, M. A.; Jones, Ronald N.

2001-01-01

344

Characterisation of Coagulase-Negative Staphylococci Isolated from Blood Infections: Incidence, Susceptibility to Glycopeptides, and Molecular Epidemiology  

Microsoft Academic Search

.   The purpose of this study was to determine incidence of coagulase-negative staphylococci (CNS) bacteraemia and to characterise\\u000a the epidemiology of isolates with reduced susceptibility to glycopeptides. CNS isolates from bloodstream infections were collected\\u000a and characterised by determination of the species, analysis of antibiotic susceptibility, and restriction fragment length\\u000a polymorphism using pulsed-field gel electrophoresis. The medical records of patients with

K. Boisson; M. Thouverez; D. Talon; X. Bertrand

2002-01-01

345

Morbidity associated with central venous catheter-use in a cohort of 212 hospitalized subjects with HIV infection  

Microsoft Academic Search

Technical complications and nosocomial bloodstream infections associated with short-term central venous catheterization remain a heavy burden in terms of morbidity, mortality and cost in HIV-positive subjects. Between 1994 and 1997, 327 central venous catheters (CVCs) inserted in 212 patients for a total of 5005 catheter days were investigated. Forty-two technical complications (13%) occurred in 40 patients. Logistic regression analysis revealed

E. Tacconelli; M. Tumbarello; K. de Gaetano Donati; S. Bertagnolio; M. Pittiruti; F. Leone; G. Morace; R. Cauda

2000-01-01

346

Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected children and infants in northern Tanzania  

PubMed Central

Summary OBJECTIVE To describe the contribution of paediatric HIV and of HIV co-infections to admissions to a hospital in Moshi, Tanzania, using contemporary laboratory methods. METHODS During 1 year, we enrolled consecutively admitted patients aged ?2 months and <13 years with current or recent fever. All patients underwent standardized clinical history taking, a physical examination and HIV antibody testing; standard aerobic blood cultures and malaria film were also done, and hospital outcome was recorded. Early infant HIV diagnosis by HIV-1 RNA PCR was performed on those aged <18 months. HIV-infected patients also received serum cryptococcal antigen testing and had their CD4-positive T-lymphocyte count and percent determined. RESULTS A total of 467 patients were enrolled whose median age was 2 years (range 2 months–13 years); Of those patients, 57.2% were female and 12.2% were HIV-infected. Admission clinical diagnosis of HIV disease was made in 10.7% and of malaria in 60.4%. Of blood cultures, 5.8% grew pathogens; of these 25.9% were Salmonella enterica (including 6 Salmonella Typhi) and 22.2% Streptococcus pneumoniae. Plasmodium falciparum was identified on blood film of 1.3%. HIV infection was associated with S. pneumoniae (odds ratio 25.7, 95% CI 2.8, 234.0) bloodstream infection (BSI), but there was no evidence of an association with Escherichia coli or P. falciparum; Salmonella Typhi BSI occurred only among HIV-uninfected participants. The sensitivity and specificity of an admission clinical diagnosis of malaria were 100% and 40.3%; and for an admission diagnosis of bloodstream infection, they were 9.1% and 86.4%, respectively. CONCLUSION Streptococcus pneumoniae is a leading cause of bloodstream infection among paediatric admissions in Tanzania and is closely associated with HIV infection. Malaria was over-diagnosed clinically, whereas invasive bacterial disease was underestimated. HIV and HIV co-infections contribute to a substantial proportion of paediatric febrile admissions, underscoring the value of routine HIV testing.

Crump, John A.; Ramadhani, Habib O.; Morrissey, Anne B.; Msuya, Levina J.; Yang, Lan-Yan; Chow, Shein-Chung; Morpeth, Susan C.; Reyburn, Hugh; Njau, Boniface N.; Shaw, Andrea V.; Diefenthal, Helmut C.; Bartlett, John A.; Shao, John F.; Schimana, Werner; Cunningham, Coleen K.; Kinabo, Grace D.

2011-01-01

347

Genotyping of 353 Staphylococcus aureus bloodstream isolates collected between 2004 and 2009 at a Norwegian university hospital and potential associations with clinical parameters.  

PubMed

We analyzed 353 Staphylococcus aureus bloodstream isolates from 2004 to 2009 to identify dominant genotypes, changes over time, and associations between genotype, phenotype, and clinical parameters. The isolates were genotyped with regard to spa type and presence of Panton-Valentine leukocidin and toxic shock syndrome toxin 1-encoding genes. A high level of genetic diversity was detected. All but three isolates were methicillin sensitive. Interestingly, spa clonal complex 021 showed a weak association with higher all-cause hospital mortality. PMID:22785198

Aamot, Hege Vangstein; Blomfeldt, Anita; Eskesen, Arne N

2012-07-11

348

Nationwide German Multicenter Study on Prevalence of Antibiotic Resistance in Staphylococcal Bloodstream Isolates and Comparative In Vitro Activities of Quinupristin-Dalfopristin  

Microsoft Academic Search

Antibiotic-resistant gram-positive bacteria have become an increasing problem in the last two decades. In order to evaluate the prevalence of antibiotic resistance in staphylococcal bloodstream isolates in Germany, 2,042 staphylococci collected in 21 tertiary-care hospitals were investigated during a 3-year period (March 1996 to March 1999). Altogether, 1,448 S. aureus isolates and 594 coagulase-negative staphylococci (CoNS) that comprised 13 different

CHRISTOF VON EIFF; RALF RENEREINERT; MICHAEL KRESKEN; JOHANNES BRAUERS; DIETER HAFNER; GEORG PETERS

2000-01-01

349

Differentiation of a culture-adapted mutant bloodstream form of Trypanosoma brucei into the procyclic form results in growth arrest of the cells  

Microsoft Academic Search

The bloodstream forms of Trypanosoma brucei brucei monomorphic strain 427 serially passaged in rats can differentiate in vitro equally well in HMI-9, HMI-10, SDM-79 or Cunningham's medium into the insect (procyclic) forms by a simple temperature shift from 37 to 26°C in the presence of citrate and cis-aconitate. The procyclic forms thus generated can also continue to multiply at 26°C

Martha C. Mutomba; Ching C. Wang

1995-01-01

350

Knockout of the glutamate dehydrogenase gene in bloodstream Trypanosoma brucei in culture has no effect on editing of mitochondrial mRNAs  

Microsoft Academic Search

Glutamate dehydrogenase (GDH) was shown previously to bind the 3? oligo[U] tail of the mitochondrial guide RNAs (gRNAs) of Leishmania tarentolae, apparently in the dinucleotide pocket (Bringaud F, Stripecke R, Frech GC, Freedland S, Turck C, Byrne EM, Simpson L. Mol. Cell. Biol. 1997;17:3915–3923). Bloodstream Trypanosoma brucei cells in culture represent a good system to investigate the genetic effects of

Antonio M. Estévez; Felipe Kierszenbaum; Elizabeth Wirtz; Frédéric Bringaud; Jeremy Grunstein; Larry Simpson

1999-01-01

351

Haemophilus influenzae Infections in the H. influenzae Type b Conjugate Vaccine Era ?  

PubMed Central

The widespread use of Haemophilus influenzae type b (Hib) conjugate vaccines has nearly eradicated invasive Hib disease where the vaccines are used. This success was accompanied by a shift in capsular serotypes of invasive H. influenzae disease, with nontypeable strains replacing type b strains as the most common bloodstream isolate, but there is no convincing evidence of a true increase in the incidence of non-serotype b invasive infections. H. influenzae causes predominantly mucosal infections. The introduction of vaccines for otitis media and global shifts in antimicrobial susceptibility emphasize the importance of continued surveillance of H. influenzae colonization and disease patterns.

Agrawal, Aarti; Murphy, Timothy F.

2011-01-01

352

Molecular epidemiology of fluoroquinolone-resistant Escherichia coli bloodstream isolates from patients admitted to European cancer centers.  

PubMed Central

Previous reports have suggested an increasing incidence of highly fluoroquinolone-resistant Escherichia coli causing bacteremia among cancer patients on prophylactic therapy. We used genotyping by pulsed-field gel electrophoresis of chromosomal DNA digests and random amplified polymorphic DNA fingerprinting to study clonal relationships among such isolates obtained at 10 cancer centers located across Europe and the Middle East. Analysis by both methods indicated that isolates from different centers were genotypically unrelated to each other. There were five centers from which more than one individual patient isolate was available, and most demonstrated significant within-center genetic diversity of strains. Strains shared among patients could be identified at two centers. At the center with the largest number of bloodstream isolates from cancer patients available, fluoroquinolone-resistant control isolates from surgical patients and fluoroquinolone-susceptible control isolates from patients admitted to medical services during the same time period were unrelated to resistant cancer patient isolates and to each other as well. A substantial number of fluoroquinolone-resistant isolates (19 of 58) were nontypeable by pulsed-field gel electrophoresis. Fluoroquinolone resistance was commonly associated with multiple antibiotic resistance to chemically unrelated antibacterial agents irrespective of the origin of the isolates.

Oethinger, M; Conrad, S; Kaifel, K; Cometta, A; Bille, J; Klotz, G; Glauser, M P; Marre, R; Kern, W V

1996-01-01

353

Inhibition of mitogen-induced proliferation of mouse T and B lymphocytes by bloodstream forms of Trypanosoma cruzi.  

PubMed

The role of virulent forms of Trypanosoma cruzi in modulating mitogen-induced lymphocyte responses was investigated in this work. Bloodstream forms of T. cruzi inhibited normal mouse spleen cell responses to Con A and LPS in a dose-dependent manner. Reduced responses were observed over relatively large ranges of concentration of Con A (50-fold) and LPS (160-fold). The inhibitory action of the parasites could not be overcome by increasing the mitogen dose beyond optimal levels. Furthermore, absorption of mitogen solutions with four times as many parasites as used in the proliferation assays revealed that sufficient mitogen activity remained to produce optimal lymphocyte responses. Therefore, reduced lymphocyte responsiveness was not due to absorption of mitogen by the parasite. Inhibited responses were also seen when a sonicated T. cruzi preparation was used, indicating that parasite viability was not required to produce suppression. Inhibition of Con A- or LPS-induced responses by the parasites occurred only when the trypanosomes were incorporated into the system during the first 24 hr of culture. These results show that virulent forms of T. cruzi can induce suppression of T and B cell responses in vitro, and suggest that the parasite affects lymphocyte commitment to blastogenesis during the early stages of lymphocyte activation. PMID:6401309

Maleckar, J R; Kierszenbaum, F

1983-02-01

354

[The microbiologist and the catheter related infection].  

PubMed

Different multicentre epidemiological studies such as ENVIN-HELICS or EPINE, have remarked that catheter related bloodstream infection (CRBI) is an increasingly condition in hospital environment. The microbiologist plays a major role in the diagnosis, either by recommending what type of catheter must be considered for confirmatory diagnosis, when these samples must be sent for culture, when is indicated to perform surveillance studies of the catheter and what results are clinically significant to be informed. In this paper, different aspects of the CRBI, such as the pathogenesis, etiology, epidemiology and diagnosis are reviewed. The different microbiological diagnostic methods, both conservatives and those involving the removal of the catheter are up-to-dated. PMID:20559602

García-Rodríguez, J; de Pablos, M; Gutiérrez, A

2010-06-01

355

Prevalence, distribution and antifungal susceptibility profiles of Candida parapsilosis, Candida orthopsilosis and Candida metapsilosis bloodstream isolates.  

PubMed

The Candida parapsilosis group encompasses three species: C. parapsilosis, Candida orthopsilosis and Candida metapsilosis. These species are phenotypically indistinguishable, and molecular methods are needed for their detection. We analysed 152 unique blood culture isolates of the C. parapsilosis group obtained during 1997-2011. The isolates were screened by PCR amplification of the gene encoding secondary alcohol dehydrogenase, followed by digestion with the restriction enzyme BanI. Isolates with RFLP patterns distinct from those of the C. parapsilosis group were characterized as C. parapsilosis sensu stricto (90.8?%), C. orthopsilosis (8.6?%) and C. metapsilosis (0.6?%). Antifungal susceptibility tests indicated that all isolates were susceptible to itraconazole, amphotericin B and caspofungin. Although C. orthopsilosis and C. metapsilosis isolates were susceptible to fluconazole, higher MICs (?2 mg l(-1)) were observed for C. orthopsilosis. Three isolates (2.0?%) of C. parapsilosis sensu stricto were resistant to voriconazole. Five C. parapsilosis isolates (3.3?%) were intermediate, and a single isolate (0.7?%) was resistant (MIC 16 mg l(-1)) to fluconazole. These data were confirmed using reference strains. It was observed that C. parapsilosis isolates were less susceptible to all triazoles, and this finding deserves further attention to assess the appearance of cross-resistance phenomena. In conclusion, C. metapsilosis and C. orthopsilosis are involved in a small but significant number of invasive infections in Brazil. PMID:22493277

Bonfietti, Lucas Xavier; Martins, Marilena dos Anjos; Szeszs, Maria Walderez; Pukiskas, Sandra Brasil Stolf; Purisco, Sonia Ueda; Pimentel, Fabiana Cortez; Pereira, Graziella Hanna; Silva, Dayane Cristina; Oliveira, Lidiane; Melhem, Marcia de Souza Carvalho

2012-04-05

356

Identification of device-associated infections utilizing administrative data.  

PubMed

BACKGROUND: Health care-associated infections are a cause of significant morbidity and mortality in US hospitals. Recent changes have broadened the scope of health care-associated infections surveillance data to use in public reporting and of administrative data for determining Medicare reimbursement adjustments for hospital-acquired conditions. METHODS: Infection surveillance results for catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia were compared with infections identified by hospital administrative data. The sensitivity and specificity of administrative data were calculated, with surveillance data considered the gold standard. RESULTS: The sensitivity of administrative data diagnosis codes for CAUTI, CLABSI, and ventilator-associated pneumonia were 0%, 21%, and 25%, respectively. The incorporation of additional diagnosis codes in definitions increased the sensitivity of administrative data somewhat with little decrease in specificity. Positive predictive values for definitions corresponding to Centers for Medicare and Medicaid services-defined hospital-acquired conditions were 0% for CAUTI and 41% for CLABSI. CONCLUSIONS: Although infection surveillance methods and administrative data are widely used as tools to identify health care-associated infections, in our study administrative data failed to identify the same infections that were detected by surveillance. Hospitals, already incentivized by the use of performance measures to improve the quality of patient care, should also recognize the need for ongoing scrutiny of appropriate quality measures. PMID:23768437

Cass, Anna L; Kelly, J William; Probst, Janice C; Addy, Cheryl L; McKeown, Robert E

2013-06-12

357

Impact of microbial attachment on intravascular catheter-related infections.  

PubMed

Intravascular catheters (IVCs) are the most frequently used medical devices in hospitals. However, they are associated with life-threatening IVC-related bloodstream infection (IVC-BSI), which is one of the main hospital-acquired infections, and continue to be associated with morbidity, mortality and additional medical cost. Most published studies focus on measuring the rate of IVC-BSIs and addressing their importance, but only a few studies have mentioned the possible routes for microbes entering the bloodstream, which would help in developing effective prevention methods, and large trial studies are lacking. Some studies on IVC-BSIs have reported the most frequently isolated microbes, but caution needs to be made since many fastidious microbes are not isolated under current laboratory conditions. Although it is known that microbes colonise IVC surfaces and develop biofilms, leading to IVC-BSI, the relationships of microbial biofilms with patients' symptoms or outcomes remain unclear. Here we discuss the knowledge gained from microbial research in other (non-IVC) medical and non-medical applications that may be helpful in understanding the IVC context. In addition, published theory and data regarding microbial colonisation and biofilm development specifically in IVCs are reviewed. More research is needed to explore mechanisms of IVC-BSI and to provide superior prevention strategies. PMID:21435841

Zhang, Li; Gowardman, John; Rickard, Claire M

2011-03-23

358

Novel Approaches to the Diagnosis, Prevention and Treatment of Medical Device-Associated Infections  

PubMed Central

Synopsis The pathogenesis of device-associated infections is related to biofilm bacteria that exhibit distinct characteristics with respect to growth rate, structural features, and protection from host immune mechanisms when compared to planktonic counterparts. Biofilm-associated infections are prevented, diagnosed and treated differently than infections not associated with biofilms. This article reviews innovative concepts for the prevention of biofilm formation, such as use of antisense molecules, quorum-sensing inhibitors, and bacteriophages, and novel approaches for treatment, such as enhancement of antimicrobial activity against biofilm bacteria by use of electric current or ultrasound. Specific approaches for the diagnosis and prevention of catheter-associated urinary tract and bloodstream infections, infections associated with orthopedic implants, and cardiovascular implantable electronic devices, are also discussed.

Vergidis, Paschalis; Patel, Robin

2011-01-01

359

Molecular characterization of an early invasive Staphylococcus epidermidis prosthetic joint infection.  

PubMed

Historically regarded as a skin commensal, Staphylococcus epidermidis has been increasingly implicated in invasive foreign body infections such as catheter-related bloodstream infections, indwelling device infections, and prosthetic joint infections. We report a case of an aggressive, difficult-to-eradicate, invasive prosthetic hip infection occurring early after hardware implant and associated with a high-grade bacteremia and assess its salient molecular characteristics. The clinical and molecular characteristics of this isolate mirror the pathogenesis and persistence commonly seen with invasive methicillin-resistant S. aureus and may be attributed to the combination of resistance genes (SCCmec type IV), putative virulence factors (arcA and opp3a), cytolytic peptide production (?-type phenol-soluble modulins), and biofilm adhesion, interaction, and maturation (bhp, aap, and ?-type phenol-soluble modulins). PMID:21510745

Rosenthal, Marnie E; Dever, Lisa L; Moucha, Calin S; Chavda, Kalyan D; Otto, Michael; Kreiswirth, Barry N

2011-04-21

360

Hospital staffing and health care-associated infections: a systematic review of the literature.  

PubMed

In the past 10 years, many researchers have examined relationships between hospital staffing and patients' risk of health care-associated infection (HAI). To gain understanding of this evidence base, a systematic review was conducted, and 42 articles were audited. The most common infection studied was bloodstream infection (n=18; 43%). The majority of researchers examined nurse staffing (n=38; 90%); of these, only 7 (18%) did not find a statistically significant association between nurse staffing variable(s) and HAI rates. Use of nonpermanent staff was associated with increased rates of HAI in 4 studies (P<.05). Three studies addressed infection control professional staffing with mixed results. Physician staffing was not found to be associated with patients' HAI risk (n=2). The methods employed and operational definitions used for both staffing and HAI varied; despite this variability, trends were apparent. Research characterizing effective staffing for infection control departments is needed. PMID:18767987

Stone, Patricia W; Pogorzelska, Monika; Kunches, Laureen; Hirschhorn, Lisa R

2008-10-01

361

Healthcare-Associated Infections at a Children's Cancer Hospital, 1983-2008  

PubMed Central

Background. Little is known about the incidence and etiology of healthcare-associated infections in immunosuppressed children. Methods. Data collected prospectively between 1983 and 2008 were used to analyze changes in the rate, types of infection, and infecting organisms over time in patients treated at a children's cancer hospital. Neutropenia was evaluated as a risk factor. Results. Over the 26-year study period, 1986 healthcare-associated infections were identified during 1653 hospitalizations. The infection rate decreased significantly from 5.6 to 2.0 infections per 100 discharges (P < .01) and from 9.0 to 3.7 infections per 1000 patient-days (P < .01). Bloodstream infections were the most common type of infection (32.7% of all infections). Staphylococci (46.4% of Gram-positive bacteria), Escherichia coli (36.7% of Gram-negative bacteria), and Candida spp. (68.7% of fungi) were the most common pathogens isolated. An absolute neutrophil count (ANC) nadir <100 per mm3 was significantly associated (P < .0001) with an increased rate of infections compared with higher ANC nadirs. Conclusions. Despite a steady expansion in hospital capacity and patient encounters over the last 3 decades, rates of healthcare-associated infections decreased significantly at our hospital. These data suggest that sustained decreases in the rate of healthcare-associated infections in immunosuppressed children are possible. An ANC <100 per mm3 is a risk factor for healthcare-associated infections in this population.

McCullers, Jonathan A.; Williams, Bonnie F.; Wu, Song; Smeltzer, Matthew P.; Williams, Bobby G.; Hayden, Randall T.; Howard, Scott C.; Pui, Ching-Hon; Hughes, Walter T.

2012-01-01

362

Paradoxical Effect of Caspofungin against Candida Bloodstream Isolates Is Mediated by Multiple Pathways but Eliminated in Human Serum?  

PubMed Central

Paradoxical growth of Candida in vitro at echinocandin concentrations exceeding the MIC is well described, but the clinical relevance is unknown. We assessed echinocandin paradoxical effects against Candida bloodstream isolates (BSI) in the presence or absence of human serum and investigated regulatory mechanisms. As determined by broth microdilution, a paradoxical effect was evident for 60% (18/30), 23% (7/30), and 13% (4/30) of Candida albicans BSI exposed to caspofungin, anidulafungin, and micafungin, respectively, at achievable human serum concentrations (?8 ?g/ml). A paradoxical effect was not evident among 34 C. glabrata BSI and was observed only for caspofungin against C. parapsilosis (4%, 1/23). As determined in time-kill studies, a caspofungin paradoxical effect was demonstrated by C. albicans (2/3), C. glabrata (1/3), and C. parapsilosis (1/3), including BSI that were determined to be negative by microdilution. In 50% human serum, a paradoxical effect was eliminated at caspofungin concentrations up to 64 ?g/ml for 100% (8/8) of the C. albicans BSI. A caspofungin paradoxical effect was also eliminated by chitin synthase inhibitor nikkomycin Z and at achievable concentrations of calcineurin pathway inhibitors, tacrolimus and cyclosporine. Moreover, these agents were synergistic with caspofungin against 100, 100, and 88% (7/8) of C. albicans, respectively, and exerted their own paradoxical effects. Finally, paradoxical growth was eliminated in C. albicans irs4- and inp51-null mutants, which lack phosphatidylinositol-(4,5)-bisphosphate 5?-phosphatase. Our findings suggest that the paradoxical effect is unlikely to be important in vivo but remains an important tool to study cell wall stress responses. We implicate the Irs4-Inp51 phosphatidylinositol-(4,5)-bisphosphate 5?-phosphatase as a novel regulator of paradoxical growth.

Shields, Ryan K.; Nguyen, M. Hong; Du, Chen; Press, Ellen; Cheng, Shaoji; Clancy, Cornelius J.

2011-01-01

363

Paradoxical effect of caspofungin against Candida bloodstream isolates is mediated by multiple pathways but eliminated in human serum.  

PubMed

Paradoxical growth of Candida in vitro at echinocandin concentrations exceeding the MIC is well described, but the clinical relevance is unknown. We assessed echinocandin paradoxical effects against Candida bloodstream isolates (BSI) in the presence or absence of human serum and investigated regulatory mechanisms. As determined by broth microdilution, a paradoxical effect was evident for 60% (18/30), 23% (7/30), and 13% (4/30) of Candida albicans BSI exposed to caspofungin, anidulafungin, and micafungin, respectively, at achievable human serum concentrations (?8 ?g/ml). A paradoxical effect was not evident among 34 C. glabrata BSI and was observed only for caspofungin against C. parapsilosis (4%, 1/23). As determined in time-kill studies, a caspofungin paradoxical effect was demonstrated by C. albicans (2/3), C. glabrata (1/3), and C. parapsilosis (1/3), including BSI that were determined to be negative by microdilution. In 50% human serum, a paradoxical effect was eliminated at caspofungin concentrations up to 64 ?g/ml for 100% (8/8) of the C. albicans BSI. A caspofungin paradoxical effect was also eliminated by chitin synthase inhibitor nikkomycin Z and at achievable concentrations of calcineurin pathway inhibitors, tacrolimus and cyclosporine. Moreover, these agents were synergistic with caspofungin against 100, 100, and 88% (7/8) of C. albicans, respectively, and exerted their own paradoxical effects. Finally, paradoxical growth was eliminated in C. albicans irs4- and inp51-null mutants, which lack phosphatidylinositol-(4,5)-bisphosphate 5'-phosphatase. Our findings suggest that the paradoxical effect is unlikely to be important in vivo but remains an important tool to study cell wall stress responses. We implicate the Irs4-Inp51 phosphatidylinositol-(4,5)-bisphosphate 5'-phosphatase as a novel regulator of paradoxical growth. PMID:21422223

Shields, Ryan K; Nguyen, M Hong; Du, Chen; Press, Ellen; Cheng, Shaoji; Clancy, Cornelius J

2011-03-21

364

Urine as a Specimen to Diagnose Infections in Twenty-First Century: Focus on Analytical Accuracy  

PubMed Central

Urine as a clinical specimen to diagnose infections has been used since ancient times. Many rapid technologies to assist diagnosis of infections are currently in use. Alongside traditional enzyme immunoassays (EIA), new technologies have emerged. Molecular analysis of transrenal DNA to diagnose infections is also a rapidly growing field. The majority of EIAs utilize the detection of excreted sugar compounds of the outer microbial cell-wall shed into the bloodstream and excreted into the urine. This mini-review focuses on current knowledge on rapid urinary antigen detection tests to diagnose most common infections, and highlights their diagnostic utility. The past and the future of urinalysis are also briefly discussed. The analysis of the literature shows that some methods are not quantitative, and analytical sensitivity may remain suboptimal. In addition, the performance criteria and technical documentation of some commercial tests are insufficient. Clinical microbiologists and physicians should be alert to assay limitations.

Tuuminen, Tamara

2012-01-01

365

The essential neutral sphingomyelinase is involved in the trafficking of the variant surface glycoprotein in the bloodstream form of Trypanosoma brucei  

PubMed Central

Sphingomyelin is the main sphingolipid in Trypanosoma brucei, the causative agent of African sleeping sickness. In vitro and in vivo characterization of the T. brucei neutral sphingomyelinase demonstrates that it is directly involved in sphingomyelin catabolism. Gene knockout studies in the bloodstream form of the parasite indicate that the neutral sphingomyelinase is essential for growth and survival, thus highlighting that the de novo biosynthesis of ceramide is unable to compensate for the loss of sphingomyelin catabolism. The phenotype of the conditional knockout has given new insights into the highly active endocytic and exocytic pathways in the bloodstream form of T. brucei. Hence, the formation of ceramide in the endoplasmic reticulum affects post-Golgi sorting and rate of deposition of newly synthesized GPI-anchored variant surface glycoprotein on the cell surface. This directly influences the corresponding rate of endocytosis, via the recycling endosomes, of pre-existing cell surface variant surface glycoprotein. The trypanosomes use this coupled endocytic and exocytic mechanism to maintain the cell density of its crucial variant surface glycoprotein protective coat. TbnSMase is therefore genetically validated as a drug target against African trypanosomes, and suggests that interfering with the endocytic transport of variant surface glycoprotein is a highly desirable strategy for drug development against African trypanosomasis.

Young, Simon A; Smith, Terry K

2010-01-01

366

Mycoplasma gallisepticum Invades Chicken Erythrocytes during Infection?  

PubMed Central

Recently, it was demonstrated using in vitro assays that the avian pathogen Mycoplasma gallisepticum is able to invade nonphagocytic cells. It was also shown that this mycoplasma can survive and multiply intracellularly for at least 48 h and that this cell invasion capacity contributes to the systemic spread of M. gallisepticum from the respiratory tract to the inner organs. Using the gentamicin invasion assay and a differential immunofluorescence technique combined with confocal laser scanning microscopy, we were able to demonstrate in in vitro experiments that M. gallisepticum is also capable of invading sheep and chicken erythrocytes. The frequencies of invasion of three well-defined M. gallisepticum strains were examined over a period of 24 h, and a significant increase in invasiveness occurred after 8 h of infection. In addition, blood samples derived from chickens experimentally infected via the aerosol route with the virulent strain M. gallisepticum Rlow were analyzed. Surprisingly, M. gallisepticum Rlow was detected in the bloodstream of infected chickens by nested PCR, as well as by differential immunofluorescence and interference contrast microscopy that showed that mycoplasmas were not only on the surface but also inside chicken erythrocytes. This finding provides novel insight into the pathomechanism of M. gallisepticum and may have implications for the development of preventive strategies.

Vogl, Gunther; Plaickner, Astrid; Szathmary, Susan; Stipkovits, Laszlo; Rosengarten, Renate; Szostak, Michael P.

2008-01-01

367

Infection control in IV therapy: a review of the chain of infection.  

PubMed

The aim of this article is to review the principles of infection control relating to intravenous (IV) therapy. IV therapy and peripheral IV cannulation are common procedures. Zingg and Pittet (2009) noted that as many as 80% of hospitalized patients will have a cannula in situ, and Hart (2008) suggested that patients who require IV therapy are often seriously ill and immunocompromised, thus are more susceptible to infection. The Department of Health (DH) (2007a) estimated that 6000 patients acquire a catheter-related bloodstream infection every year in the UK. Robust standards of practice are therefore paramount to ensure safe and competent practice, both in peripheral IV cannulation and IV care. Using the chain of infection as a framework to review practice will enable practitioners to ensure thorough standards of practice, and the Royal College of Nursing (RCN) (2005) stated that only trained and competent staff using strict aseptic techniques should be involved in IV or cannulae care. Furthermore, the Code (Nursing and Midwifery Council (NMC), (2008) stipulates all practitioners must deliver care based on the best available evidence and/or best practice, and that knowledge and skills for safe and effective practice must be kept up-to-date throughout each health professional's working life. PMID:21042241

Lavery, Irene

368

Differential tissular distribution of Litomosoides sigmodontis microfilariae between microfilaremic and amicrofilaremic mice following experimental infection  

PubMed Central

Filariases are caused by onchocercid nematodes that are transmitted by arthropod vectors. More than 180 million people are infected worldwide. Mass drug administration has been set up in many endemic areas to control the parasite burden. Although very successful in limiting microfilarial load, transmission has not been completely interrupted in such areas. A proportion of infected patients with lymphatic filariasis or loiasis are known to be amicrofilaremic, as they do not present microfilariae in their bloodstream despite the presence of adult worms. A mirror status also exists in CBA/Ca mice infected with Litomosoides sigmodontis, the well-established model of filariasis. Using this model, the goal of this study was to determine if the kinetics of blood clearance of microfilariae differed between amicrofilaremic CBA/Ca mice and microfilaremic BALB/c mice. For this purpose, a qPCR approach was devised to detect microfilariae in different tissues, after a controlled inoculation of microfilariae. We showed that the rapid clearance of microfilariae from the pleural cavity or from the bloodstream of CBA/Ca mice was associated with a massive accumulation of first stage larvae in the lungs, liver and spleen.

Bouchery, T.; Ehrhardt, K.; Lefoulon, E.; Hoffmann, W.; Bain, O.; Martin, C.

2012-01-01

369

Differential tissular distribution of Litomosoides sigmodontis microfilariae between microfilaremic and amicrofilaremic mice following experimental infection.  

PubMed

Filariases are caused by onchocercid nematodes that are transmitted by arthropod vectors. More than 180 million people are infected worldwide. Mass drug administration has been set up in many endemic areas to control the parasite burden. Although very successful in limiting microfilarial load, transmission has not been completely interrupted in such areas. A proportion of infected patients with lymphatic filariasis or loiasis are known to be amicrofilaremic, as they do not present microfilariae in their bloodstream despite the presence of adult worms. A mirror status also exists in CBA/Ca mice infected with Litomosoides sigmodontis, the well-established model of filariasis. Using this model, the goal of this study was to determine if the kinetics of blood clearance of microfilariae differed between amicrofilaremic CBA/Ca mice and microfilaremic BALB/c mice. For this purpose, a qPCR approach was devised to detect microfilariae in different tissues, after a controlled inoculation of microfilariae. We showed that the rapid clearance of microfilariae from the pleural cavity or from the bloodstream of CBA/Ca mice was associated with a massive accumulation of first stage larvae in the lungs, liver and spleen. PMID:23193519

Bouchery, T; Ehrhardt, K; Lefoulon, E; Hoffmann, W; Bain, O; Martin, C

2012-11-01

370

Eye Infections  

MedlinePLUS

Your eyes can get infections from bacteria, fungi, or viruses. Eye infections can occur in different parts of the eye and can affect just one eye or both. Two common eye infections are Conjunctivitis - also known as pinkeye. Conjunctivitis is ...

371

Staphylococcal Infections  

MedlinePLUS

... of bacteria. There are over 30 types, but Staphylococcus aureus causes most staph infections (pronounced "staff infections"), including ... Some staph bacteria such as MRSA (methicillin-resistant Staphylococcus aureus) are resistant to certain antibiotics, making infections harder ...

372

Infections (Orthopedic)  

MedlinePLUS

... infections. Examples include HIV, rheumatoid arthritis, diabetes mellitus, hemophilia, and sickle cell anemia. You can become infected ... your doctor right away for early diagnosis and treatment if you suspect infection. Tell the doctor about ...

373

Importance of recrudescent avian infection in West Nile virus overwintering: incomplete antibody neutralization of virus allows infrequent vector infection.  

PubMed

After the acute infection period, birds persistently infected with West Nile virus (family Flaviviridae, genus Flavivirus, WNV) occasionally shed virus into the bloodstream, but these virions normally are inactivated by neutralizing antibody. The current work tested the hypothesis that these host neutralizing antibodies protect mosquito vectors from WNV infection and reevaluated the minimum WNV infectious dose necessary to infect Culex tarsalis Coquillett. To determine whether host antibodies protect mosquitoes from infection, Cx. tarsalis and Culex stigmatosoma Dyar were fed bloodmeals containing avian blood, WNV, and sera with or without WNV-specific neutralizing antibodies. When viral particles were completely bound by antibody, mosquitoes were protected from infection; however, when incompletely bound, WNV titers as low as 10(2.3) plaque-forming units (pfu)/ml resulted in 5% infection. These data indicated that avian antibodies were protective to mosquito vectors and were not dissociated during digestion. Because recrudescent viremias may not attain the same magnitude as initial acute viremias, Cx. tarsalis vector competence was reevaluated focusing on the fate of low-titered bloodmeals. Females were evaluated for vector competence after ingesting bloodmeals containing 10(2.2), 10(3.4), 10(4.5), 10(5.5), or 10(6.5) WNV pfu/ml. Infection increased with bloodmeal titer, with 1% of the mosquitoes ingesting 10(3.4) pfu/ml and 45% of the mosquitoes ingesting 10(6.5) pfu/ml developing disseminated infections. The incomplete neutralization of recrudescent virus may be sufficient to infect a low proportion of competent blood-feeding Culex mosquitoes and perhaps allow persistently infected birds to provide a mechanism for arbovirus overwintering. PMID:22897050

Wheeler, Sarah S; Vineyard, Meighan P; Barker, Christopher M; Reisen, William K

2012-07-01

374

Efflux pumps expression and its association with porin down-regulation and ?-lactamase production among Pseudomonas aeruginosa causing bloodstream infections in Brazil  

PubMed Central

Background Multi-drug efflux pumps have been increasingly recognized as a major component of resistance in P. aeruginosa. We have investigated the expression level of efflux systems among clinical isolates of P. aeruginosa, regardless of their antimicrobial susceptibility profile. Results Aztreonam exhibited the highest in vitro activity against the P. aeruginosa isolates studied (64.4% susceptibility), whereas susceptibility rates of imipenem and meropenem were both 47.5%. The MexXY-OprM and MexAB-OprM efflux systems were overexpressed in 50.8% and 27.1% of isolates studied, respectively. Overexpression of the MexEF-OprN and MexCD-OprJ systems was not observed. AmpC ?-lactamase was overexpressed in 11.9% of P. aeruginosa isolates. In addition, decreased oprD expression was also observed in 69.5% of the whole collection, and in 87.1% of the imipenem non-susceptible P. aeruginosa clinical isolates. The MBL-encoding genes blaSPM-1 and blaIMP-1 were detected in 23.7% and 1.7% P. aeruginosa isolates, respectively. The blaGES-1 was detected in 5.1% of the isolates, while blaGES-5 and blaCTX-M-2 were observed in 1.7% of the isolates evaluated. In the present study, we have observed that efflux systems represent an adjuvant mechanism for antimicrobial resistance. Conclusions Efflux systems in association of distinct mechanisms such as the porin down-regulation, AmpC overproduction and secondary ?-lactamases play also an important role in the multi-drug resistance phenotype among P. aeruginosa clinical isolates.

2010-01-01

375

Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit  

Microsoft Academic Search

Purpose  Cleansing the skin of intensive care unit (ICU) patients daily with chlorhexidine gluconate (CHG) has been associated with\\u000a beneficial effects, including a reduction in central-line-associated bacteremias (CLABSIs). Most studies have been done in\\u000a medical ICUs. In this study, we evaluated the effectiveness of daily chlorhexidine skin cleansing on CLABSI rates in a surgical\\u000a ICU.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In Fall 2005, the 30-bed surgical

Kyle J. Popovich; Bala Hota; Robert Hayes; Robert A. Weinstein; Mary K. Hayden

2010-01-01

376

Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukaemic patients: a randomized controlled trial  

Microsoft Academic Search

It has been suggested that central venous catheters impregnated with antiseptics such as chlohexidine and silver-sulfadiazine reduce the risk of catheter-related bacteraemia in intensive care patients. Patients suffering from haematologic malignancy treated by chemotherapy through a central venous catheter are at even greater sisk of catheter-related bacteraemia. A prospective double-blind randomized controlled trial was performed in order to investigate the

C. Logghe; Ch. Van Ossel; W. D'Hoore; H. Ezzedine; G. Wauters; J. J. Haxhe

1997-01-01

377

Efflux pumps expression and its association with porin down-regulation and ?-lactamase production among Pseudomonas aeruginosa causing bloodstream infections in Brazil  

Microsoft Academic Search

BACKGROUND: Multi-drug efflux pumps have been increasingly recognized as a major component of resistance in P. aeruginosa. We have investigated the expression level of efflux systems among clinical isolates of P. aeruginosa, regardless of their antimicrobial susceptibility profile. RESULTS: Aztreonam exhibited the highest in vitro activity against the P. aeruginosa isolates studied (64.4% susceptibility), whereas susceptibility rates of imipenem and

Danilo E Xavier; Renata C Picão; Raquel Girardello; Lorena CC Fehlberg; Ana C Gales

2010-01-01

378

[Etiologic agents and risk factors in nosocomial urinary tract infections].  

PubMed

Nosocomial urinary tract infection (NUSI) is one of the most common hospital acquired infections. In this study, we aimed to determine the risk factors, frequency and the bacterial etiology of NUSI in hospitalized patients at Trace University Hospital, Turkey. Between September 1st 2004 to March 1st 2005, 104 NUSI episodes from 91 adult patients (mean age; 60.8 +/- 16.1 years; 46 were female) were determined among 8704 patients admitted to the hospital. During the study period, cumulative incidence of NUSI was 1.04% and episode rate of NUSI was 1.19%. The most important risk factors for NUSI were detected as urinary catheterization (78.8%), antimicrobial therapy within the previous 15 days (60.6%), fecal incontinence (33.7%) and surgical operations [29.8% (42% of them were urological pertainings)]. In 37.8% of the episodes urinary catheterization was considered as performed unnecessarily. In 26% of the episodes another infection (pneumoniae, abdominal infection, wound infection) accompanied. The causative microorganisms were resistant to the antibiotics used for therapy in 93.6% of the episodes. A total of 118 microorganisms (14 were polymicrobial) have been isolated from the urine cultures. The most frequently isolated ones were Escherichia coil (n: 48; 40.8%), Candida spp. (n: 27; 23%), Enterococcus spp. (n: 13; 11%), Pseudomonas aeruginosa (n: 9; 7.6%), Klebsiella pneumoniae (n: 8; 6.8%) and Acinetobacter spp. (n: 5; 4.2%). The highest susceptibility rates of E. coli isolates were against imipenem and nitrofurantoin (100%) and amikacin (97.7%), the lowest susceptibility rates were against ampicillin (26.7%) and amoxycillin-clavulonate (44.4%). No glycopeptid resistance was detected for Enterococcus spp. while the susceptibility rates to penicilin and nitrofurantoin were 38.5% and 63.6%, respectively. Since the number of the other bacterial species was low (<10) their antimicrobial resistance rates were not evaluated. Extended-spectrum beta-lactamase (ESBL) production was determined in 27% of E. coli and in 25% of K. pneumoniae isolates, and cases with ESBL producing strains had significiantly higher antibiotic consumption rate in the previous 15 days (p = 0.004). Blood cultures which were collected during NUSI episodes yielded positive results in 31.8%. The mortality rate due to NUSI was significantly higher in cases with bloodstream infection (p = 0.000). In conclusion, the high rates of NUSI associated with bloodstream infections and mortality detected have pointed out serious problems in our hospital, and indicated that more attention should be paid on urinary catheterisation, rational antibiotic usage and control of nosocomial infections. PMID:18697422

Akkoyun, Seviç; Kulo?lu, Figen; Tokuç, Burcu

2008-04-01

379

Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Patients on Chronic Dialysis in the United States, 2005-2011.  

PubMed

Background.?Approximately 15 700 invasive methicillin-resistant Staphylococcus aureus (MRSA) infections occurred in US dialysis patients in 2010. Frequent hospital visits and prolonged bloodstream access, especially via central venous catheters (CVCs), are risk factors among hemodialysis patients. We describe the epidemiology of and recent trends in invasive MRSA infections among dialysis patients. Methods.?We analyzed population-based data from 9 US metropolitan areas from 2005 to 2011. Cases were defined as MRSA isolated from a normally sterile body site in a surveillance area resident who received dialysis, and were classified as hospital-onset (HO; culture collected >3 days after hospital admission) or healthcare-associated community-onset (HACO; all others). Incidence was calculated using denominators from the US Renal Data System. Temporal trends in incidence and national estimates were calculated controlling for age, sex, and race. Results.?From 2005 to 2011, 7489 cases were identified; 85.7% were HACO infections, and 93.2% were bloodstream infections. Incidence of invasive MRSA infections decreased from 6.5 to 4.2 per 100 dialysis patients (annual decrease, 7.3%) with annual decreases of 6.7% for HACO and 10.5% for HO cases. Among cases identified during 2009-2011, 70% of patients were hospitalized in the year prior to infection. Among hemodialysis cases, 60.4% of patients were dialyzed through a CVC. The 2011 national estimated number of MRSA infections was 15 169. Conclusions.?There has been a substantial decrease in invasive MRSA infection incidence among dialysis patients. Most cases had previous hospitalizations, suggesting that efforts to control MRSA in hospitals might have contributed to the declines. Infection prevention measures should include improved vascular access and CVC care. PMID:23964088

Nguyen, Duc B; Lessa, Fernanda C; Belflower, Ruth; Mu, Yi; Wise, Matthew; Nadle, Joelle; Bamberg, Wendy M; Petit, Susan; Ray, Susan M; Harrison, Lee H; Lynfield, Ruth; Dumyati, Ghinwa; Thompson, Jamie; Schaffner, William; Patel, Priti R

2013-08-19

380

Mycobacterium avium infection and AIDS: a therapeutic dilemma in rapid evolution.  

PubMed

Note from Dr. Merle A. Sande--The role of Mycobacterium avium as a pathogen in the human immunodeficiency virus-infected population has been confusing and controversial to clinicians who care for AIDS patients. The organism is commonly isolated from respiratory secretions of patients with other infections and often seems part of the resident flora; even when isolated from the bone marrow or bloodstream, its impact on the course of AIDS and contribution to systemic diseases are unknown. However, an increasing subset of patients without other documented opportunistic infections or malignancies has symptoms that respond to therapy directed against M. avium. Studies are in progress to evaluate chemotherapeutic agents. Accordingly, the subject is here reviewed and guidelines offered to infectious disease clinicians by one with a long-standing interest in mycobacterial disease who has made numerous contributions to the field. PMID:2037799

Ellner, J J; Goldberger, M J; Parenti, D M

1991-06-01

381

Antibiotic susceptibility profiles of uncommon bacterial species causing severe infections in Italy.  

PubMed

This study presents the results of the italian "Severe infections project" involving bacteria that can be considered rare causes of disease. we isolated 30 uncommon human pathogens from a total of 60 strains (1.2% of all the isolates). The most frequent sources of uncommon human pathogens were primary bloodstream infections (48.3%) and pneumonia (20%). Species such as Comamonas testosteroni, Enterococcus hirae, Kluyvera ascorbata, Kluyvera cryocrescens, Leclercia adecarboxylata and Ochrobactrum anthropi were recovered from bacteremia patients. Clinically useful antimicrobial agents were tested against each isolate. Resistance to 4 or more antibiotics tested was found in Achromobacter xylosoxidans, O. anthropi, Pseudomonas stutzeri, Citrobacter braakii, Enterobacter sakazakii, K. ascorbata, Proteus penneri and Serratia plymuthica. About 16% of the Gram-negative species were resistant to third-generation cephalosporins and 28.6% of the staphylococci were oxacillin-resistant. the results from this study offer indications for empirical therapy for severe infections from uncommon human pathogens. PMID:19567344

Nicolosi, D; Nicolosi, V M; Cappellani, A; Nicoletti, G; Blandino, G

2009-06-01

382

Acute and persistent infection by a transfected Mo7 strain of Babesia bovis.  

PubMed

A Mo7-derived Babesia bovis line stably transfected with the gfp-bsd gene was inoculated into two four to five months old calves, while two additional calves were inoculated with Mo7 parasites. Similar mild clinical signs were detected in all calves. B. bovis rap-1 was identified in the bloodstream by PCR four days post inoculation (dpi), and consistently over ten months thereafter. Transfusion of blood from experimentally infected calves into four naïve splenectomized calves at 212 dpi resulted in acute disease in recipients, confirming persistent infection in the four donor animals. The proportion of GFP expressing parasites recovered from a splenectomized recipient calf is undistinguishable from transfected parasites that were maintained in long term culture under blasticidin selection. Furthermore, the sequences of transfected genes in recovered parasites remained unaltered. Together, the data demonstrates that exogenous B. bovis transgenes can be expressed and remain stable throughout acute and persistent infection in calves. PMID:22669120

Suarez, Carlos E; Laughery, Jacob M; Schneider, David A; Sondgeroth, Kerry S; McElwain, Terry F

2012-06-02

383

Large IncHI2-plasmids encode extended-spectrum ?-lactamases (ESBLs) in Enterobacter spp. bloodstream isolates, and support ESBL-transfer to Escherichia coli.  

PubMed

We investigated the prevalence of extended-spectrum ?-lactamases (ESBLs) in Enterobacter spp. bloodstream isolates from 19 hospital laboratories in Norway during 2011. A total of 62/230 (27%) isolates were resistant to third-generation cephalosporins and four (1.7%) were ESBL-positive; blaCTX -M-15 (n = 3) and blaSHV -12 (n = 1). This is comparable to the prevalence of ESBLs in clinical isolates of Escherichia coli and Klebsiella pneumoniae in Norway during the same period. All ESBL-positive isolates were multidrug resistant (MDR) and harboured plasmid-mediated quinolone resistance. Three isolates supported transfer of large IncHI2-plasmids harbouring ESBL- and MDR-encoding genes to E. coli recipients by in vitro conjugation. PMID:23800169

Nilsen, E; Haldorsen, B C; Sundsfjord, A; Simonsen, G S; Ingebretsen, A; Naseer, U; Samuelsen, O

2013-06-25

384

Skin Infections  

MedlinePLUS

... it can get infected by them. Some common types of skin infections are Bacterial: Cellulitis and impetigo. Staphylococcal infections can also affect the skin. Viral: Shingles, warts, and herpes simplex Fungal: Athlete's foot and yeast infections Parasitic: Body lice, head lice, and scabies ...

385

Parasitic Infections  

Microsoft Academic Search

Infection of the central nervous system (CNS) by different parasites is in endemic proportion in different parts of the world. The distribution of the type of infection depends on the food habits, prevalence of the type of infection in the region, and local hygienic conditions in many developing countries in Asia, Africa, Central and South America, and Mexico. These infections

Rakesh K. Gupta; Kee-Hyun Chang

386

Microsatellite mapping of Mycobacterium leprae populations in infected humans.  

PubMed

To investigate genetic diversity in a bacterial population, we measured the copy numbers of simple sequence repeats, or microsatellites, in Mycobacterium leprae from patients living in and around Hyderabad, India. Three microsatellite loci containing trinucleotide or dinucleotide repeats were amplified from infected tissues, and the copy numbers were established by sequence analysis. Extensive diversity was observed in a cross-sectional survey of 33 patients, but closely related profiles were found for members of a multicase family likely to share a common transmission source. Sampling of multiple tissues from single individuals demonstrated identical microsatellite profiles in the skin, nasal cavity, and bloodstream but revealed differences at one or more loci for M. leprae present in nerves. Microsatellite mapping of M. leprae represents a useful tool for tracking short transmission chains. Comparison of skin and nerve lesions suggests that the evolution of disease within an individual involves the expansion of multiple distinct subpopulations of M. leprae. PMID:15528676

Young, Saroj K; Taylor, G Michael; Jain, Suman; Suneetha, Lavanya M; Suneetha, Sujai; Lockwood, Diana N J; Young, Douglas B

2004-11-01

387

Microsatellite Mapping of Mycobacterium leprae Populations in Infected Humans  

PubMed Central

To investigate genetic diversity in a bacterial population, we measured the copy numbers of simple sequence repeats, or microsatellites, in Mycobacterium leprae from patients living in and around Hyderabad, India. Three microsatellite loci containing trinucleotide or dinucleotide repeats were amplified from infected tissues, and the copy numbers were established by sequence analysis. Extensive diversity was observed in a cross-sectional survey of 33 patients, but closely related profiles were found for members of a multicase family likely to share a common transmission source. Sampling of multiple tissues from single individuals demonstrated identical microsatellite profiles in the skin, nasal cavity, and bloodstream but revealed differences at one or more loci for M. leprae present in nerves. Microsatellite mapping of M. leprae represents a useful tool for tracking short transmission chains. Comparison of skin and nerve lesions suggests that the evolution of disease within an individual involves the expansion of multiple distinct subpopulations of M. leprae.

Young, Saroj K.; Taylor, G. Michael; Jain, Suman; Suneetha, Lavanya M.; Suneetha, Sujai; Lockwood, Diana N. J.; Young, Douglas B.

2004-01-01

388

Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy  

Microsoft Academic Search

Background  This study assesses the impact that a resident oversight and credentialing policy for central venous catheter (CVC) placement\\u000a had on institution-wide central line associated bloodstream infections (CLABSI). We therefore investigated the rate of CLABSI\\u000a per 1,000 line days during the 12 months before and after implementation of the policy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This is a retrospective analysis of prospectively collected data at an

Robert A Cherry; Cheri E West; Maria C Hamilton; Colleen M Rafferty; Christopher S Hollenbeak; Gregory M Caputo

2011-01-01

389

Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices  

Microsoft Academic Search

Goals  Central venous catheter (CVC)-related bloodstream infection (CR-BSI) is a significant complication in hematology patients.\\u000a A range of CVC devices may be used, and risks for the development of complications are not uniform. The objectives of this\\u000a study were to determine the natural history and rate of CVC-related complications and risk factors for CR-BSI and to compare\\u000a device-specific complications in a

Leon J. Worth; John F. Seymour; Monica A. Slavin

2009-01-01

390

Trauma-related Infections in Battlefield Casualties From Iraq  

PubMed Central

Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. Methods: Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. Results: Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). Conclusions: Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options.

Petersen, Kyle; Riddle, Mark S.; Danko, Janine R.; Blazes, David L.; Hayden, Richard; Tasker, Sybil A.; Dunne, James R.

2007-01-01

391

Hand infections.  

PubMed

Many acute hand and upper extremity infections should be treated as surgical emergencies to avoid stiffness, contracture, pain, and amputation. Proper treatment requires understanding of anatomy and how this influences the behavior of certain infections, common offending organisms, antibiotic treatment, management of host factors, and surgical intervention. This article reviews the microbiology, antibiotic coverage, and surgical treatment of the most common infections in the hand: paronychia, felon, herpetic whitlow, flexor tenosynovitis, deep space infections, septic arthritis, bites from humans and animals, necrotizing fasciitis, mycobacterium infections, and fungal infections. Recommendations are based on the most recent available evidence. PMID:24095077

Franko, Orrin I; Abrams, Reid A

2013-10-01

392

Hand Infections  

MedlinePLUS

... throbbing infection, called “felon”, occurs in the closed space of the fatty tissues of the finger tip ... many patients require weeks of intravenous antibiotics. Deep space infections There are spaces in between the different ...

393

Rotavirus Infections  

MedlinePLUS

Rotavirus is a virus that causes gastroenteritis. Symptoms include severe diarrhea, vomiting, fever, and dehydration. Almost all ... the U.S. are likely to be infected with rotavirus before their 5th birthday. Infections happen most often ...

394

Fungal Infections  

MedlinePLUS

... too. Candida (say: kan -duh-duh) is a yeast, similar to a fungus. It most often affects ... and around the vagina. This is called a yeast infection. Continue Why Do Kids Get Fungal Infections? ...

395

Streptococcal Infections  

MedlinePLUS

... red rash on the body. Impetigo - a skin infection Toxic shock syndrome Cellulitis and necrotizing fasciitis (flesh-eating disease) Group B strep can cause blood infections, pneumonia and meningitis in newborns. A screening test ...

396

Bacterial Infections  

MedlinePLUS

... make you sick. Examples of bacteria that cause infections include Streptococcus, Staphylococcus, and E. coli. Antibiotics are ... them. Later, you could get or spread an infection that those antibiotics cannot cure. NIH: National Institute ...

397

Infection Control  

MedlinePLUS

... lives are lost because of the spread of infections in hospitals. Health care workers can take steps ... of infectious diseases. These steps are part of infection control. Proper hand washing is the most effective ...

398

Campylobacter Infections  

MedlinePLUS

Campylobacter infection is a common foodborne illness. You get it from eating raw or undercooked poultry. You can also ... you need to take antibiotics. To prevent campylobacter infection, cook poultry thoroughly. Use a separate cutting board ...

399

Giardia Infections  

MedlinePLUS

... water. Diarrhea is the main symptom of giardia infection. Others include Passing gas Greasy stools Stomach cramps ... people have no symptoms at all. Symptoms of infection often last two to six weeks. Stool sample ...

400

Tapeworm Infection  

MedlinePLUS

... you ingest microscopic tapeworm eggs. For example, a pig infected with tapeworm will pass tapeworm eggs in ... America, China or Southeast Asia where free-range pigs are common. Complications Intestinal tapeworm infections usually aren' ...

401

Staph Infections  

MedlinePLUS

... most staph infections are caused by the species Staphylococcus aureus (S. aureus) . S. aureus most commonly causes skin infections like ... You may also have heard about methicillin-resistant Staphylococcus aureus or MRSA for short. MRSA is a type ...

402

Opportunistic Infections  

MedlinePLUS

... mm 3 OPPORTUNISTIC INFECTIONS Pnuemocystis Jirovecii ( Carinii ) Pneumonia (PCP) PCP is a fungal infection and is the OI ... available for patients who are at risk for PCP, but who are not ready to start antiretroviral ...

403

Dengue infections.  

PubMed

Background: Dengue fever is one of the most common mosquito-borne viral illnesses in the world. It is usually transmitted to humans through the bite of an infected Aedes aegypti or Aedes albopictus mosquito. Dengue infections are caused by four antigenically distinct but closely related viruses (DEN 1?4). Infection with any one of the viruses is thought to provide lifetime immunity to future infections from the same virus but only short-term cross-immunity to the other types, leading to the possibility of secondary infections. Dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), more severe types of dengue infections, sometimes result when an individual is subsequently infected with a second virus serotype during their lifetime. The most commonly accepted theory for the development of these more severe dengue infections is that of antibody-dependent enhancement, although other factors likely play a role. Infections complicated by DHF/DSS in areas where dengue is endemic are most often seen in the later half of the first year of life, when waning maternal antibodies may enhance the development of a more severe infection, and in young school-age children experiencing secondary infections. Widespread infections are most commonly seen during the rainy season of endemic areas when the breeding habitat of the Aedes mosquito is most favorable. PMID:23817881

Burnett, Mark

2013-01-01

404

Spinal infections  

Microsoft Academic Search

Spinal infections can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, epidural infections, meningitis, polyradiculopathy and myelitis. Radiological evaluations have gained importance in the diagnosis, treatment planning, treatment and treatment monitoring of the spinal infections. Conventional radiographs are usually the initial imaging study. The sensitivity and specificity of the plain radiographs are very

E. Turgut Tali

2004-01-01

405

Device-related infections in critically ill patients. Part II: Prevention of ventilator-associated pneumonia and urinary tract infections.  

PubMed

Device utilization in critically ill patients is responsible for a high risk of complications such as catheter-related bloodstream infections (CRBSI), ventilator-associated pneumonia (VAP) and urinary tract infections (UTI). In this article we will review the current status of data regarding the prevention of VAP and UTI. The results of the more recent (5 years) randomized controlled trials are reviewed and discussed. General recommendations include staff education and use of a surveillance program with a restrictive antibiotic policy. Adequate time must be allowed for hand washing and barrier precautions must always be used during device manipulation. Specific measures for VAP prevention are: 1) use of multi-use, closed-system suction catheters; 2) no routine change of the breathing circuit; 3) lubrication of the cuff of the endotracheal tube (ET) with a water-soluble gel; 4) maintenance of patient in semi-recumbent position to improve chest physiotherapy in intubated patients. Specific measures for UTI prevention include: 1) use of a catheter-valve instead of a standard drainage system; 2) use of a silver-alloy, hydro gel-coated latex urinary catheter instead of uncoated catheters. Biofilm represents a new variable: the capacity of bacteria to organize a biofilm on a device surface can explain the difficulty in preventing and eradicating an infection in a critically ill patient. More clinical trials are needed to verify the efficacy of prevention measures of ICU infections. PMID:14998076

Di Filippo, A; De Gaudio, A R

2003-12-01

406

Occurrence of Extended-Spectrum and AmpC Beta-Lactamases in Bloodstream Isolates of Klebsiella pneumoniae: Isolates Harbor Plasmid-Mediated FOX5 and ACT1 AmpC Beta-Lactamases  

Microsoft Academic Search

We tested 190 Klebsiella pneumoniae bloodstream isolates recovered from 189 patients in 30 U.S. hospitals in 23 states to determine the occurrence of extended-spectrum -lactamase (ESBL) and AmpC -lactamase producers. Based on growth inhibition by clavulanic acid by disk and MIC test methods, 18 (9.5%) of the isolates produced ESBLs. Although the disk diffusion method with standard breakpoints identified 28

Philip E. Coudron; Nancy D. Hanson; Michael W. Climo

2003-01-01

407

Methicillin-Resistant Staphylococcus aureus Infection and Hospitalization in High-Risk Patients in the Year following Detection  

PubMed Central

Background Many studies have evaluated methicillin-resistant Staphylococcus aureus (MRSA) infections during single hospitalizations an