Sample records for paucimobilis bloodstream infections

  1. Sphingomonas paucimobilis bloodstream infections associated with contaminated intravenous fentanyl.

    PubMed

    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

    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

  2. [Sphingomonas paucimobilis infection with underlying submandibular sialolithiasis].

    PubMed

    Karab?çak, Ci?dem; Karab?çak, Hasan; A?alar, Canan; Kazkayas?, Mustafa

    2011-01-01

    Sphingomonas paucimobilis (S. paucimobilis), is a gram-negative, aerobic, non-fermentative, oxidase (+) and catalase (+) bacterium. Although S. paucimobilis is isolated very rarely, it can cause both nosocomial and community-acquired infections. A patient admitted to our clinic had a complaint of swelling in the right mandibular region and pain increasing while eating for the previous week. Bimanual palpation revealed a painful swelling of 1x1x1 cm in size inside the right Wharton's duct. Via massage over the right submandibular gland, a purulent drainage came up from the opening of the Wharton's duct and it was cultivated and S. paucimobilis was isolated. There was no ultrasonographic evidence of calculi in the duct or in the gland, but during the right submandibular gland massage, two stones came out through the Wharton's duct. The infection was observed to be eradicated with a 14-day ampicillin-sulbactam treatment. In the control examination after six months, there were no pathological signs or symptoms and the ultrasonogram was normal. As far as we know, this is the first sialadenitis case with underlying sialolithiasis where S. paucimobilis was isolated. PMID:21303318

  3. Sphingomonas paucimobilis infections in children: 24 case reports.

    PubMed

    Bayram, Nuri; Devrim, Ilker; Apa, Hur?it; Gülfidan, Gamze; Türky?lmaz, Hande Namal; Günay, Ilker

    2013-01-01

    Sphingomonas paucimobilis is a causative agent of infection in immunocompromised patients, and healthcare-associated infection. Although the infections associated with S.paucimobilis occurs rarely, it has been encountered with increasing frequency in clinical settings. In the current study we reported clinical features of the children with S.paucimobilis infection, and the antimicrobial susceptibilities of the isolated strains among the patients. This study was conducted in Dr. Behçet Uz Children's Hospital, Turkey, during the period of January 2005 and December 2012. The medical records of pediatric patients with positive cultures for S.paucimobilis were reviewed. Sphingomonas paucimobilis isolates were recovered from 24 pediatric patients. The median age was 4 years (ranging from 3 days infant to 15 years) and 58,3% were male. Eight (33,3%) of the patients were under 1 months of age. Among the patients; 13 (54,2%) infections were community related however 11(45.8%) infections were nosocomial infection. The median duration of hospital stay was 7 days (ranging from 4 to 22 days). The most effective antibiotics were fluoroquinolones, carbapenems, and trimethoprim/sulfamethoxazole. This is the first largest study in children to evaluate the clinical features of S. paucimobilis infections. Sphingomonas paucimobilis may cause infections in both previously healthy and immunocompromised children. Although variable antimicrobial regimens were achieved to the patients, there was no attributable fatality due to S.paucimobilis infections due to the low virulence of the bacteria. PMID:23795278

  4. Bloodstream infections and central line-associated bloodstream infections.

    PubMed

    Watson, Christopher M; Al-Hasan, Majdi N

    2014-12-01

    It is estimated that more than 575,000 individuals develop bloodstream infections (BSI) annually in North America, accounting for nearly 80,000 deaths. Central line-associated BSI (CLABSI) is a major contributor to the cost of health care. Although primary BSI may be seen by the surgeon, a secondary BSI is more likely to be encountered, especially CLABSI. Prompt identification of the source of infection in patients with secondary BSI is paramount. This practice allows early source control and initiation of appropriate antimicrobial therapy, with subsequent improvement in outcomes. An understanding of evidence-based preventative measures and bundles is important. PMID:25440121

  5. Candida Infection of the Bloodstream - Candidemia

    MedlinePLUS

    ... common infections, like Candidemia or other fungal infections. Candida species can also enter the bloodstream alongside a catheter ... blood. In many cases, the species found is Candida albicans , however, other species of Candida, Candida tropicalis , C. glabrata and C. ...

  6. Intravascular Catheter-Related Bloodstream Infection

    PubMed Central

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

    2013-01-01

    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. PMID:24167648

  7. Investigational antimicrobial drugs for bloodstream infections.

    PubMed

    Korbila, Ioanna P; Falagas, Matthew E

    2008-08-01

    Bloodstream infections, especially those arising from multidrug-resistant strains, are an alarming public health threat requiring continuous efforts for new drug development. In this review, antibiotics at an advanced development stage for the treatment of patients with bloodstream infections are identified through a search of the available literature sources. Eight compounds currently undergoing phase II and/or phase III trials were identified. Isavuconazole, a triazole, is undergoing a phase III trial for the potential treatment of candidemia. Ceftobiprol medocaril, which belongs to the cephalosporin class, is undergoing regulatory review for the treatment of skin infections. Three lipoglycopeptides, oritavancin, dalbavancin and telavancin, are being tested against Gram-positive cocci in clinical trials. Also, human lactoferrin peptide 1-11, which appears to be a promising agent, is being tested in patients with Staphylococcus epidermidis bacteremia and in patients with candidemia. Iclaprim, a novel dihydrofolate reductase inhibitor, has completed two phase III trials for complicated skin and skin structure infections. The revival of an old class of antibiotics, polymyxins, in an effort to combat resistance, has also necessitated further investigation of these agents; colistin (polymyxin E) is at the forefront of this class of compounds, and is being assessed in a phase III efficacy trial. This overview of investigational antibiotics for bloodstream infections highlights that the pace of antimicrobial drug research and development is slower than the evolution of resistance. Only eight relevant compounds were identified in the pipeline of antibiotic research, none of which demonstrate a novel mechanism of action. PMID:18666035

  8. The impact of hospital-acquired bloodstream infections.

    PubMed Central

    Wenzel, R. P.; Edmond, M. B.

    2001-01-01

    Nosocomial bloodstream infections are a leading cause of death in the United States. If we assume a nosocomial infection rate of 5%, of which 10% are bloodstream infections, and an attributable mortality rate of 15%, bloodstream infections would represent the eighth leading cause of death in the United States. Because most risk factors for dying after bacteremia or fungemia may not be changeable, prevention efforts must focus on new infection-control technology and techniques. PMID:11294700

  9. Bloodstream infection caused by Campylobacter lari.

    PubMed

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

    2013-04-01

    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

  10. Update on catheter-related bloodstream infections in ICU patients.

    PubMed

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

    2011-03-01

    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

  11. Comparison of Total Hospital-Acquired Bloodstream Infections to Central Line-Associated Bloodstream Infections and Implications for Outcome Measures in Infection Control

    PubMed Central

    Leekha, Surbhi; Li, Shanshan; Thom, Kerri A.; Anne Preas, Michael; Caffo, Brian S.; Morgan, Daniel J.; Harris, Anthony D.

    2014-01-01

    Validity of the central line-associated bloodstream infection (CLABSI) measure is compromised by subjectivity. We observed significant decreases in both CLABSI and total hospital-acquired bloodstream infection (BSI) following a CLABSI prevention intervention in adult intensive care units. Total hospital-acquired BSI could be explored as an adjunct, objective CLABSI measure. PMID:23917916

  12. Acinetobacter baumannii bloodstream infection while receiving tigecycline: a cautionary report

    Microsoft Academic Search

    Anton Y. Peleg; Brian A. Potoski; Rhonda Rea; Jennifer Adams; Jigme Sethi; Blair Capitano; Shahid Husain; Eun J. Kwak; Sunil V. Bhat

    2007-01-01

    Objectives: Tigecycline has shown in vitro activity against Acinetobacter baumannii. Yet, published clinical experience with tigecycline use outside clinical trials is lacking. We describe, for the first time, bloodstream infection caused by tigecycline-non-susceptible A. baumannii occurring in patients receiving tigecycline for other indications. The possible mechanisms of resistance and pharmacokinetic limitations of the drug are addressed. Methods: The clinical records

  13. Prospective study on central venous line associated bloodstream infections

    Microsoft Academic Search

    Mine Wagner; Jan Bonhoeffer; Thomas O Erb; René Glanzmann; Frank Martin Häcker; Michael Paulussen; Daniel Weibel; Ulrich Heininger

    2011-01-01

    ObjectiveTo prospectively assess the incidence rates and characteristics of central venous line associated bloodstream infections (CLABSI) in one institution.MethodsAll patients with indwelling central venous catheters (CVC) between 1 April 2008 and 31 March 2009 were enrolled. The medical records of patients were reviewed and information on relevant characteristics entered into a standardised questionnaire. Central laboratory records were regularly checked for

  14. Development of a statewide collaborative to decrease NICU central line-associated bloodstream infections

    Microsoft Academic Search

    J Schulman; R L Stricof; T P Stevens; I R Holzman; E P Shields; R M Angert; R S Wasserman-Hoff; S M Nafday; L Saiman

    2009-01-01

    Objective:To characterize hospital-acquired bloodstream infection rates among New York State's 19 regional referral NICUs (at regional perinatal centers; RPCs) and develop strategies to promote best practices to reduce central line-associated bloodstream infections (CLABSIs).Study Design:During 2006 and 2007, RPC NICUs reported bloodstream infections, patient-days and central line-days to the Department of Health, and shared their results. Aiming to improve, participants created

  15. Catheter-Related Bloodstream Infection by Tsukamurella inchonensis in an Immunocompromised Patient

    PubMed Central

    Takebe, Isao; Sawabe, Etsuko; Ohkusu, Kiyofumi; Tojo, Naoko

    2014-01-01

    We report a case of catheter-related bloodstream infection by Tsukamurella inchonensis, identified using 16S rRNA gene sequencing, in a patient with myelofibrosis who underwent a bone marrow transplant. Tsukamurella species infections are rare. To our knowledge, this is the first case of T. inchonensis bloodstream infection in an immunocompromised patient. PMID:24671800

  16. Biofilm-based central line-associated bloodstream infections.

    PubMed

    Yousif, Ammar; Jamal, Mohamed A; Raad, Issam

    2015-01-01

    Different types of central venous catheters (CVCs) have been used in clinical practice to improve the quality of life of chronically and critically ill patients. Unfortunately, indwelling devices are usually associated with microbial biofilms and eventually lead to catheter-related bloodstream infections (CLABSIs).An estimated 250,000-400,000 CLABSIs occur every year in the United States, at a rate of 1.5 per 1,000 CVC days and a mortality rate of 12-25 %. The annual cost of caring for patients with CLABSIs ranges from 296 million to 2.3 billion dollars.Biofilm formation occurs on biotic and abiotic surfaces in the clinical setting. Extensive studies have been conducted to understand biofilm formation, including different biofilm developmental stages, biofilm matrix compositions, quorum-sensing regulated biofilm formation, biofilm dispersal (and its clinical implications), and multi-species biofilms that are relevant to polymicrobial infections.When microbes form a matured biofilm within human hosts through medical devices such as CVCs, the infection becomes resistant to antibiotic treatment and can develop into a chronic condition. For that reason, many techniques have been used to prevent the formation of biofilm by targeting different stages of biofilm maturation. Other methods have been used to diagnose and treat established cases of CLABSI.Catheter removal is the conventional management of catheter associated bacteremia; however, the procedure itself carries a relatively high risk of mechanical complications. Salvaging the catheter can help to minimize these complications.In this article, we provide an overview of microbial biofilm formation; describe the involvement of various genetic determinants, adhesion proteins, organelles, mechanism(s) of biofilm formation, polymicrobial infections, and biofilm-associated infections on indwelling intravascular catheters; and describe the diagnosis, management, and prevention of catheter-related bloodstream infections. PMID:25366227

  17. [A rare cause of nosocomial bacteremia: Sphingomonas paucimobilis].

    PubMed

    Bulut, Cemal; Yetkin, M Arzu; Koruk, Süda Tekin; Erdinç, F Sebnem; Karakoç, Esra Alp

    2008-10-01

    Sphingomonas paucimobilis, is a yellow-pigmented, aerobic, non-fermentative, non-spore-forming, gram-negative bacillus. Infections by S. paucimobilis which is widely found in nature and hospital environments are rarely serious or life threatening. In this report we present a case of hospital acquired bloodstream infection due to S. paucimobilis. The patient had a history of hydrocephalus diagnosed at sixth months of his birth and had experienced two ventriculoperitoneal shunt surgery. He was hospitalized and been treated for bronchopneumonia. On the 47th day of hospitalization, blood cultures (BACTEC, Becton Dickinson, USA) were taken because of a body temperature of 38.5 degrees C. One of the blood cultures was positive for gram-negative rods. After 48 h 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 and citrate utilisation. Motility was negative as well. The isolate has been identified as S. paucimobilis by using mini API (bioMerieux, France) system. The antibiotic susceptibility test was also performed with the same system and the strain was found susceptible to ceftazidime, ceftriaxone, cefoperazone, cefepime, cefotaxime, ciprofloxacin, imipenem, piperacillin-tazobactam, aztreonam, amikasin and gentamicin. Treatment with intravenous ceftriaxone (2 x 750 mg/day) was initiated. He responded well to the treatment and discharged on the tenth day. This case was reported to emphasize that S. paucimobilis should be kept in mind as a nosocomial infectious agent and the infections should be treated according to the sensitivity test results. PMID:19149092

  18. Bloodstream infections due to Peptoniphilus spp.: report of 15 cases

    PubMed Central

    Brown, K; Church, D; Lynch, T; Gregson, D

    2014-01-01

    Peptoniphilus spp. are Gram-positive anaerobic cocci (GPAC) that were formerly classified in the genus Peptostreptococcus. This study describes 15 cases of Peptoniphilus spp. bloodstream infection (BSI) diagnosed from 2007 to 2011 using 16S rDNA sequencing in patients with pneumonia, pre-term delivery, soft tissue infection or colon or bladder disease. Seven out of 15 (47%) of these cases had polymicrobial BSIs. One of the isolates was closely related to P. duerdenii (EU526290), while the other 14 isolates were most closely related to a Peptoniphilus sp. reference strain (ATCC 29743) and P. hareii (Y07839). Peptoniphilus is a rare but important cause of BSI. PMID:24773457

  19. Uncommon aetiological agents of catheter-related bloodstream infections.

    PubMed

    Reigadas, E; Rodríguez-Créixems, M; Sánchez-Carrillo, C; Martín-Rabadán, P; Bouza, E

    2015-03-01

    SUMMARY The clinical and microbiological characteristics of catheter-related bloodstream infection (CR-BSI) due to uncommon microorganisms was assessed in a retrospective case-control study over a 9-year period in a tertiary teaching hospital. Uncommon microorganisms were defined as those representing <0·5% of all CR-BSI. Diagnosis of CR-BSI required that the same microorganism was grown from at least one peripheral venous blood culture and a catheter tip culture. Thirty-one episodes of CR-BSI were identified due to 13 different genera and these accounted for 2·3% of all CR-BSI in the hospital. Although these infections were not associated with increased mortality, they occurred in patients with more severe underlying conditions who were receiving prolonged antibiotic therapy. PMID:24887020

  20. Cefotaxime resistance and outcome of Klebsiella spp bloodstream infection.

    PubMed

    Ortega, M; Marco, F; Soriano, A; Almela, M; Martínez, J A; López, J; Pitart, C; Mensa, J

    2011-12-01

    We attempt to describe the epidemiology and outcome associated with cefotaxime-resistant (CTX-R) Klebsiella spp bacteraemia. Klebsiella spp bloodstream infection episodes prospectively collected through a blood culture surveillance programme from January 1991 to December 2008 in a single institution were analysed. A total of 910 monomicrobial episodes of Klebsiella spp bacteraemia were identified during the study period. The most important sources were from urinary tract infection, unknown sources, billiary focus and catheter related infection. There were 112 (12%) CTX-R isolates. Out of 112 isolates, 98 were CTX-R by Extended-Spectrum ?-Lactamase production. Shock on presentation and mortality were significantly more frequent in CTX-R than in CTX susceptible isolates. Inappropriate empirical therapy was received in 50 (45%) cases in the CTX-R Klebsiella spp group (13 cases of death, 26%). Predictive factors associated with CTX-R Klebsiella spp isolate were: previous ?-lactam therapy (OR?=?4.16), nosocomial acquired bacteraemia (OR?=?1.93), solid organ trasplantation (OR?=?2.09) and shock (OR?=?1.90). Independent risk factors associated with mortality in Klebsiella spp bacteraemia were: age (OR?=?1.03), liver cirrhosis (OR?=?2.63), ultimately or rapidly fatal prognosis of underlying disease (OR?=?2.44), shock (OR?=?8.60), pneumonia (OR?=?4.96) or intraabdominal (OR?=?3.85) source of bacteraemia and CTX-R isolate (OR?=?4.63). Klebsiella spp is an important cause of bloodstream infection. CTX-R isolates have been increasing since 2000. CTX-R is an independent factor associated with mortality in Klebsiella spp bacteraemia. PMID:21509474

  1. [Bloodstream infections after liver and hematopoietic stem cell transplantation].

    PubMed

    Peri?, Zinaida; Tambi?-Andrasevi?, Arjana; Mrzljak, Ana; Kosuta, Iva; Kovacevi?, Visnja; Gustin, Denis; Vrhovac, Radovan

    2012-12-01

    The aim of this retrospective study was to evaluate and compare the incidence, timing and etiology of bloodstream infections (BSIs) in patients treated with liver-(LT) or hematopoietic stem cell transplantation (HSCT) in a single institution. We evaluated 280 consecutive transplantations over a period of 34 months. Our results demonstrated 84 episodes of BSIs (47 in LT patients and 37 in HSCT patients) at a median of 28 days post-transplantation. Relative incidence of 34.6 and 29.4 BSI episodes per 100 LT and HSCT patients, respectively, did not differ significantly between the two groups (p = 0.52). BSIs in HSCT patients occurred significantly earlier (p = 0.003) than in LT patients. The recently described reemergence of gram-negative (GN) pathogens as causative agents of BSIs in these patients was confirmed: GN bacilli were the predominant isolates in the LT group, responsible for 58.5% of BSIs and a very frequent (39%) cause of BSIs in the HSCT group. A higher incidence of resistant enterobacteriaceae producing extended spectrum beta-lactamases was found in isolates from LT patients compared to HSCT patients. In both groups, Pseudomonas aeruginosa was the most difficult to treat organism, with 57% of these isolates in LT patients and 44% in HSCT patients being resistant to carbapenems. To conclude, BSIs were confirmed to be important infectious complications of both LT and HSCT. Surveillance and analysis of bacteria causing bloodstream and other serious infections in transplanted patients remain the main prerequisites for planning interventions regarding prevention and treatment of infections in these patients. PMID:23814965

  2. Antibiogram for Haemodialysis Catheter-Related Bloodstream Infections

    PubMed Central

    Abdul Gafor, Abdul Halim; Cheong Ping, Pau; Zainal Abidin, Anis Farahanum; Saruddin, Muhammad Zulhilmie; Kah Yan, Ng; Adam, Siti Qania'ah; Ramli, Ramliza; Sulong, Anita; Periyasamy, Petrick

    2014-01-01

    Background. Haemodialysis (HD) catheter-related bloodstream infections (CRBSIs) are a major complication of long-term catheter use in HD. This study identified the epidemiology of HD CRBSIs and to aid in the choice of empiric antibiotics therapy given to patients with HD CRBSIs. Methods. Patients with HD CRBSIs were identified. Their blood cultures were performed according to standard sterile technique. Specimens were sent to the microbiology lab for culture and sensitivity testing. Results were tabulated in antibiograms. Results. 18 patients with a median age of 61.0 years (IQR: 51.5–73.25) were confirmed to have HD CRBSIs based on our study criteria. Eight (44.4%) patients had gram-negative infections, 7 (38.9%) patients gram-positive infections, and 3 (16.7%) patients had polymicrobial infections. We noted that most of the gram-negative bacteria were sensitive to ceftazidime. Unfortunately, cloxacillin resistance was high among gram-positive organisms. Coagulase-negative Staphylococcus and Bacillus sp. were the most common gram-positive organisms and they were sensitive to vancomycin. Conclusion. Our study revealed the increased incidence of gram-negative organism in HD CRBSIs. Antibiogram is an important tool in deciding empirical antibiotics for HD CRBSIs. Tailoring your antibiotics accordingly to the antibiogram can increase the chance of successful treatment and prevent the emergence of bacterial resistance. PMID:24587904

  3. Vaccine protection of leukopenic mice against Staphylococcus aureus bloodstream infection.

    PubMed

    Rauch, Sabine; Gough, Portia; Kim, Hwan Keun; Schneewind, Olaf; Missiakas, Dominique

    2014-11-01

    The risk for Staphylococcus aureus bloodstream infection (BSI) is increased in immunocompromised individuals, including patients with hematologic malignancy and/or chemotherapy. Due to the emergence of antibiotic-resistant strains, designated methicillin-resistant S. aureus (MRSA), staphylococcal BSI in cancer patients is associated with high mortality; however, neither a protective vaccine nor pathogen-specific immunotherapy is currently available. Here, we modeled staphylococcal BSI in leukopenic CD-1 mice that had been treated with cyclophosphamide, a drug for leukemia and lymphoma patients. Cyclophosphamide-treated mice were highly sensitive to S. aureus BSI and developed infectious lesions lacking immune cell infiltrates. Virulence factors of S. aureus that are key for disease establishment in immunocompetent hosts-?-hemolysin (Hla), iron-regulated surface determinants (IsdA and IsdB), coagulase (Coa), and von Willebrand factor binding protein (vWbp)-are dispensable for the pathogenesis of BSI in leukopenic mice. In contrast, sortase A mutants, which cannot assemble surface proteins, display delayed time to death and increased survival in this model. A vaccine with four surface antigens (ClfA, FnBPB, SdrD, and SpAKKAA), which was identified by genetic vaccinology using sortase A mutants, raised antigen-specific immune responses that protected leukopenic mice against staphylococcal BSI. PMID:25183728

  4. A Catheter-related Bloodstream Infection With Mycobacterium frederiksbergense in an Immunocompromised Child.

    PubMed

    Senozan, Erin A; Adams, Daniel J; Giamanco, Nicole M; Warwick, Anne B; Eberly, Matthew D

    2015-04-01

    We report a case of a catheter-related bloodstream infection with Mycobacterium frederiksbergense in an immunocompromised child with acute lymphoblastic leukemia. Nontuberculous mycobacteria have been implicated in central venous catheter infections in immunosuppressed individuals, however, to our knowledge this is the first reported case of invasive infection with this organism. PMID:25259934

  5. In vitro antifungal susceptibility of Malassezia furfur from bloodstream infections.

    PubMed

    Iatta, Roberta; Figueredo, Luciana A; Montagna, Maria Teresa; Otranto, Domenico; Cafarchia, Claudia

    2014-11-01

    Fungaemia caused by Malassezia spp. in hospitalized patients requires prompt and appropriate therapy, but standard methods for the definition of the in vitro antifungal susceptibility have not been established yet. In this study, the in vitro susceptibility of Malassezia furfur from bloodstream infections (BSIs) to amphotericin B (AMB), fluconazole (FLC), itraconazole (ITC), posaconazole (POS) and voriconazole (VRC) was assessed using the broth microdilution (BMD) method of the Clinical and Laboratory Standards Institute (CLSI) with different media such as modified Sabouraud dextrose broth (SDB), RPMI and Christensen's urea broth (CUB). Optimal broth media that allow sufficient growth of M. furfur, and produce reliable and reproducible MICs using the CLSI BMD protocol were assessed. Thirty-six M. furfur isolates collected from BSIs of patients before and during AMB therapy, and receiving FLC prophylaxis, were tested. A good growth of M. furfur was observed in RPMI, CUB and SDB at 32 °C for 48 and 72 h. No statistically significant differences were detected between the MIC values registered after 48 and 72 h incubation. ITC, POS and VRC displayed lower MICs than FLC and AMB. These last two antifungal drugs showed higher and lower MICs, respectively, when the isolates were tested in SDB. SDB is the only medium in which it is possible to detect isolates with high FLC MICs in patients receiving FLC prophylaxis. A large number of isolates showed high AMB MIC values regardless of the media used. In conclusion, SDB might be suitable to determine triazole susceptibility. However, the media, the drug formulation or the breakpoints herein applied might not be useful for assessing the AMB susceptibility of M. furfur from BSIs. PMID:25168965

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

    Microsoft Academic Search

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

    2008-01-01

    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

  7. Monitoring and Reducing Central Line-Associated Bloodstream Infections: A National Survey of State Hospital Associations

    Microsoft Academic Search

    David J. Murphy; Dale M. Needham; Christine Goeschel; Eddy Fan; Sara E. Cosgrove; Peter J. Pronovost

    2010-01-01

    Central line–associated bloodstream infections (CLABSIs) acquired in health care institutions are common and costly. A novel monitoring and prevention program dramatically reduced CLABSIs across one state. The extent to which other states have adopted similar efforts is unknown. State hospital associations were surveyed regarding their efforts to address these infections. All 50 responding associations endorsed the importance of improving patient

  8. Eradicating Central Line–Associated Bloodstream Infections Statewide: The Hawaii Experience

    Microsoft Academic Search

    Della M. Lin; Laura Bauer; John R. Combes; Christine T. George; Christine A. Goeschel; Lisa H. Lubomski; Simon C. Mathews; Melinda D. Sawyer; David A. Thompson; Sam R. Watson; Bradford D. Winters; Jill A. Marsteller; Sean M. Berenholtz; Peter J. Pronovost; Julius Cuong Pham

    2012-01-01

    The authors’ goal was to determine if a national intensive care unit (ICU) collaborative to reduce central line-associated bloodstream infections (CLABSIs) would succeed in Hawaii. The intervention period (July 2009 to December 2010) included a comprehensive unit-based safety program; a multifaceted approach to CLABSI prevention; and monitoring of infections. The primary outcome was CLABSI rate. A total of 20 ICUs,

  9. Advances in prevention and management of central line-associated bloodstream infections in patients with cancer.

    PubMed

    Raad, Issam; Chaftari, Anne-Marie

    2014-11-15

    Central lines, which are essential for treating cancer, are associated with at least 400,000 episodes of bloodstream infection in patients with cancer every year in the United States. Effective novel interventions for preventing and managing these infections include antimicrobial-coated catheters and antimicrobial lock solutions. PMID:25352628

  10. First case report of bloodstream infection by Rhizomucor pusillus in a child with hemophagocytic lymphohistiocytosis

    PubMed Central

    Dien Bard, Jennifer; Mangahis, Aida; Hofstra, Thomas C.; Bender, Jeffrey M.

    2014-01-01

    We describe an unusual presentation of fatal infection due to Rhizomucor pusillus bloodstream infection in a 12-year old pediatric patient recently diagnosed with hemophagocytic lymphohistiocytosis. R. pusillus was isolated from one blood culture drawn on Day 11 of hospitalization. PMID:24967155

  11. Incidence of central line related/associated bloodstream infections in an acute hospital.

    PubMed

    O'Hanlon, M; Dornikova, G; Curran, R; Staunton, M; Woolhead, A; Kennedy, M; Tinsley, A; Shepherd, E; Doherty, T

    2014-09-01

    Bloodstream infection related to a central venous catheter in the intensive care unit is a substantial clinical and economic problem. The aim of the study was to examine the incidence of central line related bloodstream infections and central line associated bloodstream infections in Our Lady of Lourdes Hospital, Drogheda, during a six month period, using an active patient based prospective surveillance method. CLRBSI rate in ICU/HDU was 0.93/1000 central line days. There was no CLABSI identified in the studied time period. However, further interventions are needed, particularly with CVC care bundle. Also, the implementation of 2% chlorhexidin in 70% isopropylalcohol use for skin asepsis, which is recommended by the Irish national guidelines, would be beneficial. PMID:25282973

  12. A rare cause of bacteremia in a pediatric patient with Down syndrome: Sphingomonas paucimobilis.

    PubMed

    Özdemir, Mehmet; Pekcan, Sevgi; Demircili, Mehmet Emin; Ta?bent, Fatma Esenkaya; Feyzio?lu, Bahad?r; Pirinç, ?erife; Baykan, Mahmut

    2011-01-01

    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. PMID:21960744

  13. Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: a case-control study

    PubMed Central

    2014-01-01

    Background Polymicrobial infections in adults and children are associated with increase in mortality, duration of intensive care and healthcare costs. Very few studies have characterized polymicrobial bloodstream infections in the neonatal unit. Considerable variation has been reported in incidence of polymicrobial infections and associated clinical outcomes. We characterized the risk factors and outcomes of polymicrobial bloodstream infections in our neonatal units in a tertiary hospital in North America. Methods In a retrospective case control study design, we identified infants in the neonatal intensive care unit with positive blood cultures at Texas Children’s Hospital, over a 16-year period from January 1, 1997 to December 31, 2012. Clinical data from online databases were available from January 2009 to December 2012. For each polymicrobial bloodstream infection (case), we matched three infants with monomicrobial bloodstream infection (control) by gestational age and birth weight. Results We identified 2007 episodes of bloodstream infections during the 16 year study period and 280 (14%) of these were polymicrobial. Coagulase-negative Staphylococcus, Enterococcus, Klebsiella and Candida were the most common microbial genera isolated from polymicrobial infections. Polymicrobial bloodstream infections were associated with more than 3-fold increase in mortality and an increase in duration of infection. Surgical intervention was a significant risk factor for polymicrobial infection. Conclusion The frequency and increased mortality emphasizes the clinical significance of polymicrobial bloodstream infections in the neonatal intensive care unit. Clinical awareness and focused research on neonatal polymicrobial infections is urgently needed. PMID:25022748

  14. Weather parameters and nosocomial bloodstream infection: a case-referent study

    PubMed Central

    Caldeira, Silvia Maria; da Cunha, Antonio Ribeiro; Akazawa, Renata Tamie; Moreira, Rayana Gonçalves; de Souza, Lenice do Rosário; Fortaleza, Carlos Magno Castelo Branco

    2015-01-01

    OBJECTIVE To evaluate if temperature and humidity influenced the etiology of bloodstream infections in a hospital from 2005 to 2010. METHODS The study had a case-referent design. Individual cases of bloodstream infections caused by specific groups or pathogens were compared with several references. In the first analysis, average temperature and humidity values for the seven days preceding collection of blood cultures were compared with an overall “seven-days moving average” for the study period. The second analysis included only patients with bloodstream infections. Several logistic regression models were used to compare different pathogens and groups with respect to the immediate weather parameters, adjusting for demographics, time, and unit of admission. RESULTS Higher temperatures and humidity were related to the recovery of bacteria as a whole (versus fungi) and of gram-negative bacilli. In the multivariable models, temperature was positively associated with the recovery of gram-negative bacilli (OR = 1.14; 95%CI 1.10;1.19) or Acinetobacter baumannii (OR = 1.26; 95%CI 1.16;1.37), even after adjustment for demographic and admission data. An inverse association was identified for humidity. CONCLUSIONS The study documented the impact of temperature and humidity on the incidence and etiology of bloodstream infections. The results correspond with those from ecological studies, indicating a higher incidence of gram-negative bacilli during warm seasons. These findings should guide policies directed at preventing and controlling healthcare-associated infections.

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

    NASA Astrophysics Data System (ADS)

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

    2010-02-01

    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.

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

    Microsoft Academic Search

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

    2006-01-01

    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

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

    Microsoft Academic Search

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

    2011-01-01

    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

  18. Genome Sequence of a Strain of the Human Pathogenic Bacterium Pseudomonas alcaligenes That Caused Bloodstream Infection.

    PubMed

    Suzuki, Masato; Suzuki, Satowa; Matsui, Mari; Hiraki, Yoichi; Kawano, Fumio; Shibayama, Keigo

    2013-01-01

    Pseudomonas alcaligenes, a Gram-negative aerobic bacterium, is a rare opportunistic human pathogen. Here, we report the whole-genome sequence of P. alcaligenes strain MRY13-0052, which was isolated from a bloodstream infection in a medical institution in Japan and is resistant to antimicrobial agents, including broad-spectrum cephalosporins and monobactams. PMID:24179116

  19. Detection of bloodstream infections and prediction of bronchopulmonary dysplasia in preterm neonates with an electronic nose.

    PubMed

    Rogosch, Tobias; Herrmann, Nina; Maier, Rolf F; Domann, Eugen; Hattesohl, Akira; Koczulla, Andreas Rembert; Zemlin, Michael

    2014-09-01

    We show that smellprints of volatile organic components measured with an electronic nose (Cyranose 320; Smiths Detection Group Ltd, Watford, United Kingdom) differ between tracheal aspirates from preterm neonates with or without laboratory-confirmed bloodstream infections and with or without subsequent development of bronchopulmonary dysplasia. Tracheal aspirate smellprints could be useful noninvasive diagnostic markers for preterm neonates. PMID:24929333

  20. Anti-Infective Locks for Treatment of Central Line-Associated Bloodstream Infection: A Systematic Review and Meta-Analysis

    Microsoft Academic Search

    John C. O’Horo; Germana L. M. Silva; Nasia Safdar

    2011-01-01

    Central line-associated bloodstream infections (CLABSI) are associated with considerable morbidity, mortality and economic costs. In most cases, catheter removal is considered an essential component of managing CLABSI. However, in patients with poor access, catheter salvage may have to be attempted rather than removal and replacement of catheters. Anti-infective lock therapy (ALT) – instilling an antibiotic or antiseptic into the catheter

  1. Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream Infections

    Microsoft Academic Search

    E. Yoko Furuya; Andrew Dick; Eli N. Perencevich; Monika Pogorzelska; Donald Goldmann; Patricia W. Stone; Frank R. Deleo

    2011-01-01

    BackgroundCentral line-associated bloodstream infections (CLABSI) represent a serious patient safety issue. To prevent these infections, bundled interventions are increasingly recommended. We examine the extent of adoption of Central Line (CL) Bundle elements throughout US intensive care units (ICU) and determine their effectiveness in preventing CLABSIs.Methodology\\/Principal FindingsIn this cross-sectional study, National Healthcare Safety Network (NHSN) hospitals provided the following: ICU-specific NHSN-reported

  2. Risk factors for central-line-associated bloodstream infections: a focus on comorbid conditions.

    PubMed

    Pepin, Christopher S; Thom, Kerri A; Sorkin, John D; Leekha, Surbhi; Masnick, Max; Preas, Michael Anne; Pineles, Lisa; Harris, Anthony D

    2015-04-01

    Centers for Disease Control and Prevention (CDC) risk adjustment methods for central-line-associated bloodstream infections (CLABSI) only adjust for type of intensive care unit (ICU). This cohort study explored risk factors for CLABSI using 2 comorbidity classification schemes, the Charlson Comorbidity Index (CCI) and the Chronic Disease Score (CDS). Our study supports the need for additional research into risk factors for CLABSI, including electronically available comorbid conditions. Infect Control Hosp Epidemiol 2014;00(0): 1-3. PMID:25782906

  3. Protein A Suppresses Immune Responses during Staphylococcus aureus Bloodstream Infection in Guinea Pigs

    PubMed Central

    Kim, Hwan Keun; Falugi, Fabiana; Thomer, Lena; Missiakas, Dominique M.

    2015-01-01

    ABSTRACT ? Staphylococcus aureus infection is not associated with the development of protective immunity, and disease relapses occur frequently. We hypothesize that protein A, a factor that binds immunoglobulin Fc? and cross-links VH3 clan B cell receptors (IgM), is the staphylococcal determinant for host immune suppression. To test this, vertebrate IgM was examined for protein A cross-linking. High VH3 binding activity occurred with human and guinea immunoglobulin, whereas mouse and rabbit immunoglobulins displayed little and no binding, respectively. Establishing a guinea pig model of S. aureus bloodstream infection, we show that protein A functions as a virulence determinant and suppresses host B cell responses. Immunization with SpAKKAA, which cannot bind immunoglobulin, elicits neutralizing antibodies that enable guinea pigs to develop protective immunity. Importance? Staphylococcus aureus is the leading cause of soft tissue and bloodstream infections; however, a vaccine with clinical efficacy is not available. Using mice to model staphylococcal infection, earlier work identified protective antigens; however, corresponding human clinical trials did not reach their endpoints. We show that B cell receptor (IgM) cross-linking by protein A is an important immune evasion strategy of S. aureus that can be monitored in a guinea pig model of bloodstream infection. Further, immunization with nontoxigenic protein A enables infected guinea pigs to elicit antibody responses that are protective against S. aureus. Thus, the guinea pig model may support preclinical development of staphylococcal vaccines. PMID:25564466

  4. [Bloodstream infections of the intravascular access devices - case reports and review of the literature].

    PubMed

    Sochor, M; Pelikánová, Z; Sercl, M; Mellanová, V; Lazarov, P P; Fá?ková, D

    2012-01-01

    Long-term access devices (VAD) in oncology patients are the elemental procedure of contemporary treatment. Apart from their indisputable benefit they are linked with an increased risk of infectious complications, ranging between simple colonisation of a device to catheter related bloodstream infections. The decision to salvage or extract the VAD in case of bloodstream infection depends on patient's clinical state, localisation of infection (site of insertion, catheter or pocket), casual agent and complications (e.g. endocarditis, septic embolization, osteomyelitis and so on). Authors present 5 case reports of portacath sepsis in their oncology department in 2011 (i.e. 4.46% of 112 inserted ports). In the second part of the article they review current literature data about prevention and treatment of infectious complications of vascular devices in cancer patients. PMID:23102200

  5. Assessing the Necessity of the Standardized Infection Ratio for Reporting Central Line-Associated Bloodstream Infections

    PubMed Central

    Saman, Daniel M.; Kavanagh, Kevin T.

    2013-01-01

    This brief article presents results that support the contention that risk adjustment via the standardized infection ratio (SIR) for the reporting of central line-associated bloodstream infections (CLABSIs) may be no more predictive than standard rate adjustments utilizing CLABSIs per central line days (i.e., CLABSI rates). Recent data posted on the U.S. Department of Health and Human Services’ Hospital Compare website showed that nearly 70% of 1721 reporting hospitals with at least 1000 central line days had five or fewer infections during 2011. These hospitals had 39.3% of the total central line days and a significantly lower SIR than poorer performing hospitals with six or more CLABSIs (p<0.0001). In addition, 19 hospitals are presented which had central line days between 9000 to over 22,000 that also had zero to three CLABSIs. Some of these hospitals were university referral centers and inner city facilities. There was great variation of CLABSI cases among US hospitals. Evidence is mounting that all hospitals should be able to achieve a near zero incidence of CLABSIs and that these infections may in fact be near ‘never events’, which begs whether risk adjustment with the SIR is needed and whether it adds more information than does rate adjustment using CLABSI rates. PMID:24223966

  6. Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients

    Microsoft Academic Search

    M. Koldehoffa

    2004-01-01

    Taurolidine is an antimicrobial agent that was originally used in the local treatment of peritonitis and was shown to be effective in the prevention of catheter-related bloodstream infections (CR-BSI). In this pilot study, we used taurolidine solution as an intravenous (i.v.) lock into the totally implantable intravascular devices of 11 consecutive oncological patients with catheter-related bloodstream infections not responding to

  7. Persistent bloodstream infection with Kocuria rhizophila related to a damaged central catheter.

    PubMed

    Moissenet, Didier; Becker, Karsten; Mérens, Audrey; Ferroni, Agnès; Dubern, Béatrice; Vu-Thien, Hoang

    2012-04-01

    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. PMID:22259211

  8. Statins are associated with improved outcomes of bloodstream infection in solid-organ transplant recipients

    Microsoft Academic Search

    J. Hsu; D. R. Andes; V. Knasinski; J. Pirsch; N. Safdar

    2009-01-01

    Among recipients of intra-abdominal solid-organ transplants, bloodstream infections (BSIs) are a major cause of mortality.\\u000a We undertook a retrospective cohort study of recipients of kidney, pancreas, and\\/or liver transplants with BSIs at a single\\u000a center over an 11-year period. Multivariate analysis using logistic regression was used to determine independent predictors\\u000a of 15-day mortality and clinical cure, with a focus on

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

    PubMed Central

    Becker, Karsten; Mérens, Audrey; Ferroni, Agnès; Dubern, Béatrice; Vu-Thien, Hoang

    2012-01-01

    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. PMID:22259211

  10. Elimination of central-venous-catheter-related bloodstream infections from the intensive care unit

    Microsoft Academic Search

    Andrew G Longmate; Kirsteen S Ellis; Louise Boyle; Shaun Maher; Chris J S Cairns; Suzanne M Lloyd; Colin Lang

    2011-01-01

    IntroductionCentral-venous-catheter (CVC)-related bloodstream infection (CRBSI) is a complication of intensive care stay which can have important adverse consequences for both patient and institution. There are a number of evidence-based interventions that reduce CRBSI, but it is recognised that consistently applying the best evidence every time is a challenge.MethodsThe authors set out to reduce CRBSI and introduced interventions in our intensive

  11. Independent influence of negative blood cultures and bloodstream infections on in-hospital mortality

    PubMed Central

    2014-01-01

    Background The independent influence of blood culture testing and bloodstream infection (BSI) on hospital mortality is unclear. Methods We included all adults treated in non-psychiatric services at our hospital between 2004 and 2011. We identified all blood cultures and their results to determine the independent association of blood culture testing and BSI on death in hospital using proportional hazards modeling that adjusted for important covariates. Results Of 297 070 hospitalizations, 48 423 had negative blood cultures and 5274 had BSI. 12 529 (4.2%) died in hospital. Compared to those without blood cultures, culture-negative patients and those with BSI were sicker. Culture-negative patients had a significantly increased risk of death in hospital (adjusted hazard ratio [HR] ranging between 3.1 and 4.4 depending on admission urgency, extent of comorbidities, and whether the blood culture was taken in the intensive care unit). Patients with BSI had a significantly increased risk of death (adj-HR ranging between 3.8 and 24.3] that was significantly higher when BSI was: diagnosed within the first hospital day; polymicrobial; in patients who were exposed to immunosuppressants or were neutropenic; or due to Clostridial and Candidal organisms. Death risk in culture negative and bloodstream infection patients decreased significantly with time. Conclusions Risk of death in hospital is independently increased both in patients with negative blood cultures and further in those with bloodstream infection. Death risk associated with bloodstream infections varied by the patient’s immune status and the causative microorganism. PMID:24444097

  12. Improving the Diagnosis of Bloodstream Infections: PCR Coupled with Mass Spectrometry

    PubMed Central

    Jordana-Lluch, Elena; Giménez, Montserrat; Quesada, M. Dolores; Ausina, Vicente; Martró, Elisa

    2014-01-01

    The reference method for the diagnosis of bloodstream infections is blood culture followed by biochemical identification and antibiotic susceptibility testing of the isolated pathogen. This process requires 48 to 72 hours. The rapid administration of the most appropriate antimicrobial treatment is crucial for the survival of septic patients; therefore, a rapid method that enables diagnosis directly from analysis of a blood sample without culture is needed. A recently developed platform that couples broad-range PCR amplification of pathogen DNA with electrospray ionization mass spectrometry (PCR/ESI-MS) has the ability to identify virtually any microorganism from direct clinical specimens. To date, two clinical evaluations of the PCR/ESI-MS technology for the diagnosis of bloodstream infections from whole blood have been published. Here we discuss them and describe recent improvements that result in an enhanced sensitivity. Other commercially available assays for the molecular diagnosis of bloodstream infections from whole blood are also reviewed. The use of highly sensitive molecular diagnostic methods in combination with conventional procedures could substantially improve the management of septic patients. PMID:24818144

  13. The bacterial amyloid curli is associated with urinary source bloodstream infection.

    PubMed

    Hung, Chia; Marschall, Jonas; Burnham, Carey-Ann D; Byun, Albert S; Henderson, Jeffrey P

    2014-01-01

    Urinary tract infections are the most common cause of E. coli bloodstream infections (BSI) but the mechanism of bloodstream invasion is poorly understood. Some clinical isolates have been observed to shield themselves with extracellular amyloid fibers called curli at physiologic temperature. We hypothesize that curli fiber assembly at 37 °C promotes bacteremic progression by urinary E. coli strains. Curli expression by cultured E. coli isolates from bacteriuric patients in the presence and absence of bacteremia were compared using Western blotting following amyloid fiber disruption with hexafluoroisopropanol. At 37 °C, urinary isolates from bacteremic patients were more likely to express curli than those from non-bacteremic patients [16/22 (73%) vs. 7/21 (33%); p = 0.01]. No significant difference in curli expression was observed at 30 °C [86% (19/22) vs. 76% (16/21); p = 0.5]. Isolates were clonally diverse between patients, indicating that this phenotype is distributed across multiple lineages. Most same-patient urine and blood isolates were highly related, consistent with direct invasion of urinary bacteria into the bloodstream. 37 °C curli expression was associated with bacteremic progression of urinary E. coli isolates in this population. These findings suggest new future diagnostic and virulence-targeting therapeutic approaches. PMID:24465838

  14. Current strategies for the prevention and management of central line-associated bloodstream infections

    PubMed Central

    Han, Zhuolin; Liang, Stephen Y; Marschall, Jonas

    2010-01-01

    Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs). While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment. PMID:21694903

  15. Catheter related bloodstream infection following PICC removal in preterm infants

    Microsoft Academic Search

    R W Brooker; W J Keenan

    2007-01-01

    Objective:Describe the incidence of catheter-related blood stream infection (CRBSI), following removal of peripherally inserted central venous catheters (PICC) in preterm infants.Study Design:A retrospective cohort study of infants <29 weeks gestational age with a PICC revealed 101 PICCs placed (2159 PICC days). Patients were hospitalized in a level III Neonatal Intensive Care Unit (NICU) between January 2002 and December 2003. ?2

  16. Procalcitonin Levels in Gram-Positive, Gram-Negative, and Fungal Bloodstream Infections

    PubMed Central

    Ferranti, Marta; Moretti, Amedeo; Al Dhahab, Zainab Salim; Cenci, Elio; Mencacci, Antonella

    2015-01-01

    Procalcitonin (PCT) can discriminate bacterial from viral systemic infections and true bacteremia from contaminated blood cultures. The aim of this study was to evaluate PCT diagnostic accuracy in discriminating Gram-positive, Gram-negative, and fungal bloodstream infections. A total of 1,949 samples from patients with suspected bloodstream infections were included in the study. Median PCT value in Gram-negative (13.8?ng/mL, interquartile range (IQR) 3.4–44.1) bacteremias was significantly higher than in Gram-positive (2.1?ng/mL, IQR 0.6–7.6) or fungal (0.5?ng/mL, IQR 0.4–1) infections (P < 0.0001). Receiver operating characteristic analysis showed an area under the curve (AUC) for PCT of 0.765 (95% CI 0.725–0.805, P < 0.0001) in discriminating Gram-negatives from Gram-positives at the best cut-off value of 10.8?ng/mL and an AUC of 0.944 (95% CI 0.919–0.969, P < 0.0001) in discriminating Gram-negatives from fungi at the best cut-off of 1.6?ng/mL. Additional results showed a significant difference in median PCT values between Enterobacteriaceae and nonfermentative Gram-negative bacteria (17.1?ng/mL, IQR 5.9–48.5 versus 3.5?ng/mL, IQR 0.8–21.5; P < 0.0001). This study suggests that PCT may be of value to distinguish Gram-negative from Gram-positive and fungal bloodstream infections. Nevertheless, its utility to predict different microorganisms needs to be assessed in further studies. PMID:25852221

  17. Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA

    PubMed Central

    Herzer, Kurt R; Niessen, Louis; Constenla, Dagna O; Ward, William J; Pronovost, Peter J

    2014-01-01

    Objective To assess the cost-effectiveness of a multifaceted quality improvement programme focused on reducing central line-associated bloodstream infections in intensive care units. Design Cost-effectiveness analysis using a decision tree model to compare programme to non-programme intensive care units. Setting USA. Population Adult patients in the intensive care unit. Costs Economic costs of the programme and of central line-associated bloodstream infections were estimated from the perspective of the hospital and presented in 2013 US dollars. Main outcome measures Central line-associated bloodstream infections prevented, deaths averted due to central line-associated bloodstream infections prevented, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was performed. Results Compared with current practice, the programme is strongly dominant and reduces bloodstream infections and deaths at no additional cost. The probabilistic sensitivity analysis showed that there was an almost 80% probability that the programme reduces bloodstream infections and the infections’ economic costs to hospitals. The opportunity cost of a bloodstream infection to a hospital was the most important model parameter in these analyses. Conclusions This multifaceted quality improvement programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections. PMID:25256190

  18. Sphingomonas paucimobilis osteomyelitis in an immunocompetent patient. A rare case report and literature review.

    PubMed

    Pascale, Renato; Russo, Enrico; Esposito, Isabella; Leone, Sebastiano; Esposito, Silvano

    2013-10-01

    Sphingomonas paucimobilis occurs widely both in natural and nosocomial environments, including hospital water systems, respiratory therapy equipment, and laboratory instruments. It is an opportunistic pathogen that rarely causes infections in humans. Among S. paucimobilis nosocomial infections, osteomyelitis is particularly rare. Almost all infections occur in patients with comorbidities such as malignancy, immunosuppressant therapy, diabetes mellitus and acquired immunodeficiency syndrome. We present the first case of Sphingomonas paucimobilis osteomyelitis in an immunocompetent patient and include updated literature concerning infections by this microorganism. PMID:24177306

  19. Decreasing central line-associated bloodstream infections in the Non-ICU population.

    PubMed

    Medina, Alma; Serratt, Teresa; Pelter, Michele; Brancamp, Tami

    2014-01-01

    Central line-associated bloodstream infection (CLABSI) rates above the national average precipitated a quality improvement project aimed at reducing this trend. We implemented daily chlorhexidine bathing and used 4 strategies to promote a change in practice and culture in our medical/surgical units. These strategies include the following: (1) staff education, (2) leadership support, (3) resource availability, and (4) increased awareness and accountability. Since implementing these strategies, there has been a significant reduction in CLABSI rates in the medical/surgical units. PMID:24202197

  20. Candida kefyr as a cause of bloodstream infection and adjunctive role of biomarkers in its diagnosis.

    PubMed

    Khan, Z; Ahmad, S; Al-Obaid, K; Joseph, L; Chandy, R

    2015-03-01

    A rare case of bloodstream infection caused by Candida kefyr is described. The diagnosis was established by repeatedly isolating the yeast in blood cultures and by detecting C. kefyr-specific DNA in serum samples. Demonstration of elevated serum levels of ?-D-glucan and Candida mannan also provided additional diagnostic evidence. The identity of the isolates was confirmed by PCR sequencing of the ITS region of rDNA. This is the first report of C. kefyr candidemia from Kuwait and the Middle East. The report highlights emerging clinical significance of rare Candida spp. in etiology of candidemia and reinforces the adjunctive role of biomarkers in diagnosis. PMID:25442911

  1. Preventing central line-associated bloodstream infections: a qualitative study of management practices.

    PubMed

    Scheck McAlearney, Ann; Hefner, Jennifer L; Robbins, Julie; Harrison, Michael I; Garman, Andrew

    2015-05-01

    OBJECTIVE To identify factors that may explain hospital-level differences in outcomes of programs to prevent central line-associated bloodstream infections. DESIGN Extensive qualitative case study comparing higher- and lower-performing hospitals on the basis of reduction in the rate of central line-associated bloodstream infections. In-depth interviews were transcribed verbatim and analyzed to determine whether emergent themes differentiated higher- from lower-performing hospitals. SETTING Eight US hospitals that had participated in the federally funded On the CUSP-Stop BSI initiative. PARTICIPANTS One hundred ninety-four interviewees including administrative leaders, clinical leaders, professional staff, and frontline physicians and nurses. RESULTS A main theme that differentiated higher- from lower-performing hospitals was a distinctive framing of the goal of "getting to zero" infections. Although all sites reported this goal, at the higher-performing sites the goal was explicitly stated, widely embraced, and aggressively pursued; in contrast, at the lower-performing hospitals the goal was more of an aspiration and not embraced as part of the strategy to prevent infections. Five additional management practices were nearly exclusively present in the higher-performing hospitals: (1) top-level commitment, (2) physician-nurse alignment, (3) systematic education, (4) meaningful use of data, and (5) rewards and recognition. We present these strategies for prevention of healthcare-associated infection as a management "bundle" with corresponding suggestions for implementation. CONCLUSIONS Some of the variance associated with CLABSI prevention program outcomes may relate to specific management practices. Adding a management practice bundle may provide critical guidance to physicians, clinical managers, and hospital leaders as they work to prevent healthcare-associated infections. Infect Control Hosp Epidemiol 2015;00(0): 1-7. PMID:25703102

  2. Bloodstream Infections in Community Hospitals in the 21st Century: A Multicenter Cohort Study

    PubMed Central

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

    2014-01-01

    Background While the majority of healthcare in the US is provided in community hospitals, the epidemiology and treatment of bloodstream infections in this setting is unknown. Methods and Findings We undertook this multicenter, retrospective cohort study to 1) describe the epidemiology of bloodstream infections (BSI) in a network of community hospitals and 2) determine risk factors for inappropriate therapy for bloodstream infections in community hospitals. 1,470 patients were identified as having a BSI in 9 community hospitals in the southeastern US from 2003 through 2006. The majority of BSIs were community-onset, healthcare associated (n?=?823, 56%); 432 (29%) patients had community-acquired BSI, and 215 (15%) had hospital-onset, healthcare-associated BSI. BSIs due to multidrug-resistant pathogens occurred in 340 patients (23%). Overall, the three most common pathogens were S. aureus (n?=?428, 28%), E. coli (n?=?359, 24%), coagulase-negative Staphylococci (n?=?148, 10%), though type of infecting organism varied by location of acquisition (e.g., community-acquired). Inappropriate empiric antimicrobial therapy was given to 542 (38%) patients. Proportions of inappropriate therapy varied by hospital (median?=?33%, range 21–71%). Multivariate logistic regression identified the following factors independently associated with failure to receive appropriate empiric antimicrobial therapy: hospital where the patient received care (p<0.001), assistance with ?3 ADLs (p?=?0.005), Charlson score (p?=?0.05), community-onset, healthcare-associated infection (p?=?0.01), and hospital-onset, healthcare-associated infection (p?=?0.02). Important interaction was observed between Charlson score and location of acquisition. Conclusions Our large, multicenter study provides the most complete picture of BSIs in community hospitals in the US to date. The epidemiology of BSIs in community hospitals has changed: community-onset, healthcare-associated BSI is most common, S. aureus is the most common cause, and 1 of 3 patients with a BSI receives inappropriate empiric antimicrobial therapy. Our data suggest that appropriateness of empiric antimicrobial therapy is an important and needed performance metric for physicians and hospital stewardship programs in community hospitals. PMID:24643200

  3. The Outcomes of Using Colistin for Treating Multidrug Resistant Acinetobacter Species Bloodstream Infections

    PubMed Central

    Lim, Seung-Kwan; Lee, Sang-Oh; Choi, Seong-Ho; Choi, Jae-Phil; Kim, Sung-Han; Jeong, Jin-Yong; Choi, Sang-Ho; Woo, Jun Hee

    2011-01-01

    Despite the identification of Acinetobacter baumannii isolates that demonstrate susceptibility to only colistin, this antimicrobial agent was not available in Korea until 2006. The present study examined the outcomes of patients with multidrug resistant (MDR) Acinetobacter species bloodstream infection and who were treated with or without colistin as part of their regimen. The colistin group was given colistin as part of therapy once colistin became available in 2006. The non-colistin group was derived from the patients who were treated with other antimicrobial regimens before 2006. Mortality within 30 days of the onset of bacteremia occurred for 11 of 31 patients in the colistin group and for 15 of 39 patients in the non-colistin group (35.5% vs 38.5%, respectively, P = 0.80). Renal dysfunction developed in 50.0% of the 20 evaluable patients in the colistin group, but in 28.6% of the 35 evaluable patients in the non-colistin group (P = 0.11). On multivariate analysis, only an Acute Physiological and Chronic Health Evaluation II score ? 21 was associated with mortality at 30 days. This result suggests that administering colistin, although it is the sole microbiologically appropriate agent, does not influence the 30 day mortality of patients with a MDR Acinetobacter spp. bloodstream infection. PMID:21394298

  4. 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

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

    2008-01-01

    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,

  5. Reduction of central line-associated bloodstream infections in a pediatric hematology/oncology population.

    PubMed

    Wilson, Matthew Z; Deeter, Deana; Rafferty, Colleen; Comito, Melanie M; Hollenbeak, Christopher S

    2014-01-01

    This study reports the results of an initiative to reduce central line-associated bloodstream infections (CLABSIs) among pediatric hematology/oncology patients, a population at increased risk for CLABSI. The study design was a pre-post comparison of a series of specific interventions over 40 months. Logistic regression was used to determine if the risk of developing CLABSI decreased in the postintervention period, after controlling for covariates. The overall CLABSI rate fell from 9 infections per 1000 line days at the beginning of the study to zero in a cohort of 291 patients encompassing 2107 admissions. Admissions during the intervention period had an 86% reduction in odds of developing a CLABSI, controlling for other factors. At the study team's institution, an initiative that standardized blood culturing techniques, lab draw times, line care techniques, and provided physician and nurse education was able to eliminate CLABSI among pediatric hematology/oncology patients. PMID:24226650

  6. Catheter-related Mycobacterium fortuitum bloodstream infection: rapid identification using MALDI-TOF mass spectrometry.

    PubMed

    Artacho-Reinoso, M J; Olbrich, P; Solano-Paéz, P; Ybot-Gonzalez, P; Lepe, J A; Neth, O; Aznar, J

    2014-04-01

    We present the case of a 6-year-old boy diagnosed with stage III mediastinal Non Hodgkin Lymphoblastic T cell Lymphoma who suffered from catheter-related bloodstream infection (CRBI) due to Mycobacterium fortuitum whilst receiving chemotherapy. Isolation of this rare pathogen was done directly from blood culture and identification was made rapidly within 48?h using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectro-metry as well as specific polymerase chain reaction (PCR)-reverse hybridization method. This allowed prompt directed antibiotic therapy apart from central venous catheter removal and resulted in an excellent clinical response. This case highlights the potential benefit of using MALDI-TOF mass spectrometry, a fast, cost-effective and precise methodology, in the diagnosis and subsequent management of invasive bacterial infection. PMID:24554588

  7. Bloodstream infections in patients with hematological malignancies: which is more fatal – cancer or resistant pathogens?

    PubMed Central

    Gedik, Habip; ?im?ek, Funda; Kantürk, Arzu; Yildirmak, Taner; Arica, Deniz; Aydin, Demet; Demirel, Naciye; Yoku?, Osman

    2014-01-01

    Background The primary objective of this study was to report the incidence of bloodstream infections (BSIs) and clinically or microbiologically proven bacterial or fungal BSIs during neutropenic episodes in patients with hematological malignancies. Methods In this retrospective observational study, all patients in the hematology department older than 14 years who developed febrile neutropenia during chemotherapy for hematological cancers were evaluated. Patients were included if they had experienced at least one neutropenic episode between November 2010 and November 2012 due to chemotherapy in the hematology ward. Results During 282 febrile episodes in 126 patients, 66 (23%) episodes of bacteremia and 24 (8%) episodes of fungemia were recorded in 48 (38%) and 18 (14%) patients, respectively. Gram-negative bacteria caused 74% (n=49) of all bacteremic episodes. Carbapenem-resistant Gram-negative bacteria (n=6) caused 12% and 9% of Gram-negative bacteremia episodes and all bacteremia episodes, respectively. Carbapenem-resistant Gram-negative bacteria included Acinetobacter baumannii (n=4), Pseudomonas aeruginosa (n=1), and Serratia marcescens (n=1). Culture-proven invasive fungal infection occurred in 24 episodes in 18 cases during the study period, with 15 episodes in ten cases occurring in the first study year and nine episodes in eight cases in the second study year. In 13 of 18 cases (72%) with bloodstream yeast infections, previous azole exposure was recorded. Candida parapsilosis, C. glabrata, and C. albicans isolates were resistant to voriconazole and fluconazole. Conclusion BSIs that occur during febrile neutropenic episodes in hematology patients due to Gram-negative bacteria should be treated initially with non-carbapenem-based antipseudomonal therapy taking into consideration antimicrobial stewardship. Non-azole antifungal drugs, including caspofungin and liposomal amphotericin B, should be preferred as empirical antifungal therapy in the events of possible or probable invasive fungal infections with an absence of pulmonary findings due to increase azole resistance. PMID:25258539

  8. Sphingomonas paucimobilis: a persistent Gram-negative nosocomial infectious organism.

    PubMed

    Ryan, M P; Adley, C C

    2010-07-01

    Non-fermenting Gram-negative bacilli create a significant problem in clinical settings, being the most widespread cause of nosocomial infections. They are opportunistic pathogens that take advantage of underlying conditions and diseases. Sphingomonas paucimobilis, a non-fermenting Gram-negative bacillus, is regarded as of minor clinical significance; however, many instances of infections with this organism can be found in the literature. Infections include bacteraemia/septicaemia caused by contaminated solutions, e.g. distilled water, haemodialysis fluid and sterile drug solutions. Cases of pseudobacteraemia have been recorded in association with S. paucimobilis, as have many cases of unusual infections both invasive and severe, e.g. septic arthritis and osteomyelitis. No cases of death have been recorded in the literature related to S. paucimobilis. This review illustrates that S. paucimobilis is a more important pathogen than previously thought. PMID:20434794

  9. [Septic monarthritis caused by Sphingomonas paucimobilis].

    PubMed

    Dischereit, G; Burk, M; Storck-Müller, K; Lange, U

    2013-10-01

    Sphingomonas paucimobilis, formerly known as Pseudomonas paucimobilis, is a rare cause of septic arthritis and is therefore regarded as being of minor clinical interest in rheumatological diagnostics. In this connection the yellow pigmented, aerobic, glucose non-fermenting, Gram negative bacillus is usually associated with immunocompromised patients. A case of septic arthritis in a 70-year-old man with chronic obstructive pulmonary disease (COPD) initially presenting with right knee pain, swelling and redness is reported. After diagnosis of septic gonarthritis due to Sphingomonas paucimobilis, the infection was successfully treated by oral antibiotic therapy with ofloxacine based on the patient's antibiotic susceptibility profile, combined with analgesic and anti-inflammatory local physical therapy several times a day leading to a considerable improvement in the symptoms so that operative interventions could therefore be avoided. PMID:23921948

  10. Taurolidine Lock Is Superior to Heparin Lock in the Prevention of Catheter Related Bloodstream Infections and Occlusions

    PubMed Central

    Olthof, Evelyn D.; Versleijen, Michelle W.; Huisman–de Waal, Getty; Feuth, Ton; Kievit, Wietske; Wanten, Geert J. A.

    2014-01-01

    Background and Aims Patients on home parenteral nutrition (HPN) are at risk for catheter-related complications; mainly infections and occlusions. We have previously shown in HPN patients presenting with catheter sepsis that catheter locking with taurolidine dramatically reduced re-infections when compared with heparin. Our HPN population therefore switched from heparin to taurolidine in 2008. The aim of the present study was to compare long-term effects of this catheter lock strategy on the occurrence of catheter-related bloodstream infections and occlusions in HPN patients. Methods Data of catheter-related complications were retrospectively collected from 212 patients who received HPN between January 2000 and November 2011, comprising 545 and 200 catheters during catheter lock therapy with heparin and taurolidine, respectively. We evaluated catheter-related bloodstream infection and occlusion incidence rates using Poisson-normal regression analysis. Incidence rate ratios were calculated by dividing incidence rates of heparin by those of taurolidine, adjusting for underlying disease, use of anticoagulants or immune suppressives, frequency of HPN/fluid administration, composition of infusion fluids, and duration of HPN/fluid use before catheter creation. Results Bloodstream infection incidence rates were 1.1/year for heparin and 0.2/year for taurolidine locked catheters. Occlusion incidence rates were 0.2/year for heparin and 0.1/year for taurolidine locked catheters. Adjusted incidence ratios of heparin compared to taurolidine were 5.9 (95% confidence interval, 3.9–8.7) for bloodstream infections and 1.9 (95% confidence interval, 1.1–3.1) for occlusions. Conclusions Given that no other procedural changes than the catheter lock strategy were implemented during the observation period, these data strongly suggest that taurolidine decreases catheter-related bloodstream infections and occlusions in HPN patients compared with heparin. PMID:25379781

  11. Bloodstream Infection among Children Presenting to a General Hospital Outpatient Clinic in Urban Nepal

    PubMed Central

    Pradhan, Rahul; Shrestha, Umesh; Gautam, Samir C.; Thorson, Stephen; Shrestha, Kabindra; Yadav, Bharat K.; Kelly, Dominic F.; Adhikari, Neelam; Pollard, Andrew J.; Murdoch, David R.

    2012-01-01

    Background There are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital. Methods We prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter). Blood from all patients was tested by conventional culture and by real-time PCR for Rickettsia typhi. Results Putative etiological agents for fever were identified in 164 (15%) patients. Salmonella enterica serovar Typhi (S. Typhi) was identified in 107 (10%), S. enterica serovar Paratyphi A (S. Paratyphi) in 30 (3%), Streptococcus pneumoniae in 6 (0.6%), S. enterica serovar Typhimurium in 2 (0.2%), Haemophilus influenzae type b in 1 (0.1%), and Escherichia coli in 1 (0.1%) patient. S. Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2%) patients were PCR positive for R. typhi. No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus. Conclusions Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal. PMID:23115652

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

    Microsoft Academic Search

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

    2004-01-01

    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,

  13. Community Acquired Bacteremia by Sphingomonas paucimobilis: Two Rare Case Reports.

    PubMed Central

    Nandy, Shyamasree; Dudeja, Mridu; Das, Ayan Kumar; Tiwari, Rachna

    2013-01-01

    S.paucimobilis has a diverse nutritional substrate spectrum and found in both environmental and hospital settings. Sphingomonas paucimobilis is rarely isolated from clinical specimen. This low virulence organism since has been reported to cause a variety of diseases since 1979. It has been reported to be associated with both community acquired and nosocomial diseases including bacteremia, catheter related sepsis, diarrhoeal diseases, peritonitis, meningitis, cutaneous infections, endopthalmitis, visceral infections , urinary tract infections etc. We report two cases of community acquired primary bacteremia by Sphingomonas paucimobilis. One of the patients was 55-year-old female who had gallbladder carcinoma and the other was a 2-year-old healthy male who had no history of any underlying disease. Both got admission in hospital with complaints of pyrexia. Blood culture yielded S.paucimobilis which was found to be sensitive to quinolones, chloramphenicol, carbapenems, aminoglycosides and beta lactams except penicillin and amoxicillin. PMID:24551684

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

    PubMed Central

    Pereira, Carlos Alberto Pires; Marra, Alexandre R.; Camargo, Luis Fernando Aranha; Pignatari, Antônio Carlos Campos; Sukiennik, Teresa; Behar, Paulo Renato Petersen; Medeiros, Eduardo Alexandrino Servolo; Ribeiro, Julival; Girão, 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

    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. PMID:23861860

  15. The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis

    PubMed Central

    2011-01-01

    Introduction Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. We investigated the correlation of mortality in NF with bloodstream infection and with the presence of co-morbidities. Methods In this retrospective study, we analyzed 323 patients who presented with necrotizing fasciitis at two different institutions. Bloodstream infection (BSI) was defined as a positive blood culture result. The patients were categorized as survivors and non-survivors. Eleven clinically important variables which were statistically significant by univariate analysis were selected for multivariate regression analysis and a stepwise logistic regression model was developed to determine the association between BSI and mortality. Results Univariate logistic regression analysis showed that patients with hypotension, heart disease, liver disease, presence of Vibrio spp. in wound cultures, presence of fungus in wound cultures, and presence of Streptococcus group A, Aeromonas spp. or Vibrio spp. in blood cultures, had a significantly higher risk of in-hospital mortality. Our multivariate logistic regression analysis showed a higher risk of mortality in patients with pre-existing conditions like hypotension, heart disease, and liver disease. Multivariate logistic regression analysis also showed that presence of Vibrio spp in wound cultures, and presence of Streptococcus Group A in blood cultures were associated with a high risk of mortality while debridement > = 3 was associated with improved survival. Conclusions Mortality in patients with necrotizing fasciitis was significantly associated with the presence of Vibrio in wound cultures and Streptococcus group A in blood cultures. PMID:21693053

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

    PubMed Central

    2010-01-01

    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 entry. Closed infusion containers were designed to overcome this flaw. However, open infusion containers are still widely used throughout the world. The objective of the study was to determine the effect of switching from open (glass, burettes, and semi-rigid) infusion containers to closed, fully collapsible, plastic infusion containers (Viaflex®) on the rate and time to onset of central line-associated bloodstream infections CLABs. Methods An open label, prospective cohort, active healthcare-associated infection surveillance, sequential study was conducted in four ICUs in Mexico. Centers for Disease Control National Nosocomial Infections Surveillance Systems definitions were used to define device-associated infections. Results A total of 1,096 adult patients who had a central line in place for >24 hours were enrolled. The CLAB rate was significantly higher during the open versus the closed container period (16.1 versus 3.2 CLAB/1000 central line days; RR = 0.20, 95% CI = 0.11-0.36, P < 0.0001). The probability of developing CLAB remained relatively constant in the closed container period (1.4% Days 2-4 to 0.5% Days 8-10), but increased in the open container period (4.9% Days 2-4 to 5.4% Days 8-10). The chance of acquiring a CLAB was significantly decreased (81%) in the closed container period (Cox proportional hazard ratio 0.19, P < 0.0001). Mortality was statistically significantly lower during the closed versus the open container period (23.4% versus 16.1%; RR = 0.69, 95% CI = 0.54-0.88, P < 0.01). Conclusions Closed infusion containers significantly reduced CLAB rate, the probability of acquiring CLAB, and mortality. PMID:20122280

  17. Short-Dwell Ethanol Lock Therapy in Children Is Associated With Increased Clearance of Central Line–Associated Bloodstream Infections

    Microsoft Academic Search

    Eric J. McGrath; Ralph Salloum; Xinguang Chen; Yifan Jiang; Kathrina Boldt-MacDonald; Cristie Becker; Roland Chu; Jocelyn Y. Ang

    2011-01-01

    Background. Central line–associated bloodstream infection (CLABSI) is a known complication of central line use. Salvage of infected central lines with ethanol lock therapy (ELT) with systemic antimicrobials may be an alternative treatment option in children. Methods. Retrospective review was performed in children with CLASBI who underwent short-dwell ELT (70% ethanol, 4- to 25-hour dwell times ?3 days) with systemic antimicrobials

  18. Bacterial Bloodstream Infection in Neutropenic Adult Patients after Myeloablative Cord Blood Transplantation: Experience of a Single Institution in Japan

    Microsoft Academic Search

    Akira Tomonari; Satoshi Takahashi; Jun Ooi; Nobuhiro Tsukada; Takaaki Konuma; Takeshi Kobayashi; Aki Sato; Kashiya Takasugi; Tohru Iseki; Arinobu Tojo; Shigetaka Asano

    2007-01-01

    Bacterial infection is one of the most important causes of morbidity and mortality after unrelated cord blood transplantation\\u000a (CBT). In the present study, we studied 101 adult patients with respect to the incidence, outcome, and risk factors for bacterial\\u000a bloodstream infection (BSI) within 30 days after CBT using a myeloablative conditioning regimen. Bacterial BSI occurred in\\u000a 12 patients within 30

  19. Seasonal trend and clinical presentation of Bacillus cereus bloodstream infection: association with summer and indwelling catheter.

    PubMed

    Kato, K; Matsumura, Y; Yamamoto, M; Nagao, M; Ito, Y; Takakura, S; Ichiyama, S

    2014-08-01

    Bacillus cereus, an opportunistic pathogen, can cause fatal infection. However, B. cereus bloodstream infections (BSIs) have not been well characterised. From 2008 to 2013, B. cereus isolates from all of the specimens and patients with B. cereus BSIs were identified. Environmental samples were collected to detect B. cereus contamination. We also characterised the clinical presentation of B. cereus BSI through analyses of risk factors for BSI and mortality. A total of 217 clinical B. cereus isolates was detected. Fifty-one patients with nosocomial infections were diagnosed as B. cereus BSI, and 37 had contaminated blood cultures. The number of B. cereus isolates and BSI patients was significantly greater from June to September than from January to April (4.9 vs. 1.5 per month and 1.2 vs. 0.2, respectively). All BSIs were nosocomial and related to central or peripheral vascular catheter. Urinary catheter [odds ratio (OR) 6.93, 95% confidence interval (CI) 2.40-20.0] was the independent risk factor associated with BSI patients when compared to patients regarded as contaminated. In-hospital mortality among BSI patients was 20% and was associated with urinary catheter (OR 34.7, 95 % CI 1.89-63.6) and higher Charlson index (OR 1.99, 95 % CI 1.26-3.12). The number of B. cereus isolates and BSI increased during summer. Inpatients with indwelling vascular or urinary catheters should be carefully monitored for potential B. cereus BSIs. PMID:24584718

  20. Ribose 5-Phosphate Isomerase B Knockdown Compromises Trypanosoma brucei Bloodstream Form Infectivity

    PubMed Central

    Loureiro, Inês; Faria, Joana; Clayton, Christine; Macedo-Ribeiro, Sandra; Santarém, Nuno; Roy, Nilanjan; Cordeiro-da-Siva, Anabela; Tavares, Joana

    2015-01-01

    Ribose 5-phosphate isomerase is an enzyme involved in the non-oxidative branch of the pentose phosphate pathway, and catalyzes the inter-conversion of D-ribose 5-phosphate and D-ribulose 5-phosphate. Trypanosomatids, including the agent of African sleeping sickness namely Trypanosoma brucei, have a type B ribose-5-phosphate isomerase. This enzyme is absent from humans, which have a structurally unrelated ribose 5-phosphate isomerase type A, and therefore has been proposed as an attractive drug target waiting further characterization. In this study, Trypanosoma brucei ribose 5-phosphate isomerase B showed in vitro isomerase activity. RNAi against this enzyme reduced parasites' in vitro growth, and more importantly, bloodstream forms infectivity. Mice infected with induced RNAi clones exhibited lower parasitaemia and a prolonged survival compared to control mice. Phenotypic reversion was achieved by complementing induced RNAi clones with an ectopic copy of Trypanosoma cruzi gene. Our results present the first functional characterization of Trypanosoma brucei ribose 5-phosphate isomerase B, and show the relevance of an enzyme belonging to the non-oxidative branch of the pentose phosphate pathway in the context of Trypanosoma brucei infection. PMID:25568941

  1. Reducing bloodstream infections in an outpatient hemodialysis center--New Jersey, 2008-2011.

    PubMed

    2012-03-16

    Patients undergoing hemodialysis are at risk for bloodstream infections (BSIs), and preventing these infections in this high-risk population is a national priority. During 2008, an estimated 37,000 BSIs related to central lines occurred among hemodialysis patients in the United States. This is almost as many as the estimated 41,000 central line-associated BSIs that occurred during 2009 among patients in critical-care units and wards of acute-care hospitals. In 2009, to decrease BSI incidence in a New Jersey outpatient hemodialysis center, a package of interventions was instituted, beginning with participation in a national collaborative BSI prevention program and augmented by a social and behavioral change process to enlist staff members in infection prevention. Rates of BSIs related to the patient's vascular access (i.e., access-related BSIs [ARBs]) were evaluated in the preintervention and postintervention periods. The incidence of all ARBs decreased from 2.04 per 100 patient-months preintervention to 0.75 (p=0.03) after initiating program interventions and to 0.24 (p<0.01) after adding a behavioral change intervention. Only one ARB occurred during the last 12 postintervention months. At this hemodialysis facility, participating in a collaborative prevention program along with implementation of a behavioral change strategy was associated with a large decrease in ARBs. Other outpatient hemodialysis facilities also might reduce ARBs by adopting similar approaches to prevention. PMID:22419049

  2. Bloodstream infections in very low birth weight infants with intestinal failure

    PubMed Central

    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

    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. PMID:21840538

  3. Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis.

    PubMed

    Rhee, Yoona; Heung, Michael; Chen, Benrong; Chenoweth, Carol E

    2015-04-01

    OBJECTIVE Little is known about patient-specific factors contributing to central line-associated bloodstream infection (CLABSI) outside of the intensive care unit (ICU). We sought to describe these factors and hypothesized that dialysis patients would comprise a significant proportion of this cohort. DESIGN Retrospective observational study from January 2010 to December 2011 SETTING An 880-bed tertiary teaching hospital PATIENTS Patients with CLABSI in non-ICU wards METHODS CLABSI patients were identified from existing infection-control databases and primary chart review was conducted. National Health and Safety Network (NHSN) definitions were utilized for CLABSI and pathogen classification. CLABSI rates were calculated per patient day. Total mortality rates were inclusive of hospice patients. RESULTS Over a 2-year period, 104 patients incurred 113 CLABSIs for an infection rate of 0.35 per 1,000 patient days. The mean length of hospital stay prior to CLABSI was 16±13.3 days, which was nearly 3 times that of hospital-wide non-ICU length of stay. Only 11 patients (10.6%) received dialysis within 48 hours of CLABSI. However, 67% of patients had a hematologic malignancy, and 91.8% of those admitted with a malignant hematologic diagnosis were neutropenic at the time of CLABSI. Enterococcus spp. was the most common organism recovered, and half of all central venous catheters (CVCs) present were peripherally inserted central catheters (PICC lines). Mortality rates were 18.3% overall and 27.3% among dialysis patients. CONCLUSIONS In patients with CLABSIs outside of the ICU, only 10.6% received dialysis prior to infection. However, underlying hematologic malignancy, neutropenia, and PICC lines were highly prevalent in this population. Infect Control Hosp Epidemiol 2015;00(0):1-7. PMID:25782897

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

    PubMed Central

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

    2013-01-01

    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. PMID:24151435

  5. Use of a policy-driven education program to reduce central line-associated bloodstream infection rates.

    PubMed

    Williams, Dustin W

    2015-01-01

    Central line-associated bloodstream infections (CLABSIs) account for a significant portion of hospital-acquired infections. Current research supports the use of chlorhexidine for site cleansing and staff education programs on infection-control practices to reduce CLABSI rates. This project evaluates the efficacy of implementing site cleaning policies and protocols and formal staff education in reducing CLABSI rates in a critical access hospital. Efficacy was measured by infection rates per 1000 catheter days through a retrospective chart review before and after implementation of a policy and protocol bundle and staff education. PMID:25545975

  6. Survey of Physicians’ Perspectives and Knowledge about Diagnostic Tests for Bloodstream Infections

    PubMed Central

    She, Rosemary C.; Alrabaa, Sally; Lee, Seung Heon; Norvell, Meghan; Wilson, Andrew; Petti, Cathy A.

    2015-01-01

    Background Physicians rely on blood culture to diagnose bloodstream infections (BSI) despite its limitations. As new technologies emerge for rapid BSI diagnosis, optimization of their application to patient care requires an understanding of clinicians’ perspectives on BSI diagnosis and how a rapid test would influence medical decisions. Methods We administered a 26-question survey to practitioners in infectious diseases/microbiology, critical care, internal medicine, and hematology/oncology services in USA and Germany about current standards in diagnosing and treating BSI and a hypothetical rapid BSI test. Results Responses from 242 providers had roughly equal representation across specialties. For suspected BSI patients, 78% of practitioners would administer empiric broad spectrum antibiotics although they estimated, on average, that 31% of patients received incorrect antibiotics while awaiting blood culture results. The ability of blood culture to rule in or rule out infection was very/extremely acceptable in 67% and 36%, respectively. Given rapid test results, 60–87% of practitioners would narrow the spectrum of antimicrobial therapy depending on the microorganism detected, with significantly higher percentages when resistance determinants were also tested. Over half of respondents felt a rapid test would be very/extremely influential on clinical practice. Conclusions Limitations of blood culture were perceived as a barrier to patient care. A rapid test to diagnose BSI would impact clinical practice, but the extent of impact may be limited by prevailing attitudes and practices. Opportunities exist for interventions to influence practitioners’ behaviors in BSI management particularly with emergence of newer diagnostic tests. PMID:25811910

  7. Utilizing a line maintenance team to reduce central-line-associated bloodstream infections in a neonatal intensive care unit

    Microsoft Academic Search

    G Holzmann-Pazgal; A Kubanda; K Davis; A M Khan; K Brumley; S E Denson

    2012-01-01

    Objective:To determine the association of a central-line maintenance team on the incidence of central-line-associated bloodstream infections (CLABSIs) in the neonatal intensive care unit (NICU).Study Design:Central line maintenance in the NICU was limited to a line team starting in March 2008. CLABSI rates were determined before (December 2006 to February 2008) and after implementation of the line team ( March 2008

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

    Microsoft Academic Search

    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

    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%

  9. Bloodstream infections and inpatient length of stay among pediatric cancer patients with febrile neutropenia in Mexico City.

    PubMed

    Avilés-Robles, Martha; Ojha, Rohit P; González, Miriam; Ojeda-Diezbarroso, Karla; Dorantes-Acosta, Elisa; Jackson, Bradford E; Johnson, Kyle M; Caniza, Miguela A

    2014-11-01

    We assessed the association between bloodstream infections (BSIs) and inpatient length of stay among pediatric cancer patients with febrile neutropenia in Mexico City. The estimated length of stay for BSIs was 19 days, which corresponded with a 100% (95% confidence limits, 60%-160%) relative increase in the length of stay compared with patients for whom no pathogen was identified. Feasible options for reducing the length of stay should be considered to alleviate patient and resource burden. PMID:25234044

  10. The impact of central line insertion bundle on central line-associated bloodstream infection

    PubMed Central

    2014-01-01

    Background Knowledge about the impact of each central line insertion bundle on central line-associated bloodstream infection (CLABSI) is limited. Methods A quality-improvement intervention, including education, central venous catheter (CVC) insertion bundle, process and outcome surveillance, have been introduced since March 2013. Outcome surveillances, including CLABSI per 1,000 catheter-days, CLABSI per 1,000 inpatient-days, and catheter utilization rates (days of catheter use divided by total inpatient-days), were measured. As a baseline measurement for a comparison, we retrospectively collected data from March 1, 2012 to December 31, 2012. Results During this 10-month period, there were a total of 687 CVC insertions, and 627 (91.2%) insertions were performed by intensivists. The rate of CLABSI significantly declined from 1.65 per 1000 catheter-day during the pre-intervention period to 0.65 per 1000 catheter-day post-intervention period (P?=?0.039). CLABSI more likely developed in subjects in which a maximal sterile barrier was not used compared with subjects in which it was used (P?=?0.03). Moreover, CVC inserted by non-intensivists were more likely to become infected than CVC inserted by intensivists (P?=?0.010). Conclusions This multidisciplinary infection control intervention, including a central line insertion care bundle, can effectively reduce the rate of CLABSI. The impact of different care bundle varies, and a maximal sterile barrier precaution during catheter insertion is an essential component of the care line insertion bundle. PMID:24985729

  11. The role of Staphylococcus aureus carriage in the pathogenesis of bloodstream infection

    PubMed Central

    2014-01-01

    Background Staphylococcus aureus (SA) colonisation is associated with development of bloodstream infection (BSI), with the majority of colonising and infecting strains identical by pulsed-field gel electrophoresis (PFGE). We examined SA colonisation in patients with SABSI to delineate better the relationship between the two. Methods Patients with SABSI were swabbed in the nose, throat, groin, axilla and rectum. Isolates were typed using PFGE. Logistic regression was performed to determine factors associated with positive swabs. Results 79 patients with SABSI had swabs taken. 46 (58%) had ??1 screening swab positive for S. aureus; of these 37 (80%) were in the nose, 11 (24%) in the throat, 12 (26%) in the groin, 11 (24%) in the axilla and 8 (17%) in the rectum. On multivariate analysis, days from blood culture to screening swabs (OR 0.5, 95% CI 0.32-0.78, P?=?0.003) and methicillin resistance (OR 9.5, 95% CI 1.07-84.73, P?=?0.04) were associated with having positive swabs. Of 46 participants who had a blood sample and 1 other sample subtyped, 33 (72%, 95% CI 57-84%) had all identical subtypes, 1 (2%) had subtypes varying by 1–3 bands and 12 (26%) had subtypes ??3 bands different. 30/36 (83%) blood-nose pairs were identical. Conclusion Overall, 58% of patients with SABSI had positive screening swabs. Of these, only 80% had a positive nose swab ie less than half (37/79, 47%) of all SABSI patients were nasally colonised. This may explain why nasal mupirocin alone has not been effective in preventing SA infection. Measures to eradicate non-nasal carriage should also be included. PMID:24996783

  12. Incidence, Clinical Characteristics and Attributable Mortality of Persistent Bloodstream Infection in the Neonatal Intensive Care Unit

    PubMed Central

    Hsu, Jen-Fu; Chu, Shih-Ming; Lee, Chiang-Wen; Yang, Pong-Hong; Lien, Reyin; Chiang, Ming-Chou; Fu, Ren-Huei; Huang, Hsuan-Rong; Tsai, Ming-Horng

    2015-01-01

    Background An atypical pattern of neonatal sepsis, characterized by persistent positive blood culture despite effective antimicrobial therapy, has been correlated with adverse outcomes. However, previous studies focused only on coagulate-negative staphylococcus infection. Methods All episodes of persistent bloodstream infection (BSI), defined as 3 or more consecutive positive blood cultures with the same bacterial species, at least two of them 48 hours apart, during a single sepsis episode, were enrolled over an 8-year period in a tertiary level neonatal intensive care unit. These cases were compared with all non-persistent BSI during the same period. Results We identified 81 episodes of persistent BSI (8.5% of all neonatal late-onset sepsis) in 74 infants, caused by gram-positive pathogens (n=38, 46.9%), gram-negative pathogens (n=21, 25.9%), fungus (n=20, 24.7%) and polymicrobial bacteremia (n=2, 2.5%). Persistent BSI does not differ from non-persistent BSI in most clinical characteristics and patient demographics, but tends to have a prolonged septic course, longer duration of feeding intolerance and more frequent requirement of blood transfusions. No difference was observed for death attributable to infection (9.8% vs. 6.5%), but neonates with persistent BSI had significantly higher rates of infectious complications (29.6% vs. 9.2%, P < 0.001), death from all causes (21.6% vs. 11.7%, P = 0.025), and duration of hospitalization among survivors [median (interquartile range): 80.0 (52.5-117.5) vs. 64.0 (40.0-96.0) days, P = 0.005] than those without persistent BSI. Conclusions Although persistent BSI does not contribute directly to increased mortality, the associated morbidities, infectious complications and prolonged septic courses highlight the importance of aggressive treatment to optimize outcomes. PMID:25875677

  13. Hospital-Wide Multidisciplinary, Multimodal Intervention Programme to Reduce Central Venous Catheter-Associated Bloodstream Infection

    PubMed Central

    Zingg, Walter; Cartier, Vanessa; Inan, Cigdem; Touveneau, Sylvie; Theriault, Michel; Gayet-Ageron, Angèle; Clergue, François; Pittet, Didier; Walder, Bernhard

    2014-01-01

    Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88–0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI. PMID:24714418

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

    PubMed Central

    2013-01-01

    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. PMID:23551847

  15. Factors predicting the cause and prognosis of central line-associated bloodstream infections.

    PubMed

    Nemoto, Takaaki; Kunishima, Hiroyuki; Shimizu, Gohji; Hirose, Masanori; Yamasaki, Yukitaka; Nishisako, Hisashi; Takagi, Taeko; Matsuda, Takahide

    2015-02-01

    The increased use of indwelling catheters has led to an increased number of deaths due to central line-associated bloodstream infection (CLABSI). Improving CLABSI outcomes requires the identification of clinical characteristics affecting drug selection and factors associated with poor prognosis. The medical records of inpatients admitted to St. Marianna University School of Medicine between April 1, 2010 and March 31, 2013 were evaluated for the results of catheter tip cultures. The clinical characteristics of these cases and the characteristics of the pathogens involved were investigated to identify prognostic factors. Of the 1629 catheter cultures investigated, 183 were CLABSIs. Among them, 105 were caused by gram-positive bacteria, 43 by gram-negative bacteria, and 35 by fungi. Gram-negative CLABSIs were more common in cases with prior colonization by gram-negative bacteria and post-surgical cases. Fungal CLASBIs were more common in the cases with prior colonization by fungi, high-calorie infusion enforcement, broad-spectrum antibiotic treatment, and post-surgical cases. Death was significantly more likely in cases with findings of inflammation at the catheter insertion site and in those with abnormal body temperature, tachycardia, or abnormal white blood cell count. Thus, when treating CLABSI in post-surgical cases and in cases with prior colonization by gram-negative bacteria, therapy should include anti-pseudomonal agents. Considering the factors predicting poor prognostic identified in this study, clinicians must check the vital signs and catheter insertion site in patients with indwelling catheters. PMID:25483264

  16. Bloodstream infection as a predictor for mortality in severe burn patients: an 11-year study.

    PubMed

    Egozi, D; Hussein, K; Filson, S; Mashiach, T; Ullmann, Y; Raz-Pasteur, A

    2014-10-01

    In this study we collected and analysed data of the severe burn patients at our institution over an 11-year period in order to shed light on the controversial role of bloodstream infection (BSI) as a predictive factor for mortality in this burn population. The factors examined were age, total body surface area, smoke inhalation, presence of BSI, and BSI with resistant bacteria. In total 1081 burn patients were hospitalized from 2001 to 2011, of whom 4% died. We focused here on 158 severe burn patients, 74 of whom developed BSI, and 35 who died. Using univariate analysis, it appeared that the BSI group had a threefold greater chance of mortality compared to the non-BSI group. Patients with a Ryan score 3 had a 100% chance of mortality and those with a score 0 had 0%. Thus, focusing only on Ryan score 1 and score 2 patients, BSI did not contribute to mortality, nor was it shown to contribute to mortality in a multivariate analysis in which the score and BSI were included together. When BSI did occur, it predicted longer hospitalization periods. We conclude that BSI predicts longer length of hospitalization stay but does not contribute to the prediction of mortality beyond that offered by the Ryan score in a severe burn population. PMID:24093600

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

    PubMed Central

    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

    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. PMID:24098449

  18. Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study.

    PubMed

    Wu, Jian-nong; Gan, Tie-er; Zhu, Yue-xian; Cao, Jun-min; Ji, Cong-hua; Wu, Yi-hua; Lv, Bin

    2015-01-01

    In many traditional Chinese medicine (TCM) hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. A retrospective surveillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions. Escherichia coli (25.5%) was the most common Gram-negative and coagulase-negative staphylococcus (CoNS) (14.1%) was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsiella pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glycopeptide were the most frequently used for nBSI therapy. Only about one-third of patients (157/482) received appropriate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score >4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs. PMID:25559958

  19. Clinical outcomes in patients with heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) bloodstream infection.

    PubMed

    Casapao, Anthony M; Leonard, Steven N; Davis, Susan L; Lodise, Thomas P; Patel, Nimish; Goff, Debra A; Laplante, Kerry L; Potoski, Brian A; Rybak, Michael J

    2013-06-24

    The prevalence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) infections varies in the literature, complicated by the lack of routine screening procedures; however, limited data suggest hVISA has been associated with persistent bloodstream infections (BSI) and vancomycin failure yet these studies have been confounded by design. We conducted this study to characterize patients with BSI caused by hVISA compared to vancomycin-susceptible Staphylococcus aureus (VSSA) treated with vancomycin. This retrospective, multi-center matched (1:1) cohort study compared the clinical characteristics and outcomes of hVISA and VSSA. Patients with hVISA methicillin-resistant Staphylococcus aureus (MRSA) BSI from 2004-2012 were matched to VSSA-MRSA BSI. The primary outcome was vancomycin failure, defined as a composite of: persistent bacteremia (? 7 days), persistent signs and symptoms, change of MRSA antibiotic, recurrent BSI, or MRSA-related mortality. We identified 122 matched cases. Overall vancomycin failure was 57%; 82% hVISA vs. 33% VSSA, (p < 0.001). Individual components of failure in hVISA vs. VSSA: persistent bacteremia: 59% vs. 21%, (p < 0.001); MRSA therapy changed: 54% vs. 25%, (p = 0.001); MRSA-related mortality: 21% vs. 10%, (p = 0.081), recurrence of BSI: 26% vs. 2%, (p < 0.001). Using logistic regression analysis and adjusting for covariates, hVISA (aOR, 11.1; 95% CI 4.3-28.7) and ICU admission (aOR, 4.5; 95% CI 1.8-11.6) were still independently associated with vancomycin failure. Relative to VSSA BSI, patients with hVISA were more likely to experience failure to vancomycin, including persistent bacteremia and recurrence. Our results indicate that hVISA was responsible for considerable morbidity. PMID:23796929

  20. Clinical Outcomes in Patients with Heterogeneous Vancomycin-Intermediate Staphylococcus aureus Bloodstream Infection

    PubMed Central

    Casapao, Anthony M.; Leonard, Steven N.; Davis, Susan L.; Lodise, Thomas P.; Patel, Nimish; Goff, Debra A.; LaPlante, Kerry L.; Potoski, Brian A.

    2013-01-01

    The prevalence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) infections varies in the literature, a problem complicated by the lack of routine screening procedures; however, limited data suggest that hVISA has been associated with persistent bloodstream infections (BSI) and vancomycin failure, yet these studies have been confounded by design issues. We conducted this study to compare the characteristics of patients with BSI caused by hVISA with those with vancomycin-susceptible Staphylococcus aureus (VSSA) treated with vancomycin. This retrospective, multicenter matched (1:1) cohort study compared the clinical characteristics and outcomes of hVISA and VSSA. Patients with hVISA methicillin-resistant Staphylococcus aureus (MRSA) BSI from 2004 to 2012 were matched to VSSA-MRSA BSI patients. The primary outcome was failure of vancomycin treatment, defined as a composite of persistent bacteremia (?7 days), persistent signs and symptoms, change of MRSA antibiotic, recurrent BSI, or MRSA-related mortality. We identified 122 matched cases. The overall vancomycin failure rate was 57% (82% hVISA versus 33% VSSA; P < 0.001). The individual components of failure in hVISA versus VSSA were persistent bacteremia, 59% versus 21% (P < 0.001); change in MRSA therapy, 54% versus 25% (P = 0.001); MRSA-related mortality, 21% versus 10% (P = 0.081); and recurrence of BSI, 26% versus 2% (P < 0.001). Using logistic regression analysis and adjusting for covariates, hVISA (adjusted odds ratio [aOR], 11.1; 95% confidence interval [CI], 4.3 to 28.7) and intensive care unit (ICU) admission (aOR, 4.5; 95% CI, 1.8 to 11.6) were still independently associated with vancomycin failure. Relative to VSSA BSI, patients with hVISA were more likely to experience failure of vancomycin treatment, including persistent bacteremia and recurrence. Our results indicate that hVISA was responsible for considerable morbidity. PMID:23796929

  1. Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study*

    PubMed Central

    Wu, Jian-nong; Gan, Tie-er; Zhu, Yue-xian; Cao, Jun-min; Ji, Cong-hua; Wu, Yi-hua; Lv, Bin

    2015-01-01

    In many traditional Chinese medicine (TCM) hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. A retrospective surveillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions. Escherichia coli (25.5%) was the most common Gram-negative and coagulase-negative staphylococcus (CoNS) (14.1%) was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsiella pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glycopeptide were the most frequently used for nBSI therapy. Only about one-third of patients (157/482) received appropriate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score >4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs. PMID:25559958

  2. Routine surveillance for bloodstream infections in a pediatric hematopoietic stem cell transplant cohort: Do patients benefit?

    PubMed Central

    Rigby, Heather; Fernandez, Conrad V; Langley, Joanne; Mailman, Tim; Crooks, Bruce; Higgins, Ann

    2007-01-01

    BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients are at a high risk for late bloodstream infection (BSI). Controversy exists regarding the benefit of surveillance blood cultures in this immunosuppressed population. Despite the common use of this practice, the practical value is not well established in non-neutropenic children following HSCT. METHODS: At the IWK Health Centre (Halifax, Nova Scotia), weekly surveillance blood cultures from central lines are drawn from children following HSCT until the line is removed. A retrospective chart review was performed to determine the utility and cost of this practice. Eligible participants were non-neutropenic HSCT recipients with central venous access lines. The cost of laboratory investigations, nursing time, hospital stay and interventions for positive surveillance cultures was calculated. RESULTS: Forty-three HSCTs were performed in 41 children. Donors were allogenic in 33 cases (77%) and autologous in 10 cases (23%). There were 316 patient contacts for surveillance cultures (mean seven per patient) and 577 central line lumens sampled. Three of 43 patients (7%) had clinically significant positive surveillance blood cultures. Bacteria isolated were Klebsiella pneumoniae (n=2) and Corynebacterium jeikeium (n=1). All follow-up cultures before initiation of antimicrobial therapy were sterile. All three patients were admitted for antimicrobial therapy if they were not already hospitalized and/or had an uncomplicated course. The estimated total cost of BSI surveillance and management of asymptomatic infection over six years was $27,989. CONCLUSION: The present study suggests that BSI surveillance in children following HSCT engraftment has a very low yield and significant cost. It is unclear whether it contributes to improved patient outcomes. PMID:18923737

  3. Klebsiella pneumoniae bloodstream infection: epidemiology and impact of inappropriate empirical therapy.

    PubMed

    Girometti, Nicolò; Lewis, Russell E; Giannella, Maddalena; Ambretti, Simone; Bartoletti, Michele; Tedeschi, Sara; Tumietto, Fabio; Cristini, Francesco; Trapani, Filippo; Gaibani, Paolo; Viale, Pierluigi

    2014-10-01

    Multidrug resistance associated with extended-spectrum beta-lactamase (ESBL) and Klebsiella pneumoniae carbapenemase (KPC) among K. pneumoniae is endemic in southern Europe. We retrospectively analyzed the impact of resistance on the appropriateness of empirical therapy and treatment outcomes of K. pneumoniae bloodstream infections (BSIs) during a 2-year period at a 1420-bed tertiary-care teaching hospital in northern Italy. We identified 217 unique patient BSIs, including 92 (42%) KPC-positive, 49 (23%) ESBL-positive, and 1 (0.5%) metallo-beta-lactamase-positive isolates. Adequate empirical therapy was administered in 74% of infections caused by non-ESBL non-KPC strains, versus 33% of ESBL and 23% of KPC cases (p < 0.0001). To clarify the impact of resistance on BSI treatment outcomes, we compared several different models comprised of non-antibiotic treatment-related factors predictive of patients' 30-day survival status. Acute Physiology and Chronic Health Evaluation (APACHE) II score determined at the time of positive blood culture was superior to other investigated models, correctly predicting survival status in 83% of the study cohort. In multivariate analysis accounting for APACHE II, receipt of inadequate empirical therapy was associated with nearly a twofold higher rate of death (adjusted hazard ratio 1.9, 95% confidence interval 1.1-3.4; p = 0.02). Multidrug-resistant K. pneumoniae accounted for two-thirds of all K. pneumoniae BSIs, high rates of inappropriate empirical therapy, and twofold higher rates of patient death irrespective of underlying illness. PMID:25398065

  4. Bloodstream infections in adult patients undergoing cord blood transplantation from unrelated donors after myeloablative conditioning regimen.

    PubMed

    Sanz, Jaime; Cano, Isabel; González-Barberá, Eva M; Arango, Marcos; Reyes, Jheremy; Montesinos, Pau; Lorenzo, Ignacio; Jarque, Isidro; Martínez, Jesús; López, Francisca; Arilla, María J; Lancharro, Aima; Moscardó, Federico; López-Hontangas, José L; Salavert, Miguel; Sanz, Miguel A; Sanz, Guillermo F

    2015-04-01

    The incidence, epidemiology, and risk factors of bloodstream infection (BSI) and their impact on transplant outcomes after umbilical cord blood transplantation (UCBT) are not well defined. Between May 1997 and December 2012, 202 isolates in 189 episodes of BSI were registered in 134 of 241 patients who underwent single-unit myeloablative UCBT. Cumulative incidence (CI) of developing at least 1 episode of BSI was 21%, 29%, 34%, 42%, and 52% at days +7, +14, +30, +100, and +365, respectively. The median time of onset for the first BSI episode was day +10 (range, day -7 to +1217). Early BSI before day 7 was associated with increased nonrelapse mortality (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; P = .04), whereas BSI before day 14 was an independent adverse risk factor for neutrophil recovery (RR, .6; 95% CI, .5 to .9; P = .002). A higher CD8(+) cell dose of the graft was the only variable independently associated with reduced risk of BSI (RR, .1; 95% CI, .02 to .7; P = .02). The gram-negative rod (GNR) to gram-positive bacteria ratio was .9 before day +30 and 1.6 thereafter (P = .03). Escherichia coli (31%) and Pseudomonas sp. (28%) were the most frequently isolated among GNR. The overall crude mortality rate was 12% at day 7 and was higher for GNR (18%) compared with gram-positive bacteria (7%) (P = .03). These findings emphasize the importance of preventing bacterial infections during conditioning and the very early post-UCBT period. PMID:25585274

  5. Neonatal intensive care unit collaboration to decrease hospital-acquired bloodstream infections: from comparative performance reports to improvement networks.

    PubMed

    Schulman, Joseph; Wirtschafter, David D; Kurtin, Paul

    2009-08-01

    This two-part article provides a general guide to thinking about data-driven clinical performance evaluation and describes two statewide improvement networks anchored in such comparisons. Part 1 examines key ideas for making fair comparisons among providers. Part 2 describes the development of a data-driven collaborative that aims to reduce central line associated bloodstream infections in neonatal ICUs across New York State, and a more mature collaborative in California that has already succeeded in reducing these infections; it provides sufficient detail and tools to be of practical help to others seeking to create such networks. The content illustrates concepts with broad applicability for pediatric quality improvement. PMID:19660632

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

    PubMed

    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

    2013-03-01

    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

  7. Polymicrobial Bloodstream Infection in Neonates: Microbiology, Clinical Characteristics, and Risk Factors

    PubMed Central

    Tsai, Ming-Horng; Chu, Shih-Ming; Hsu, Jen-Fu; Lien, Reyin; Huang, Hsuan-Rong; Chiang, Ming-Chou; Fu, Ren-Huei; Lee, Chiang-Wen; Huang, Yhu-Chering

    2014-01-01

    Background Polymicrobial bloodstream infections (PBSIs) have been associated with complex underlying medical conditions and a high incidence of specific microorganisms in several settings, but the relevant data are scarce in neonates. Methods Positive blood cultures from January 2004 to December 2011 in the neonatal intensive care unit (NICU) of Chang Gung Memorial Hospital (CGMH) were reviewed. Each neonate with PBSI (case episode) was matched to two episodes of monomicrobial BSI (control episode) by birth weight, gestational age and gender. Records were reviewed to compare their underlying medical conditions, organisms isolated, adequacy of therapy, clinical characteristics and outcomes. Results Forty-five episodes of PBSI (4.4% of all neonatal BSIs) were identified in 43 neonates. Gram-negative organisms constituted 59.8% of all PBSI pathogens, and 33 (73.3%) of PBSIs were caused by at least one Gram-negative organism. PBSIs were significantly more likely to be the recurrent episode and have endotracheal tube in place. No significant difference was found between PBSIs and controls in terms of demographics and most chronic conditions. PBSIs were significantly associated with a higher severity of illness, a longer duration of septic symptoms, and a higher rate of modification of antimicrobial regimens than monomicrobial BSIs. However, the sepsis-attributable mortality rates were comparable between these two groups. Conclusions In the NICU, PBSIs were more often caused by Gram-negative bacilli, and often occurred in neonates without any chronic conditions. The clinical significance of PBSIs included a more severe illness, longer duration of septic symptoms and a higher rate of modification of antimicrobial regimens. PMID:24454692

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

    PubMed Central

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

    2013-01-01

    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. PMID:23577195

  9. Bloodstream infections among carriers of carbapenem-resistant Klebsiella pneumoniae: etiology, incidence and predictors.

    PubMed

    Amit, S; Mishali, H; Kotlovsky, T; Schwaber, M J; Carmeli, Y

    2015-01-01

    Carriers of carbapenem-resistant Klebsiella pneumoniae (CRKP) are increasingly recognised through active surveillance in much of the world. We studied incidence, aetiology and predictors of bloodstream infections (BSI) among such carriers. Via a retrospective cohort study conducted in a tertiary care teaching hospital, we examined occurrence of BSI within 45 days of CRKP carrier detection. Three nested case-control studies were conducted to analyse parameters associated with all-cause (ALL), Gram-negative rod (GNR) and CRKP BSI. Cases and controls were compared with respect to demographics, clinical parameters and recent receipt of antibiotics. A total of 431 patients were identified as CRKP carriers (28% by clinical culture, 72% by rectal surveillance), mean age was 75.2 years. Twenty percent of the patients (n = 85) developed BSI, of them 80% (n = 68) with GNR. Of 83 GNR isolates, 58 (70%) were Enterobacteriaceae, of which 19 were CRKP and 20 were extended-spectrum ?-lactamase (ESBL) producers (23% and 24% of total GNR, respectively); 29% of the GNR isolates were nonfermenters (14.5% Pseudomonas aeruginosa, 14.5% Acinetobacter baumannii). Mechanical ventilation predicted ALL BSI (p = 0.04), whereas Clostridium difficile-associated diarrhoea predicted GNR BSI (p = 0.04). Receipt of broad-spectrum antibiotics (piperacillin-tazobactam, amikacin, imipenem) was significantly associated with ALL BSI or GNR BSI. No exposure independently predicted CRKP BSI. We conclude that patients detected as CRKP carriers are at high risk for BSI within 45 days of detection, primarily with multidrug-resistant GNR. Lack of predictive factors differentiating between pathogens and associated high mortality raises once more the dilemma regarding the appropriate empiric therapy for CRKP carriers who develop severe sepsis. PMID:25636924

  10. CHLORHEXIDINE-IMPREGNATED DRESSING FOR PREVENTION OF CATHETER-RELATED BLOODSTREAM INFECTION: A META-ANALYSIS

    PubMed Central

    Safdar, Nasia; O’Horo, John C.; Ghufran, Aiman; Bearden, Allison; Didier, Maria Eugenia; Chateau, Dan; Maki, Dennis G.

    2014-01-01

    Background Catheter related bloodstream infections (CRBSI) are associated with significant morbidity and mortality and effective methods for their prevention are needed. Objective To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and CRBSI using meta-analysis. Data Sources Multiple computerized database searches supplemented by manual searches including relevant conference proceedings. Study Selection Randomized controlled trials (RCT) evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and CRBSI. Data Extraction Data were extracted on patient and catheter characteristics and outcomes. Data Synthesis Pooled estimates of the relative risk (RR) and 95% confidence intervals (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenszel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I2. Subgroup analyses were used to explore heterogeneity. Results Nine RCTs met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced incidence of CRBSI (random effects RR 0.57, 95% CI 0.42–0.79, P=0.002). The incidence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects RR 0.51, 95% CI 0.39–0.67, P< 0.001). There was significant benefit for prevention of catheter colonization and CRBSI, including arterial catheters used for hemodynamic monitoring. Other than in low birth weight infants, adverse effects were rare and minor. Conclusions Our analysis shows that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, CRBSI and warrants routine use in patients at high risk of CRBSI and CVC or arterial catheter colonization in ICUs. PMID:24674924

  11. The changing epidemiology of Staphylococcus aureus bloodstream infection: a multinational population-based surveillance study.

    PubMed

    Laupland, K B; Lyytikäinen, O; Søgaard, M; Kennedy, K J; Knudsen, J D; Ostergaard, C; Galbraith, J C; Valiquette, L; Jacobsson, G; Collignon, P; Schønheyder, H C

    2013-05-01

    Although the epidemiology of Staphylococcus aureus bloodstream infection (BSI) has been changing, international comparisons are lacking. We sought to determine the incidence of S. aureus BSI and assess trends over time and by region. Population-based surveillance was conducted nationally in Finland and regionally in Canberra, Australia, western Sweden, and three areas in each of Canada and Denmark during 2000-2008. Incidence rates were age-standardized and gender-standardized to the EU 27-country 2007 population. During 83 million person-years of surveillance, 18,430 episodes of S. aureus BSI were identified. The overall annual incidence rate for S. aureus BSI was 26.1 per 100,000 population, and those for methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) were 24.2 and 1.9 per 100,000, respectively. Although the overall incidence of community-onset MSSA BSI (15.0 per 100,000) was relatively similar across regions, the incidence rates of hospital-onset MSSA (9.2 per 100,000), community-onset MRSA (1.0 per 100,000) and hospital-onset MRSA (0.8 per 100,000) BSI varied substantially. Whereas the overall incidence of S. aureus BSI did not increase over the study period, there was an increase in the incidence of MRSA BSI. Major changes in the occurrence of community-onset and hospital-onset MSSA and MRSA BSI occurred, but these varied significantly among regions, even within the same country. Although major changes in the epidemiology of community-onset and hospital-onset MSSA and MRSA BSIs are occurring, this multinational population-based study did not find that the overall incidence of S. aureus BSI is increasing. PMID:22616816

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

    PubMed Central

    Bouza, Emilio; Sousa, Dolores; Rodríguez-Créixems, Marta; Lechuz, Juan García; Muñoz, Patricia

    2007-01-01

    “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. PMID:17567782

  13. Predictors of agr Dysfunction in Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates among Patients with MRSA Bloodstream Infections ?

    PubMed Central

    Butterfield, Jill M.; Tsuji, Brian T.; Brown, Jack; Ashley, Elizabeth Dodds; Hardy, Dwight; Brown, Kristen; Forrest, Alan; Lodise, Thomas P.

    2011-01-01

    Despite emerging evidence that dysfunction in the accessory gene regulator (agr) locus is associated with deleterious outcomes among patients treated with vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) infections, factors predictive of agr dysfunction have not been evaluated. This study describes the epidemiology of agr dysfunction, identifies predictors of agr dysfunction in MRSA isolates among those with MRSA bloodstream infections, and describes the relationship between agr dysfunction and other microbiologic phenotypes. A cross-sectional study of patients with MRSA bloodstream infections at two institutions in upstate New York was performed. Clinical data on demographics, comorbidities, disease severity, hospitalization history, and antibiotic history were collected. Microbiologic phenotypes, including agr dysfunction, MIC values by broth microdilution (BMD) and Etest, and vancomycin heteroresistance (hVISA) were tested. Multivariable analyses were performed to identify factors predictive of agr dysfunction. Among 200 patients with an MRSA bloodstream infection, the proportion of strains with agr dysfunction was 31.5%. The distribution of MICs determined by both BMD and Etest were equivalent across agr groups, and there was no association between agr dysfunction and the presence of hVISA. Severity of illness, comorbidities, and hospitalization history were comparable between agr groups. In the multivariate analysis, prior antibiotic exposure was the only factor of variables studied found to be predictive of agr dysfunction. This relationship was predominantly driven by prior beta-lactam and fluoroquinolone administration in the bivariate analysis. Identifying these institution-specific risk factors can be used to develop a process to assess the risk of agr dysfunction and guide empirical antibiotic therapy decisions. PMID:21930887

  14. Predictors of agr dysfunction in methicillin-resistant Staphylococcus aureus (MRSA) isolates among patients with MRSA bloodstream infections.

    PubMed

    Butterfield, Jill M; Tsuji, Brian T; Brown, Jack; Ashley, Elizabeth Dodds; Hardy, Dwight; Brown, Kristen; Forrest, Alan; Lodise, Thomas P

    2011-12-01

    Despite emerging evidence that dysfunction in the accessory gene regulator (agr) locus is associated with deleterious outcomes among patients treated with vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) infections, factors predictive of agr dysfunction have not been evaluated. This study describes the epidemiology of agr dysfunction, identifies predictors of agr dysfunction in MRSA isolates among those with MRSA bloodstream infections, and describes the relationship between agr dysfunction and other microbiologic phenotypes. A cross-sectional study of patients with MRSA bloodstream infections at two institutions in upstate New York was performed. Clinical data on demographics, comorbidities, disease severity, hospitalization history, and antibiotic history were collected. Microbiologic phenotypes, including agr dysfunction, MIC values by broth microdilution (BMD) and Etest, and vancomycin heteroresistance (hVISA) were tested. Multivariable analyses were performed to identify factors predictive of agr dysfunction. Among 200 patients with an MRSA bloodstream infection, the proportion of strains with agr dysfunction was 31.5%. The distribution of MICs determined by both BMD and Etest were equivalent across agr groups, and there was no association between agr dysfunction and the presence of hVISA. Severity of illness, comorbidities, and hospitalization history were comparable between agr groups. In the multivariate analysis, prior antibiotic exposure was the only factor of variables studied found to be predictive of agr dysfunction. This relationship was predominantly driven by prior beta-lactam and fluoroquinolone administration in the bivariate analysis. Identifying these institution-specific risk factors can be used to develop a process to assess the risk of agr dysfunction and guide empirical antibiotic therapy decisions. PMID:21930887

  15. Sphingomonas paucimobilis bacteraemia and septic arthritis in a diabetic patient presenting with septic pulmonary emboli.

    PubMed

    Kuo, I-Ching; Lu, Po-Liang; Lin, Wei-Ru; Lin, Chun-Yu; Chang, Yu-Wei; Chen, Tun-Chieh; Chen, Yen-Hsu

    2009-09-01

    Sphingomonas paucimobilis, a yellow-pigmented, aerobic, glucose non-fermenting, Gram-negative bacillus, is a rare cause of human infection normally associated with immunocompromised hosts. We report a case of bacteraemia and septic arthritis in a 47-year-old diabetic man who presented with septic pulmonary emboli due to S. paucimobilis. The patient had an initial presentation of fever, right knee pain, coughing, dyspnoea and chest pain. The infection was treated successfully by surgical debridement combined with meropenem plus ciprofloxacin, based on the patient's antibiotic susceptibility profile. To our knowledge, this is the first case report for septic pulmonary emboli having arisen from an S. paucimobilis infection. PMID:19528166

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

    PubMed Central

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

    2012-01-01

    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 PMID:22883740

  17. Lodderomyces elongisporus masquerading as Candida parapsilosis as a cause of bloodstream infections.

    PubMed

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

    2008-01-01

    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. PMID:17959765

  18. Bench-to-bedside review: Challenges of diagnosis, care and prevention of central catheter-related bloodstream infections in children

    PubMed Central

    2013-01-01

    Central venous catheters (CVCs) are indispensable in modern pediatric medicine. CVCs provide secure vascular access, but are associated with a risk of severe complications, in particular bloodstream infection. We provide a review of the recent literature about the diagnostic and therapeutic challenges of catheter-related bloodstream infection (CRBSI) in children and its prevention. Variations in blood sampling and limitations in blood culturing interfere with accurate and timely diagnosis of CRBSI. Although novel molecular testing methods appear promising in overcoming some of the present diagnostic limitations of conventional blood sampling in children, they still need to solidly prove their accuracy and reliability in clinical practice. Standardized practices of catheter insertion and care remain the cornerstone of CRBSI prevention although their implementation in daily practice may be difficult. Technology such as CVC impregnation or catheter locking with antimicrobial substances has been shown less effective than anticipated. Despite encouraging results in CRBSI prevention among adults, the goal of zero infection in children is still not in range. More high-quality research is needed in the field of prevention, accurate and reliable diagnostic measures and effective treatment of CRBSI in children. PMID:24041298

  19. Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: A heparin-controlled prospective trial

    Microsoft Academic Search

    Tanya M. Bisseling; Martine C. Willems; Michelle W. Versleijen; Jan C. Hendriks; Renate K. Vissers; Geert J. Wanten

    2010-01-01

    BACKGROUND & AIMS: Catheter-related bloodstream infections remain the major threat for Home Parenteral Nutrition programs. Taurolidine, a potent antimicrobial agent, holds promise as an effective catheter lock to prevent such infections. Aim of the present study was to compare taurolidine with heparin, the most frequently used lock, in this respect in these high-risk patients. METHODS: Thirty patients from one referral

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

    Microsoft Academic Search

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

    2009-01-01

    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-

  1. Predominance of Gram-negative bacilli and increasing antimicrobial resistance in nosocomial bloodstream infections at a university hospital in southern Taiwan, 1996-2003

    Microsoft Academic Search

    Chi-Jung Wu; Hsin-Chun Lee; Nan-Yao Lee; Hsin-I Shih; Nai-Ying Ko; Li-Rong Wang; Wen-Chien Ko

    Background and Purpose: While nosocomial infections cause substantial morbidity and mortality, the availability of timely and accurate epidemiological information on nosocomial pathogens is essential to the appropriate selection of empirical therapy. This study analyzed nosocomial bloodstream infections (NBSIs) surveillance data to determine trends in the distribution of pathogens and antimicrobial susceptibilities of these pathogens. Methods: During the period from 1996

  2. Healthcare-associated bloodstream infections in critically ill patients: descriptive cross-sectional database study evaluating concordance with clinical site isolates

    PubMed Central

    2014-01-01

    Background Healthcare-associated bloodstream infections are related to both increased antibiotic use and risk of adverse outcomes. An in-depth understanding of their epidemiology is essential to reduce occurrence and to improve outcomes by targeted prevention strategies. The objectives of the study were to determine the epidemiology, source and concordance of healthcare-associated bloodstream infections with clinical site isolates. Methods We conducted a descriptive cross-sectional study in critically ill adults admitted to a tertiary semi-closed intensive care unit in England to determine the epidemiology, source and concordance of healthcare-associated bloodstream infections with clinical site isolates. All nosocomial positive blood cultures over a 4-year study period were identified. Pathogens detected and concordances with clinical site are reported as proportions. Results Contaminant pathogens accounted for half of the isolates. The most common non-contaminant pathogens cultured were Pseudomonas spp. (8.0%), Enterococcus spp. (7.3%) and Escherichia coli (5.6%). Central venous catheter-linked bloodstream infections represent only 6.0% of the positive blood cultures. Excluding contaminants and central venous line infections, in only 39.5% of the bloodstream infections could a concordant clinical site source be identified, the respiratory and urinary tracts being the most common. Conclusions Clinical practice should focus on a) improving blood culture techniques to reduce detection of contaminant pathogens and b) ensuring paired clinical site cultures are performed alongside all blood cultures to better understand the epidemiology and potential implications of primary and secondary discordant health-care associated bloodstream infections. PMID:25593750

  3. High Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawi

    PubMed Central

    Bedell, Richard A.; Anderson, Suzanne T. B.; van Lettow, Monique; Åkesson, Ann; Corbett, Elizabeth L.; Kumwenda, Moses; Chan, Adrienne K.; Heyderman, Robert S.; Zachariah, Rony; Harries, Anthony D.; Ramsay, Andrew R.

    2012-01-01

    Background Tuberculosis (TB) and serious bloodstream infections (BSI) may contribute to the high early mortality observed among patients qualifying for antiretroviral therapy (ART) with unexplained weight loss, chronic fever or chronic diarrhea. Methods and Findings A prospective cohort study determined the prevalence of undiagnosed TB or BSI among ambulatory HIV-infected adults with unexplained weight loss and/or chronic fever, or diarrhea in two routine program settings in Malawi. Subjects with positive expectorated sputum smears for AFB were excluded. Investigations Bacterial and mycobacterial blood cultures, cryptococcal antigen test (CrAg), induced sputum (IS) for TB microscopy and solid culture, full blood count and CD4 lymphocyte count. Among 469 subjects, 52 (11%) had microbiological evidence of TB; 50 (11%) had a positive (non-TB) blood culture and/or positive CrAg. Sixty-five additional TB cases were diagnosed on clinical and radiological grounds. Nontyphoidal Salmonellae (NTS) were the most common blood culture pathogens (29 cases; 6% of participants and 52% of bloodstream isolates). Multivariate analysis of baseline clinical and hematological characteristics found significant independent associations between oral candidiasis or lymphadenopathy and TB, marked CD4 lymphopenia and NTS infection, and severe anemia and either infection, but low positive likelihood ratios (<2 for all combinations). Conclusions We observed a high prevalence of TB and serious BSI, particularly NTS, in a program cohort of chronically ill HIV-infected outpatients. Baseline clinical and hematological characteristics were inadequate predictors of infection. HIV clinics need better rapid screening tools for TB and BSI. Clinical trials to evaluate empiric TB or NTS treatment are required in similar populations. PMID:22761767

  4. [Endogenous postpartum panophthalmitis induced by sphingomonas paucimobili].

    PubMed

    Kriet, M M; Bouya, Y; Louaya, S

    2011-01-01

    Endogenous panophthalmitis is a rare eye disease with purulent necrosis of all the ocular structures. It is a rare but serious condition that occurs when bacteria cross the blood-ocular barrier and multiply within the eye. Although rare, endogenous panophthamitis is a potentially devastating intraocular infection resulting in a poor visual and anatomic prognosis. We present a 39-year-old woman, without any previous history, who developed a endogenous panophthalmitis in the left eye secondary to a puerperal endomyometritis secondary to infection with Sphingomonas paucimobilis. Despite systemic antibiotic therapy and intraocular injections, there was an evolution to purulent corneal melting. PMID:22003763

  5. Clonal distribution of bone sialoprotein-binding protein gene among Staphylococcus aureus isolates associated with bloodstream infections.

    PubMed

    Wi?niewska, Katarzyna; Piórkowska, Anna; Kasprzyk, Joanna; Bronk, Marek; ?wie?, Krystyna

    2014-11-01

    Staphylococcus aureus is a leading cause of bloodstream infections (BSI) and diseases that may be caused by hematogenous spread. The staphylococcal adhesin, for which the association with the infections emerging as a complication of septicemia has been well documented, is a bone sialoprotein-binding protein (Bbp). The aim of the study was to assess the prevalence of a bbp gene in S. aureus bloodstream isolates associated with BSI and to investigate to what degree the distribution of this gene is linked to the clonality of the population. Spa typing, used in order to explore the genetic population structure of the isolates, yielded 29 types. Six spa clusters and seven singletons were identified. The most frequent was spa clonal complex CC021 associated with MLST CC30 (38%). The bbp gene was found in 47% of isolates. Almost all isolates (95%) clustered in spa clonal complex CC021 were positive for this gene. All isolates carrying the bbp gene were sensitive to methicillin, and if clustered in the spa CC021, belonged to agr group III. Our study shows that Bbp is not strictly associated with BSI. However, one may conclude that for clonally related S. aureus strains most commonly causing BSI, the risk of Bbp-mediated complications of septicemia is expected to be higher than for other strains. PMID:24827510

  6. Evaluation of real-time PCR and pyrosequencing for screening incubating blood culture bottles from adults with suspected bloodstream infection.

    PubMed

    McCann, Chase D; Moore, Miranda S; May, Larissa S; McCarroll, Matthew G; Jordan, Jeanne A

    2015-03-01

    Several molecular platforms can identify bacteria associated with bloodstream infections but require positive culture bottles as starting material. Here, we describe results of screening 1140 blood cultures at 8h postinoculation, from 918 eligible adults being evaluated for bloodstream infection. DNA was extracted and analyzed by 16S and/or 23S rRNA real-time PCR/pyrosequencing. Compared to culture, PCR/pyrosequencing displayed 90.9% sensitivity, 99.6% specificity, 95.7% positive predictive value, and 99.1% negative predictive value. Overall concordance rate was 98.9% (1127/1140). In 4 cases with molecular-positive/culture-negative results, medical chart reviews provided evidence of identical bacteria from subsequent blood or concomitant urine/sputum cultures. Nine culture-positive/molecular-negative cases were associated with either polymicrobial growth, grew only in the anaerobic bottle of the clinical pair, and/or were detected by PCR/pyrosequencing after 8h. In summary, this approach accurately detected and identified bacteria in ~91% of culture-confirmed cases significantly sooner than the phenotypic identification was available, having the potential to improve antibiotic stewardship. PMID:25534615

  7. [Assessment of diagnostic methods for the catheter-related bloodstream infections in intensive care units].

    PubMed

    Ataman Hatipo?lu, Ci?dem; Ipekkan, Korhan; Oral, Behiç; Onde, Ufuk; Bulut, Cemal; Demiröz, Ali Pekcan

    2011-01-01

    The majority of catheter-related bloodstream infections (CR-BSI) are associated with central venous catheters (CVCs) and most of them develop in patients staying at intensive care units (ICUs). The aim of this study was to assess the performance of different methods for the diagnosis of CR-BSI in neurology and neurosurgery ICUs of our hospital. This prospective study was carried out between January 2007 and January 2008 and all of the patients were followed daily for CR-BSI after the insertion of CVCs. Blood cultures were taken simultaneously from the catheter lumen and from at least one peripheral vein when there was a suspicion of CR-BSI. Additionally, from patients whose CVCs were removed, catheter tip cultures were taken and from patients with exit site infection, cultures of the skin surrounding the catheter entrance were taken. Catheter tip cultures were done by using quantitative and semiquantitative culture methods. Blood cultures taken from the catheter lumen and peripheral vein were incubated in the BACTEC 9050 (Becton Dickinson, USA) automated blood culture system. Gram and acridine orange (AO) staining were used for the smears prepared from the catheter tips and blood cultures. To evaluate the value of culture and staining methods in the diagnosis of CR-BSI; sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of each method were determined. A total of 148 patients (66 male, 82 female; age range: 1-94 years, mean age: 58.7 ± 21.8 years) were included in the study, of whom 67 (45.3%) were from neurology and 81 (54.7%) were from neurosurgery ICUs. One hundred ninety-nine CVC application performed in 148 patients were evaluated. Mean duration of catheterization was 8.5 ± 5.2 days. Thirty-two episodes of CR-BSI among 199 catheterizations (16%) in 29 patients among a total of 148 patients (19.6%) were determined. The most frequently isolated microorganisms were methicillin-resistant coagulase-negative staphylococci (8/32; 25%), penicillin-resistant Enterococcus spp. (8/32; 25%) and Candida albicans (4/32; 12.5%). Sensitivity, specificity, PPV and NPVs of the quantitative and semiquantitative culture methods of the catheter tip and the differential time to positivity (positive result obtained at least two hours earlier in blood cultures drawn through the catheter than the peripheral blood cultures which were taken simultaneously) between blood cultures drawn through the catheter and those drawn from the peripheral vein were 100% for the diagnosis of CR-BSI. Sensitivity and NPV of the isolation method of the same microorganism from blood culture drawn through the catheter and drawn from the peripheral vein were 100%, specificity was 85% and PPV was 88% for the diagnosis of CR-BSI. Sensitivity, specificity, PPV and NPVs of Gram and drawn simultaneously from the peripheral vein and quantitative and semiquantitative cultures of the catheter tip in patients with removed catheter, were important factors in terms of diagnosis of CR-BSI. It was also concluded that AO staining could provide additional benefit in the diagnosis of CR-BSI since it has higher sensitivity, specificity, PPV and NPVs for peripheral blood cultures and catheter tip cultures compared to Gram staining. PMID:21341162

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

    PubMed Central

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

    2011-01-01

    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. PMID:21825294

  9. Prediction of failure in vancomycin-treated methicillin-resistant Staphylococcus aureus bloodstream infection: a clinically useful risk stratification tool.

    PubMed

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

    2011-10-01

    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. PMID:21825294

  10. Osteomyelitis and Secondary Septic Arthritis Caused by Sphingomonas paucimobilis

    Microsoft Academic Search

    R. M. Charity; A. F. Foukas

    2005-01-01

    We describe a case of osteomyelitis and secondary septic arthritis caused by Sphingomonas paucimobilis in an immunosupressed adolescent which did not present typically, leading to a delay in diagnosis. This case highlights the need to thoroughly investigate musculoskeletal pain in the immunocompromised patient in order to exclude an infection as a cause.

  11. The Impact of Nosocomial Bloodstream Infections on Mortality, Length of Stay and Hospital Costs in Older Adults

    PubMed Central

    Kaye, Keith S.; Marchaim, Dror; Chen, Ting-Yi; Baures, Timothy; Anderson, Deverick J.; Choi, Yong; Sloane, Richard; Schmader, Kenneth E.

    2014-01-01

    Background Nosocomial bloodstream infections (BSI) are hazardous and costly events. This study was undertaken to quantify the impact of nosocomial BSI on older patients, including mortality, length of stay (LOS), and costs attributed to BSI. Methods A multi-state, multi-center, matched, retrospective cohort study was conducted from January 1994 through June 2002 in eight hospitals from the Southern-Central United States. Patients aged > 65 years with nosocomial BSI were enrolled. Controls without bloodstream infection were matched to cases. Outcomes during the 90-day period following hospital discharge were evaluated to determine the association between BSI and mortality, hospital costs, and LOS. Results Eight-hundred thirty cases and 830 matched controls were identified, all with a mean age of 74.4 years. Among cases, 81% of BSIs were central line-associated and Staphylococcus aureus was the most common pathogen accounting for 34.6% of infections (2/3 were methicillin resistant). The mortality rate of cases was 49.4%, compared to 33.2% for controls (OR 2.1, p<0.001), LOS was 29.2 days for cases and 20.2 days for controls (p<0.001), and hospital charges were $102,276 for cases compared to $69,690 for controls (p<0.001). The mean LOS and mean costs attributable to BSI were 10 days and $43,208, respectively. Conclusion Nosocomial BSI in older adults was significantly associated with increases in 90-day mortality, increased LOS, and increased costs of care. Preventive interventions to eliminate nosocomial BSIs in older adults would likely be cost effective. PMID:24438554

  12. The cost effective management of Central Line-Associated Bloodstream Infections (CLABSIs) comparing the central line bundle to antimicrobialcoated central venous catheters: A systematic review

    Microsoft Academic Search

    Nayla C Raad

    2012-01-01

    Central Line-Associated Bloodstream Infections (CLABSIs) are one of the most costly and preventable cases of morbidity and mortality among intensive care units (ICUs) in health care today. In 2008, the Centers for Medicare and Medicaid Services Medicare Program, under the Deficit Reduction Act, announced it will no longer reimburse hospitals for such adverse events among those related to CLABSIs. This

  13. Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals

    PubMed Central

    Corzo-Leon, Dora E.; Alvarado-Matute, Tito; Colombo, Arnaldo L.; Cornejo-Juarez, Patricia; Cortes, Jorge; Echevarria, Juan I.; Guzman-Blanco, Manuel; Macias, Alejandro E.; Nucci, Marcio; Ostrosky-Zeichner, Luis; Ponce-de-Leon, Alfredo; Queiroz-Telles, Flavio; Santolaya, Maria E.; Thompson-Moya, Luis; Tiraboschi, Iris N.; Zurita, Jeannete; Sifuentes-Osornio, Jose

    2014-01-01

    Introduction Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI). Objective To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City. Design Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010. Methods All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis. Results CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days). C. albicans was the predominant species (46%), followed by C. tropicalis (26%). C. glabrata was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate reached 46%, and risk factors for death were APACHE II score ?16 (OR?=?6.94, CI95%?=?2.34–20.58, p<0.0001), and liver disease (OR?=?186.11, CI95%?=?7.61–4550.20, p?=?0.001). Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed. Conclusions The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI. PMID:24830654

  14. Nosocomial Fungemia Due to Exophiala jeanselmei var. jeanselmei and a Rhinocladiella Species: Newly Described Causes of Bloodstream Infection

    PubMed Central

    Nucci, Marcio; Akiti, Tiyomi; Barreiros, Gloria; Silveira, Fernanda; Revankar, Sanjay G.; Sutton, Deanna A.; Patterson, Thomas F.

    2001-01-01

    Fungi have become increasingly important causes of nosocomial bloodstream infections. The major cause of nosocomial fungemia has been Candida spp, but increasingly molds and other yeasts have caused disease. Exophiala jeanselmei and members of the genus Rhinocladiella are dematiaceous moulds, which have been infrequently associated with systemic infection and have not been described as causes of fungemia. In this paper, the occurrence of 23 cases of fungemia due to these organisms over a 10-month period is reported and the clinical characteristics of patients and outcomes are described. The majority of patients were immunosuppressed; 21 of 23 (91%) had received blood products and 78% had a central venous catheter. All patients had at least one manifestation of fever, but only one patient had signs or symptoms suggesting deep-seated infection. Antifungal therapy was given to 19 of the 23 patients; of those who did not receive therapy, 3 died prior to the culture result and 1 had been discharged without therapy. Antifungal susceptibility of the organisms showed activity of amphotericin B, itraconazole, and the new triazole antifungals voriconazole and posaconazole. E. jeanselmei and Rhinocladiella species are potential causes of nosocomial fungemia and may be associated with systemic infection. PMID:11158099

  15. Effect of 2013 National Healthcare Safety Network definition changes on central line bloodstream infection rates: Audit results from the New York State Department of Health.

    PubMed

    Hazamy, Peggy Ann; Haley, Valerie B; Tserenpuntsag, Boldtsetseg; Tsivitis, Marie; Giardina, Rosalie; Knab, Robin; Lutterloh, Emily

    2015-03-01

    Surveillance criteria for central line-associated bloodstream infections (CLABSIs) are continually being refined to more accurately reflect infections related to central lines. An audit of 567 medical records from adult, pediatric, and neonatal intensive care unit patients with a central line and a positive blood culture showed a 16% decrease in CLABSI rates after the 2013 National Healthcare Safety Network definitions compared with the 2012 definitions. PMID:25556048

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

    Microsoft Academic Search

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

    2001-01-01

    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

  17. Outbreak of Sphingomonas paucimobilis septicemia in a neonatal intensive care unit.

    PubMed

    Mutlu, Mehmet; Bayramoglu, Gülçin; Yilmaz, Gürdal; Saygin, Berna; Aslan, Yakup

    2011-09-01

    We describe an outbreak of Sphingomonas paucimobilis in 13 newborn infants with septicemia and septic shock. Fifteen available isolates were obtained from patients and distilled water. Pulsed field gel electrophoresis showed that there was a cross-transmission of S. paucimobilis in eleven patients but these types were not the same the isolate obtained from the distilled water. The outbreak was terminated by taking appropriate control measures for infection and change of source of distilled water. PMID:21719938

  18. Sphingomonas paucimobilis: an unusual cause of meningitis-case report.

    PubMed

    Tai, Mei-Ling Sharon; Velayuthan, Rukumani Devi

    2014-01-01

    Sphingomonas paucimobilis is an aerobic gram-negative bacillus. The bacteria can cause infections, which can be devastating and, therefore, the patients need adequate and early antibiotic cover. We are presenting an interesting case of meningitis secondary to an unusual S. paucimobilis infection. This is the second case to our knowledge in the literature on meningitis due to S. paucimobilis. The 31-year-old previously healthy man presented with 2 months' history of weight loss and loss of appetite. He had fever and headache for 3 weeks. He was also speaking irrelevantly for 3 weeks. He had change of behaviour for 1 day. The patient was a farmer and worked in the soil. On examination, he was not responding to questions and was not obeying commands. Computed tomography (CT) brain with contrast revealed meningeal enhancement and cerebral oedema. Lumbar puncture was performed. Cerebrospinal fluid (CSF) opening pressure was more than 50 cm H2O. CSF analysis showed meningitis picture with raised white cell count of 210/?L (predominantly neutrophils), glucose 3.1 mmol/L, and raised protein 2.47 g/L. He was given intravenous ceftriaxone. The following day, his condition deteriorated. CSF culture grew S. paucimobilis sensitive to ceftriaxone. S. paucimobilis causes severe meningitis. This can lead to hydrocephalus, which results in a need for extraventricular drainage. A good occupational history is important with regard to finding the aetiology of serious meningitis (including rare bacteria) even before the culture result is known. Appropriate treatment can be given early and adequately to prevent mortality. PMID:24201101

  19. Incidence, risk factors and microbiology of central vascular catheter-related bloodstream infection in an intensive care unit.

    PubMed

    Hajjej, Zied; Nasri, Mourad; Sellami, Walid; Gharsallah, Hedi; Labben, Iheb; Ferjani, Mustapha

    2014-03-01

    Although there are many studies about catheter related infection in industrialized countries, very few have analyzed it in emerging countries. The aim of our study was to determine the incidence, microbiological profile and risk factors for catheter-related bloodstream infection (CRBSI) in a Tunisian medical intensive care unit. Over eight months (1 January 2012-30 August 2012) a prospective, observational study was performed in an 18-bed medical surgical intensive care unit at Tunis military hospital. Patients who required central venous catheter (CVC) placement for a duration greater than 48 h were included in the study. Two hundred sixty patients, with a total of 482 CVCs were enrolled. The mean duration of catheterization was 9.6 ± 6.2 days. The incidence for CRBSI and catheter colonization (CC) was 2.4 and 9.3 per 1000 catheter days, respectively. Risk factors independently associated with CRBSI were diabetes mellitus, long duration of catheterization, sepsis at insertion and administration of one or more antibiotics before insertion. The mortality rate among the CRBSI group was 21.8%. The predominant microorganisms isolated from CRBSI and CC episodes were Gram negative bacilli. All Gram negative organisms isolated among dead patients in CRBSI group were Extensive Drug Resistant (XDR). In our study the mortality rate among patients with CRBSI was high despite a low incidence of CRBSI. This high rate can be explained by the high-virulent status of Gram negative bacteria involved in CRBSI. PMID:24508422

  20. A Crossover Intervention Trial Evaluating the Efficacy of a Chlorhexidine-Impregnated Sponge (BIOPATCH®) to Reduce Catheter-Related Bloodstream Infections in Hemodialysis Patients

    PubMed Central

    Camins, Bernard C.; Richmond, Amy M.; Dyer, Kathrin L.; Zimmerman, Heather N.; Coyne, Daniel W.; Rothstein, Marcos; Fraser, Victoria J.

    2011-01-01

    Background Catheter-related bloodstream infections (BSI) account for the majority of hemodialysis-related infections. There are no published data on the efficacy of the chlorhexidine-impregnated foam dressing at reducing catheter-related BSI in hemodialysis patients. Design Prospective non-blinded cross-over intervention trial to determine the efficacy of a chlorhexidine-impregnated foam dressing (Biopatch®) to reduce catheter-related BSI in hemodialysis patients. Setting Two outpatient dialysis centers Patients A total of 121 patients who were dialyzed through tunneled central venous catheters received the intervention during the trial. Methods The primary outcome of interest was the incidence of catheter-related bloodstream infections. A nested cohort study of all patients who received the Biopatch® Antimicrobial Dressing was also conducted. Backward stepwise logistic regression analysis was used to determine independent risk factors for development of BSI. Results 37 bloodstream infections occurred in the intervention group for a rate of 6.3 BSIs/1000 dialysis sessions and 30 bloodstream infections in the control group for a rate of 5.2 BSIs/1000 dialysis sessions and [RR 1.22, CI (0.76, 1.97); P=0.46]. The Biopatch® Antimicrobial Dressing was well-tolerated with only two patients (<2%) experiencing dermatitis that led to its discontinuation. The only independent risk factor for development of BSI was dialysis treatment at one dialysis center [aOR 4.4 (1.77, 13.65); P=0.002]. Age ? 60 years [aOR 0.28 (0.09, 0.82); P=0.02] was associated with lower risk for BSI. Conclusion The use of a chlorhexidine-impregnated foam dressing (Biopatch®) did not decrease catheter-related BSIs among hemodialysis patients with tunneled central venous catheters. PMID:20879855

  1. Closed Catheter Access System Implementation in Reducing the Bloodstream Infection Rate in Low Birth Weight Preterm Infants

    PubMed Central

    Rundjan, Lily; Rohsiswatmo, Rinawati; Paramita, Tiara Nien; Oeswadi, Chrissela Anindita

    2015-01-01

    Background: Bloodstream infection (BSI) is one of the significant causes of morbidity and mortality encountered in a neonatal intensive care unit, especially in developing countries. Despite the implementation of infection control practices, such as strict hand hygiene, the BSI rate in our hospital is still high. The use of a closed catheter access system to reduce BSI related to intravascular catheter has hitherto never been evaluated in our hospital. Objective: To determine the effects of closed catheter access system implementation in reducing the BSI rate in preterm neonates with low birth weight. Methods: Randomized clinical trial was conducted on 60 low birth weight preterm infants hospitalized in the neonatal unit at Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September 2013. Randomized subjects either received a closed or non-closed catheter access system. Subjects were monitored for 2?weeks for the development of BSI based on clinical signs, abnormal infection parameters, and blood culture. Results: Closed catheter access system implementation gave a protective effect toward the occurrence of culture-proven BSI (relative risk 0.095, 95% CI 0.011–0.85, p?=?0.026). Risk of culture-proven BSI in the control group was 10.545 (95% CI 1.227–90.662, p?=?0.026). BSI occurred in 75% of neonates without risk factors of infection in the control group compared to none in the study group. Conclusion: The use of a closed catheter access system reduced the BSI in low birth weight preterm infants. Choosing the right device design, proper disinfection of device, and appropriate frequency of connector change should be done simultaneously. PMID:25853110

  2. Prevention of Central Line–Associated Bloodstream Infections: A Journey Toward Eliminating Preventable Harm

    Microsoft Academic Search

    Christine A. Goeschel; Sara E. Cosgrove; Mark Romig; Sean M. Berenholtz

    2011-01-01

    Central line–associated blood stream infections (CLABSI) are among the most common, lethal, and costly health care–associated\\u000a infections. Recent large collaborative quality improvement efforts have achieved unprecedented and sustained reductions in\\u000a CLABSI rates and demonstrate that these infections are largely preventable, even for exceedingly ill patients. The broad acceptance\\u000a that zero CLABSI rates are an achievable goal has motivated and stimulated

  3. Clinical and Molecular Characteristics of Emerging Hypervirulent Klebsiella pneumoniae Bloodstream Infections in Mainland China

    PubMed Central

    Liu, Ying Mei; Li, Bin Bin; Zhang, Yu Yu; Zhang, Wu; Shen, Hong; Li, Hui

    2014-01-01

    Recently, the newly emerged hypervirulent Klebsiella pneumoniae strain (hvKP) has caused great concern globally, but the clinical features and molecular characteristics of bacteremia caused by hvKP are rarely reported in mainland China. Seventy patients with K. pneumoniae bacteremia were investigated to study the clinical features of hvKP infection from 2008 till 2012 in Beijing Chao-Yang Hospital. The molecular characteristics of the hvKP strains were also studied using PCR, multilocus sequence typing, and pulsed-field gel electrophoresis (PFGE) methods. hvKP was identified in 31.4% of the patients with K. pneumoniae bacteremia, which displayed 4 serotypes (K1, K2, K20, and K57). Patients with hvKP infection tended to have no underlying diseases compared to those with classic K. pneumoniae (cKP). More hvKP-positive patients (95.5%) had community-acquired infection than did cKP-infected patients (35.4%) (P < 0.001). The 30-day mortality rate was lower in hvKP-infected patients than in cKP-infected patients (4.5% compared to 16.7%). Resistance to tested antimicrobials was significantly greater in cKP- than in hvKP-infected patients. Two extended-spectrum-beta-lactamase (ESBL)-producing hvKP strains were found. Seven novel sequence types (STs) and 4 new alleles of K. pneumoniae were revealed. A strong correlation was found between two STs (ST23, ST1265) and the K1 serotype. The hvKP isolates (n = 22) had 14 different PFGE patterns, and among them 10 K1 isolates shared similar PFGE patterns. The emerging hvKP strain was prevalent in patients with severe community-acquired infections in healthy individuals in China. Identification of ESBL-producing hvKP strains in hvKP-infected patients will facilitate clinical management of hvKP infection. PMID:24982067

  4. 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

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

    1999-01-01

    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

  5. Controlled Clinical Laboratory Comparison of Two Supplemented Aerobic and Anaerobic Media Used in Automated Blood Culture Systems To Detect Bloodstream Infections

    Microsoft Academic Search

    R. ZIEGLER; I. JOHNSCHER; P. MARTUS; D. LENHARDT; H.-M. JUST; Klinikum Nurnberg

    1998-01-01

    A 20-ml blood sample was collected from adult patients with suspected bloodstream infections and distrib- uted equally into the four volume-controlled bottles of a blood culture set consisting of aerobic and anaerobic BACTEC Plus\\/F bottles and aerobic and anaerobic BacT\\/Alert FAN bottles. All bottles were incubated in their respective instruments for a standard 5-day protocol or until the instruments signalled

  6. 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

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

    2010-01-01

    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

  7. Carbapenemase-Producing Klebsiella pneumoniae Bloodstream Infections: Lowering Mortality by Antibiotic Combination Schemes and the Role of Carbapenems

    PubMed Central

    Tsaousi, Sophia; Tzouvelekis, Leonidas S.; Anyfantis, Ioannis; Psichogiou, Mina; Argyropoulou, Athina; Stefanou, Ioanna; Sypsa, Vana; Miriagou, Vivi; Nepka, Martha; Georgiadou, Sarah; Markogiannakis, Antonis; Goukos, Dimitris; Skoutelis, Athanasios

    2014-01-01

    Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) are currently among the most important nosocomial pathogens. An observational study was conducted during 2009 to 2010 in two hospitals located in a high-prevalence area (Athens, Greece). The aims were (i) to evaluate the clinical outcome of patients with CP-Kp bloodstream infections (BSIs), (ii) to identify predictors of mortality, and (iii) to evaluate the various antibiotic schemes employed. A total of 205 patients with CP-Kp BSIs were identified: 163 (79.5%) were infected with KPC or KPC and VIM, and 42 were infected with VIM producers. For definitive treatment, 103 patients received combination therapy (two or more active drugs), 72 received monotherapy (one active drug), and 12 received therapy with no active drug. The remaining 18 patients died within 48 h after the onset of bacteremia. The all-cause 28-day mortality was 40%. A significantly higher mortality rate was observed in patients treated with monotherapy than in those treated with combination therapy (44.4% versus 27.2%; P = 0.018). The lowest mortality rate (19.3%) was observed in patients treated with carbapenem-containing combinations. In the Cox proportion hazards model, ultimately fatal disease (hazards ratio [HR], 3.25; 95% confidence interval [CI], 1.51 to 7.03; P = 0.003), the presence of rapidly fatal underlying diseases (HR, 4.20; 95% CI, 2.19 to 8.08; P < 0.001), and septic shock (HR, 2.15; 95% CI, 1.16 to 3.96; P = 0.015) were independent predictors of death. Combination therapy was strongly associated with survival (HR of death for monotherapy versus combination, 2.08; 95% CI, 1.23 to 3.51; P = 0.006), mostly due to the effectiveness of the carbapenem-containing regimens. PMID:24514083

  8. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections.

    PubMed

    Stevens, V; Geiger, K; Concannon, C; Nelson, R E; Brown, J; Dumyati, G

    2014-05-01

    Previous work has suggested that central-line-associated bloodstream infection (CLABSI) is associated with increased costs and risk of mortality; however, no studies have looked at both total and variable costs, and information on outcomes outside of the intensive-care unit (ICU) is sparse. The aim of this study was to determine the excess in-hospital mortality and costs attributable to CLABSI in ICU and non-ICU patients. We conducted a retrospective cohort and cost-of-illness study from the hospital perspective of 398 patients at a tertiary-care academic medical centre from 1 January 2008 to 31 December 2010. All CLABSI patients and a simple random sample drawn from a list of all central lines inserted during the study period were included. Generalized linear models with log link and gamma distribution were used to model costs as a function of CLABSI and important covariates. Costs were adjusted to 2010 US dollars by use of the personal consumption expenditures for medical care index. We used multivariable logistic regression to identify independent predictors of in-hospital mortality. Among both ICU and non-ICU patients, adjusted variable costs for patients with CLABSI were c. $32 000 (2010 US dollars) higher on average than for patients without CLABSI. After we controlled for severity of illness and other healthcare-associated infections, CLABSI was associated with a 2.27-fold (95% CI 1.15-4.46) increased risk of mortality. Other healthcare-associated infections were also significantly associated with greater costs and mortality. Overall, CLABSI was associated with significantly higher adjusted in-hospital mortality and total and variable costs than those for patients without CLABSI. PMID:24112305

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

    PubMed Central

    2013-01-01

    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

  10. Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000-2009

    PubMed Central

    2014-01-01

    Background Invasive methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infections are major causes of numerous neonatal intensive care unit (NICU) outbreaks. There have been increasing reports of MRSA outbreaks in various neonatal intensive care units (NICUs) over the last decade. Our objective was to review the experience of Staphylococcus aureus sepsis in our NICU in the last decade and describe the trends in the incidence of Staphylococcus aureus blood stream infections from 2000 to 2009. Methods A retrospective perinatal database review of all neonates admitted to our NICU with blood cultures positive for Staphylococcus aureus from (Jan 1st 2000 to December 31st 2009) was conducted. Infants were identified from the database and data were collected regarding their clinical characteristics and co-morbidities, including shock with sepsis and mortality. Period A represents patients admitted in 2000-2003. Period B represents patients seen in 2004-2009. Results During the study period, 156/11111 infants were identified with Staphylococcus aureus blood stream infection: 41/4486 (0.91%) infants in Period A and 115/6625 (1.73%) in Period B (p?infections in Period B (24% vs. 55% p?infections observed in the two periods, infants in period B notably had significantly more pneumonia cases (2.4% vs. 27%, p?=?0.0005) and a significantly higher mortality rate (0% vs. 15.7%, p?=?0.0038). The incidences of skin and soft tissue infections and of necrotizing enterocolitis were not significantly changed in the two periods. Conclusion There was an increase in the incidence of Staphylococcus aureus infection among neonates after 2004. Although MSSA continues to be a problem in the NICU, MRSA infections were more prevalent in the past 6 years in our NICU. Increased severity of staphylococcal infections and associated rising mortality are possibly related to the increasing MRSA infections with a more virulent community-associated strain. PMID:24886471

  11. Staphylococcus aureus bloodstream infection: A pooled analysis of five prospective, observational studies

    PubMed Central

    Kaasch, Achim J.; Barlow, Gavin; Edgeworth, Jonathan D.; Fowler, Vance G.; Hellmich, Martin; Hopkins, Susan; Kern, Winfried V.; Llewelyn, Martin J.; Rieg, Siegbert; Rodriguez-Baño, Jesús; Scarborough, Matthew; Seifert, Harald; Soriano, Alex; Tilley, Robert; T?r?k, M. Estée; Wei?, Verena; Wilson, A. Peter R.; Thwaites, Guy E.

    2014-01-01

    Summary Objectives Staphylococcus aureus bacteraemia is a common, often fatal infection. Our aim was to describe how its clinical presentation varies between populations and to identify common determinants of outcome. Methods We conducted a pooled analysis on 3395 consecutive adult patients with S. aureus bacteraemia. Patients were enrolled between 2006 and 2011 in five prospective studies in 20 tertiary care centres in Germany, Spain, United Kingdom, and United States. Results The median age of participants was 64 years (interquartile range 50–75 years) and 63.8% were male. 25.4% of infections were associated with diabetes mellitus, 40.7% were nosocomial, 20.6% were caused by methicillin-resistant S. aureus (MRSA), although these proportions varied significantly across studies. Intravenous catheters were the commonest identified infective focus (27.7%); 8.3% had endocarditis. Crude 14 and 90-day mortality was 14.6% and 29.2%, respectively. Age, MRSA bacteraemia, nosocomial acquisition, endocarditis, and pneumonia were independently associated with death, but a strong association was with an unidentified infective focus (adjusted hazard ratio for 90-day mortality 2.92; 95% confidence interval 2.33 to 3.67, p < 0.0001). Conclusion The baseline demographic and clinical features of S. aureus bacteraemia vary significantly between populations. Mortality could be reduced by assiduous MRSA control and early identification of the infective focus. PMID:24247070

  12. Increase in bloodstream infection due to vancomycin-susceptible Enterococcus faecium in cancer patients: risk factors, molecular epidemiology and outcomes.

    PubMed

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

    2013-01-01

    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

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

    PubMed Central

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

    2013-01-01

    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

  14. In vitro activity of two amphotericin B formulations against Malassezia furfur strains recovered from patients with bloodstream infections.

    PubMed

    Iatta, Roberta; Immediato, Davide; Montagna, Maria Teresa; Otranto, Domenico; Cafarchia, Claudia

    2015-04-01

    Although guidelines for the treatment of Malassezia furfur fungemia are not yet defined, clinical data suggest that amphotericin B (AmB) is effective for treating systemic infections. In the absence of clinical breakpoints for Malassezia yeasts, epidemiological cut-off values (ECVs) are useful to discriminate between isolates with and without drug resistance. This study aimed to compare the distribution of minimal inhibitory concentration (MIC) and the ECVs for AmB of both deoxycholate (d-AmB) and liposomal (l-AmB) formulations of M. furfur isolates. The 84 M. furfur strains analyzed, which included 56 from blood, sterile sites and catheters, and 28 from skin, were isolated from patients with bloodstream infections. MICs were determined by the modified broth microdilution method of the Clinical and Laboratory Standards Institute (CLSI). The l-AmB MIC and the ECVs were two-fold lower than those of d-AmB and a lower l-AmB mean MIC value was found for blood isolates than from skin. The ECVs for l-AmB and d-AmB were 8?mg/l and 32 mg/l, respectively. Three strains (3.6%) showed l-AmB MIC higher than ECV (MIC > 8?mg/l) of which two were isolated from the catheter tip of patients treated with micafugin, l-Amb and fluconazole, and one from skin. The results showed that the l-AmB might be employed for assessing the in vitro antifungal susceptibility of M. furfur by a modified CLSI protocol and that ECVs might be useful for detecting the emergence of resistance. PMID:25631480

  15. A collaborative, systems-level approach to eliminating healthcare-associated MRSA, central-line-associated bloodstream infections, ventilator-associated pneumonia, and respiratory virus infections.

    PubMed

    Henderson, Donna M; Staiger, Thomas O; Peterson, Gene N; Sinanan, Mika N; Angiulo, Cindy L; Makarewicz, Vanessa A; Wild, Lorie M; Whimbey, Estella E

    2012-01-01

    To achieve sustainable reductions in healthcare-associated infections (HAIs), the University of Washington Medical Center (UWMC) deployed a collaborative, systems-level initiative. With the sponsorship of senior leadership, multidisciplinary teams were established to address healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA), central-line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and respiratory virus infections. The goal of the initiative was to eliminate these four HAIs among medical center inpatients by 2012. In the first 24 months of the project, the number of healthcare-associated MRSA cases decreased 58%; CLABSI cases decreased 54%. Staff and provider compliance with infection prevention measures improved and remained strong, for example, 96% compliance with hand hygiene, 98% compliance with the recommended influenza vaccination program, and 100% compliance with the VAP bundle. Achieving these results required an array of coordinated, systems-level interventions. Critical project success factors were believed to include creating organizational alignment by declaring eliminating HAIs as an organizational breakthrough goal, having the organization's executive leadership highly engaged in the project, coordination by an experienced and effective project leader and manager, collaboration by multidisciplinary project teams, and promoting transparency of results across the organization. PMID:22860887

  16. Evaluating state-specific antibiotic resistance measures derived from central line-associated bloodstream infections, national healthcare safety network, 2011.

    PubMed

    Soe, Minn M; Edwards, Jonathan R; Sievert, Dawn M; Ricks, Philip M; Magill, Shelley S; Fridkin, Scott K

    2015-01-01

    DISCLOSURE The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Diseases Registry. OBJECTIVE Describe the impact of standardizing state-specific summary measures of antibiotic resistance that inform regional interventions to reduce transmission of resistant pathogens in healthcare settings. DESIGN Analysis of public health surveillance data. METHODS Central line-associated bloodstream infection (CLABSI) data from intensive care units (ICUs) of facilities reporting to the National Healthcare Safety Network in 2011 were analyzed. For CLABSI due to methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum cephalosporin (ESC)-nonsusceptible Klebsiella species, and carbapenem-nonsusceptible Klebsiella species, we computed 3 state-level summary measures of nonsusceptibility: crude percent nonsusceptible, model-based adjusted percent nonsusceptible, and crude infection incidence rate. RESULTS Overall, 1,791 facilities reported CLABSIs from ICU patients. Of 1,618 S. aureus CLABSIs with methicillin-susceptibility test results, 791 (48.9%) were due to MRSA. Of 756 Klebsiella CLABSIs with ESC-susceptibility test results, 209 (27.7%) were due to ESC-nonsusceptible Klebsiella, and among 661 Klebsiella CLABSI with carbapenem susceptibility test results, 70 (10.6%) were due to carbapenem-nonsusceptible Klebsiella. All 3 state-specific measures demonstrated variability in magnitude by state. Adjusted measures, with few exceptions, were not appreciably different from crude values for any phenotypes. When linking values of crude and adjusted percent nonsusceptible by state, a state's absolute rank shifted slightly for MRSA in 5 instances and only once each for ESC-nonsusceptible and carbapenem-nonsusceptible Klebsiella species. Infection incidence measures correlated strongly with both percent nonsusceptibility measures. CONCLUSIONS Crude state-level summary measures, based on existing NHSN CLABSI data, may suffice to assess geographic variability in antibiotic resistance. As additional variables related to antibiotic resistance become available, risk-adjusted summary measures are preferable. Infect Control Hosp Epidemiol 2015;36(1): 54-64. PMID:25627762

  17. Beyond the intensive care unit bundle: Implementation of a successful hospital-wide initiative to reduce central line-associated bloodstream infections.

    PubMed

    Klintworth, Gemma; Stafford, Jane; O'Connor, Mark; Leong, Tim; Hamley, Lee; Watson, Kerrie; Kennon, Jacqueline; Bass, Pauline; Cheng, Allen C; Worth, Leon J

    2014-06-01

    A multimodal hospital-wide central line-associated bloodstream infection (CLABSI) risk reduction strategy was implemented over a 20-month period at an Australian center. Reduced CLABSI rates were observed in both intensive care units (ICUs) (incidence rate ratio [IRR], 0.39; P < .001) and non-ICU wards (IRR, 0.54; P < .001). The median time to CLABSI onset was 7.5 days for ICU events and 13 days for non-ICU events. The timing of infection demonstrates the need for more careful attention to postinsertion care and access of central venous catheters. PMID:24837122

  18. Systematic Review and Meta-Analysis of Linezolid and Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Bloodstream Infections

    PubMed Central

    Whang, Donald W.; Miller, Loren G.; Partain, Neil M.

    2013-01-01

    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; I2 = 0 [where I2 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

  19. Impact of Postplacement Adjustment of Peripherally Inserted Central Catheters on the Risk of Bloodstream Infection and Venous Thrombus Formation

    PubMed Central

    Baxi, Sanjiv M.; Shuman, Emily K.; Scipione, Christy A.; Chen, Benrong; Sharma, Aditi; Rasanathan, Jennifer J. K.; Chenoweth, Carol E.

    2014-01-01

    OBJECTIVE Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line–associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment. DESIGN Retrospective cohort study. SETTING University of Michigan Health System, a large referral hospital. PATIENTS Patients who had PICCs placed between February 2007 and August 2007. METHODS The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records. RESULTS There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI (P = .04), whereas 2 or 3 or more adjustments had no association with CLABSI (P = .58 and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation (P = .59, .85, and .78, respectively). Immunosuppression (P < .01), power-injectable PICCs (P = .05), and 3 PICC lumens compared with 1 lumen (P = .02) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation (P = .03). CONCLUSIONS Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT. PMID:23838218

  20. A Case-Control Study to Identify Risk Factors for Totally Implantable Central Venous Port-Related Bloodstream Infection

    PubMed Central

    Lee, Guk Jin; Hong, Sook Hee; Roh, Sang Young; Park, Sa Rah; Lee, Myung Ah; Chun, Hoo Geun; Hong, Young Seon; Kang, Jin Hyoung; Kim, Sang Il; Kim, Youn Jeong; Chun, Ho Jong; Oh, Jung Suk

    2014-01-01

    Purpose To date, the risk factors for central venous port-related bloodstream infection (CVPBSI) in solid cancer patients have not been fully elucidated. We conducted this study in order to determine the risk factors for CVP-BSI in patients with solid cancer. Materials and Methods A total of 1,642 patients with solid cancer received an implantable central venous port for delivery of chemotherapy between October 2008 and December 2011 in a single center. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of 130 patients, who were individually matched with respect to age, sex, and catheter insertion time. Results CVP-BSI occurred most frequently between September and November (37.9%). The most common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus (n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factor for CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancer than in other cancer (p=0.002). Initial metastatic disease and long catheter-stay were statistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor for mortality in patients with CVP-BSI (p=0.047). Conclusion In analysis of the results with respect to risk factors, prolonged catheter-stay should be avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastatic solid cancer, especially non-gastrointestinal cancer. In addition, avoidance of unnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally, considering the fact that confounding factors may have affected the results, conduct of a well-designed prospective controlled study is warranted. PMID:25038760

  1. Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain.

    PubMed

    Puig-Asensio, M; Padilla, B; Garnacho-Montero, J; Zaragoza, O; Aguado, J M; Zaragoza, R; Montejo, M; Muñoz, P; Ruiz-Camps, I; Cuenca-Estrella, M; Almirante, B

    2014-04-01

    A prospective, multicentre, population-based surveillance programme for Candida bloodstream infections was implemented in five metropolitan areas of Spain to determine its incidence and the prevalence of antifungal resistance, and to identify predictors of death. Between May 2010 and April 2011, Candida isolates were centralized to a reference laboratory for species identification by DNA sequencing and for susceptibility testing by EUCAST reference procedure. Prognostic factors associated with early (0-7 days) and late (8-30 days) death were analysed using logistic regression modelling. We detected 773 episodes: annual incidence of 8.1 cases/100 000 inhabitants, 0.89/1000 admissions and 1.36/10 000 patient-days. Highest incidence was found in infants younger than 1 year (96.4/100 000 inhabitants). Candida albicans was the predominant species (45.4%), followed by Candida parapsilosis (24.9%), Candida glabrata (13.4%) and Candida tropicalis (7.7%). Overall, 79% of Candida isolates were susceptible to fluconazole. Cumulative mortality at 7 and 30 days after the first episode of candidaemia was 12.8% and 30.6%, respectively. Multivariate analysis showed that therapeutic measures within the first 48 h may improve early mortality: antifungal treatment (OR 0.51, 95% CI 0.27-0.95) and central venous catheter removal (OR 0.43, 95% CI 0.21-0.87). Predictors of late death included host factors (e.g. patients' comorbid status and signs of organ dysfunction), primary source (OR 1.63, 95% CI 1.03-2.61), and severe sepsis or septic shock (OR 1.77, 95% CI 1.05-3.00). In Spain, the proportion of Candida isolates non-susceptible to fluconazole is higher than in previous reports. Early mortality may be improved with strict adherence to guidelines. PMID:24125548

  2. Risk Factors and Prognosis of Nosocomial Bloodstream Infections Caused by Extended-Spectrum-?-Lactamase-Producing Escherichia coli?

    PubMed Central

    Rodríguez-Baño, Jesús; Picón, Encarnación; Gijón, Paloma; Hernández, José Ramón; Cisneros, Jose M.; Peña, Carmen; Almela, Manuel; Almirante, Benito; Grill, Fabio; Colomina, Javier; Molinos, Sonia; Oliver, Antonio; Fernández-Mazarrasa, Carlos; Navarro, Gemma; Coloma, Ana; López-Cerero, Lorena; Pascual, Alvaro

    2010-01-01

    Extended-spectrum-?-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.4 to 15.7), the previous use of oxyimino-?-lactams (OR = 6.0; 95% CI = 3.0 to 11.8), and unknown BSI source (protective; OR = 0.4; 95% CI = 0.2 to 0.9), and duration of hospital stay (OR = 1.02; 95% CI = 1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR = 3.9; 95% CI = 1.2 to 12.9), a high-risk source (OR = 5.5; 95% CI = 1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR = 6.5; 95% CI = 1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-?-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality. PMID:20181897

  3. Contribution of the BacT/Alert MB Mycobacterium Bottle to Bloodstream Infection Surveillance in Thailand: Added Yield for Burkholderia pseudomallei.

    PubMed

    Jorakate, Possawat; Higdon, Melissa; Kaewpan, Anek; Makprasert, Sirirat; Yuenprakhon, Somkhit; Tawisaid, Kittisak; Dejsirilert, Surang; Whistler, Toni; Baggett, Henry C

    2015-03-01

    Community-acquired bloodstream infections cause substantial morbidity and mortality worldwide, but microbiology capacity and surveillance limitations have challenged good descriptions of pathogen distribution in many regions, including Southeast Asia. Active surveillance for bloodstream infections has been conducted in two rural Thailand provinces for >7 years. Blood specimens were divided into two culture bottles, one optimized for aerobic growth (F bottle) and a second for enhanced growth of mycobacteria (MB bottle), and processed with the BactT/Alert 3D system. Because the routine use of MB culture bottles is resource intensive (expensive and requires prolonged incubation), we assessed the added yield of MB bottles by comparing the proportion of pathogens detected by MB versus that by F bottles from 2005 to 2012. Of 63,066 blood cultures, 7,296 (12%) were positive for at least one pathogen; the most common pathogens were Escherichia coli (28%), Burkholderia pseudomallei (11%), Klebsiella pneumoniae (9%), and Staphylococcus aureus (6%). Two bottles improved the yield overall, but the added yield attributable to the MB bottles was limited to a few pathogens. In addition to the detection of mycobacteria and some fungi, MB bottles improved the detection of B. pseudomallei (27% [MB] versus 8% [F]; P < 0.0001), with added benefit if therapy was initiated prior to the blood culture. The targeted use of MB bottles is warranted for patients at risk for mycobacterial and fungal infections and for infection with B. pseudomallei, a common cause of septicemia in Thailand. PMID:25588650

  4. Use of bundled interventions, including a checklist to promote compliance with aseptic technique, to reduce catheter-related bloodstream infections in the intensive care unit

    PubMed Central

    Simpson, C David; Hawes, Judith; James, Andrew G; Lee, Kyong-Soon

    2014-01-01

    BACKGROUND: A checklist that promotes compliance with aseptic technique during line insertion is a component of many care bundles aimed at reducing nosocomial infections among intensive care unit patients. OBJECTIVE: To determine whether the use of bundled interventions that include a checklist during central-line insertions reduces catheter-related bloodstream infections in intensive care unit patients. METHODS: A literature review was performed using methodology adapted from the American Heart Association’s International Liaison Committee on Resuscitation. RESULTS: Seventeen cohort studies were included. Thirteen studies were supportive of the intervention, while four were neutral. Infection rates ranged from 1.6 to 10.8 per 1000 central-line days in control groups, and from 0.0 to 3.8 per 1000 central-line days in the intervention groups. CONCLUSION: There is fair evidence to recommend the use of care bundles that include a checklist during central-line insertion in intensive care unit patients to reduce the incidence of catheter-related bloodstream infections. PMID:24855420

  5. Ethanol versus heparin locks for the prevention of central venous catheter-associated bloodstream infections: a randomized trial in adult haematology patients with Hickman devices.

    PubMed

    Worth, L J; Slavin, M A; Heath, S; Szer, J; Grigg, A P

    2014-09-01

    The effectiveness of ethanol locks for prevention of central venous catheter (CVC)-associated bloodstream infection (CLABSI) in adult haematology patients has not been thoroughly evaluated. This study aimed to compare prospectively heparinized saline with 70% ethanol locks using 2 h dwell time in patients with tunnelled CVCs. In saline (N = 43) and ethanol (N = 42) groups, CLABSI rates were 6.0 [95% confidence interval (CI): 3.4-9.8] and 4.1 (95% CI: 1.9-7.7) per 1000 CVC days, respectively (P = 0.42). In the ethanol group, two exit-site infections and one tunnel/pocket infection were observed. Reduction in device-associated infection was not achieved with prophylactic 70% ethanol locks in patients with haematological malignancy and tunnelled CVCs. PMID:25063013

  6. Biomarkers and Molecular Analysis to Improve Bloodstream Infection Diagnostics in an Emergency Care Unit

    PubMed Central

    Loonen, Anne J. M.; de Jager, Cornelis P. C.; Tosserams, Janna; Kusters, Ron; Hilbink, Mirrian; Wever, Peter C.; van den Brule, Adriaan J. C.

    2014-01-01

    Molecular pathogen detection from blood is still expensive and the exact clinical value remains to be determined. The use of biomarkers may assist in preselecting patients for immediate molecular testing besides blood culture. In this study, 140 patients with ? 2 SIRS criteria and clinical signs of infection presenting at the emergency department of our hospital were included. C-reactive protein (CRP), neutrophil-lymphocyte count ratio (NLCR), procalcitonin (PCT) and soluble urokinase plasminogen activator receptor (suPAR) levels were determined. One ml EDTA blood was obtained and selective pathogen DNA isolation was performed with MolYsis (Molzym). DNA samples were analysed for the presence of pathogens, using both the MagicPlex Sepsis Test (Seegene) and SepsiTest (Molzym), and results were compared to blood cultures. Fifteen patients had to be excluded from the study, leaving 125 patients for further analysis. Of the 125 patient samples analysed, 27 presented with positive blood cultures of which 7 were considered to be contaminants. suPAR, PCT, and NLCR values were significantly higher in patients with positive blood cultures compared to patients without (p < 0.001). Receiver operating characteristic curves of the 4 biomarkers for differentiating bacteremia from non-bacteremia showed the highest area under the curve (AUC) for PCT (0.806 (95% confidence interval 0.699–0.913)). NLCR, suPAR and CRP resulted in an AUC of 0.770, 0.793, and 0.485, respectively. When compared to blood cultures, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for SepsiTest and MagicPlex Sepsis Test were 11%, 96%, 43%, 80%, and 37%, 77%, 30%, 82%, respectively. In conclusion, both molecular assays perform poorly when one ml whole blood is used from emergency care unit patients. NLCR is a cheap, fast, easy to determine, and rapidly available biomarker, and therefore seems most promising in differentiating BSI from non-BSI patients for subsequent pathogen identification using molecular diagnostics. PMID:24475269

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

    PubMed

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

    2012-09-01

    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

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

    PubMed

    Laupland, Kevin B

    2010-12-01

    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

  9. Sphingomonas paucimobilis bacteraemia and shock in a patient with rheumatic carditis.

    PubMed

    Yozgat, Y; Kilic, A; Karadeniz, C; Ozdemir, R; Doksoz, O; Gulfidan, G; Mese, T

    2014-01-01

    Acute rheumatic fever (ARF) carditis is treated with steroids, which can cause changes in the cellular immune response, especially decreased CD3 (+) T cells. Nosocomial infections due to steroid use for treatment of ARF carditis or secondary to the changes in the cellular immune response have not been reported in the literature. Sphingomonas paucimobilis is a Gram-negative bacillus causing community- and hospital-acquired infections. It has been reported as causing bacteraemia/sepsis, pneumonia or peritonitis in patients with malignancies, immunosuppression or diabetes. We present a case with S. paucimobilis bacteraemia/sepsis and shock after administration of steroids for treatment of ARF carditis. We suggest early identification of the causative agent and appropriate adjustments of the treatment plan to avoid shock and possible mortality. This is the first reported case of S. paucimobilis bacteraemia/sepsis in the setting of steroid use for ARF carditis. PMID:25297038

  10. Use of six sigma strategies to pull the line on central line-associated bloodstream infections in a neurotrauma intensive care unit.

    PubMed

    Loftus, Kelli; Tilley, Terry; Hoffman, Jason; Bradburn, Eric; Harvey, Ellen

    2015-01-01

    The creation of a consistent culture of safety and quality in an intensive care unit is challenging. We applied the Six Sigma Define-Measure-Analyze-Improve-Control (DMAIC) model for quality improvement (QI) to develop a long-term solution to improve outcomes in a high-risk neurotrauma intensive care unit. We sought to reduce central line utilization as a cornerstone in preventing central line-associated bloodstream infections (CLABSIs). This study describes the successful application of the DMAIC model in the creation and implementation of evidence-based quality improvement designed to reduce CLABSIs to below national benchmarks. PMID:25768963

  11. Expression of CD64 on neutrophils can be used to predict the severity of bloodstream infection before broad range 16S rRNA PCR.

    PubMed

    Stubljar, David; Skvarc, Miha

    2015-03-01

    The aging population and increased incidence of severe bacterial infection can lead to sepsis. Interest to early identification of endangered patients and identification of pathogen do not always confirm the infection. To use biomarkers can help in early identification of infection and opportunity to start therapy timeously. All biomarkers were defined in 33 out of 96 patients. Thirty-two (97 %) patients had bacterial infection and 1 (3 %) patient had systemic inflammatory response syndrome (SIRS) without infection. PCR confirmed the infection in 27 cases and blood cultures in 8. Area under curve (AUC) for CD64 was 1.00, meanwhile other biomarkers showed 2-fold smaller AUC for positive infection. CD64 index was associated with bacterial infection (p<0.001) and could be used to confirm assessment of SIRS severity (p=0.037). As regards to our results, limited to only 33 patients, CD64 index served as a good parameter to predict bacterial infection and determine severity. The use of broad range 16S ribosomal RNA (rRNA) PCR proved to be an excellent tool to confirm bloodstream infection. The CD64 index had the highest AUC, which exceeded all the others, and could be used to predict the outcome of broad range 16S rRNA PCR from whole blood. However, C-reactive protein (CRP), procalcitonin (PCT) and sCD14 are much easier and faster to measure, but the values could be elevated in other clinical assessments. PMID:25253263

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

    Microsoft Academic Search

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

    2010-01-01

    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

  13. Epidemiology and Clinical Features of Post-Transplant Bloodstream Infection: An Analysis of 222 Consecutive Liver Transplant Recipients

    PubMed Central

    Kim, Hyun Kyung; Park, Yong Keun; Wang, Hee-Jung; Kim, Bong Wan; Shin, So Youn; Lim, Seung-Kwan

    2013-01-01

    Background Bloodstream infection (BSI) is a significant cause of morbidity and mortality in liver transplant (LT) recipients. This study aimed to investigate the epidemiology and clinical features of post-transplant BSI in LT recipients. Materials and Methods The microbiology, frequency, and outcome of post-transplant BSI in the first year after LT were retrospectively analyzed in 222 consecutive patients who had received liver transplants at a single center between 2005 and 2011. The risk factors for post-transplant BSI and death were evaluated. Results During a 1-year period after LT, 112 episodes of BSI occurred in 64 of the 222 patients (28.8%). A total of 135 microorganisms were isolated from 112 BSI episodes including 18 polymicrobial episodes. The median time to BSI onset ranged from 8 days for Klebsiella pneumoniae to 101 days for enterococci, and the overall median for all microorganisms was 28 days. The most frequent pathogens were Enterobacteriaceae members (32.5%), enterococci (17.8%), yeasts (14.0%), Staphylococcus aureus (10.3%), and Acinetobacter baumannii (10.3%); most of them showed resistance to major antibiotics. The major sources of BSI were biliary tract (36.2%), abdominal and/or wound (28.1%), and intravascular catheter (18.5%) infections. The independent risk factors for post-transplant BSI were biliary complications (odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.29 to 6.59, P = 0.010) and longer hospitalization in the intensive care unit (OR: 1.04, 95% CI: 1.00 to 1.08, P < 0.001) after LT. BSI was an independent risk factor for death (hazard ratio [HR]: 3.92, 95% CI: 2.22 to 6.91, P < 0.001), with a poorer survival rate observed in patients with BSI than in those without BSI (1-year survival rate: 60.0% versus 89.5%, respectively, P < 0.001) after LT. The strongest predictors for death in patients with BSI were hepatocellular carcinoma (HR: 3.82, 95% CI: 1.57 to 9.32, P = 0.003), candidemia (HR: 3.71, 95% CI: 1.58 to 8.71, P = 0.003), polymicrobial bacteremia (HR: 3.18, 95% CI: 1.39 to 7.28, P = 0.006), and post-transplant hemodialysis (HR: 2.44, 95% CI: 1.02 to 5.84, P = 0.044). Conclusions BSI was a frequent post-transplant complication, and most of the causative pathogens were multi-drug resistant. Biliary complications and BSIs resulting from biliary infection are major problems for LT recipients. The prevention of BSI and biliary complications is critical in improving prognosis in liver transplant recipients. PMID:24396633

  14. Reduction in Central Line-Associated Bloodstream Infection Rates After Implementations of Infection Control Measures at a Level 3 Neonatal Intensive Care Unit.

    PubMed

    Dumpa, Vikramaditya; Adler, Bonny; Allen, Delena; Bowman, Deborah; Gram, Amy; Ford, Pat; Sannoh, Sulaiman

    2014-11-01

    Advances in neonatology led to survival of micro-preemies, who need central lines. Central line-associated bloodstream infection (CLABSI) causes prolonged hospitalization, morbidities, and mortality. Health care team education decreases CLABSIs. The objective was to decrease CLABSIs using evidence-based measures. The retrospective review compared CLABSI incidence during and after changes in catheter care. In April 2011, intravenous (IV) tubing changed from Interlink to Clearlink; IV tubing changing interval increased from 24 to 72 hours. CLABSIs increased. The following measures were implemented: July 2011, reeducation of neonatal intensive care staff on Clearlink; August 2011, IV tubing changing interval returned to 24 hours; September 2011, changed from Clearlink back to Interlink; November 2011, review of entire IV process and in-service on hand hygiene; December 2011, competencies on IV access for all nurses. CLABSIs were compared during and after interventions. Means were compared using the t test and ratios using the ?(2) test; P <.05. CLABSIs decreased from 4.4/1000 to 0/1000 catheter-days; P < .05. Evidence-based interventions reduced CLABSIs. PMID:25372275

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

    Microsoft Academic Search

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

    2010-01-01

    ObjectiveTo formulate a model for translating manual infection control surveillance methods to automated, algorithmic approaches.DesignWe 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,

  16. Nosocomial outbreak of Sphingomonas paucimobilis bacteremia in a hemato/oncology unit.

    PubMed

    Kilic, Abdullah; Senses, Zeynep; Kurekci, A Emin; Aydogan, Hakan; Sener, Kenan; Kismet, Erol; Basustaoglu, A Celal

    2007-11-01

    Nosocomial Sphingomonas paucimobilis infections can arise from contaminated water and the contaminated hands of hospital staff. Within a 1-month period, we isolated six S. paucimobilis strains, including four from blood cultures of four patients and two from hospital environment specimens including tap water and a bathtub in a hemato/oncology unit. We described here these strains' molecular epidemiological analyses by pulsed-field gel electrophoresis (PFGE) and antibiotic susceptibilities by E-test. Although clinical and environmental isolates yielded three different antibiotic resistances and PFGE patterns, all four clinical strains had an identical pattern by both methods. Thus, the isolated clinical strain clone could be traced neither to health care workers nor to environmental samples. It was concluded that S. paucimobilis strains can cause outbreaks in hemato/oncology units. We did not demonstrate genetic relatedness between clinical and environmental isolates by PFGE, but did find PFGE a useful identification technique for epidemiological investigation. PMID:18032843

  17. Septic shock caused by Sphingomonas paucimobilis bacteremia in a patient with hematopoietic stem cell transplantation.

    PubMed

    Al-Anazi, K A; Abu Jafar, S; Al-Jasser, A M; Al-Shangeeti, A; Chaudri, N A; Al Jurf, M D; Al-Mohareb, F I

    2008-04-01

    Sphingomonas paucimobilis is an aerobic gram-negative bacillus that causes a variety of infections in healthy as well as in immunocompromised individuals. The organism is usually susceptible to tetracycline, chloramphenicol, aminoglycosides, trimethoprim-sulfamethoxazole, and carbapenems. However, resistance to penicillins and the first-generation cephalosporins is commonly encountered. Reported here is a patient with acute myeloid leukemia who developed S. paucimobilis bacteremia complicated by septic shock just before receiving an autologous hematopoietic stem cell transplant (SCT) at King Faisal Specialist Hospital and Research Centre in Riyadh. The septic episode was successfully treated in the intensive care unit. To our knowledge, this is the first case report of septic shock caused by S. paucimobilis bacteremia in a hematopoietic SCT recipient. PMID:17605729

  18. Diagnostic utility of LightCycler SeptiFast and procalcitonin assays in the diagnosis of bloodstream infection in immunocompromised patients.

    PubMed

    Mauro, M V; Cavalcanti, P; Perugini, D; Noto, A; Sperlì, D; Giraldi, C

    2012-08-01

    Sepsis is an increasingly prevalent cause of death, and management in the early stage is a critical issue. However, microbiological findings are generally obtained late during the course of the disease. In this study, we evaluated the clinical utility of procalcitonin (PCT) in improving the diagnosis of bloodstream infections and the potential utility of the SeptiFast (SF) test, a multiplex pathogen detection system, in the etiological diagnosis of immunocompromised patients. Seventy-nine hospitalized immunocompromised patients were included in this study. Our results demonstrate that while the PCT value correlates highly with sepsis, the results do not discriminate adequately enough to justify its independent use as a diagnostic tool. The SF test, combined with blood cultures, improves microbiological data in immunocompromised patients, especially in cases of previous antibiotic therapy and invasive fungal infection. PMID:22626731

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

    PubMed

    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

    2010-10-01

    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

  20. Implementation and performance of the BioFire FilmArray® Blood Culture Identification panel with antimicrobial treatment recommendations for bloodstream infections at a midwestern academic tertiary hospital.

    PubMed

    Southern, Timothy R; VanSchooneveld, Trevor C; Bannister, Dianna L; Brown, TeAnne L; Crismon, Amy S; Buss, Sarah N; Iwen, Peter C; Fey, Paul D

    2015-02-01

    The FilmArray® Blood Culture Identification (BCID) panel was recently implemented at a midwestern academic tertiary care hospital to provide rapid identification (ID) of common pathogens from positive blood cultures. This study evaluated the clinical performance of the BCID panel compared to culture-based ID methods. One hundred thirty-eight monomicrobial and 8 polymicrobial blood cultures were evaluated during the 30-day study resulting in the ID of 152 total organisms by culture with 115 organisms correctly identified using the BCID panel. The BCID panel had sensitivities of 80.4% (115/152) for all organisms identified during the study and 94.6% (115/122) when considering only on-panel organisms. BCID panel specificity was 100%. Implementation of the BCID panel was coupled with the development of empiric therapy recommendations for bloodstream infections by the antimicrobial stewardship team. Based on this study, the FilmArray® BCID panel is a rapid and reliable test for the detection of common bloodstream pathogens, and therapeutic decisions can be based upon panel results. PMID:25488272

  1. 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

    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

    2011-02-01

    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

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

    PubMed Central

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

    2009-01-01

    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. PMID:19403758

  3. 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

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

    2001-01-01

    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

  4. Correlation between vancomycin MIC values and those of other agents against gram-positive bacteria among patients with bloodstream infections caused by methicillin-resistant Staphylococcus aureus.

    PubMed

    Patel, N; Lubanski, P; Ferro, S; Bonafede, M; Harrington, S; Evans, A; Stellrecht, K; Lodise, T P

    2009-12-01

    An increase in the distribution of vancomycin MIC values among methicillin (meticillin)-resistant Staphylococcus aureus (MRSA) isolates has been noted. It is postulated that the shift in vancomycin MIC values may be associated with a concurrent rise in the MIC values of other anti-MRSA agents. Scant data are available on the correlation between vancomycin MIC values and the MIC values of other anti-MRSA agents. This study examined the correlation between vancomycin MIC values and the MIC values of daptomycin, linezolid, tigecycline, and teicoplanin among 120 patients with bloodstream infections caused by MRSA at a tertiary care hospital between January 2005 and May 2007. For each included patient, the MIC values of the antibiotics under study were determined by the Etest method and were separated into the following two categories: day 1 (index) and post-day 1 (subsequent). For subsequent isolates, the MIC values for each antibiotic from the post-day 1 terminal isolate were used. Among the index isolates, there was a significant correlation (P value, <0.01) between the MIC values for vancomycin and daptomycin and between the MIC values for vancomycin and teicoplanin. The MIC values for daptomycin were significantly correlated with linezolid, tigecycline, and teicoplanin MIC values. Among the 48 patients with subsequent isolates, vancomycin MIC values were significantly correlated with MIC values for daptomycin, linezolid, and teicoplanin (rho value of >or=0.38 for all comparisons). This study documented an association between vancomycin MIC values and the MIC values of other anti-MRSA antibiotics among patients with bloodstream infections caused by MRSA primarily treated with vancomycin. PMID:19805558

  5. Risk factors and treatment outcomes of bloodstream infection caused by extended-spectrum cephalosporin-resistant Enterobacter species in adults with cancer.

    PubMed

    Huh, Kyungmin; Kang, Cheol-In; Kim, Jungok; Cho, Sun Young; Ha, Young Eun; Joo, Eun-Jeong; Chung, Doo Ryeon; Lee, Nam Yong; Peck, Kyong Ran; Song, Jae-Hoon

    2014-02-01

    Treatment of Enterobacter infection is complicated due to its intrinsic resistance to cephalosporins. Medical records of 192 adults with cancer who had Enterobacter bacteremia were analyzed retrospectively to evaluate the risk factors for and the treatment outcomes in extended-spectrum cephalosporin (ESC)-resistant Enterobacter bacteremia in adults with cancer. The main outcome measure was 30-day mortality. Of the 192 patients, 53 (27.6%) had bloodstream infections caused by ESC-resistant Enterobacter species. Recent use of a third-generation cephalosporin, older age, tumor progression at last evaluation, recent surgery, and nosocomial acquisition were associated with ESC-resistant Enterobacter bacteremia. The 30-day mortality rate was significantly higher in the resistant group. Multivariate analysis showed that respiratory tract infection, tumor progression, septic shock at presentation, Enterobacter aerogenes as the culprit pathogen, and diabetes mellitus were independent risk factors for mortality. ESC resistance was significantly associated with mortality in patients with E. aerogenes bacteremia, although not in the overall patient population. PMID:24321352

  6. Production of an Attenuated Phenol-Soluble Modulin Variant Unique to the MRSA Clonal Complex 30 Increases Severity of Bloodstream Infection

    PubMed Central

    Cheung, Gordon Y. C.; Kretschmer, Dorothee; Duong, Anthony C.; Yeh, Anthony J.; Ho, Trung V.; Chen, Yan; Joo, Hwang-Soo; Kreiswirth, Barry N.; Peschel, Andreas; Otto, Michael

    2014-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of morbidity and death. Phenol-soluble modulins (PSMs) are recently-discovered toxins with a key impact on the development of Staphylococcus aureus infections. Allelic variants of PSMs and their potential impact on pathogen success during infection have not yet been described. Here we show that the clonal complex (CC) 30 lineage, a major cause of hospital-associated sepsis and hematogenous complications, expresses an allelic variant of the PSM?3 peptide. We found that this variant, PSM?3N22Y, is characteristic of CC30 strains and has significantly reduced cytolytic and pro-inflammatory potential. Notably, CC30 strains showed reduced cytolytic and chemotactic potential toward human neutrophils, and increased hematogenous seeding in a bacteremia model, compared to strains in which the genome was altered to express non-CC30 PSM?3. Our findings describe a molecular mechanism contributing to attenuated pro-inflammatory potential in a main MRSA lineage. They suggest that reduced pathogen recognition via PSMs allows the bacteria to evade elimination by innate host defenses during bloodstream infections. Furthermore, they underscore the role of point mutations in key S. aureus toxin genes in that adaptation and the pivotal importance PSMs have in defining key S. aureus immune evasion and virulence mechanisms. PMID:25144687

  7. Characteristics and Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Patients with Cancer Treated with Vancomycin: 9-Year Experience at a Comprehensive Cancer Center

    PubMed Central

    Mahajan, Sminil N.; Shah, Jharna N.; Hachem, Ray; Tverdek, Frank; Adachi, Javier A.; Mulanovich, Victor; Rolston, Kenneth V.; Raad, Issam I.

    2012-01-01

    Background. Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) can cause significant morbidity and mortality in patients with cancer. However, data on outcomes of patients treated with vancomycin are lacking. Methods. We identified 223 patients with cancer who developed MRSA BSIs between January 2001 and June 2009 and were treated with vancomycin. Treatment failure was defined as death within 60 days of infection, persistent bacteremia ?5 days, fever ?4 days, recurrence or relapse, and secondary MRSA infection. Results. The treatment failure rate was 52% (116 of 223 patients). These patients were more likely to have been hospitalized, been treated with steroids within the previous 3 months, developed acute respiratory distress syndrome, required mechanical ventilation, required intensive care unit care, and community-onset infections (all p < .05). Risk factors for MRSA-associated mortality (27 of 223 patients; 12%) included hematologic malignancy and hematopoietic stem cell transplantation, community-onset infection, secondary BSI, MRSA with minimum inhibitory concentration (MIC) ?2.0 ?g/mL, mechanical ventilation, and a late switch to an alternative therapy (?4 days after treatment failure; all p < .05). On multivariate analysis, mechanical ventilation and recent hospitalization were identified as independent predictors of vancomycin failure, and community-onset infection, secondary BSIs, and MIC ?2 ?g/mL were identified as significant predictors of MRSA-associated mortality. Conclusions. We found a high treatment failure rate for vancomycin in patients with cancer and MRSA BSIs, as well as a higher mortality. A vancomycin MIC ?2 ?g/mL was an independent predictor of MRSA-associated mortality. An early switch to an alternative therapy at the earliest sign of failure may improve outcome. PMID:22707509

  8. Taurolidine Lock Solutions for the Prevention of Catheter-Related Bloodstream Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Liu, Yong; Zhang, An-Qiang; Cao, Lin; Xia, Hong-Tao; Ma, Jun-Jie

    2013-01-01

    Background Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS) are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs. Methods We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity. Results Six randomized controlled trials (RCTs) conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21–0.55). Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G?) bacteria (P?=?0.004; RR, 0.27; CI, 0.11–0.65), and was associated with a non-significant decrease in gram-positive (G+) bacterial infections (P?=?0.07; RR, 0.41; CI, 0.15–1.09). No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75–5.28). Conclusions The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies of included studies. Therefore, additional well-designed and adequately powered RCTs are needed to confirm these findings. PMID:24278133

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

    PubMed

    Semelsberger, Carrie F

    2009-01-01

    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

  10. Fermentative production of gellan using Sphingomonas paucimobilis

    Microsoft Academic Search

    K. Madhavan Nampoothiri; Reeta Rani Singhania; C Sabarinath; Ashok Pandey

    2003-01-01

    The biopolymer gellan belongs to the family of microbial polysaccharides having a wide range of industrial applications. Attempts were made to produce gellan gum in submerged fermentation (SmF) using Sphingomonas paucimobilis ATCC 31461. Studies on the nutritional requirements for optimal exopolysaccharide production in a salt based synthetic medium revealed soluble starch (20 g\\/l) as the best carbon source and tryptone

  11. Detection of Catheter-Related Bloodstream Infections by the Differential-Time-to-Positivity Method and Gram Stain-Acridine Orange Leukocyte Cytospin Test in Neutropenic Patients after Hematopoietic Stem Cell Transplantation

    PubMed Central

    Krause, R.; Auner, H. W.; Gorkiewicz, G.; Wölfler, A.; Daxboeck, F.; Linkesch, W.; Krejs, G. J.; Wenisch, C.; Reisinger, E. C.

    2004-01-01

    For febrile neutropenic patients who received hematopoietic stem cell transplantation, the Gram stain-acridine orange leukocyte cytospin (AOLC) test and the differential-time-to-positivity method (DTP) were performed. As a diagnostic tool for catheter-related bloodstream infections in these patients, the Gram stain-AOLC test has a lower sensitivity than does the DTP method but acceptable positive and negative predictive values. PMID:15472355

  12. A survey of Preventive Measures Used and their Impact on Central Line-Associated Bloodstream Infections (CLABSI) in Intensive Care Units (SPIN-BACC)

    PubMed Central

    2013-01-01

    Background The Quebec central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) Surveillance Program saw a decrease in CLABSI rates in most ICUs. Given the surveillance trends observed in recent years, we aimed to determine what preventive measures have been implemented, if compliance to measures was monitored and its impact on CLABSI incidence rates. Methods All hospitals participating in the Quebec healthcare-associated infections surveillance program (SPIN-BACC – n?=?48) received a 77-question survey about preventive measures implemented and monitored in their ICU. The questionnaire was validated for construct, content, face validity, and reliability. We used Poisson regression to measure the association between compliance monitoring to preventive measures and CLABSI rates. Results Forty-two (88%) eligible hospitals completed the survey. Two components from the maximum barrier precautions were used less optimally: cap (88%) and full sterile body drape (71%). Preventive measures reported included daily review of catheter need (79%) and evaluation of insertion site for the presence of inflammation (90%). Two hospitals rewired lines even if an infection was suspected or documented. In adult ICUs, there was a statistically significant greater decrease in CLABSI rates in ICUs that monitored compliance to preventive insertion measures, after adjusting for teaching status and the number of hospital beds (p?=?0.036). Conclusions Hospitals participating to the SPIN-BACC program follow recommendations for CLABSI prevention, but only a minority locally monitor their application. Compliance monitoring of preventive measures for catheter insertion was associated with a decrease in CLABSI incidence rates. PMID:24289473

  13. Microbiology and Risk Factors for Central Line-Associated Bloodstream Infections among Pediatric Oncology Outpatients – a Single Institution Experience of 41 Cases

    PubMed Central

    Kelly, Matthew S.; Conway, Margaret; Wirth, Kathleen E.; Potter-Bynoe, Gail; Billett, Amy L.; Sandora, Thomas J.

    2013-01-01

    Background Risk factors for central line-associated bloodstream infections (CLABSI) among children with cancer in the outpatient setting remain poorly defined, and the microbiology may differ from hospital-onset CLABSI. Materials and Methods We conducted a matched case-control study of oncology patients followed at the Dana Farber/Children’s Hospital Cancer Center. Cases (N=41) were patients with CLABSI as per National Healthcare Safety Network criteria who had not been hospitalized in the preceding 48 hours. For each case we randomly selected two oncology outpatients with a central venous catheter and a clinic visit within 30 days of the case subject’s CLABSI. Multivariate conditional logistic regression models were used to identify independent risk factors for CLABSI. We compared the microbiology to that of 54 hospital-onset CLABSI occurring at our institution during the study period. Results Independent predictors of community-onset CLABSI included neutropenia in the prior week (odds ratio [OR] 17.46, 95% confidence interval [CI] 4.71-64.67) and tunneled externalized catheter (vs. implantable port; OR 10.30, 95% CI 2.42-43.95). Non-enteric Gram-negative bacteria were more frequently isolated from CLABSI occurring among outpatients. Discussion Pediatric oncology outpatients with recent neutropenia or tunneled externalized catheters are at increased risk of CLABSI. The microbiology of community-onset CLABSI differs from hospital-onset CLABSI. PMID:23412591

  14. Comparison of a silver-coated needleless connector and a standard needleless connector for the prevention of central line-associated bloodstream infections.

    PubMed

    Jacob, Jesse T; Chernetsky Tejedor, Sheri; Dent Reyes, Mary; Lu, Xin; Easley, Kirk A; Aurand, William L; Garrett, Gina; Graham, Kimberly; Holder, Carolyn; Robichaux, Chad; Steinberg, James P

    2015-03-01

    OBJECTIVE To assess the impact of a novel, silver-coated needleless connectors (NCs) on central-line-associated bloodstream infection (CLABSI) rates compared with a mechanically identical NCs without a silver coating. DESIGN Prospective longitudinal observation study SETTING Two 500-bed university hospitals PATIENTS All hospitalized adults from November 2009 to June 2011 with non-hemodialysis central lines INTERVENTIONS Hospital A started with silver-coated NCs and switched to standard NCs in September 2010; hospital B started with standard NCs and switched to silver-coated NCs. The primary outcome was the difference revealed by Poisson multivariate regression in CLABSI rate using standard Centers for Disease Control and Prevention surveillance definitions. The secondary outcome was a comparison of organism-specific CLABSI rates by NC type. RESULTS Among 15,845 hospital admissions, 140,186 central-line days and 221 CLABSIs were recorded during the study period. In a multivariate model, the CLABSI rate per 1,000 central-line days was lower with silver-coated NCs than with standard NCs (1.21 vs 1.79; incidence rate ratio=0.68 [95% CI: 0.52-0.89], P=.005). A lower CLABSI rate per 1,000 central-line days for the silver-coated NCs versus the standard NCs was observed with S. aureus (0.11 vs 0.30, P=.02), enterococci (0.10 vs 0.27, P=.03), and Gram-negative organisms (0.28 vs 0.63, P=.003) but not with coagulase-negative staphylococci (0.31 vs 0.36) or Candida spp. (0.42 vs 0.40). CONCLUSIONS The use of silver-coated NCs decreased the CLABSI rate by 32%. CLABSI reduction efforts should include efforts to minimize contamination of NCs. Infect Control Hosp Epidemiol 2014;00(0): 1-8. PMID:25695171

  15. Increased Anti-Flagellin and Anti-Lipopolysaccharide Immunoglobulins in Pediatric Intestinal Failure: Associations With Fever and Central Line-Associated Bloodstream Infections.

    PubMed

    Galloway, David P; Troutt, Misty L; Kocoshis, Samuel A; Gewirtz, Andrew T; Ziegler, Thomas R; Cole, Conrad R

    2014-06-01

    Background: Central line-associated bloodstream infections (CLABSIs) pose a significant challenge in the lives of patients with intestinal failure (IF). We hypothesized that plasma immunoglobulins against flagellin (FLiC) and lipopolysaccharide (LPS) would be able to differentiate CLABSIs from nonbacterial febrile episodes and that levels would increase with infection and decline following appropriate antibiotic treatment. Materials and Methods: Patients with IF, due to short bowel syndrome, between the ages of 3 months and 4 years of age, were recruited at Cincinnati Children's Hospital Medical Center. Anti-FLiC and anti-LPS plasma antibody levels were measured in 13 children with IF at baseline, during febrile events, and also following treatment with antibiotics. These were also measured in 11 healthy children without IF who were recruited as controls. Results: Plasma anti-FLiC IgA levels increased during febrile episodes in all patients with IF (baseline mean of 1.10 vs febrile episode mean of 1.32 optical density units, respectively; P = .046). Neither plasma anti-FLiC nor anti-LPS IgA or IgG levels distinguished CLABSI from nonbacterial febrile episodes compared with baseline levels. Compared with controls, patients with IF had significantly higher plasma levels of anti-FLiC and anti-LPS IgA at baseline. Conclusion: Plasma anti-FLiC IgA antibody levels rise during febrile episodes but do not differentiate between nonbacterial febrile illnesses and CLABSIs in pediatric IF. However, the upregulation of these antibodies in IF suggests the baseline systemic presence of Gram-negative bacterial products. PMID:24898211

  16. Prior statin use and 90-day mortality in Gram-negative and Gram-positive bloodstream infection: a prospective observational study.

    PubMed

    Mehl, A; Harthug, S; Lydersen, S; Paulsen, J; Åsvold, B O; Solligård, E; Damås, J K; Edna, T-H

    2015-03-01

    In several studies on patients with bloodstream infection (BSI), prior use of statins has been associated with improved survival. Gram-positive and Gram-negative bacteria alert the innate immune system in different ways. We, therefore, studied whether the relation between prior statin use and 90-day total mortality differed between Gram-positive and Gram-negative BSI. We conducted a prospective observational cohort study of 1,408 adults with BSI admitted to Levanger Hospital between January 1, 2002, and December 31, 2011. Data on the use of statins and other medications at admission, comorbidities, functional status, treatment, and outcome were obtained from the patients' hospital records. The relation of statin use with 90-day mortality differed between Gram-negative and Gram-positive BSI (p-value for interaction 0.01). Among patients with Gram-negative BSI, statin users had significantly lower 90-day total mortality [odds ratio (OR) 0.42, 95 % confidence interval (CI) 0.23-0.75, p?=?0.003]. The association remained essentially unchanged after adjusting for the effect of sex, age, functional status before the infection, and underlying diseases that were considered confounders (adjusted OR 0.38, 95 % CI 0.20-0.72, p?=?0.003). A similar analysis of patients with Gram-positive BSI showed no association of statin use with mortality (adjusted OR 1.22, 95 % CI 0.69-2.17, p?=?0.49). The present study suggests that prior statin use is associated with a lower 90-day total mortality in Gram-negative BSI, but not in Gram-positive BSI. PMID:25373530

  17. Bromhidrosis induced by sphingomonas paucimobilis: a case report.

    PubMed

    Mancini, M; Panasiti, V; Devirgiliis, V; Pietropaolo, V; Fioriti, D; Nicosia, R; Curzio, M; Roberti, V; Gobbi, S; Bottoni, U; Chiarini, F; Calvieri, S

    2009-01-01

    Bromhidrosis is a clinical disorder characterized by excessive or abnormal foul axillary odour due to the interaction of apocrine glands with micro-organisms which causes a serious personal and social handicap for affected people. We present the case of a 50-year-old caucasian female with bromhidrosis. The patient referred that this symptom had begun two months previously. Her past treatments included antibacterial soap, topical antibacterial agents and perfumes, but none of these relieved the patient of the odour. A cultural examination of axillary smear was carried out and it revealed the presence of ciprofloxacin sensible Sphingomonas paucimobilis. Therefore the patient was treated with ciprofloxacin and after 1 week the infection resolved completely. PMID:19822101

  18. Cadmium biosorption by Sphingomonas paucimobilis biomass

    Microsoft Academic Search

    J. Tangaromsuk; P. Pokethitiyook; M. Kruatrachue; E. S. Upatham

    2002-01-01

    Among microorganisms isolated in Bangkok, the gram-negative bacterium Sphingomonas paucimobilis exhibited the greatest cadmium tolerance. It was able to survive in the medium containing cadmium as high as 200 mg\\/l. However, concentrations of cadmium at 25–200 mg\\/l inhibited its growth. The biosorption properties for cadmium of this bacterial biomass and the effects of environmental factors (i.e., biosorbent type, initial pH

  19. Utility of Electronic Medical Records to Assess the Relationship Between Parenteral Nutrition and Central Line-Associated Bloodstream Infections in Adult Hospitalized Patients.

    PubMed

    Ippolito, Paul; Larson, Elaine L; Furuya, E Yoko; Liu, Jianfang; Seres, David S

    2014-06-01

    Background: Parenteral nutrition is associated with increased central line-associated bloodstream infections (CLABSIs). Electronic databases are important for identifying independent risk factors for prevention strategies. Our aims were to evaluate the utility of using electronic data sources to identify risk factors for CLABSIs, including parenteral nutrition (PN), and to assess the association between CLABSI and PN administration. Methods: Data were obtained for all discharges of adult patients in whom a central line was inserted between September 1, 2007, and December 31, 2008, in a large, academically affiliated hospital in New York City. CLABSI was defined electronically using a modified definition from the Centers for Disease Control and Prevention. A manual chart review was also undertaken to assess validity/reliability of the electronic database and gather additional information. Risk factors for CLABSI were examined using logistic regression. Results: Among 4840 patients, there were 220 CLABSIs, an incidence of 5.4 CLABSIs per 1000 central line days. Risk factors included PN (odds ratio [OR], 4.33; 95% confidence interval [CI], 2.50-7.48), intensive care unit stay (OR, 2.26; 95% CI, 1.58-3.23), renal disease (OR, 2.79; 95% CI, 2.00-3.88), and immunodeficiency (OR, 2.26; 95% CI, 1.70-3.00). Diabetes mellitus was associated with reduced CLABSI rates (OR, 0.63; 95% CI, 0.45-0.88). Conclusions: The utility of electronic medical records for determining risk factors is limited by such things as free-text data entry. Using a hybrid between fully electronic and manual chart review, reliable data were obtained. PN is associated with a high risk for CLABSI in a population highly selected for indications for PN. PMID:24898208

  20. Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: A Multicenter retrospective analysis

    PubMed Central

    Balkan, Ilker Inanc; Batirel, Ayse; Karabay, Oguz; Agalar, Canan; Akalin, Serife; Alici, Ozlem; Alp, Emine; Altay, Fatma Aybala; Altin, Nilgun; Arslan, Ferhat; Aslan, Turan; Bekiroglu, Nural; Cesur, Salih; Celik, Aygul Dogan; Dogan, Mustafa; Durdu, Bulent; Duygu, Fazilet; Engin, Aynur; Engin, Derya Ozturk; Gonen, Ibak; Guclu, Ertugrul; Guven, Tumer; Hatipoglu, Cigdem Ataman; Hosoglu, Salih; Karahocagil, Mustafa Kasim; Kilic, Aysegul Ulu; Ormen, Bahar; Ozdemir, Davut; Ozer, Serdar; Oztoprak, Nefise; Sezak, Nurbanu; Turhan, Vedat; Turker, Nesrin; Yilmaz, Hava

    2015-01-01

    Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A). Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18–89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9–297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

  1. Risk Factors for Early Onset of Catheter-Related Bloodstream Infection in an Intensive Care Unit in China: A Retrospective Study

    PubMed Central

    Tao, Fuzheng; Jiang, Ronglin; Chen, Yingzi; Chen, Renhui

    2015-01-01

    Background Catheter-related bloodstream infection (CRBSI) is a life-threatening condition encountered in patients with long-term central venous catheter (CVC) indwelling. The objective was to investigate the clinical characteristics, treatment, and prognosis of CRBSI in the intensive care unit (ICU) in a Chinese center, as well as the risk factors for early CRBSI. Material/Methods A total of 73 CRBSI patients were retrospectively studied in relation to patients’ clinical and epidemiological data, microbiological culture, and treatment. Patients were treated at the Taizhou Hospital of Integrated Traditional Chinese and Western Medicine in Zhejiang (Zhejiang Wenlin, China) between January 2010 and December 2012. Results In this Chinese center, the most common pathogens were Gram-positive cocci, followed by Gram-negative bacilli and fungi. A high prevalence of antibiotic-resistant pathogens was detected, and a higher percentage of non-Candida albicans spp. was observed. Multivariate analysis showed that an acute physiology and chronic health evaluation II (APACHE II) score >20 and >3 types of underlying diseases were independent factors associated with CRBSI occurring within 14 days of CVC indwelling. Untimely CVC removal and/or inappropriate use of antibiotics led to significantly longer time to defervescence and time to negative conversion of blood culture (all P<0.05). Conclusions In this Chinese center, Gram-positive bacteria are predominantly detected in CRBSI. APACHE II score >20 and the presence of >3 types of diseases were associated with earlier CRBSI onset. Timely removal of CVC and appropriate use of antibiotics resulted in improved outcomes. PMID:25695128

  2. Central Line–Associated Bloodstream Infection in Hospitalized Children with Peripherally Inserted Central Venous Catheters: Extending Risk Analyses Outside the Intensive Care Unit

    PubMed Central

    Advani, Sonali; Reich, Nicholas G.; Sengupta, Arnab; Gosey, Leslie

    2011-01-01

    Background. Increasingly, peripherally inserted central venous catheters (PICCs) are placed for prolonged intravenous access. Few data exist regarding risk factors for central line–associated bloodstream infection (CLABSI) complicating PICCs in hospitalized children, especially children hospitalized outside the intensive care unit (ICU). Methods.?We identified all children with a PICC inserted at The Johns Hopkins Hospital (Baltimore, MD) from 1 January 2003 through 31 December 2009 and used Poisson regression models to identify risk factors for PICC-associated CLABSIs. Results.?A total of 2592 PICCs were placed in 1819 children. One hundred sixteen CLABSIs occurred over 44,972 catheter-days (incidence rate [IR], 2.58 cases per 1000 catheter-days; 95% confidence interval [CI], 2.07–3.00 cases per 1000 catheter-days). Independent predictors of CLABSI in the entire cohort included PICC dwell time of ?21 days (IR ratio [IRR], 1.53; 95% CI, 1.05–2.26), parenteral nutrition as indication for insertion (IRR, 2.24; 95% CI, 1.31–3.84), prior PICC-associated CLABSI (IRR, 2.48; 95% CI, 1.18–5.25), underlying metabolic condition (IRR, 2.07; 95% CI, 1.14–3.74), and pediatric ICU exposure during hospitalization (IRR, 1.80; 95% CI, 1.18–2.75). Risk factors for CLABSI in children without PICU exposure included younger age, underlying malignancy and metabolic conditions, PICCs inserted in the lower extremity, and a prior PICC-associated CLABSI. Conclusions.?Prolonged catheter dwell time, pediatric ICU exposure, and administration of parenteral nutrition as the indication for PICC insertion are important predictors of PICC-associated CLABSI in hospitalized children. A careful assessment of these risk factors may be important for future success in preventing CLABSIs in hospitalized children with PICCs. PMID:21454298

  3. Performance evaluation of the Verigene® (Nanosphere) and FilmArray® (BioFire®) molecular assays for identification of causative organisms in bacterial bloodstream infections.

    PubMed

    Ward, C; Stocker, K; Begum, J; Wade, P; Ebrahimsa, U; Goldenberg, S D

    2015-03-01

    Molecular assays designed to provide bacterial identification and detection of resistance genes directly from positive blood cultures can significantly reduce the time to definitive results. This has the potential to improve patient management and antimicrobial stewardship. However, the extent of such an impact is yet to be fully assessed. We tested two such assays, the Verigene® System Bloodstream Infection Tests (Nanosphere, Inc., Northbrook, IL, USA) (both Gram-positive and Gram-negative cartridges) and the FilmArray® Blood Culture Identification Panel (BioFire® Diagnostics, Inc., Salt Lake City, UT, USA). We compared their accuracy and speed of organism and resistance gene identification to conventional culture-based methods for 173 positive blood cultures. We also retrospectively determined, for organisms deemed not to be contaminants, the potential impact on antimicrobial prescribing. Both the Verigene® and FilmArray® assays accurately identified organisms, on average, 27.95 and 29.17 h earlier than conventional methods, respectively. There were a significant number of false-positives for Pseudomonas aeruginosa with the FilmArray® assay, which may have been related to contamination of the bioMérieux BacT standard anaerobic blood culture bottles, which the manufacturer has acknowledged. Both panels provided results significantly faster than conventional methods. In our setting, the extent of the potential positive impact on antimicrobial prescribing was modest (9 out of 173 samples). However, this may be an underestimation, since probable contaminants were not included in this analysis. In conclusion, both panels gave accurate results with significantly improved turnaround times. PMID:25311986

  4. Klebsiella variicola Is a Frequent Cause of Bloodstream Infection in the Stockholm Area, and Associated with Higher Mortality Compared to K. pneumoniae

    PubMed Central

    Kabir, Muhammad Humaun; Bakhrouf, Amina; Kalin, Mats; Nauclér, Pontus; Brisse, Sylvain; Giske, Christian G.

    2014-01-01

    Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n?=?139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n?=?96), KpII (corresponding to K. quasipneumoniae, n?=?9) and KpIII (corresponding to K. variicola, n?=?34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P?=?0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10–8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n?=?1), had a mucoid phenotype (n?=?1) and/or contained virulence genes (wcaG n?=?1 and wcaG/allS n?=?1). In conclusion, the results indicate higher mortality among patients infected with isolates belonging to K. variicola. The increased mortality could not be related to any known virulence factors, including virulent capsular types or mucoid phenotype. PMID:25426853

  5. Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure

    PubMed Central

    Carmeli, Yehuda; Perencevich, Eli; Tuite, Ashleigh R.; Mermel, Leonard A.

    2014-01-01

    Objective Infections due to Gram-negative bacteria exhibit seasonal trends, with peak infection rates during warmer months. We hypothesized that the likelihood of a bloodstream infection due to Gram-negative bacteria increases with proximity to the equator. We tested this hypothesis and identified geographical, climatic and social factors associated with this variability. Design We established a network of 23 international centers in 22 cities. Setting: De-identified results of positive blood cultures from 2007–2011 and data sources for geographic, climatic and socioeconomic factors were assembled for each center. Participants Patients at the 23 centers with positive blood cultures. Main outcome Due to variability in the availability of total culture volumes across sites, our primary outcome measure was the fraction of positive blood cultures that yielded Gram-negative bacteria; sources of variability in this outcome measure were explored using meta-regression techniques. Results The mean fraction of bacteremia associated with Gram-negative bacteria was 48.4% (range 26.4% to 61.8%). Although not all sites displayed significant seasonality, the overall P-value for seasonal oscillation was significant (P<0.001). In univariate meta-regression models, temperature, latitude, latitude squared, longitude, per capita gross domestic product and percent of gross domestic product spent on healthcare were all associated with the fraction of bacteremia due to Gram-negative bacteria. In multivariable models, only percent of gross domestic product spent on healthcare and distance from the equator (ie. latitude squared) were significantly associated with the fraction of bacteremia due to Gram-negative bacteria. Conclusions The likelihood of bacteremia due to Gram-negative bacteria varies markedly between cities, in a manner that appears to have both geographic (latitude) and socioeconomic (proportion gross domestic product devoted to health spending) determinants. Thus, the optimal approach to initial management of suspected bacteremia may be geographically specific. The rapid emergence of highly antibiotic-resistant Gram-negative pathogens may have geographically specific impacts. PMID:25521300

  6. Coagulase-negative staphylococcal bloodstream and prosthetic-device-associated infections: the role of biofilm formation and distribution of adhesin and toxin genes.

    PubMed

    Giormezis, Nikolaos; Kolonitsiou, Fevronia; Foka, Antigoni; Drougka, Eleanna; Liakopoulos, Apostolos; Makri, Antonia; Papanastasiou, Anastasios D; Vogiatzi, Aliki; Dimitriou, Gabriel; Marangos, Markos; Christofidou, Myrto; Anastassiou, Evangelos D; Petinaki, Efthimia; Spiliopoulou, Iris

    2014-11-01

    Coagulase-negative staphylococci (CNS), especially Staphylococcus epidermidis and Staphylococcus haemolyticus, have emerged as opportunistic pathogens in immunocompromised patients and those with indwelling medical devices. In this study, CNS recovered from patients with bloodstream infections (BSIs) or prosthetic-device-associated infections (PDAIs) were compared in terms of biofilm formation, antimicrobial resistance, clonal distribution, and carriage of adhesin and toxin genes. A total of 226 CNS isolates (168 S. epidermidis and 58 S. haemolyticus) recovered from hospital inpatients with BSIs (100 isolates) or PDAIs (126 isolates) were tested for biofilm formation, antimicrobial susceptibility, and mecA, ica operon, adhesin (aap, bap, fnbA, atlE, fbe) and toxin (tst, sea, sec) genes. The selected CNS were classified into pulsotypes by PFGE and assigned to sequence types by multilocus sequence typing. In total, 106/226 isolates (46.9%) produced biofilm, whereas 150 (66.4%) carried the ica operon. Most isolates carried mecA and were multidrug resistant (90.7%). CNS recovered from BSIs were significantly more likely to produce biofilm (P=0.003), be resistant to antimicrobials and carry mecA (P<0.001), as compared with isolates derived from PDAIs. CNS from PDAIs were more likely to carry the aap and bap genes (P=0.006 and P=0.045, respectively). No significant differences in the carriage of toxin genes were identified (P>0.05). Although PFGE revealed genetic diversity, especially among S. epidermidis, analysis of representative strains from the main PFGE types by multilocus sequence typing revealed three major clones (ST2, ST5 and ST16). A clonal relationship was found with respect to antimicrobial susceptibility and ica and aap gene carriage, reinforcing the premise of clonal expansion in hospital settings. The results of this study suggest that the pathogenesis of BSIs is associated with biofilm formation and high-level antimicrobial resistance, whereas PDAIs are related to the adhesion capabilities of S. epidermidis and S. haemolyticus strains. PMID:25082946

  7. Late-onset bloodstream infections of Very-Low-Birth-Weight infants: data from the Polish Neonatology Surveillance Network in 2009–2011

    PubMed Central

    2014-01-01

    Background Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011. Methods The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS. Results Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%). Conclusions Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio. PMID:24939563

  8. Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: A four-year surveillance

    PubMed Central

    Ting, Joseph Y; Goh, Vicki SK; Osiovich, Horacio

    2013-01-01

    BACKGROUND: The use of central venous catheters has permitted lifesaving treatment for critically ill neonates; however, the attributable mortality rate for central line-associated bloodstream infections (CLABSIs) has been estimated to be between 4% and 20%. In 2006/2007, the authors’ neonatal intensive care unit (NICU) had a CLABSI rate that was nearly twofold higher than that reported by other Canadian NICUs. OBJECTIVE: To implement a quality improvement collaborative to reduce the incidence of neonatal CLABSI. METHODS: A retrospective observational study was performed to compare CLABSI in neonates admitted to the authors’ level III NICU between August 2007 and March 2011. The entire study period was divided into four time periods to evaluate secular trends. A comprehensive catheter-related bloodstream infection prevention initiative was implemented in August 2007. The initiatives included staff education, standardization of skin preparation protocol, introduction of new antiseptic agents, implementation of central catheter insertion and maintenance checklists, reinforcement of the use of maximal sterile barrier precautions, and revision of the central catheter configuration and maintenance protocols. RESULTS: The median CLABSI rate of 7.9 per 1000 catheter days at the beginning of the study (period 1 [August 2007 to June 2008]) gradually decreased over the entire study period (P=0.034): period 2 (July 2008 to May 2009), 3.3 per 1000 catheter days; period 3 (June 2009 to April 2010), 2.6 per 1000 catheter days; and period 4 (May 2010 to March 2011), 2.2 per 1000 catheter days. CONCLUSION: A multidisciplinary evidence-based quality improvement collaborative resulted in a significant reduction in the CLABSI rate. Continuous quality improvement measures are required to reduce catheter-related bloodstream infections among low-birth-weight infants. PMID:24489559

  9. Evaluation of the MALDI-TOF VITEK MS™ system for the identification of Candida parapsilosis, C. orthopsilosis and C. metapsilosis from bloodstream infections.

    PubMed

    Nobrega de Almeida Júnior, João; de Souza, Letícia Bonato; Motta, Adriana Lopes; Rossi, Flávia; Romano Di Gioia, Thais Sabato; Benard, Gil; Del Negro, Gilda Maria Barbaro

    2014-10-01

    Twenty-nine Candida parapsilosis, seventeen Candida orthopsilosis and two Candida metapsilosis bloodstream isolates were submitted for identification by VITEK-MS™ mass spectrometer. Four isolates, two C. orthopsilosis and two C. metapsilosis, were not identified. Inclusion of Superspectra of both species in this database is required to improve its discrimination power. PMID:25072839

  10. 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...

  11. Comparison of fluorescence in situ hybridisation using peptide nucleic acid probes, Gram stain/acridine orange leukocyte cytospin and differential time to positivity methods for detection of catheter-related bloodstream infection in patients after haematopoietic stem cell transplantation.

    PubMed

    Krause, R; Salzer, H F; Hönigl, M; Valentin, T; Auner, H W; Zollner-Schwetz, I

    2010-10-01

    In 46 febrile neutropenic patients who had undergone haematopoietic stem cell transplantation, the fluorescence in situ hybridisation using peptide nucleic acid probes (PNA FISH), Gram stain/acridine orange leukocyte cytospin (Gram/AOLC), and differential time to positivity (DTP) methods were performed for detection of catheter-related bloodstream infections (CRBSIs). As compared with the DTP method (which detected 11 patients with CRBSI), the PNA FISH and the Gram/AOLC methods detected ten of 11 CRBSI patients, resulting in a sensitivity, specificity, negative predictive value and positive predictive value of 91%, 100%, 97% and 100%, respectively, for the PNA FISH method as well as for the Gram/AOLC method. PMID:20041887

  12. The role of exopolymers in the attachment of sphingomonas paucimobilis

    Microsoft Academic Search

    J. Azeredo; R. Oliveira

    2000-01-01

    The importance of exopolymers in the adhesion of Sphingomonas paucimobilis was established by studying the attachment to glass of three mutants with defective gellan production. The attachment assays were performed in either phosphate buffered saline (controls) or in the exopolymeric solutions produced by the mutants. The exopolymer was found to have surface active properties, changing the glass surface from hydrophilic

  13. In vitro cultivation of bloodstream forms of Trypanosoma brucei, T. rhodesiense, and T. gambiense.

    PubMed

    Brun, R; Jenni, L; Schönenberger, M; Schell, K F

    1981-11-01

    A series of new in vitro systems for the cultivation of bloodstream forms of Trypanosoma (Trypanozoon) brucei brucei, T. (T.) b. rhodesiense, and T. (T.) b. gambiense was developed. The standard system consists of a feeder layer of fibroblast-like cells derived from embryos of New Zealand White rabbits (REF( or a mountain vole, Microtus montanus (MEF), with HEPES-buffered Minimum Essential Medium (MEM), with Earle's salts, supplemented with 15% inactivated rabbit serum. These two and other feeder layers were cross-checked with different sera to test for growth support of bloodstream forms of the three trypanosome subspecies studied. Cultures could be initiated with bloodstream forms from mammalian hosts or from cryopreserved stabilates. Metacyclic forms from infected Glossina m. morsitans could also be sued as inoculum; they transformed within 6 h to bloodstream forms. Maintenance of cultures and growth properties are described in detail. Experiments were undertaken to confirm that the cultivated bloodstream forms still possess some fo the characteristic features of pleomorphic bloodstream populations. Cultivated bloodstream forms were always infective for mice, and a surface coat could be demonstrated by electron microscopy. They could also be cyclically transmitted through tsetse flies, and the metacyclic forms from these flies could be brought back into culture. In vitro cloning with single bloodstream forms and metacyclic forms could be achieve with high cloning efficiency. The consumption of glucose and the production of pyruvate and lactate were determined. PMID:7320948

  14. Continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in a child: a rare case of peritonitis caused by sphingomonous paucimobilis.

    PubMed

    Tambawala, Arwa Quresh; Hamid, Sadaf; Khan, Iqtidar; Ali, Asad

    2011-02-01

    First identified in 1977, Sphingomonous Paucimobilis has emerged as an opportunistic human pathogen. It is primarily known to cause a range of mostly nosocomial, non-life-threatening infections that typically are easily treated by antibiotic therapy. Sources of its isolation linked to clinical disease include blood, spinal fluid and leg ulcers. It has also been reported as a rare cause of peritonitis in patients on continuous ambulatory peritoneal dialysis. We present a case of a child with peritonitis due to this organism. Clinical features, bacteriology and treatment option and response have been discussed. PMID:21375172

  15. Enhanced Degradation of Hexachlorocyclohexane Isomers by Sphingomonas paucimobilis

    Microsoft Academic Search

    Atuk K. Johri; Meenakshi Dua; D. M. Saxena; N. Sethunathan

    2000-01-01

    Hexachlorocyclohexane (HCH) has been banned for use in technologically advanced countries; however, it is still in use in\\u000a tropical countries like India. Earlier we reported the degradation of HCH isomers by Sphingomonas paucimobilis within 12 days of incubation. Here we report the role of different factors that could enhance the degradation rate of HCH\\u000a isomers. We found that an increase

  16. Degradation of Aromatic Hydrocarbons by Sphingomonas paucimobilis Strain EPA505

    Microsoft Academic Search

    S. P. Story; E. L. Kline; T. A. Hughes; M. B. Riley; S. S. Hayasaka

    2004-01-01

    To determine the substrate range capability of Sphingomonas paucimobilis strain EPA505, a number of aromatic compounds were tested as potential growth substrates. Strain EPA505 grew on phenanthrene, naphthalene, fluoranthene, toluene, benzoic acid, 2,3- and 3,4-dihydroxybenzoic acids, 1-chloro-2,4-dinitrobenzene, anthracene, 2-hydroxy-3-naphthoic acid and 1-hydroxy- 2-naphthoic acid, salicylic acid, and catechol. Strain EPA505 was unable to grow on coumarine 3-carboxylic acid, naphthalene dicarboxylic

  17. Emulsifying property of a viscous exopolysaccharide from Sphingomonas paucimobilis

    Microsoft Academic Search

    A. A. Ashtaputre; A. K. Shah

    1995-01-01

    A viscous exopolysaccharide fromSphingomonas paucimobilis-GS1, emulsified xylene, benzene, 2-methylnaphthalene, hexadecane, hexane, kerosene and paraffin oil as well as castor, coconut and olive oils when used at 1 mg\\/ml. It stabilized the emulsions more efficiently than commercial gums such as arabic, tragacanth, karaya and xanthan. Emulsions were stable for 6 months, from 4 to 40°C and pH 4 to 10 and

  18. Biodegradation of triphenylmethane dye Malachite Green by Sphingomonas paucimobilis

    Microsoft Academic Search

    Lamia Ayed; Kamel Chaieb; Abdelkarim Cheref; Amina Bakhrouf

    2009-01-01

    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

  19. Effect of metallo-?-lactamase production and multidrug resistance on clinical outcomes in patients with Pseudomonas aeruginosa bloodstream infection: a retrospective cohort study

    PubMed Central

    2013-01-01

    Background Blood stream infections (BSI) with Pseudomonas aeruginosa lead to poor clinical outcomes. The worldwide emergence and spread of metallo-?-lactamase (MBL) producing, often multidrug-resistant organisms may further aggravate this problem. Our study aimed to investigate the effect of MBL-producing P. aeruginosa (MBL-PA) and various other resistance phenotypes on clinical outcomes. Methods A retrospective cohort study was conducted in three German hospitals. Medical files from 2006 until 2012 were studied, and a number of 113 patients with P. aeruginosa BSI were included. The presence of VIM, IMP and NDM genes was detected using molecular techniques. Genetic relatedness was assessed through multilocus sequence typing (MLST). The effect of resistance patterns or MBL production on clinical outcomes was investigated by using multivariate Cox regression models. Results In-hospital mortality was significantly higher in patients with MBL-PA and multidrug-resistant P. aeruginosa. However, neither BSI with MBL-PA nor BSI with various resistance phenotypes of P. aeruginosa were independently associated with mortality or length of hospital stay. In multivariate models, the SAPS II score (HR 1.046), appropriate definitive treatment (HR range 0.25-0.26), and cardiovascular disease (HR range 0.44-0.46) were independent predictors of mortality. Concomitant infections were associated with an excess length of stay (HR?infection remains the key for improving clinical outcomes in patients with P. aeruginosa BSI and should be combined with a strict implementation of routine infection control measures. PMID:24176052

  20. Impact of conversion from an open ward design paediatric intensive care unit environment to all isolated rooms environment on incidence of bloodstream infections and antibiotic resistance in Southern Israel (2000 to 2008).

    PubMed

    Lazar, I; Abukaf, H; Sofer, S; Peled, N; Leibovitz, E

    2015-01-01

    We studied the epidemiology, microbiology, clinical aspects and outcome of bloodstream infections (BSI) in a tertiary paediatric intensive care unit. All BSI episodes were prospectively identified and analysed. The paediatric intensive care unit moved in 2006 from an open-plan unit to a new (all single room) unit. Three hundred and fifty-three BSI episodes occurred in 299 of 4162 patients. Overall, BSI incidence was 85 per 1000 hospitalised children. Fewer BSI episodes occurred during the last two years of the study (2007 to 2008), compared with 2000 to 2006 (70 of 1061 admissions, 6.5% versus 283 of 3101 admissions, 9.1%, respectively, P=0.01). There were 127 of 340 (37.4%) community-acquired and 213 of 340 (62.6%) nosocomial BSI episodes (31 of 1000 and 51 of 1000, respectively). Nosocomial BSI episodes decreased during 2007 to 2008 versus 2000 to 2006 (37.7% versus 55.8%, P=0.03). In 448 instances, pathogens were isolated, 231 (52%) Gram-positive and 188 (42%) Gram-negative. Coagulase-negative Staphylococci, S. pneumoniae and S. aureus (41.1%, 19.9% and 11.7%, respectively) were the most common Gram-positive and Enterobacteriaceae spp. the most frequent Gram-negative organisms (45.2%, of them Klebsiella spp. and E. coli 40% and 29.4%, respectively). A significant decrease was recorded during 2007 to 2008 in Enterobacteriaceae resistance to piperacillin, gentamicin and ciprofloxacin. Thirty of 299 (10%, 9 with S. pneumoniae-BSI) patients died. A significant decrease in BSI and nosocomial incidence and Enterobacteriaceae spp. antibiotic resistance was recorded following the conversion of the paediatric intensive care unit from an open ward to an all isolated rooms environment. PMID:25579287

  1. Risk factors for mortality in patients with bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa: clinical impact of bacterial virulence and strains on outcome.

    PubMed

    Jeong, Su Jin; Yoon, Sang Sun; Bae, Il Kwon; Jeong, Seok Hoon; Kim, June Myung; Lee, Kyungwon

    2014-10-01

    The incidence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) bacteremia has increased in recent years, and infections caused by CRPA result in higher mortality than those caused by susceptible strains. This study was performed to evaluate the risk factors for mortality and to study the impact of virulence factors and bacterial strains on clinical outcomes in patients with CRPA bacteremia. Data on 63 episodes of CRPA bacteremia that have occurred between January 1, 2007, and December 31, 2009, in a teaching hospital (2000 beds) in Seoul, Korea, were analyzed. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score at the time of CRPA bacteremia and the capacity of CRPA to form biofilm were independent predictive factors for mortality in patients with CRPA bacteremia. In addition, the biofilm-forming ability and elastase activity of strains were correlated with APACHE II scores to measure the severity of disease and estimate predicted mortality in the patients. PMID:25112900

  2. Development of trigger-based semi-automated surveillance of ventilator-associated pneumonia and central line-associated bloodstream infections in a Dutch intensive care

    PubMed Central

    2014-01-01

    Background Availability of a patient data management system (PDMS) has created the opportunity to develop trigger-based electronic surveillance systems (ESSs). The aim was to evaluate a semi-automated trigger-based ESS for the detection of ventilator-associated pneumonia (VAP) and central line-associated blood stream infections (CLABSIs) in the intensive care. Methods Prospective comparison of surveillance was based on a semi-automated ESS with and without trigger. Components of the VAP/CLABSI definition served as triggers. These included the use of VAP/CLABSI-related antibiotics, the presence of mechanical ventilation or an intravenous central line, and the presence of specific clinical symptoms. Triggers were automatically fired by the PDMS. Chest X-rays and microbiology culture results were checked only on patient days with a positive trigger signal from the ESS. In traditional screening, no triggers were used; therefore, chest X-rays and culture results had to be screened for all patient days of all included patients. Patients with pneumonia at admission were excluded. Results A total of 553 patients were screened for VAP and CLABSI. The incidence of VAP was 3.3/1,000 ventilation days (13 VAP/3,927 mechanical ventilation days), and the incidence of CLABSI was 1.7/1,000 central line days (24 CLABSI/13.887 central line days). For VAP, the trigger-based screening had a sensitivity of 92.3%, a specificity of 100%, and a negative predictive value of 99.8% compared to traditional screening of all patients. For CLABSI, sensitivity was 91.3%, specificity 100%, and negative predictive value 99.6%. Conclusions Pre-selection of patients to be checked for signs and symptoms of VAP and CLABSI by a computer-generated automated trigger system was time saving but slightly less accurate than conventional surveillance. However, this after-the-fact surveillance was mainly designed as a quality indicator over time rather than for precise determination of infection rates. Therefore, surveillance of VAP and CLABSI with a trigger-based ESS is feasible and effective. PMID:25646148

  3. Uncommon opportunistic yeast bloodstream infections from Qatar.

    PubMed

    Taj-Aldeen, Saad J; AbdulWahab, Atqah; Kolecka, Anna; Deshmukh, Anand; Meis, Jacques F; Boekhout, Teun

    2014-07-01

    Eleven uncommon yeast species that are associated with high mortality rates irrespective of antifungal therapy were isolated from 17/187 (201 episodes) pediatric and elderly patients with fungemia from Qatar. The samples were taken over a 6-year period (January 2004-December 2010). Isolated species included Kluyveromyces marxianus, Lodderomyces elongisporus, Lindnera fabianii, Candida dubliniensis, Meyerozyma guilliermondii, Candida intermedia, Pichia kudriavzevii, Yarrowia lipolytica, Clavispora lusitaniae, Candida pararugosa, and Wickerhamomyces anomalus. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry provided correct identifications compared with molecular analysis testing of the same isolates. Low minimal inhibitory concentrations were found when isavuconazole and voriconazole were used for all uncommon yeast species evaluated in this study. Resistance to antifungal drugs was low and remained restricted to a few species. PMID:24934803

  4. Tracheal colonization with Sphingomonas paucimobilis in mechanically ventilated neonates due to contaminated ventilator temperature probes

    Microsoft Academic Search

    D. Lemaitre; A. Elaichouni; M. Hundhausen; G. Claeys; P. Vanhaesebrouck; M. Vaneechoutte; G. Verschraegen

    1996-01-01

    Sphingomonas paucimobilis was isolated from tracheal secretions of a total of 85 mechanically ventilated babies in a neonatal intensive-care unit (NICU) during a two-year-period. None of the neonates developed pneumonia or sepsis. After each increase in the fluctuating number of S. paucimobilis isolates, extra attention was paid to hand hygiene and to the maintenance of the ventilation equipment. This resulted

  5. Stable transformation of pleomorphic bloodstream form Trypanosoma brucei.

    PubMed

    MacGregor, Paula; Rojas, Federico; Dean, Samuel; Matthews, Keith R

    2013-08-01

    African trypanosomes differentiate between various developmental stages both in mammalian hosts and their tsetse vector to adapt to and survive in the different environments they encounter. In the bloodstream, trypanosomes naturally exist as either proliferative slender-forms or non-proliferative stumpy-forms, the latter being responsible for both prolonged infection and transmission. However, most trypanosome studies are carried out on laboratory-adapted monomorphic cell lines, incapable of differentiating to stumpy-forms or completing the life cycle through the tsetse fly. Partly, this has been due to the inefficiency of transfection of pleomorphic strains which have retained the ability to generate stumpy-forms. Recently, Amaxa Nucleofector® technology was shown to increase transfection efficiency for monomorphic bloodstream forms. Using this technology we have optimised a similar method for pleomorphic bloodstream form transfection, generating transfection efficiencies of 10(-7)-10(-6). This permits routine genetic manipulation of pleomorphic lines, which have the most biological relevance for trypanosomes in the field. PMID:23835071

  6. The Draft Genome Sequence of Sphingomonas paucimobilis Strain HER1398 (Proteobacteria), Host to the Giant PAU Phage, Indicates That It Is a Member of the Genus Sphingobacterium (Bacteroidetes).

    PubMed

    White, Richard Allen; Suttle, Curtis A

    2013-01-01

    The draft genome sequence of Sphingomonas paucimobilis host index number (HER) 1398, host of the giant PAU phage isolated from silk moths (Bombyx mori), indicates that this isolate belongs within the genus Sphingobacterium. We suggest that Sphingomonas paucimobilis strain HER1398 be reclassified as Sphingobacterium paucimobilis strain HER1398. PMID:23929486

  7. The effect of agitation and aeration on the synthesis and molecular weight of gellan in batch cultures of Sphingomonas paucimobilis

    Microsoft Academic Search

    Ioannis Giavasis; Linda M. Harvey; Brian McNeil

    2006-01-01

    The effects of agitation and aeration upon synthesis and molecular weight of the biopolymer gellan were systematically investigated in batch fermenter cultures of the bacterium, Sphingomonas paucimobilis. High aeration rates and vigorous agitation enhanced growth of S. paucimobilis. Although gellan formation occurred mainly in parallel with cell growth, the increase in cells able to synthesise gellan did not always lead

  8. Recurrent Sphingomonas paucimobilis bacteraemia associated with a multi-bacterial water-borne epidemic among neutropenic patients

    Microsoft Academic Search

    O. Perola; T. Nousiainen; S. Suomalainen; S. Aukee; U.-M. Kärkkäinen; J. Kauppinen; T. Ojanen; M.-L. Katila

    2002-01-01

    A cluster of septicaemias due to several water-related species occurred in a haematological unit of a university hospital. In recurrent septicaemias of a leukaemic patient caused by Sphingomonas paucimobilis, genotyping of the blood isolates by use of random amplified polymorphic DNA-analysis verified the presence of two distinct S. paucimobilis strains during two of the separate episodes. A strain of S.

  9. Recurrent Sphingomonas paucimobilis -bacteraemia associated with a multi-bacterial water-borne epidemic among neutropenic patients.

    PubMed

    Perola, O; Nousiainen, T; Suomalainen, S; Aukee, S; Kärkkäinen, U-M; Kauppinen, J; Ojanen, T; Katila, M-L

    2002-03-01

    A cluster of septicaemias due to several water-related species occurred in a haematological unit of a university hospital. In recurrent septicaemias of a leukaemic patient caused by Sphingomonas paucimobilis, genotyping of the blood isolates by use of random amplified polymorphic DNA-analysis verified the presence of two distinct S. paucimobilis strains during two of the separate episodes. A strain of S. paucimobilis identical to one of the patient's was isolated from tap water collected in the haematological unit. Thus S. paucimobilis present in blood cultures was directly linked to bacterial colonization of the hospital water system. Heterogeneous finger-printing patterns among the clinical and environmental isolates indicated the distribution of a variety of S. paucimobilis clones in the hospital environment. This link also explained the multi-microbial nature of the outbreak. PMID:11886195

  10. Chlorhexidine Gluconate Cleansing in Preventing Central Line Associated Bloodstream Infection and Acquisition of Multi-drug Resistant Organisms in Younger Patients With Cancer or Undergoing Donor Stem Cell Transplant

    ClinicalTrials.gov

    2014-12-03

    Bacterial Infection; Benign Neoplasm; Malignant Neoplasm; Methicillin-Resistant Staphylococcus Aureus Infection; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Untreated Childhood Myeloid Neoplasm

  11. The Role of Exopolymers Produced by Sphingomonas paucimobilis in Biofilm Formation and Composition

    Microsoft Academic Search

    Joana Azeredo; Rosário Oliveira

    2000-01-01

    Exopolymers have been associated with the initial adhesion of bacteria, which is the primary step for biofilm formation. Moreover, the polymeric matrix of biofilms has a considerable influence on some of the most important physical and physiological properties of biofilms. The role of extracellular polymers in biofilm formation was studied using three mutants of Sphingomonas paucimobilis with increasing capabilities for

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

    Microsoft Academic Search

    Pia A. Willumsen; Erik Arvin

    1999-01-01

    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

  13. Biosynthesis and properties of an extracellular metalloprotease from the Antarctic marine bacterium Sphingomonas paucimobilis

    Microsoft Academic Search

    Marianna Turkiewicz; Ewa Gromek; Halina Kalinowska; Maria Zieli?ska

    1999-01-01

    An extracellular protease from the marine bacterium Sphingomonas paucimobilis, strain 116, isolated from the stomach of Antarctic krill, Euphausia superba Dana, was purified and characterized. The excretion of protease was maximal at temperatures from 5 to 10°C, i.e. below the temperature optimum for the strain growth (15°C). The highly purified enzyme was a metalloprotease [sensivity to ethylenediaminetetraacetic acid (EDTA)] and

  14. Degradation of alpha, beta, gamma and delta-hexachlorocyclohexanes by Sphingomonas paucimobilis

    Microsoft Academic Search

    Atul K. Johri; Meenakshi Dua; Dipika Tuteja; Renu Saxena; D. M. Saxena; Rup Lal

    1998-01-01

    Sphingomonas paucimobilis degrades aerobically a, ß, ? and d-hexachlorocyclohexane. With a-HCH, complete degradation occurred after 3 days but with ß and ?, and with d-HCH, 98 and 56 % degradation occurred after 12 and 8 days of incubation, respectively. Pentachlorocyclohexene was formed as the primary metabolite during the degradation of all the HCH isomers. © Rapid Science Ltd. 1998

  15. The production of gellan exopolysaccharide with Sphingomonas paucimobilis E2 (DSM 6314)

    Microsoft Academic Search

    D. Lobas; S. Schumpe; W.-D. Deckwer

    1992-01-01

    A new screening technique was used to isolate the bacterium Sphingomonas paucimobilis E2 (DSM 6314), which produces the exopolysaccharide gellan. The productivity was found to be about four times higher than that of the industrially used strain Auromonas elodea (ATCC 31461) it was isolated from. The polysaccharide formation was found to be predominantly growth-related.

  16. Structural studies of the exocellular polysaccharide from Sphingomonas paucimobilis strain I-886

    Microsoft Academic Search

    Camilla Falk; Per-Erik Jansson; Marguerite Rinaudo; Alain Heyraud; Göran Widmalm; Prakash Hebbar

    1996-01-01

    The exocellular polysaccharide from Sphingomonas paucimobilis strain 1-886 has been studied using methylation analysis, Smith degradation, partial acid hydrolysis, NMR spectroscopy, and mass spectrometry as the principal methods. It is concluded that the repeating unit has the following structure: The absolute configuration of the uronic acid was deduced from 1H NMR chemical shifts and is most likely d. Some preparations

  17. Thrush and Other Candida Infections

    MedlinePLUS

    ... Thrush and Other Candida Infections Article Body The fungus Candida is normally found on and in the ... candidiasis), which sometimes can become chronic. If the fungus enters the bloodstream, the infection can spread to ...

  18. Types of Healthcare-Associated Infections

    MedlinePLUS

    ... may also occur at surgery sites, known as surgical site infections. CDC works to monitor and prevent these infections because they are an important threat to patient safety. Types of HAIs Central line-associated bloodstream infection ( ...

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

    Microsoft Academic Search

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

    1998-01-01

    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).

  20. Group B Strep Infection

    MedlinePLUS

    ... Overview What is group B strep? Group B streptococcus, or group B strep for short, is a ... can develop an infection of the lungs (called pneumonia), bloodstream (called sepsis), or the fluid around the ...

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

    Microsoft Academic Search

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

    2002-01-01

    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

  2. Production of gellan gum by Sphingomonas paucimobilis NK2000 with soybean pomace

    Microsoft Academic Search

    Hyuck Jin; Nam-Kyu Lee; Myung-Kyo Shin; Sung-Koo Kim; David L Kaplan; Jin-Woo Lee

    2003-01-01

    The ammonium nitrate as a nitrogen source for the production of gellan gum by Sphingomonas paucimobilis NK2000 enhanced the cell growth but its depletion was essential for higher production of gellan gum. The highest production of gellan gum was 3.27gl?1 when the concentrations of glucose and bacto-peptone were 2.0% (w\\/v) and 0.05% (w\\/v). The production of gellan gum by S.

  3. Catalytic Mechanism of the Haloalkane Dehalogenase LinB from Sphingomonas paucimobilis UT26

    Microsoft Academic Search

    Ji?í Damborský; Dick B. Janssen; Yuji Nagata; Martin Klva?a; Radka Chaloupková; Marta Monincová; Zbyn?k Prokop

    2003-01-01

    Haloalkane dehalogenases are bacterial enzymes capable of carbon-halogen bond cleavage in halogenated compounds. To obtain insights into the mechanism of the haloalkane dehalogenase from Sphingomonas paucimobilis UT26 (LinB), we studied the steady-state and presteady-state kinetics of the conversion of the substrates 1-chlorohexane, chlorocyclohexane, and bromocyclohexane. The results lead to a proposal of a minimal kinetic mechanism consisting of three main

  4. Periplasmically located ?-santonin binding factor in Sphingomonas paucimobilis strain S ATCC 43388.

    PubMed

    Raj, M Shailaja; Furtado, I; Mavinkurve, S

    2007-12-01

    A marked reduction in uptake of ?-santonin, accompanied by loss of ability of cells to transform the substrate, is observed on shocking Sphingomonas paucimobilis strain S ATCC 43388 cells by freeze - thaw method. The shock fluid shows a 26% quench in fluorescence at 350nm on incubation with the substrate. Addition of shock fluid to the freeze thawed cells restores both uptake as well as transformation of ?-santonin to near normal. PMID:23100690

  5. The biosynthesis of the exopolysaccharide gellan results in the decrease of Sphingomonas paucimobilis tolerance to copper

    Microsoft Academic Search

    João A. Richau; Denis Choquenet; Arsénio M. Fialho; Leonilde M. Moreira; Isabel Sá-Correia

    1997-01-01

    Although it is generally accepted that extracellular anionic polysaccharide-producing bacteria are more tolerant to toxic cations than the nonproducing strains, the gellan-producing Sphingomonas paucimobilis R40 was definitively less tolerant to sublethal concentrations of copper (Cu2+) than the nonproducing variant RP10. This nonmucoid strain was spontaneously obtained during the cultivation of mucoid R40. The two variants exhibited indistinguishable genome fingerprints with

  6. Identification of the catalytic triad in the haloalkane dehalogenase from Sphingomonas paucimobilis UT26

    Microsoft Academic Search

    Kamila Hynková; Yuji Nagata; Masamichi Takagi; Ji??? Damborský

    1999-01-01

    The haloalkane dehalogenase from Sphingomonas paucimobilis UT26 (LinB) is the enzyme involved in the ?-hexachlorocyclohexane degradation. This enzyme hydrolyses a broad range of halogenated aliphatic compounds via an alkyl-enzyme intermediate. LinB is believed to belong to the family of ?\\/?-hydrolases which employ a catalytic triad, i.e. nucleophile-histidine-acid, during the catalytic reaction. The position of the catalytic triad within the sequence

  7. Isolation and characterization of phenanthrene-degrading Sphingomonas paucimobilis strain ZX4

    Microsoft Academic Search

    Ying Xia; Hang Min; Gang Rao; Zhen-mei Lv; Ji Liu; Yang-fang Ye; Xue-jun Duan

    2005-01-01

    Phenanthrene-degrading bacterium strain ZX4 was isolated from an oil-contaminated soil, and identified as Sphingomonas paucimobilis based on 16S rDNA sequence, cellular fatty acid composition, mol% G + C and Biolog-GN tests. Besides phenanthrene, strain ZX4 could also utilize naphthalene, fluorene and other aromatic compounds. The growth on salicylic acid and catechol showed that the strain degraded phenanthrene via salicylate pathway,

  8. Characterization of Sphingomonas paucimobilis SYK-6 genes involved in degradation of lignin-related compounds

    Microsoft Academic Search

    E Masai; Y Katayama; S Nishikawa; M Fukuda

    1999-01-01

    Sphingomonas paucimobilis   SYK-6 is able to grow on a wide variety of dimeric lignin compounds. These compounds are degraded via vanillate and syringate\\u000a by a unique enzymatic system, composed of etherases, O demethylases, ring cleavage oxygenases and side chain cleaving enzymes.\\u000a These unique and specific lignin modification enzymes are thought to be powerful tools for utilization of the most abundant

  9. Biodegradation kinetics of select polycyclic aromatic hydrocarbon (PAH) mixtures by Sphingomonas paucimobilis EPA505

    Microsoft Academic Search

    Anuradha M. Desai; Robin L. Autenrieth; Petros Dimitriou-Christidis; Thomas J. McDonald

    2008-01-01

    Many contaminated sites commonly have complex mixtures of polycyclic aromatic hydrocarbons (PAHs) whose individual microbial\\u000a biodegradation may be altered in mixtures. Biodegradation kinetics for fluorene, naphthalene, 1,5-dimethylnaphthalene and\\u000a 1-methylfluorene were evaluated in sole substrate, binary and ternary systems using Sphingomonas paucimobilis EPA505. The first order rate constants for fluorene, naphthalene, 1,5-dimethylnaphthalene, and 1-methylfluorene were comparable;\\u000a yet Monod parameters were significantly

  10. Biodegradation of dibenzothiophene and 4,6-dimethyldibenzothiophene by Sphingomonas paucimobilis strain TZS-7

    Microsoft Academic Search

    Jie Lu; Toshiaki Nakajima-Kambe; Toshiya Shigeno; Akiko Ohbo; Nobuhiko Nomura; Tadaatsu Nakahara

    1999-01-01

    Strain TZS-7, tentatively identified as Sphingomonas paucimobilis, was isolated from crude oil for its ability to degrade dibenzothiophene (DBT) and 4,6-dimethyldibenzothiophene (4,6-dmDBT). This strain did not utilize DBT or 4,6-dmDBT as the sole source of sulfur. However, the degradative activity was induced by various aromatic compounds, including DBT, fluorene, anthracene, naphthalene and toluene. Three products formed from 4,6-dmDBT degradation were

  11. Metabolism of 18?-glycyrrhetinic acid in Sphingomonas paucimobilis strain G5

    Microsoft Academic Search

    Keishiro Yoshida; Kazuo Furihata; Hisakazu Yamane; Toshio Omori

    2001-01-01

    Seven strains capable of utilizing 18ß-glycyrrhetinic acid (18ß-GRA) as a sole carbon and energy source were isolated from soil samples by enrichment culture technique. One of these strains, named strain G5, was identified as Sphingomonas paucimobilis. When this strain grew on 18ß-GRA, several metabolites were detected in the culture broth. A major metabolite, tentatively named M-A, was isolated and its

  12. Studies on the Exopolysaccharide from Sphingomonas paucimobilis GS1: Nutritional requirements and precursor-forming enzymes

    Microsoft Academic Search

    Anita A. Ashtaputre; Avinash K. Shah

    1995-01-01

    Studies on the nutritional requirements for optimal exopolysaccharide (EPS) production by Sphingomonas paucimobilis-GS1, in a synthetic medium revealed sucrose (40 g\\/L) and glutamate (0.5 g\\/L) or KNO3 (1 g\\/L) to be the most suitable carbon and nitrogen sources, respectively. Ammonium salts were unfavorable to EPS accumulation, and inorganic phosphate above 10 mM affected the polymer quality. Specific activities of the

  13. Postpartum fever in the presence of a fibroid: Sphingomonas paucimobilis sepsis associated with pyomyoma

    PubMed Central

    2013-01-01

    Background Pyomyoma is a life-threatening complication of uterine leiomyoma. It may occur in post- menopausal women, during pregnancy and in the postpartum period. Fever may be the only manifestation during the early stages of the disease. We detail the first reported case of postpartum pyomyoma-related sepsis due to Sphingomonas paucimobilis, a Gram-negative bacillus that is gaining recognition as an important human pathogen. Case presentation A woman presented with an asymptomatic uterine fibroid and a two-week history of fever during the postpartum period. Suppurative uterine leiomyoma was diagnosed, and blood cultures grew Sphingomonas paucimobilis. The myoma was surgically removed from the uterus without hysterectomy. Intravenous antimicrobial therapy was given for fifteen days, and the patient was discharged from hospital in good condition. Conclusion Pyomyoma should be considered in broad differential diagnosis of postpartum fever. This case highlights a unique disease manifestation of S. paucimobilis, an emerging opportunistic pathogen with increasing significance in the nosocomial setting. PMID:24308831

  14. 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

    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

    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

  15. Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Bloodstream Isolates in Urban Detroit?

    PubMed Central

    Chua, Thea; Moore, Carol L.; Perri, Mary B.; Donabedian, Susan M.; Masch, William; Vager, Dora; Davis, Susan L.; Lulek, Kaitlin; Zimnicki, Benjamin; Zervos, Marcus J.

    2008-01-01

    To gain a better understanding of epidemiology of resistance in Staphylococcus aureus, we describe the molecular epidemiology of methicillin-resistant Staphylococcus aureus bloodstream isolates in urban Detroit. Bloodstream isolates from July 2005 to February 2007 were characterized. Two hundred ten bloodstream isolates from 201 patients were evaluated. Patient characteristics were as follows: median age, 54 years; 56% male; and 71% African-American. Seventy-six percent of infections were health care associated, with 55% being community-onset infections and 21% hospital acquired, and 24% were community associated. The most common sources were skin/wound (25%), central venous catheters (24%), unknown source (20%), and endocarditis (9%). Ninety percent and 5% of isolates had a MIC of vancomycin of ?1.0 mg/liter, using automated dilution testing and E-test, respectively. Six percent of isolates showed heteroresistance to vancomycin, all occurring with isolates having a vancomycin E-test MIC of ?1.5 mg/liter. Results of pulsed-field gel electrophoresis showed 17 strain types. The predominant strains were USA100 (104 isolates) and USA300 (74 isolates). Forty-nine percent of the isolates had staphylococcal cassette chromosome mec II, and 56% had agr II. All USA300 isolates were positive for the Panton-Valentine leukocidin toxin genes and agr I. Forty-seven percent of USA300 bloodstream infections were health care associated (35% community onset and 12% hospital onset). USA300 strains were more common in injection drug users with skin/wound as the predominant source of infection. Thirty percent of the USA100 strains were closely related to vancomycin-resistant Staphylococcus aureus isolates. The results of this study show that vancomycin MICs using automated dilution testing with Vitek-2 and E-test were highly discordant. Most methicillin-resistant S. aureus strains causing bacteremia are health care associated, commonly have MICs of vancomycin that are high within the susceptible range are not detected by routine automated dilution testing, and have significant diversity of molecular characteristics. USA100 strains that are closely related to vancomycin-resistant S. aureus (VRSA) isolates and USA300 strains are common as causes of both hospital and community-onset infection. Infection control measures should focus not only on prevention of the spread of community strains in the hospital but also prevention of the spread of hospital strains associated with VRSA into the community. PMID:18508934

  16. Candida dubliniensis: An Appraisal of Its Clinical Significance as a Bloodstream Pathogen

    PubMed Central

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

    2012-01-01

    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

  17. Small Colony Variants of Staphylococcus aureus and Pacemaker-related Infection

    PubMed Central

    Wisplinghoff, Hilmar; Schnabel, Petra; von Eiff, Christof

    2003-01-01

    We describe the first known case of a device-related bloodstream infection caused by Staphylococcus aureus small colony variants. Recurrent pacemaker-related bloodstream infection within a 7-month period illustrates the poor clinical and microbiologic response to prolonged antimicrobial therapy in a patient infected with this S. aureus subpopulation. PMID:14609471

  18. Complete analysis of genes and enzymes for ?-hexachlorocyclohexane degradation in Sphingomonas paucimobilis UT26

    Microsoft Academic Search

    Y Nagata; K Miyauchi; M Takagi

    1999-01-01

      ?-Hexachlorocyclohexane (?-HCH; also called BHC or lindane) is one of the highly chlorinated pesticides which can cause serious\\u000a environmental problems. Sphingomonas paucimobilis UT26 degrades ?-HCH under aerobic conditions. The unique degradation pathway of ?-HCH in UT26 is revealed. In the upstream\\u000a pathway, ?-HCH is transformed to 2,5-dichlorohydroquinone (2,5-DCHQ) by two different dehalogenases (LinA and LinB) and one\\u000a dehydrogenase (LinC) which

  19. Hospital-acquired infections.

    PubMed

    Lobdell, Kevin W; Stamou, Sotiris; Sanchez, Juan A

    2012-02-01

    Health-acquired infection (HAI) is defined as a localized or systemic condition resulting from an adverse reaction to the presence of infectious agents or its toxins. This article focuses on HAIs that are well studied, common, and costly (direct, indirect, and intangible). The HAIs reviewed are catheter-related bloodstream infection, ventilator-associated pneumonia, surgical site infection, and catheter-associated urinary tract infection. This article excludes discussion of Clostridium difficile infections and vancomycin-resistant Enterococcus. PMID:22269261

  20. Optimization of nutrients for gellan gum production by Sphingomonas paucimobilis ATCC31461 in molasses based medium using response surface methodology

    Microsoft Academic Search

    R. M. Banik; A. Santhiagu; S. N. Upadhyay

    2007-01-01

    A molasses based medium for the production of gellan by Sphingomonas paucimobilis ATCC-31461 was developed. Placket–Burman design criterion was applied to study the effect of various nutrient supplements on gellan production using molasses. Among the 20 variables tested, molasses, tryptone, casaminoacid, disodium hydrogen orthophosphate and manganese chloride showed significant effect on gellan production. A central composite design was applied to

  1. Identification and Characterization of Genes Involved in the Downstream Degradation Pathway of  Hexachlorocyclohexane in Sphingomonas paucimobilis UT26

    Microsoft Academic Search

    Ryo Endo; Mayuko Kamakura; Keisuke Miyauchi; Masao Fukuda; Yoshiyuki Ohtsubo; Masataka Tsuda; Yuji Nagata

    2005-01-01

    Sphingomonas paucimobilis UT26 utilizes -hexachlorocyclohexane (-HCH) as a sole source of carbon and energy. In our previous study, we cloned and characterized genes that are involved in the conversion of -HCH to maleylacetate (MA) via chlorohydroquinone (CHQ) in UT26. In this study, we identified and characterized an MA reductase gene, designated linF, that is essential for the utilization of -HCH

  2. Study of the degradation activity and the strategies to promote the bioavailability of phenanthrene by Sphingomonas paucimobilis strain 20006FA.

    PubMed

    Coppotelli, Bibiana M; Ibarrolaza, Agustin; Dias, Romina L; Del Panno, Maria T; Berthe-Corti, Luise; Morelli, Irma S

    2010-02-01

    The present study describes the phenanthrene-degrading activity of Sphingomonas paucimobilis 20006FA and its ability to promote the bioavailability of phenanthrene. S. paucimobilis 20006FA was isolated from a phenanthrene-contaminated soil microcosm. The strain was able to grow in liquid mineral medium saturated with phenanthrene as the sole carbon source, showing high phenanthrene elimination (52.9% of the supplied phenanthrene within 20 days). The accumulation of 1-hydroxy-2-naphthoic acid and salicylic acid as major phenanthrene metabolites and the capacity of the strain to grow with sodium salicylate as the sole source of carbon and energy indicated that the S. paucimobilis 20006FA possesses a complete phenanthrene degradation pathway. However, under the studied conditions, the strain was able to mineralize only the 10% of the consumed phenanthrene. Investigations on the cell ability to promote bioavailability of phenanthrene showed that the S. paucimobilis strain 20006FA exhibited low cell hydrophobicity (0.13), a pronounced chemotaxis toward phenanthrene, and it was able to reduce the surface tension of mineral liquid medium supplemented with phenanthrene as sole carbon source. Scanning electron micrographs revealed that: (1) in suspension cultures, cells formed flocks and showed small vesicles on the cell surface and (2) cells were also able to adhere to phenanthrene crystals and to produce biofilms. Clearly, the strain seems to exhibit two different mechanisms to enhance phenanthrene bioavailability: biosurfactant production and adhesion to the phenanthrene crystals. PMID:19609598

  3. Optimization of culture medium compositions for gellan gum production by a halobacterium Sphingomonas paucimobilis.

    PubMed

    Zhang, Jun; Dong, Ya-chen; Fan, Lin-lin; Jiao, Zhi-hua; Chen, Qi-he

    2015-01-22

    The effect of culture medium compositions on gellan gum production produced by fermentation with a halobacterium Sphingomonas paucimobilis QHZJUJW CGMCC2428 was studied. In this work, a fractional factorial design was applied to investigate the main factors that affected gellan gum production by S. paucimobilis QHZJUJW CGMCC2428. Sucrose was the best carbon source for gellan gum and peptone displayed better inducing effect. Central composite design and response surface methodology were adopted to derive a statistical model for optimizing submerged culture medium composition. These experimental results showed that the optimum culture medium for producing gellan gum was composed of 40.00 (w/v) sucrose, 3.00% peptone (w/v), MgSO4 (w/v), 9.20% KH2PO4 (w/v), 7.50% Na2HPO4 (w/v), 4.30% K2SO4 (w/v), pH 6.8-7.0. The maximal gellan gum was 19.89±0.68 g/L, which was agreed closely with the predicated value (20.12 g/L). After incubated for 72 h under the optimized culture medium in 5-L bioreactor, the gellan gum fermentation reached about 19.90±0.68 g/L, which was higher than that in the initial cultivation medium. PMID:25439950

  4. A new strategy to enhance gellan production by two-stage culture in Sphingomonas paucimobilis.

    PubMed

    Zhu, Guilan; Sheng, Long; Tong, Qunyi

    2013-10-15

    The effects of different initial sucrose concentrations and temperatures on gellan biosynthesis by Sphingomonas paucimobilis ATCC 31461 were investigated. Lower sucrose concentrations and higher temperatures were favorable for cell growth. Higher sucrose concentrations and lower temperatures promoted gellan production but retarded cell growth. Based on these results, a two-stage culture strategy was developed to improve gellan production. During the first 24 h, S. paucimobilis was cultured in a pulse fed-batch mode with an initial sucrose concentration 10 g/L. Ten grams per liter of sucrose were added at 12 h and 24 h, and the temperature was controlled at 33 °C. Batch culture was performed, and the temperature was reduced to 28 °C to achieve a high gellan accumulation. The two-stage culture strategy achieved the highest gellan production (22.61 g/L) at 60 h that was 35.71% higher than the result of the best conventional batch operation (16.66 g/L). Meanwhile, high gellan yield was related to high UDPG-pyrophosphorylase activity and glucosyltransferase activity. PMID:23987418

  5. Biosynthesis and characterisation of silver nanoparticles using Sphingomonas paucimobilis sp. BDS1.

    PubMed

    Gou, Yujun; Zhang, Feng; Zhu, Xiaoyan; Li, Xiangqian

    2015-04-01

    Sphingomonas is a novel and abundant microbial resource for biodegradation of aromatic compounds. It has great potential in environment protection and industrial production. The use of microorganisms for the synthesis of nanoparticles is in the limelight of modern nanotechnology, since it is cost effective, non-toxic and friendly to the ever-overwhelmed environment. In this paper, the biosynthesis of silver nanoparticles (AgNPs) using Sphingomonas paucimobilis sp. BDS1 under ambient conditions was investigated for the first time. Biosynthesised AgNPs were characterised with powder ultraviolet-visible spectroscopy, X-ray diffraction, Fourier transform infrared spectroscopy (FTIR), field emission scanning electron microscopy and energy dispersive X-ray spectroscopy. The overall results revealed that well-dispersed face centred cubic spherical AgNPs in the range of 50-80 nm were produced on the surface of Sphingomonas paucimobilis sp. BDS1, after challenging pure wet biomass with silver nitrate solution. This suggests that the capture of silver ions may be a complex process of physical and chemical adsorption and the proteins on the surface of the bacteria may play the role of reduction and stabilising agent with regard to the result of FTIR. PMID:25829169

  6. Water: the bloodstream of the biosphere.

    PubMed Central

    Ripl, Wilhelm

    2003-01-01

    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. PMID:14728789

  7. First Report of Bloodstream Infection Caused by Pseudomonas fulva? †

    PubMed Central

    Seok, Yoonmi; Shin, Heebong; Lee, Yangsoon; Cho, Injoo; Na, Sungwon; Yong, Dongeun; Jeong, Seok Hoon; Lee, Kyungwon

    2010-01-01

    Pseudomonas fulva has not yet been isolated from humans as a pathogen. Herein, we report the first case of P. fulva bacteremia in a patient hospitalized due to trauma. The species was identified using biochemical and molecular genetic analyses of the 16S rRNA, gyrB, rpoB, and rpoD genes. PMID:20444972

  8. First report of bloodstream infection caused by Pseudomonas fulva.

    PubMed

    Seok, Yoonmi; Shin, Heebong; Lee, Yangsoon; Cho, Injoo; Na, Sungwon; Yong, Dongeun; Jeong, Seok Hoon; Lee, Kyungwon

    2010-07-01

    Pseudomonas fulva has not yet been isolated from humans as a pathogen. Herein, we report the first case of P. fulva bacteremia in a patient hospitalized due to trauma. The species was identified using biochemical and molecular genetic analyses of the 16S rRNA, gyrB, rpoB, and rpoD genes. PMID:20444972

  9. Effects of surfactants on fluoranthene mineralization by Sphingomonas paucimobilis strain EPA 505

    SciTech Connect

    Lantz, S.; Mueller, J.G. [SBP Technologies, Inc., Gulf Breeze, FL (United States); Lin, J.E. [Sybron Chemicals, Inc., Salem, VA (United States). Biochemical and Environmental Services; Pritchard, P.H. [Environmental Protection Agency, Gulf Breeze, FL (United States)

    1995-12-31

    Past results from surfactant-enriched biodegradation studies have been equivocal because of inhibitory effects of the surfactants and a poor understanding of the characteristics of PAH-degrading microorganisms that make them responsive to surfactants. The authors have studied the mineralization of {sup 14}C-radiolabeled fluoranthene by high cell masses of Sphingomonas paucimobilis, strain EPA 505, and have shown that initial rates of mineralization can be enhanced by concentrations of the surfactant Triton X-100 as high as 2%. Mass balances are reported that show complete degradation of fluoranthene. The presence of soil stimulated biodegradation of fluoranthene in the same manner as surfactants, presumably because of increased dissolution rates from soil particulates. The usefulness of this bacterium in the bioremediation of PAH-contaminated soil is discussed.

  10. Accessory Gene Regulator (agr) Dysfunction in Staphylococcus aureus Bloodstream Isolates from South Korean Patients

    PubMed Central

    Chong, Yong Pil; Kim, Eun Sil; Park, Su-Jin; Park, Ki-Ho; Kim, Tark; Kim, Mi-Na; Kim, Sung-Han; Lee, Sang-Oh; Choi, Sang-Ho; Woo, Jun Hee

    2013-01-01

    We describe the genetic and microbiological characteristics of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates with agr dysfunction from a tertiary-care hospital in Korea. Of these, ST5-SCCmec type II-agr group II MRSA isolates, which are known to be prevalent in hospital-acquired infections in Korea, were the most abundant, because of the clonal spread of a specific agr-defective lineage. This finding suggests that the loss of agr function may confer a potential advantage in a hospital setting. Clonal spread of a specific defective-agr strain was not observed among community-associated MRSA or methicillin-susceptible S. aureus clones, regardless of community or hospital acquisition of infection. agr-defective clones, including ST5 and ST239 MRSA, were enriched for heteroresistant vancomycin-intermediate S. aureus. PMID:23254438

  11. Biodegradation kinetics of select polycyclic aromatic hydrocarbon (PAH) mixtures by Sphingomonas paucimobilis EPA505.

    PubMed

    Desai, Anuradha M; Autenrieth, Robin L; Dimitriou-Christidis, Petros; McDonald, Thomas J

    2008-04-01

    Many contaminated sites commonly have complex mixtures of polycyclic aromatic hydrocarbons (PAHs) whose individual microbial biodegradation may be altered in mixtures. Biodegradation kinetics for fluorene, naphthalene, 1,5-dimethylnaphthalene and 1-methylfluorene were evaluated in sole substrate, binary and ternary systems using Sphingomonas paucimobilis EPA505. The first order rate constants for fluorene, naphthalene, 1,5-dimethylnaphthalene, and 1-methylfluorene were comparable; yet Monod parameters were significantly different for the tested PAHs. S. paucimobilis completely degraded all the components in binary and ternary mixtures; however, the initial degradation rates of individual components decreased in the presence of competitive PAHs. Results from the mixture experiments indicate competitive interactions, demonstrated mathematically. The generated model appropriately predicted the biodegradation kinetics in mixtures using parameter estimates from the sole substrate experiments, validating the hypothesis of a common rate-determining step. Biodegradation kinetics in mixtures were affected by the affinity coefficients of the co-occurring PAHs and mixture composition. Experiments with equal concentrations of substrates demonstrated the effect of concentration on competitive inhibition. Ternary experiments with naphthalene, 1,5-dimethylnaphthalene and 1-methylfluorene revealed delayed degradation, where depletion of naphthalene and 1,5-dimethylnapthalene occurred rapidly only after the complete removal of 1-methylfluorene. The substrate interactions observed in mixtures require a multisubstrate model to account for simultaneous degradation of substrates. PAH contaminated sites are far more complex than even ternary mixtures; however these studies clearly demonstrate the effect that interactions can have on individual chemical kinetics. Consequently, predicting natural or enhanced degradation of PAHs cannot be based on single compound kinetics as this assumption would likely overestimate the rate of disappearance. PMID:17534722

  12. Clonal relationships among bloodstream isolates of Escherichia coli.

    PubMed Central

    Maslow, J N; Whittam, T S; Gilks, C F; Wilson, R A; Mulligan, M E; Adams, K S; Arbeit, R D

    1995-01-01

    The clonal relationships among 187 bloodstream isolates of Escherichia coli from 179 patients at Boston, Mass., Long Beach, Calif., and Nairobi, Kenya, were determined by multilocus enzyme electrophoresis (MLEE), analysis of polymorphisms associated with the ribosomal operon (ribotyping), and serotyping. MLEE based on 20 enzymes resolved 101 electrophoretic types (ETs), forming five clusters; ribotyping resolved 56 distinct patterns concordant with the analysis by MLEE. The isolates at each study site formed a genetically diverse group and demonstrated similar clonal structures, with the same small subset of lineages accounting for the majority of isolates at each site. Moreover, two ribotypes accounted for approximately 30% of the isolates at each study site. One cluster contained the majority (65%) of isolates and, by direct comparison of the ETs and ribotypes of individual isolates, was genetically indistinguishable from the largest cluster for each of two other collections of E. coli causing pyelonephritis and neonatal meningitis (R. K. Selander, T. K. Korhonen, V. Väisänen-Rhen, P. H. Williams, P. E. Pattison, and D. A. Caugent, Infect. Immun. 52:213-222, 1986; M. Arthur, C. E. Johnson, R. H. Rubin, R. D. Arbeit, C. Campanelli, C. Kim, S. Steinbach, M. Agarwal, R. Wilkinson, and R. Goldstein, Infect. Immun. 57:303-313, 1989), thus defining a virulent set of lineages. The isolates within these virulent lineages typically carried DNA homologous to the adhesin operon pap or sfa and the hemolysin operon hly and expressed O1, O2, O4, O6, O18, O25, or O75 antigens. DNA homologous to pap was distributed among isolates of each major cluster, whereas hly was restricted to isolates of two clusters, typically detected in pap-positive strains, and sfa was restricted to isolates of one cluster, typically detected in pap- and hly-positive strains. The occurrence of pap-positive isolates in the same geographically and genetically divergent lineages suggests that this operon was acquired early in the radiation of E. coli, while hly and sfa were acquired subsequently, most likely by pap-positive and pap- and hly-positive precursors, respectively. PMID:7790051

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

    PubMed Central

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

    2013-01-01

    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. PMID:23505454

  14. A Novel Tetrahydrofolate-Dependent O-Demethylase Gene Is Essential for Growth of Sphingomonas paucimobilis SYK-6 with Syringate

    Microsoft Academic Search

    Eiji Masai; Miyuki Sasaki; Yasunori Minakawa; Tomokuni Abe; Tomonori Sonoki; Keisuke Miyauchi; Yoshihiro Katayama; Masao Fukuda

    2004-01-01

    Sphingomonas paucimobilis SYK-6 degrades syringate to 3-O-methylgallate (3MGA), which is finally con- verted to pyruvate and oxaloacetate via multiple pathways in which protocatechuate 4,5-dioxygenase, 3MGA dioxygenase, and gallate dioxygenase are involved. Here we isolated the syringate O-demethylase gene (desA), which complemented the growth deficiency on syringate of a Tn5 mutant of the SYK-6 derivative strain. The desA gene is located

  15. Effects of the Inoculant Strain Sphingomonas paucimobilis 20006FA on Soil Bacterial Community and Biodegradation in Phenanthrene-contaminated Soil

    Microsoft Academic Search

    B. M. Coppotelli; A. Ibarrolaza; M. T. Del Panno; I. S. Morelli

    2008-01-01

    The effects of the inoculant strain Sphingomonas paucimobilis 20006FA (isolated from a phenanthrene-contaminated soil) on the dynamics and structure of microbial communities and phenanthrene\\u000a elimination rate were studied in soil microcosms artificially contaminated with phenanthrene. The inoculant managed to be\\u000a established from the first inoculation as it was evidenced by denaturing gradient gel electrophoresis analysis, increasing\\u000a the number of cultivable

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

    Microsoft Academic Search

    R. M. Banik; A. Santhiagu

    2006-01-01

    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%.

  17. Sphingomonas paucimobilis beta-glucosidase Bgl1: a member of a new bacterial subfamily in glycoside hydrolase family 1.

    PubMed Central

    Marques, Ana Rita; Coutinho, Pedro M; Videira, Paula; Fialho, Arsénio M; Sá-Correia, Isabel

    2003-01-01

    The Sphingomonas paucimobilis beta-glucosidase Bgl1 is encoded by the bgl1 gene, associated with an 1308 bp open reading frame. The deduced protein has a potential signal peptide of 24 amino acids in the N-terminal region, and experimental evidence is consistent with the processing and export of the Bgl1 protein through the inner membrane to the periplasmic space. A His(6)-tagged 44.3 kDa protein was over-produced in the cytosol of Escherichia coli from a recombinant plasmid, which contained the S. paucimobilis bgl1 gene lacking the region encoding the putative signal peptide. Mature beta-glucosidase Bgl1 is specific for aryl-beta-glucosides and has no apparent activity with oligosaccharides derived from cellulose hydrolysis and other saccharides. A structure-based alignment established structural relations between S. paucimobilis Bgl1 and other members of the glycoside hydrolase (GH) family 1 enzymes. At subsite -1, the conserved residues required for catalysis by GH1 enzymes are present in Bgl1 with only minor differences. Major differences are found at subsite +1, the aglycone binding site. This alignment seeded a sequence-based phylogenetic analysis of GH1 enzymes, revealing an absence of horizontal transfer between phyla. Bootstrap analysis supported the definition of subfamilies and revealed that Bgl1, the first characterized beta-glucosidase from the genus Sphingomonas, represents a very divergent bacterial subfamily, closer to archaeal subfamilies than to others of bacterial origin. PMID:12444924

  18. Review Article von Willebrand factor, Jedi knight of the bloodstream

    E-print Network

    Springer, Timothy A.

    blood vessels are cut, the forces in the bloodstream increase and change character. The dark side are so closely intertwined that, like mem- bers of the Jedi Order in the movie Star Wars who learn to use to be learned. (Blood. 2014;124(9):1412-1425) "The Force will be with you, always." Obi-Wan Kenobi to Luke

  19. Elemental composition of acidocalcisomes of Trypanosoma cruzi bloodstream trypomastigote forms

    Microsoft Academic Search

    Alexandre S. Corrêa; Leonardo R. Andrade; Maurilio J. Soares

    2002-01-01

    The elemental composition of acidocalcisomes present in Trypanosoma cruzi bloodstream trypomastigotes was analyzed by X-ray microanalysis. Acidocalcisomes appear as electron-dense vesicles dispersed throughout the cytoplasm. X-ray microanalysis of whole cells adhered to Formvar-coated grids showed that they contained C, O, Na, Mg, P, S, Ca and Zn, although in some acidocalcisomes iron was also detected. However, in ultra-thin sections of

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

    SciTech Connect

    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

    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.

  1. Characterization of ligV essential for catabolism of vanillin by Sphingomonas paucimobilis SYK-6.

    PubMed

    Masai, Eiji; Yamamoto, Yuko; Inoue, Tomohiko; Takamura, Kazuhiro; Hara, Hirofumi; Kasai, Daisuke; Katayama, Yoshihiro; Fukuda, Masao

    2007-10-01

    The vanillin dehydrogenase gene (ligV), which conferred the ability to transform vanillin into vanillate on Escherichia coli, was isolated from Sphingomonas paucimobilis SYK-6. The ligV gene consists of a 1,440-bp open reading frame encoding a polypeptide with a molecular mass of 50,301 Da. The deduced amino acid sequence of ligV showed about 50% identity with the known vanillin dehydrogenases of Pseudomonas vanillin degraders. The gene product of ligV (LigV) produced in E. coli preferred NAD+ to NADP+ and exhibited a broad substrate preference, including vanillin, benzaldehyde, protocatechualdehyde, m-anisaldehyde, and p-hydroxybenzaldehyde, but the activity toward syringaldehyde was less than 5% of that toward vanillin. Insertional inactivation of ligV in SYK-6 indicated that ligV is essential for normal growth on vanillin. On the other hand, growth on syringaldehyde was only slightly affected by ligV disruption, indicating the presence of a syringaldehyde dehydrogenase gene or genes in SYK-6. PMID:17928721

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

    SciTech Connect

    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

    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.

  3. Oxidation of Methyl-Substituted Naphthalenes: Pathways in a Versatile Sphingomonas paucimobilis Strain†

    PubMed Central

    Dutta, Tapan K.; Selifonov, Sergey A.; Gunsalus, Irwin C.

    1998-01-01

    Aromatic compounds with alkyl substituents are abundant in fossil fuels. These compounds become important environmental sources of soluble toxic products, developmental inhibitors, etc. principally through biological activities. To assess the effect of methyl substitution on the completeness of mineralization and accumulation of pathway products, an isolate from a phenanthrene enrichment culture, Sphingomonas paucimobilis 2322, was used. Washed cell suspensions containing cells grown on 2,6-dimethylnaphthalene in mineral medium were incubated with various mono-, di-, and trimethylnaphthalene isomers, and the products were identified and quantified by gas chromatography and mass spectrometry. The data revealed enzymes with relaxed substrate specificity that initiate metabolism either by methyl group monoxygenation or by ring dioxygenation. Congeners with a methyl group on each ring initially hydroxylate a methyl, and this is followed by conversion to a carboxyl; when there are two methyl groups on a single ring, the first reaction is aryl dioxygenation of the unsubstituted ring. Intermediates are channeled to primary ring fission via dihydrodiols to form methyl-substituted salicylates. Further evidence that there are multiple pathways comes from the fact that both phthalate and (methyl)salicylate are formed from 2-methylnaphthalene. PMID:9572967

  4. Genetically modified microorganism Spingomonas paucimobilis UT26 for simultaneously degradation of methyl-parathion and ?-hexachlorocyclohexane.

    PubMed

    Lan, Wen S; Lu, Ti K; Qin, Zhi F; Shi, Xiu J; Wang, Jin J; Hu, Yun F; Chen, Bin; Zhu, Yi H; Liu, Zheng

    2014-07-01

    Bioremediation of pesticide residues by bacteria is an efficient and environmentally friendly method to deal with environmental pollution. In this study, a genetically modified microorganism (GMM) named UT26XEGM was constructed by introducing a parathion hydrolase gene into an initially ?-hexachlorocyclohexane (?-HCH) degrading bacterium Spingomonas paucimobilis UT26. In order to reduce its potential risk of gene escaping into the environment for the public concern on biosafety, a suicide system was also designed that did not interfere with the performance of the GMM until its physiological function was activated by specific signal. The system was designed with circuiting suicide cassettes consisting of killing genes gef and ecoRIR from Escherichia coli controlled by Pm promoter and the xylS gene. The cell viability and original degradation characteristics were not affected by the insertion of exogenous genes. The novel GMM was capable of degrading methyl-parathion and ?-HCH simultaneously. In laboratory scale testing, the recombinant bacteria were successfully applied to the bioremediation of mixed pesticide residues with the activity of self-destruction after 3-methylbenzoate induction. PMID:24648032

  5. Infections

    MedlinePLUS

    ... Infections Warts West Nile Virus What Is "PANS"? Whooping Cough (Pertussis) Yersiniosis Ear Infections Can Chronic Ear Infections ... Scarlet Fever Sinusitis Strep Throat Tuberculosis Walking Pneumonia Whooping Cough (Pertussis) Medical Tests A Directory of Medical Tests ...

  6. The pigment of Pseudomonas paucimobilis is a carotenoid (Nostoxanthin), rather than a brominated aryl-polyene (xanthomonadin)

    Microsoft Academic Search

    Christie L. Jenkins; Arthur G. Andrewes; Thomas J. McQuade; Mortimer P. Starr

    1979-01-01

    The main pigment fromPseudomanas paucimobilis (formerly, Weaver's group IIk, biotype 1), a bacterium isolated from the hospital environment or clinical pecimens and sometimes\\u000a confused with members of the genusXanthomonas, has been shown to be the carotenoid (2R, 3R, 2?R, 3?R)-?,?-carotene-2,3,2?,3?-tetrol (nostoxanthin) rather than a brominated aryl-polyene (xanthomonadin) pigment of the sort characteristically\\u000a and invariably made by phytopathogenicXanthomonas species. This identification

  7. Degradation of the phenoxy acid herbicide diclofop-methyl by Sphingomonas paucimobilis isolated from a Canadian prairie soil

    Microsoft Academic Search

    A Adkins

    1999-01-01

    Sphingomonas paucimobilis  , isolated from a soil in Manitoba, Canada, was able to utilize diclofop-methyl, (R,S)-methyl-2-[4-(2,4-dichlorophenoxy)phenoxy]propionate, as the sole source of carbon and energy. An actively growing aerobic\\u000a culture completely degraded 1.5??g diclofop-methyl ml?1 to diclofop acid within 54?h, at 25°C. A biphasic growth pattern indicated that this organism was capable of degrading diclofop\\u000a acid to 4-(2,4-dichlorophenoxy)phenol and 2,4-dichlorophenol and\\/or phenol.

  8. Method and apparatus for injecting a substance into the bloodstream of a subject

    DOEpatents

    Lambrecht, R.M.; Bennett, G.W.; Duncan, C.C.; Ducote, L.W.

    1983-10-18

    An apparatus and method is disclosed for injecting a substance, such as a radiopharmaceutical, into the bloodstream of a subject. The apparatus comprises an injection means, such as a servo controlled syringe, a means for measuring the concentration of that substance in the subject's bloodstream, and means for controlling the injection in response to the measurement so that the concentration of the substance follows a predetermined function of time. The apparatus of the subject invention functions to inject a substance into a subject's bloodstream at a rate controlled by an error signal proportional to the difference between the concentration of the substance in the subject's bloodstream and the predetermined function. 2 figs.

  9. Method and apparatus for injecting a substance into the bloodstream of a subject

    DOEpatents

    Lambrecht, Richard M. (Quogue, NY); Bennett, Gerald W. (East Moriches, NY); Duncan, Charles C. (New Haven, CT); Ducote, Louis W. (Shoreham, NY)

    1983-10-18

    An apparatus and method for injecting a substance, such as a radiopharmaceutical, into the bloodstream of a subject. The apparatus comprises an injection means, such as a servo controlled syringe, a means for measuring the concentration of that substance in the subject's bloodstream, and means for controlling the injection in response to the measurement so that the concentration of the substance follows a predetermined function of time. The apparatus of the subject invention functions to inject a substance into a subject's bloodstream at a rate controlled by an error signal proportional to the difference between the concentration of the substance in the subject's bloodstream and the predetermined function.

  10. [Effect of the inoculant strain Sphingomonas paucimobilis 20006FA on the bacterial composition of a phenanthrene-degrading consortium].

    PubMed

    Madueño, L; Coppotelli, B M; Morelli, I S

    2009-01-01

    The effect of the inoculant strain Sphingomonas paucimobilis 20006FA on the bacterial composition of a phenanthrene-degrading consortium obtained from a pristine soil in sequencing batch cultures was studied. Inoculated (F200+1) and non-inoculated (F200) phenanthrene-degrading consortia, were obtained. Bacterial diversity of consortia was studied at cultivable (phenotype and genotype characterization) and non-cultivable (PCR-DGGE) levels. During the successive cultures, a loss in the phenanthrene-degrading capacity and a decrease in the bacterial diversity were observed in both consortia. Although inoculation did not produce any significant changes in the consortia phenanthrene-degrading capacity (29.9% F200 and 27.6% F200+1), it did produce changes in the bacterial composition, showing a differential structural dynamics in the DGGE profiles of the inoculated consortium. In both consortia, a dominant band placed at the same position as that of the DNA of the inoculant strain in the DGGE gel could be observed. However, isolated cultures from the consortia which had an identical band position to that of S. paucimobilis 20006FA in the PCR-DGGE profile showed low similarity with respect to the inoculant strain (RAPD). PMID:19623894

  11. Growth-promoting Sphingomonas paucimobilis?ZJSH1 associated with Dendrobium officinale through phytohormone production and nitrogen fixation.

    PubMed

    Yang, Suijuan; Zhang, Xinghai; Cao, Zhaoyun; Zhao, Kaipeng; Wang, Sai; Chen, Mingxue; Hu, Xiufang

    2014-11-01

    Growth-promoting Sphingomonas paucimobilis?ZJSH1, associated with Dendrobium officinale, a traditional Chinese medicinal plant, was characterized. At 90 days post-inoculation, strain ZJSH1 significantly promoted the growth of D.?officinale seedlings, with increases of stems by 8.6% and fresh weight by 7.5%. Interestingly, the polysaccharide content extracted from the inoculated seedlings was 0.6% higher than that of the control. Similar growth promotion was observed with the transplants inoculated with strain ZJSH1. The mechanism of growth promotion was attributed to a combination of phytohormones and nitrogen fixation. Strain ZJSH1 was found using the Kjeldahl method to have a nitrogen fixation activity of 1.15?mg?l(-1) , which was confirmed by sequencing of the nifH gene. Using high-performance liquid chromatography-mass spectrometry, strain ZJSH1 was found to produce various phytohormones, including salicylic acid (SA), indole-3-acetic acid (IAA), Zeatin and abscisic acid (ABA). The growth curve showed that strain ZJSH1 grew well in the seedlings, especially in the roots. Accordingly, much higher contents of SA, ABA, IAA and c-ZR were detected in the inoculated seedlings, which may play roles as both phytohormones and 'Systemic Acquired Resistance' drivers. Nitrogen fixation and secretion of plant growth regulators (SA, IAA, Zeatin and ABA) endow S.?paucimobilis?ZJSH1 with growth-promoting properties, which provides a potential for application in the commercial growth of D.?officinale. PMID:25142808

  12. Growth-promoting Sphingomonas paucimobilis?ZJSH1 associated with Dendrobium officinale through phytohormone production and nitrogen fixation

    PubMed Central

    Yang, Suijuan; Zhang, Xinghai; Cao, Zhaoyun; Zhao, Kaipeng; Wang, Sai; Chen, Mingxue; Hu, Xiufang

    2014-01-01

    Growth-promoting Sphingomonas paucimobilis?ZJSH1, associated with Dendrobium officinale, a traditional Chinese medicinal plant, was characterized. At 90 days post-inoculation, strain ZJSH1 significantly promoted the growth of D. officinale seedlings, with increases of stems by 8.6% and fresh weight by 7.5%. Interestingly, the polysaccharide content extracted from the inoculated seedlings was 0.6% higher than that of the control. Similar growth promotion was observed with the transplants inoculated with strain ZJSH1. The mechanism of growth promotion was attributed to a combination of phytohormones and nitrogen fixation. Strain ZJSH1 was found using the Kjeldahl method to have a nitrogen fixation activity of 1.15 mg l?1, which was confirmed by sequencing of the nifH gene. Using high-performance liquid chromatography-mass spectrometry, strain ZJSH1 was found to produce various phytohormones, including salicylic acid (SA), indole-3-acetic acid (IAA), Zeatin and abscisic acid (ABA). The growth curve showed that strain ZJSH1 grew well in the seedlings, especially in the roots. Accordingly, much higher contents of SA, ABA, IAA and c-ZR were detected in the inoculated seedlings, which may play roles as both phytohormones and ‘Systemic Acquired Resistance’ drivers. Nitrogen fixation and secretion of plant growth regulators (SA, IAA, Zeatin and ABA) endow S. paucimobilis?ZJSH1 with growth-promoting properties, which provides a potential for application in the commercial growth of D. officinale. PMID:25142808

  13. Murine cytomegalovirus displays selective infection of cells within hours after systemic administration

    E-print Network

    Larson-Prior, Linda

    to the bloodstream. We demonstrate that MCMV productively infected CD169+ subcapsular sinus macrophages pulp by 17 h. By 48 h after infection, there was widespread infection in the spleen and liver in the spleen and liver. Thus, early MCMV infection produces a distinct pattern of infection of selective cells

  14. The investment case for preventing NICU-associated infections

    PubMed Central

    Donovan, Edward F.; Sparling, Karen; Lake, Michael R.; Narendran, Vivek; Schibler, Kurt; Haberman, Beth; Rose, Barbara; Meinzen-Derr, Jareen

    2013-01-01

    Nosocomial (hospital-associated or NICU-associated) infections occur in as many as 10–36% of very low birth weight infants cared for in newborn intensive care units (NICU). Objective To determine the potentially avoidable, incremental costs of care associated with NICU-associated bloodstream infections. Study Design This is a retrospective study that included all NICU admissions of infants 401–1500 grams birth weight in the greater Cincinnati region from January 1, 2005 through December 31, 2007. Non-physician costs of care were compared between infants who developed at least one bacterial bloodstream infection prior to NICU discharge or death and infants who did not. Costs were adjusted for clinical and demographic characteristics that are present in the first three days of life and are known associates of infection. Results Among 900 study infants with no congenital anomaly and no major surgery, 82 (9.1%) developed at least one bacterial bloodstream infection. On average, the cost of NICU care was $16,800 greater per infant who experienced NICU-associated bloodstream infection. Conclusions Potentially avoidable costs of care associated with bloodstream infection can be used to justify investments in the reliable implementation of evidence-based interventions designed to prevent these infections. PMID:22836823

  15. von Willebrand factor, Jedi knight of the bloodstream.

    PubMed

    Springer, Timothy A

    2014-08-28

    When blood vessels are cut, the forces in the bloodstream increase and change character. The dark side of these forces causes hemorrhage and death. However, von Willebrand factor (VWF), with help from our circulatory system and platelets, harnesses the same forces to form a hemostatic plug. Force and VWF function are so closely intertwined that, like members of the Jedi Order in the movie Star Wars who learn to use "the Force" to do good, VWF may be considered the Jedi knight of the bloodstream. The long length of VWF enables responsiveness to flow. The shape of VWF is predicted to alter from irregularly coiled to extended thread-like in the transition from shear to elongational flow at sites of hemostasis and thrombosis. Elongational force propagated through the length of VWF in its thread-like shape exposes its monomers for multimeric binding to platelets and subendothelium and likely also increases affinity of the A1 domain for platelets. Specialized domains concatenate and compact VWF during biosynthesis. A2 domain unfolding by hydrodynamic force enables postsecretion regulation of VWF length. Mutations in VWF in von Willebrand disease contribute to and are illuminated by VWF biology. I attempt to integrate classic studies on the physiology of hemostatic plug formation into modern molecular understanding, and point out what remains to be learned. PMID:24928861

  16. Optimization of gellan gum production by Sphingomonas paucimobilis ATCC 31461 with nonionic surfactants using central composite design.

    PubMed

    Arockiasamy, Santhiagu; Banik, Rathindra Mohan

    2008-03-01

    The effect of nonionic surfactants on gellan production by Sphingomonas paucimobilis was studied by the addition of 0.5, 0.75, 1.0, 1.25 and 1.5 g/l surfactants to shake flask culture. The nonionic surfactants Tween 80, Tween 40 and Triton X-100 improved gellan production by S. paucimobilis, and the maximum yield (10.44 g/l) was obtained with Triton X-100 at 0.75 g/l compared with that of the control fermentation (8.63 g/l) without surfactant. The DO profiles associated with gellan production in a 5-l laboratory fermentor showed higher oxygen and mass transfers during fermentation with surfactant than during control fermentation without surfactant. The addition of surfactant also resulted in a polymer with high viscosity as manifested by its lower acetyl content, than that obtained by control fermentation. A central composite design (CCD) was used to determine the maximum gellan production at optimum values for three process parameters (Triton X-100 concentration, pH, and temperature) each at five levels in a laboratory fermentor. The maximum gellan yield (14.62 g/l) was obtained in a 5-l laboratory fermentor with 1.0 g/l Triton X-100 and at pH 6.0 and temperature 29.6 degrees C. Further studies on the effects of agitation and DOT level demonstrated that the surfactants enhanced oxygen transfer resulting in higher gellan production (27.86 g/l) at higher agitation speed (1000 rpm) and 100% DOT level. PMID:18397769

  17. Healthcare associated infections (HAI) perspectives.

    PubMed

    Al-Tawfiq, Jaffar A; Tambyah, Paul A

    2014-01-01

    Healthcare associated infections (HAI) are among the major complications of modern medical therapy. The most important HAIs are those related to invasive devices: central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP) as well as surgical site infections (SSI). HAIs are associated with significant mortality, morbidities and increasing healthcare cost. The cited case-fatality rate ranges from 2.3% to 14.4% depending on the type of infection. In this mini-review, we shed light on these aspects as well as drivers to decrease HAIs. PMID:24861643

  18. Pulmonary Infection Caused by Mycobacterium neoaurum: The First Case in Korea

    PubMed Central

    Kim, Chang-Ki; Choi, Soo In; Jeon, Byung Ryul; Lee, Yong-Wha; Lee, You Kyoung

    2014-01-01

    Mycobacterium neoaurum is rapidly growing mycobacteria that can cause human infections. It commonly causes bloodstream infections in immunocompromised hosts, and unlike other mycobacteria species, it rarely causes pulmonary infections. We confirmed the first pulmonary infection case in Korea caused by M. neoaurum using full-length 16S rRNA gene sequencing. PMID:24790914

  19. Identification of four structural genes and two putative promoters necessary for utilization of phenanthrene naphthalene, fluoranthene, and by Sphingomonas paucimobilis var. EPA505

    Microsoft Academic Search

    Sandra P Story; Stephen H Parker; Jon D Kline; Tzuen-Rong J Tzeng; James G Mueller; Ellis L Kline

    2000-01-01

    Sphingomonas paucimobilis var. EPA505 utilizes fluoranthene (FLA), naphthalene (NAP), and phenanthrene (PHE) as sole carbon sources for energy and growth. A genetic library of EPA505 was constructed using mini-Tn5 promoter reporter genes encoding for tetracycline resistance (tcp?) or luminescence (luxABp?). Out of 2250 Tn5 mutants, ten were deficient in utilization of FLA, NAP, and\\/or PHE as sole carbon sources. Three

  20. Fatty acid-specific, regiospecific, and stereospecific hydroxylation by cytochrome P450 (CYP152B1) from Sphingomonas paucimobilis : Substrate structure required for ?-hydroxylation

    Microsoft Academic Search

    Isamu Matsunaga; Tatsuo Sumimoto; Atsuo Ueda; Emi Kusunose; Kosuke Ichihara

    2000-01-01

    Fatty acid ?-hydroxylase from Sphingomonas paucimobilis is an unusual cytochrome P450 enzyme that hydroxylates the ?-carbon of fatty acids in the presence of H2O2. Herein, we describe our investigation concerning the utilization of various substrates and the optical configuration of\\u000a the ?-hydroxyl product using a recombinant form of this enzyme. This enzyme can metabolize saturated fatty acids with carbon\\u000a chain

  1. Genetic and Biochemical Characterization of 4Carboxy2-Hydroxymuconate-6Semialdehyde Dehydrogenase and Its Role in the Protocatechuate 4,5Cleavage Pathway in Sphingomonas paucimobilis SYK-6

    Microsoft Academic Search

    EIJI MASAI; KIYOTAKA MOMOSE; HIROFUMI HARA; SEIJI NISHIKAWA; YOSHIHIRO KATAYAMA; MASAO FUKUDA

    2000-01-01

    Protocatechuate (PCA) is the key intermediate metabolite in the lignin degradation pathway of Sphingomo- nas paucimobilis SYK-6 and is metabolized to pyruvate and oxaloacetate via the PCA 4,5-cleavage pathway. We characterized the 4-carboxy-2-hydroxymuconate-6-semialdehyde (CHMS) dehydrogenase gene (ligC). CHMS is the 4,5-cleavage product of PCA and is converted into 2-pyrone-4,6-dicarboxylate (PDC) by LigC. We found that ligC was located 295 bp

  2. Cloning and Characterization of linR, Involved in Regulation of the Downstream Pathway for  Hexachlorocyclohexane Degradation in Sphingomonas paucimobilis UT26

    Microsoft Academic Search

    Keisuke Miyauchi; Haeng-Seog Lee; Masao Fukuda; Masamichi Takagi; Yuji Nagata

    2002-01-01

    In Sphingomonas paucimobilis UT26, LinD and LinE activities, which are responsible for the degradation of -hexachlorocyclohexane, are inducibly expressed in the presence of their substrates, 2,5-dichlorohydroqui- none (2,5-DCHQ) and chlorohydroquinone (CHQ). The nucleotide sequence of the 1-kb upstream region of the linE gene was determined, and an open reading frame (ORF) was found in divergent orientation from linE. Because the

  3. 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

    KEISUKE MIYAUCHI; YUGO ADACHI; YUJI NAGATA; MASAMICHI TAKAGI

    1999-01-01

    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.

  4. Construction and Characterization of Histidine-Tagged Haloalkane Dehalogenase (LinB) of a New Substrate Class from a ?-Hexachlorocyclohexane-Degrading Bacterium, Sphingomonas paucimobilis UT26

    Microsoft Academic Search

    Yuji Nagata; Kamila Hynková; Ji??? Damborský; Masamichi Takagi

    1999-01-01

    The linB gene product (LinB), which is involved in the degradation of ?-hexachlorocyclohexane in Sphingomonas paucimobilis UT26, is a member of haloalkane dehalogenases with a broad range of substrate specificity. Elucidation of the factors determining its substrate specificity is of interest. Aiming to facilitate purification of recombinant LinB protein for site-directed mutagenesis analysis, a 6-histidyl tail was added to the

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

    Microsoft Academic Search

    PAULA A. VIDEIRA; LUISA L. CORTES; ARSENIO M. FIALHO; I. Sa-Correia

    2000-01-01

    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 phospho- mannomutase (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

  6. Cloning and Sequencing of a 2,5-Dichlorohydroquinone Reductive Dehalogenase Gene Whose Product Is Involved in Degradation of g-Hexachlorocyclohexane by Sphingomonas paucimobilis

    Microsoft Academic Search

    KEISUKE MIYAUCHI; SEUG-KYO SUH; YUJI NAGATA; MASAMICHI TAKAGI

    1998-01-01

    Sphingomonas (formerly Pseudomonas) paucimobilis UT26 utilizes g-hexachlorocyclohexane (g-HCH), a halogenated organic insecticide, as a sole carbon and energy source. In a previous study, we showed that g-HCH is degraded to 2,5-dichlorohydroquinone (2,5-DCHQ) (Y. Nagata, R. Ohtomo, K. Miyauchi, M. Fukuda, K. Yano, and M. Takagi, J. Bacteriol. 176:3117-3125, 1994). In the present study, we cloned and characterized a gene, designated

  7. Convergent and divergent points in catabolic pathways involved in utilization of fluoranthene, naphthalene, anthracene, and phenanthrene by Sphingomonas paucimobilis var. EPA505

    Microsoft Academic Search

    S P Story; S H Parker; S S Hayasaka; M B Riley; E L Kline

    2001-01-01

      Catabolic pathways for utilization of naphthalene (NAP), anthracene (ANT), phenanthrene (PHE), and fluoranthene (FLA) by Sphingomonas paucimobilis EPA505 were identified. Accumulation of catabolic intermediates was investigated with three classes of Tn5 mutants with the\\u000a following polycyclic aromatic hydrocarbon (PAH)-negative phenotypes; (class I NAP? PHE? FLA?, class II NAP? PHE?, and class III FLA?). Class I mutant 200pbhA had a Tn5

  8. Organization of lin Genes and IS6100 among Different Strains of Hexachlorocyclohexane-Degrading Sphingomonas paucimobilis: Evidence for Horizontal Gene Transfer

    Microsoft Academic Search

    Charu Dogra; Vishakha Raina; Rinku Pal; Mrutyunjay Suar; Sukanya Lal; K.-H. Gartemann; C. Holliger; J. R. van der Meer; R. Lal

    2004-01-01

    The organization of lin genes and IS6100 was studied in three strains of Sphingomonas paucimobilis (B90A, Sp, and UT26) which degraded hexachlorocyclohexane (HCH) isomers but which had been isolated at different geographical locations. DNA-DNA hybridization data revealed that most of the lin genes in these strains were associated with IS6100, an insertion sequence classified in the IS6 family and initially

  9. Characterization of the ugpG gene encoding a UDP-glucose pyrophosphorylase from the gellan gum producer Sphingomonas paucimobilis ATCC 31461

    Microsoft Academic Search

    A. R. Marques; P. B. Ferreira; I. Sá-Correia; A. M. Fialho

    2003-01-01

    The ugpG gene, which codes for a UDP-glucose pyrophosphorylase (UGP) (or glucose-1-phosphate uridylyltransferase; EC 2.7.7.9) in Sphingomonas paucimobilis ATCC 31461, was cloned and sequenced. This industrial strain produces the exopolysaccharide gellan, a new commercial gelling agent, and the ugpG gene may convert glucose-1-phosphate into UDP-glucose in the gellan biosynthetic pathway. The ugpG gene is capable of restoring the capacity of

  10. Chronic Superantigen Exposure Induces Systemic Inflammation, Elevated Bloodstream Endotoxin, and Abnormal Glucose Tolerance in Rabbits: Possible Role in Diabetes

    PubMed Central

    Vu, Bao G.; Stach, Christopher S.; Kulhankova, Katarina; Salgado-Pabón, Wilmara; Klingelhutz, Aloysius J.

    2015-01-01

    ABSTRACT Excessive weight and obesity are associated with the development of diabetes mellitus type 2 (DMII) in humans. They also pose high risks of Staphylococcus aureus colonization and overt infections. S. aureus causes a wide range of severe illnesses in both healthy and immunocompromised individuals. Among S. aureus virulence factors, superantigens are essential for pathogenicity. In this study, we show that rabbits that are chronically exposed to S. aureus superantigen toxic shock syndrome toxin-1 (TSST-1) experience impaired glucose tolerance, systemic inflammation, and elevated endotoxin levels in the bloodstream, all of which are common findings in DMII. Additionally, such DMII-associated findings are also seen through effects of TSST-1 on isolated adipocytes. Collectively, our findings suggest that chronic exposure to S. aureus superantigens facilitates the development of DMII, which may lead to therapeutic targeting of S. aureus and its superantigens. PMID:25714716

  11. Diagnostic Utility of Broad Range Bacterial 16S rRNA Gene PCR with Degradation of Human and Free Bacterial DNA in Bloodstream Infection Is More Sensitive Than an In-House Developed PCR without Degradation of Human and Free Bacterial DNA

    PubMed Central

    Rogina, Petra; Kofol, Romina; Kaasch, Achim

    2014-01-01

    We compared a commercial broad range 16S rRNA gene PCR assay (SepsiTest) to an in-house developed assay (IHP). We assessed whether CD64 index, a biomarker of bacterial infection, can be used to exclude patients with a low probability of systemic bacterial infection. From January to March 2010, 23 patients with suspected sepsis were enrolled. CD64 index, procalcitonin, and C-reactive protein were measured on admission. Broad range 16S rRNA gene PCR was performed from whole blood (SepsiTest) or blood plasma (IHP) and compared to blood culture results. Blood samples spiked with Staphylococcus aureus were used to assess sensitivity of the molecular assays in vitro. CD64 index was lower in patients where possible sepsis was excluded than in patients with microbiologically confirmed sepsis (P = 0.004). SepsiTest identified more relevant pathogens than blood cultures (P = 0.008); in three patients (13%) results from blood culture and SepsiTest were congruent, whereas in four cases (17.4%) relevant pathogens were detected by SepsiTest only. In vitro spiking experiments suggested equal sensitivity of SepsiTest and IHP. A diagnostic algorithm using CD64 index as a decision maker to perform SepsiTest shows improved detection of pathogens in patients with suspected blood stream infection and may enable earlier targeted antibiotic therapy. PMID:25120284

  12. Cyclodextrin mediates rapid changes in lipid balance in Npc1?/? mice without carrying cholesterol through the bloodstream[S

    PubMed Central

    Taylor, Anna M.; Liu, Bing; Mari, Yelenis; Liu, Benny; Repa, Joyce J.

    2012-01-01

    An injection of 2-hydroxypropyl-?-cyclodextrin (HP-?-CD) to mice lacking Niemann Pick type C (NPC) protein results in delayed neurodegeneration, decreased inflammation, and prolonged lifespan. Changes in sterol balance observed in Npc1?/? mice 24 h after HP-?-CD administration suggest that HP-?-CD facilitates the release of accumulated lysosomal cholesterol, the molecular hallmark of this genetic disorder. Current studies were performed to evaluate the time course of HP-?-CD effects. Within 3 h after HP-?-CD injection, decreases in cholesterol synthesis rates and increases in cholesteryl ester levels were detected in tissues of Npc1?/? mice. The levels of RNAs for target genes of sterol-sensing transcription factors were altered by 6 h in liver, spleen, and ileum. Despite the cholesterol-binding capacity of HP-?-CD, there was no evidence of increased cholesterol in plasma or urine of treated Npc1?/? mice, suggesting that HP-?-CD does not carry sterol from the lysosome into the bloodstream for ultimate urinary excretion. Similar changes in sterol balance were observed in cultured cells from Npc1?/? mice using HP-?-CD and sulfobutylether-?-CD, a variant that can interact with sterol but not facilitate its solubilization. Taken together, our results demonstrate that HP-?-CD works in cells of Npc1?/? mice by rapidly liberating lysosomal cholesterol for normal sterol processing within the cytosolic compartment. PMID:22892156

  13. Parenteral nutritional therapy and risk of infection: review with proposed management guidelines

    Microsoft Academic Search

    P. DELLA LOGGIA; V. KIREN; D. GIACOMAZZI; R. LUZZATI

    2009-01-01

    Parenteral nutritional therapy increases the risk of infection when compared with enteral feeding or delayed nutrition. On the other hand, some clinical circumstances require the delivery of nu- trition by central vascular catheter for both critically ill and chronically ill patients. Catheter-related bloodstream infection remains one of the most frequent infective complications in these patients, with an incidence ranging from

  14. In vitro activities of isavuconazole and other antifungal agents against Candida bloodstream isolates.

    PubMed

    Seifert, H; Aurbach, U; Stefanik, D; Cornely, O

    2007-05-01

    Isavuconazole is the active component of the new azole antifungal agent BAL8557, which is entering phase III clinical development. This study was conducted to compare the in vitro activities of isavuconazole and five other antifungal agents against 296 Candida isolates that were recovered consecutively from blood cultures between 1995 and 2004 at a tertiary care university hospital. Microdilution testing was done in accordance with CLSI (formerly NCCLS) guideline M27-A2 in RPMI-1640 MOPS (morpholinepropanesulfonic acid) broth. The antifungal agents tested were amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, and isavuconazole. C. albicans was the most common species, representing 57.1% of all isolates. There was no trend found in favor of non-Candida albicans species over time. In terms of MIC(50)s, isavuconazole was more active (0.004 mg/liter) than amphotericin B (0.5 mg/liter), itraconazole (0.008 mg/liter), voriconazole (0.03 mg/liter), flucytosine (0.125 mg/liter), and fluconazole (8 mg/liter). For isavuconazole, MIC(50)s/MIC(90)s ranged from 000.2/0.004 mg/liter for C. albicans to 0.25/0.5 mg/liter for C. glabrata. Two percent of isolates (C. glabrata and C. krusei) were resistant to fluconazole; C. albicans strains resistant to fluconazole were not detected. There were only two isolates with MICs for isavuconazole that were >0.5 mg/liter: both were C. glabrata isolates, and the MICs were 2 and 4 mg/liter, respectively. In conclusion, isavuconazole is highly active against Candida bloodstream isolates, including fluconazole-resistant strains. It was more active than itraconazole and voriconazole against C. albicans and C. glabrata and appears to be a promising agent against systemic Candida infections. PMID:17307977

  15. Effects of the inoculant strain Sphingomonas paucimobilis 20006FA on soil bacterial community and biodegradation in phenanthrene-contaminated soil.

    PubMed

    Coppotelli, B M; Ibarrolaza, A; Del Panno, M T; Morelli, I S

    2008-02-01

    The effects of the inoculant strain Sphingomonas paucimobilis 20006FA (isolated from a phenanthrene-contaminated soil) on the dynamics and structure of microbial communities and phenanthrene elimination rate were studied in soil microcosms artificially contaminated with phenanthrene. The inoculant managed to be established from the first inoculation as it was evidenced by denaturing gradient gel electrophoresis analysis, increasing the number of cultivable heterotrophic and PAH-degrading cells and enhancing phenanthrene degradation. These effects were observed only during the inoculation period. Nevertheless, the soil biological activity (dehydrogenase activity and CO(2) production) showed a late increase. Whereas gradual and successive changes in bacterial community structures were caused by phenanthrene contamination, the inoculation provoked immediate, significant, and stable changes on soil bacterial community. In spite of the long-term establishment of the inoculated strain, at the end of the experiment, the bioaugmentation did not produce significant changes in the residual soil phenanthrene concentration and did not improve the residual effects on the microbial soil community. PMID:17694405

  16. Cloning and sequencing of a 2,5-dichlorohydroquinone reductive dehalogenase gene whose product is involved in degradation of gamma-hexachlorocyclohexane by Sphingomonas paucimobilis.

    PubMed

    Miyauchi, K; Suh, S K; Nagata, Y; Takagi, M

    1998-03-01

    Sphingomonas (formerly Pseudomonas) paucimobilis UT26 utilizes gamma-hexachlorocyclohexane (gamma-HCH), a halogenated organic insecticide, as a sole carbon and energy source. In a previous study, we showed that gamma-HCH is degraded to 2,5-dichlorohydroquinone (2,5-DCHQ) (Y. Nagata, R. Ohtomo, K. Miyauchi, M. Fukuda, K. Yano, and M. Takagi, J. Bacteriol. 176:3117-3125, 1994). In the present study, we cloned and characterized a gene, designated linD, directly involved in the degradation of 2,5-DCHQ. The linD gene encodes a peptide of 343 amino acids and has a low level of similarity to proteins which belong to the glutathione S-transferase family. When LinD was overproduced in Escherichia coli, a 40-kDa protein was found after sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Northern blot analysis revealed that expression of the linD gene was induced by 2,5-DCHQ in S. paucimobilis UT26. Thin-layer chromatography and gas chromatography-mass spectrometry analyses with the LinD-overexpressing E. coli cells revealed that LinD converts 2,5-DCHQ rapidly to chlorohydroquinone (CHQ) and also converts CHQ slowly to hydroquinone. LinD activity in crude cell extracts was increased 3.7-fold by the addition of glutathione. All three of the Tn5-induced mutants of UT26, which lack 2,5-DCHQ dehalogenase activity, had rearrangements or a deletion in the linD region. These results indicate that LinD is a glutathione-dependent reductive dehalogenase involved in the degradation of gamma-HCH by S. paucimobilis UT26. PMID:9515900

  17. Characterization of the 4Carboxy4Hydroxy2-Oxoadipate Aldolase Gene and Operon Structure of the Protocatechuate 4,5Cleavage Pathway Genes in Sphingomonas paucimobilis SYK-6

    Microsoft Academic Search

    Hirofumi Hara; Eiji Masai; Keisuke Miyauchi; Yoshihiro Katayama; Masao Fukuda

    2003-01-01

    The protocatechuate (PCA) 4,5-cleavage pathway is the essential metabolic route for degradation of low- molecular-weight products derived from lignin by Sphingomonas paucimobilis SYK-6. In the 10.5-kb EcoRI fragment carrying the genes for PCA 4,5-dioxygenase (ligAB), 2-pyrone-4,6-dicarboxylate hydrolase (ligI), 4-oxalomesaconate hydratase (ligJ), and a part of 4-carboxy-2-hydroxymuconate-6-semialdehyde dehydroge- nase (ligC), we found the ligK gene, which encodes 4-carboxy-4-hydroxy-2-oxoadipate (CHA) aldolase. The

  18. Cloning of a Sphingomonas paucimobilis SYK-6 Gene Encoding a Novel Oxygenase That Cleaves Lignin-Related Biphenyl and Characterization of the Enzyme

    Microsoft Academic Search

    XUE PENG; TAKASHI EGASHIRA; KAORU HANASHIRO; EIJI MASAI; SEIJI NISHIKAWA; YOSHIHIRO KATAYAMA; KAZUHIDE KIMBARA; MASAO FUKUDA

    1998-01-01

    Sphingomonas paucimobilis SYK-6 transforms 2,2*-dihydroxy-3,3*-dimethoxy-5,5*-dicarboxybiphenyl (DDVA), a lignin-related biphenyl compound, to 5-carboxyvanillic acid via 2,2*,3-trihydroxy-3*-methoxy-5,5*-dicarboxy- biphenyl (OH-DDVA) as an intermediate (15). The ring fission of OH-DDVA is an essential step in the DDVA degradative pathway. A 15-kb EcoRI fragment isolated from the cosmid library complemented the growth deficiency of a mutant on OH-DDVA. Subcloning and deletion analysis showed that a

  19. Developmental regulation and extracellular release of a VSG expression-site-associated gene product from Trypanosoma brucei bloodstream forms

    PubMed Central

    Barnwell, Eleanor M.; van Deursen, Frederick J.; Jeacock, Laura; Smith, Katherine A.; Maizels, Rick M.; Acosta-Serrano, Alvaro; Matthews, Keith

    2010-01-01

    Trypanosomes evade host immunity by exchanging variant surface glycoprotein (VSG) coats. VSG genes are transcribed from telomeric expression sites, which contain a diverse family of expression-site-associated genes (ESAGs). We have discovered that the mRNAs for one ESAG family, ESAG9, are strongly developmentally regulated, being enriched in stumpy forms, a life-cycle stage in the mammalian bloodstream that is important for the maintenance of chronic parasite infections and for tsetse transmission. ESAG9 gene sequences are highly diverse in the genome and encode proteins with weak similarity to the massively diverse MASP proteins in Trypanosoma cruzi. We demonstrate that ESAG9 proteins are modified by N-glycosylation and can be shed to the external milieu, this being dependent upon coexpression with at least one other family member. The expression profile and extracellular release of ESAG9 proteins represents a novel and unexpected aspect of the transmission biology of trypanosomes in their mammalian host. We suggest that these molecules might interact with the external environment, with possible implications for infection chronicity or parasite transmission. PMID:20826456

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

    PubMed Central

    Barry, Kevin P.; Taylor, Erika A.

    2014-01-01

    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 × 106 M?1s?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

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

    PubMed Central

    Fialho, Arsénio M.; Martins, Lígia O.; Donval, Marie-Lucie; Leitão, Jorge H.; Ridout, Michael J.; Jay, Andrew J.; Morris, Victor J.; Sá-Correia, Isabel

    1999-01-01

    The dairy industry produces large quantities of whey as a by-product of cheese production and is increasingly 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 31461 in media containing glucose, lactose (5 to 30 g/liter), and sweet cheese whey. We found that altering the growth medium can markedly affect the polysaccharide yield, acyl substitution level, polymer rheological properties, and susceptibility to degradation. Depression of gellan production from lactose compared with gellan production from glucose (approximately 30%) did not appear to occur at the level of synthesis of sugar nucleotides, which are the donors of monomers used for biosynthesis of the repetitive tetrasaccharide unit of gellan. The lactose-derived biopolymer had the highest total acyl content; the glucose- and whey-derived gellans had similar total acyl contents but differed markedly in their acetate and glycerate levels. Rheological studies revealed how the functionality of a gellan polysaccharide is affected by changes in the acyl substitution. PMID:10347031

  2. ISOLATION AND CHARACTERIZATION OF KINETOPLAST DNA FROM BLOODSTREAM FORM OF TRYPANOSOMA BRUCEI

    E-print Network

    Schnaufer, Achim

    ISOLATION AND CHARACTERIZATION OF KINETOPLAST DNA FROM BLOODSTREAM FORM OF TRYPANOSOMA BRUCEI ALAN-circle, in addition to the major mini-circle component in kinetoplast DNA (kDNA) net- works of Trypanosorna brucei cut the maxi-circle at a single site, allowing its isolation in a linear form with a tool wt of 12.2 x

  3. Cell density triggers slender to stumpy differentiation of Trypanosoma brucei bloodstream forms in culture

    Microsoft Academic Search

    Birgit Reuner; Erik Vassella; Barbara Yutzy; Michael Boshart

    1997-01-01

    Differentiation from replicating slender forms to non-dividing stumpy bloodstream forms of T. brucei limits the parasite population size in the mammalian host in addition to and independently of the antibody response. Using a culture system for pleomorphic strains of T. brucei we show that slender forms very efficiently differentiate to stumpy forms in vitro and that the induction of differentiation

  4. Bloodstream form pre-adaptation to the tsetse fly in Trypanosoma brucei

    PubMed Central

    Rico, Eva; Rojas, Federico; Mony, Binny M.; Szoor, Balazs; MacGregor, Paula; Matthews, Keith R.

    2013-01-01

    African trypanosomes are sustained in the bloodstream of their mammalian hosts by their extreme capacity for antigenic variation. However, for life cycle progression, trypanosomes also must generate transmission stages called stumpy forms that are pre-adapted to survive when taken up during the bloodmeal of the disease vector, tsetse flies. These stumpy forms are rather different to the proliferative slender forms that maintain the bloodstream parasitaemia. Firstly, they are non proliferative and morphologically distinct, secondly, they show particular sensitivity to environmental cues that signal entry to the tsetse fly and, thirdly, they are relatively robust such that they survive the changes in temperature, pH and proteolytic environment encountered within the tsetse midgut. These characteristics require regulated changes in gene expression to pre-adapt the parasite and the use of environmental sensing mechanisms, both of which allow the rapid initiation of differentiation to tsetse midgut procyclic forms upon transmission. Interestingly, the generation of stumpy forms is also regulated and periodic in the mammalian blood, this being governed by a density-sensing mechanism whereby a parasite-derived signal drives cell cycle arrest and cellular development both to optimize transmission and to prevent uncontrolled parasite multiplication overwhelming the host. In this review we detail recent developments in our understanding of the molecular mechanisms that underpin the production of stumpy forms in the mammalian bloodstream and their signal perception pathways both in the mammalian bloodstream and upon entry into the tsetse fly. These discoveries are discussed in the context of conserved eukaryotic signaling and differentiation mechanisms. Further, their potential to act as targets for therapeutic strategies that disrupt parasite development either in the mammalian bloodstream or upon their transmission to tsetse flies is also discussed. PMID:24294594

  5. Bloodstream form pre-adaptation to the tsetse fly in Trypanosoma brucei.

    PubMed

    Rico, Eva; Rojas, Federico; Mony, Binny M; Szoor, Balazs; Macgregor, Paula; Matthews, Keith R

    2013-01-01

    African trypanosomes are sustained in the bloodstream of their mammalian hosts by their extreme capacity for antigenic variation. However, for life cycle progression, trypanosomes also must generate transmission stages called stumpy forms that are pre-adapted to survive when taken up during the bloodmeal of the disease vector, tsetse flies. These stumpy forms are rather different to the proliferative slender forms that maintain the bloodstream parasitaemia. Firstly, they are non proliferative and morphologically distinct, secondly, they show particular sensitivity to environmental cues that signal entry to the tsetse fly and, thirdly, they are relatively robust such that they survive the changes in temperature, pH and proteolytic environment encountered within the tsetse midgut. These characteristics require regulated changes in gene expression to pre-adapt the parasite and the use of environmental sensing mechanisms, both of which allow the rapid initiation of differentiation to tsetse midgut procyclic forms upon transmission. Interestingly, the generation of stumpy forms is also regulated and periodic in the mammalian blood, this being governed by a density-sensing mechanism whereby a parasite-derived signal drives cell cycle arrest and cellular development both to optimize transmission and to prevent uncontrolled parasite multiplication overwhelming the host. In this review we detail recent developments in our understanding of the molecular mechanisms that underpin the production of stumpy forms in the mammalian bloodstream and their signal perception pathways both in the mammalian bloodstream and upon entry into the tsetse fly. These discoveries are discussed in the context of conserved eukaryotic signaling and differentiation mechanisms. Further, their potential to act as targets for therapeutic strategies that disrupt parasite development either in the mammalian bloodstream or upon their transmission to tsetse flies is also discussed. PMID:24294594

  6. Invasive Salmonella enterica serotype typhimurium infections, Democratic Republic of the Congo, 2007-2011.

    PubMed

    Ley, Benedikt; Le Hello, Simon; Lunguya, Octavie; Lejon, Veerle; Muyembe, Jean-Jacques; Weill, François-Xavier; Jacobs, Jan

    2014-04-01

    Infection with Salmonella enterica serotype Typhimurium sequence type (ST) 313 is associated with high rates of drug resistance, bloodstream infections, and death. To determine whether ST313 is dominant in the Democratic Republic of the Congo, we studied 180 isolates collected during 2007-2011; 96% belonged to CRISPOL type CT28, which is associated with ST313. PMID:24655438

  7. Invasive Salmonella enterica Serotype Typhimurium Infections, Democratic Republic of the Congo, 2007–2011

    PubMed Central

    Ley, Benedikt; Le Hello, Simon; Lunguya, Octavie; Lejon, Veerle; Muyembe, Jean-Jacques; Jacobs, Jan

    2014-01-01

    Infection with Salmonella enterica serotype Typhimurium sequence type (ST) 313 is associated with high rates of drug resistance, bloodstream infections, and death. To determine whether ST313 is dominant in the Democratic Republic of the Congo, we studied 180 isolates collected during 2007–2011; 96% belonged to CRISPOL type CT28, which is associated with ST313. PMID:24655438

  8. Hospital-associated infections in small animal practice.

    PubMed

    Stull, Jason W; Weese, J Scott

    2015-03-01

    Hospital-associated infections (HAIs) occur in veterinary hospitals of all types and sizes, and their frequency is likely to increase. Urinary tract infections, pneumonia, bloodstream infections, surgical site infections, and infectious diarrhea are the HAIs most frequently identified in veterinary medicine. A hospital infection control program, consisting of an infectious disease control officer, written protocols, and staff training, is critical to reducing HAIs and promoting patient, staff, and client health. Infection control protocols (plans) should include discussion of hand hygiene and use of personal protective equipment, cleaning and disinfection, patient management, with-in hospital surveillance, and antimicrobial stewardship. PMID:25559054

  9. The antimicrobial susceptibility, biofilm formation and genotypic profiles of Staphylococcus haemolyticus from bloodstream infections

    PubMed Central

    Silva, Patricia Vollú; Cruz, Raquel Souza; Keim, Luiz Sérgio; de Paula, Geraldo Renato; Carvalho, Bernadete Teixeira Ferreira; Coelho, Leonardo Rocchetto; Carvalho, Maria Cícera da Silva; da Rosa, Joel Mauricio Corrêa; Figueiredo, Agnes Marie Sá; Teixeira, Lenise Arneiro

    2013-01-01

    We analysed the antimicrobial susceptibility, biofilm formation and genotypic profiles of 27 isolates of Staphylococcus haemolyticus obtained from the blood of 19 patients admitted to a hospital in Rio de Janeiro, Brazil. Our analysis revealed a clinical significance of 36.8% and a multi-resistance rate of 92.6% among these isolates. All but one isolate carried the mecA gene. The staphylococcal cassette chromosome mec type I was the most prevalent mec element detected (67%). Nevertheless, the isolates showed clonal diversity based on pulsed-field gel electrophoresis analysis. The ability to form biofilms was detected in 66% of the isolates studied. Surprisingly, no icaAD genes were found among the biofilm-producing isolates. PMID:24037208

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

    Microsoft Academic Search

    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

    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

  11. Current Approaches to the Diagnosis of Bacterial and Fungal Bloodstream Infections for the ICU

    PubMed Central

    Murray, Patrick R.; Masur, Henry

    2014-01-01

    Healthcare systems spend considerable resources collecting and processing blood cultures for the detection of blood stream pathogens. The process is initiated with the collection of blood cultures that depend upon proper skin disinfection, collection of an adequate number of specimens and volume of blood, and prompt processing in a sensitive culture system. Complementing blood cultures and gaining in use are techniques such as nucleic acid amplification tests and mass spectroscopy that allow clinical laboratories to detect and identify organisms from blood cultures substantially faster than conventional systems. Moreover, certain resistance mutations can be detected within hours of organism detection, thus providing valuable guidance to clinicians who strive to initiate the appropriate antimicrobial therapy as rapidly as possible, and who wish to discontinue unnecessary drugs expeditiously. Molecular and mass spectroscopy techniques are changing sepsis diagnosis rapidly and will provide far more specific information far more quickly, but the performance characteristics of these systems must be understood by intensivists who use such information to guide their patient management. PMID:23034460

  12. Use of multiplex PCR in diagnosis of bloodstream infections in kidney patients.

    PubMed

    Fernández-Romero, Natalia; Quiles, Inmaculada; Jiménez, Carlos; Oliva, María Ovidea Lopez; Rivas, Begoña; Mingorance, Jesús; Romero-Gómez, María Pilar

    2014-10-01

    The LightCycler® SeptiFast Test (Roche Diagnostics GmbH, Mannheim, Germany) was prospectively compared with the standard blood culture technique in a series of 86 kidney patients. The sensitivity of the PCR compared with the culture was 71%, and the specificity was 88%. All the species identified by culture in these patients were in the SeptiFast panel. The median time to results was 1 day for the PCR, 3 days for positive cultures, and 5 days for negative cultures. PMID:25107361

  13. Current approaches to the diagnosis of bacterial and fungal bloodstream infections in the intensive care unit.

    PubMed

    Murray, Patrick R; Masur, Henry

    2012-12-01

    Healthcare systems spend considerable resources collecting and processing blood cultures for the detection of blood stream pathogens. The process is initiated with the collection of blood cultures that depend upon proper skin disinfection, collection of an adequate number of specimens and volume of blood, and prompt processing in a sensitive culture system. Complementing blood cultures and gaining in use are techniques such as nucleic acid amplification tests and mass spectroscopy that allow clinical laboratories to detect and identify organisms from blood cultures substantially faster than conventional systems. Furthermore, certain resistance mutations can be detected within hours of organism detection, thus providing valuable guidance to clinicians who strive to initiate the appropriate antimicrobial therapy as rapidly as possible, and who wish to discontinue unnecessary drugs expeditiously. Molecular and mass spectroscopy techniques are changing sepsis diagnosis rapidly and will provide far more specific information far more quickly, but the performance characteristics of these systems must be understood by intensivists who use such information to guide their patient management. PMID:23034460

  14. Certification in infection control matters: Impact of infection control department characteristics and policies on rates of multidrug-resistant infections

    PubMed Central

    Pogorzelska, Monika; Stone, PatriciaW.; Larson, Elaine L.

    2012-01-01

    Background The study objective is to describe infection control policies aimed at multidrug-resistant organisms (MDRO) in California hospitals and assess the relationship among these policies, structural characteristics, and rates of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) bloodstream infections and Clostridium difficile infections. Methods Data on infection control policies, structural characteristics, and MDRO rates were collected through a 2010 survey of California infection control departments. Bivariate and multivariable Poisson and negative binomial regressions were conducted. Results One hundred eighty hospitals provided data (response rate, 54%). Targeted MRSA screening upon admission was reported by the majority of hospitals (87%). The majority of hospitals implemented contact precautions for confirmed MDRO and C difficile patients; presumptive isolation/contact precautions for patients with pending screens were less frequently implemented. Few infection control policies were associated with lower MDRO rates. Hospitals with a certified infection control director had significantly lower rates of MRSA bloodstream infections (P < .05). Conclusion Although most California hospitals are involved in activities to decrease MDRO, there is variation in specific activities utilized with the most focus placed on MRSA. This study highlights the importance of certification and its significant impact on infection rates. Additional research is needed to confirm these findings. PMID:22381222

  15. Trypanosoma brucei FKBP12 Differentially Controls Motility and Cytokinesis in Procyclic and Bloodstream Forms

    PubMed Central

    Brasseur, Anaïs; Rotureau, Brice; Vermeersch, Marjorie; Blisnick, Thierry; Salmon, Didier; Bastin, Philippe; Pays, Etienne; Vanhamme, Luc

    2013-01-01

    FKBP12 proteins are able to inhibit TOR kinases or calcineurin phosphatases upon binding of rapamycin or FK506 drugs, respectively. The Trypanosoma brucei FKBP12 homologue (TbFKBP12) was found to be a cytoskeleton-associated protein with specific localization in the flagellar pocket area of the bloodstream form. In the insect procyclic form, RNA interference-mediated knockdown of TbFKBP12 affected motility. In bloodstream cells, depletion of TbFKBP12 affected cytokinesis and cytoskeleton architecture. These last effects were associated with the presence of internal translucent cavities limited by an inside-out configuration of the normal cell surface, with a luminal variant surface glycoprotein coat lined up by microtubules. These cavities, which recreated the streamlined shape of the normal trypanosome cytoskeleton, might represent unsuccessful attempts for cell abscission. We propose that TbFKBP12 differentially affects stage-specific processes through association with the cytoskeleton. PMID:23104568

  16. Cysteine eliminates the feeder cell requirement for cultivation of Trypanosoma brucei bloodstream forms in vitro

    PubMed Central

    1985-01-01

    In all previous studies, bloodstream forms of Trypanosoma brucei could be grown in vitro only when supported by a feeder layer of mammalian fibroblasts. We have axenically cultivated bloodstream T. brucei by adding L-cysteine at regular intervals and appropriate concentrations. The optimum cysteine concentration depends on cell density and is close to physiological serum levels. At concentrations greater than 24 mg/liter (2 X 10(-4) M), cysteine was acutely toxic to trypanosome concentrations of 3 X 10(7)/ml. Toxicity was prevented by addition of pyruvate or catalase, which neutralize H2O2 produced by cysteine autoxidation. In uptake studies using [35S]cysteine and [35S]cystine, T. brucei efficiently incorporated only cysteine. The Km for cysteine uptake was 4 X 10(-4) M. Cystine supported axenic growth if low concentrations of 2-mercaptoethanol were added at regular intervals. PMID:4045385

  17. High-efficiency clonal growth of bloodstream- and insect-form Trypanosoma brucei on agarose plates.

    PubMed Central

    Carruthers, V B; Cross, G A

    1992-01-01

    This report describes a method for growing both bloodstream- and procyclic-form Trypanosoma brucei as colonies on agarose plates. Procyclic colonies, which took 2 weeks to develop, grew with approximately 17% plating efficiency on SDM-79/0.65% agarose supplemented with 20% (vol/vol) conditioned medium. Bloodstream forms were adapted to in vitro growth in liquid HMI-9 medium and then spread on HMI-9/0.65% agarose plates, where they grew to visible colonies in 3-5 days. Plating efficiencies were from 3 to 80%, depending upon the trypanosome variant and experiment. Colonies were proven to be the result of growth from a single cell and contained approximately 10(6) cells at maturity. Colonies were transferred to filters and probed for multicopy and single-copy genes. Potential uses of this method in conjunction with classical and reverse genetic approaches to studying trypanosomes are discussed. Images PMID:1528898

  18. A microfluidic device for separating erythrocytes polluted by lead (II) from a continuous bloodstream flow.

    PubMed

    Wang, Ming-Wen

    2012-03-01

    To sort and separate erythrocytes contaminated by lead (II) from whole bloodstream flow, the first step is to use a microchannel to transport the blood cells into a microdevice. Within the device, polluted erythrocytes can be separated from the bloodstream by applying local dielectrophoretic (DEP) forces. Exploiting the fact that Pb(2+) ions attach to the membranes of the erythrocytes, we utilize the microfluidic DEP device to perform property-based fractionation of the blood samples and to separate the polluted erythrocytes from the continuous bloodstream flow. Atomic absorption spectrometer analysis reveals that, to remove lead-polluted erythrocytes, the most effective driving velocity was less than 0.1 cm/s through our microfluidic DEP device, based on an applied power of 10 V(peak-peak) and a frequency of 15.5 MHz AC field. We were able to remove 80% of the polluted erythrocytes. Using gentle DEP manipulating techniques to efficiently sort unique cells within a complex biological sample may potentially allow biological sorting to be performed outside of hospitals, in facilities without biological analyzing equipment. PMID:22522535

  19. Mouse infection and pathogenesis by Trypanosoma brucei motility mutants.

    PubMed

    Kisalu, Neville K; Langousis, Gerasimos; Bentolila, Laurent A; Ralston, Katherine S; Hill, Kent L

    2014-06-01

    The flagellum of Trypanosoma brucei is an essential and multifunctional organelle that drives parasite motility and is receiving increased attention as a potential drug target. In the mammalian host, parasite motility is suspected to contribute to infection and disease pathogenesis. However, it has not been possible to test this hypothesis owing to lack of motility mutants that are viable in the bloodstream life cycle stage that infects the mammalian host. We recently identified a bloodstream-form motility mutant in 427-derived T.?brucei in which point mutations in the LC1 dynein subunit disrupt propulsive motility but do not affect viability. These mutants have an actively beating flagellum, but cannot translocate. Here we demonstrate that the LC1 point mutant fails to show enhanced cell motility upon increasing viscosity of the surrounding medium, which is a hallmark of wild type T.?brucei, thus indicating that motility of the mutant is fundamentally altered compared with wild type cells. We next used the LC1 point mutant to assess the influence of trypanosome motility on infection in mice. Wesurprisingly found that disrupting parasite motility has no discernible effect on T.?brucei bloodstream infection. Infection time-course, maximum parasitaemia, number of waves of parasitaemia, clinical features and disease outcome are indistinguishable between motility mutant and control parasites. Our studies provide an important step toward understanding the contribution of parasite motility to infection and a foundation for future investigations of T.?brucei interaction with the mammalian host. PMID:24286532

  20. [Nosocomial infections: definition, frequence and risk factors].

    PubMed

    Diouf, E; Bèye, M D; Diop, Ndoye M; Kane, O; Ka, Sall B

    2007-01-01

    Infection is nosocomial if it missed at the time patient admission in the health establishment. When infectious status of the patient on admission is unknown, infection is generally regarded as nosocomial if it appears after a time of at least 48 hours of hospitalization. For surgical site infection, the commonly allowed time is 30 days, or, in case of prosthesis or an implant, one year after surgical intervention. Nosocomial infections (NI) constitute major health care problem from their frequency, their cost, their gravity. Mortality related to NI can attempt 70% in certain units like intensive care units. Two ways of contamination are possible: the endogenous way is responsible of majority of hospital infections. The normally sterile sites are contaminated then colonized by the flora which is carrying the patient himself, with the favor of a rupture of the barriers of defense. The exogenic way is associated colonization, possibly followed by infection, of the patient by external bacteria, coming from others patients or from environment, transmitted in an indirect way (aerosols, manuportage, materials). Whatever its mode of transmission, apparition of nosocomial infection can be related to several supporting factors: age and pathology, certain treatments (antibiotic which unbalance patients' flora and select resistant bacteria, immunosuppressive treatments), invasive practices necessary to the patient treatment. The prevalence of nosocomial infections is higher in the intensive care units where certain studies bring back rates of 42.8% versus 12.1% in others services. The four sites of nosocomial infection most frequently concerned are: the respiratory site, urinary infections, bloodstream infections (Catheters related bloodstream infections in particular), and surgical sites infections. The relative proportion of these infections varies according to principal activity of the unity. PMID:19102097

  1. Infective Endocarditis

    MedlinePLUS

    ... can be caused by bacteria, fungi, or other microorganisms that enter your bloodstream. (You may have heard ... usually group A strep—and not by other microorganisms.) Normally, microorganisms live on your skin, in your ...

  2. Carbohydrade Recognition at Infection Site

    NSDL National Science Digital Library

    Bruce Alberts

    1998-07-01

    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.

  3. The ethanolamine branch of the Kennedy pathway is essential in the bloodstream form of Trypanosoma brucei

    PubMed Central

    Gibellini, Federica; Hunter, William N; Smith, Terry K

    2009-01-01

    Phosphatidylethanolamine (GPEtn), a major phospholipid component of trypanosome membranes, is synthesized de novo from ethanolamine through the Kennedy pathway. Here the composition of the GPEtn molecular species in the bloodstream form of Trypanosoma brucei is determined, along with new insights into phospholipid metabolism, by in vitro and in vivo characterization of a key enzyme of the Kennedy pathway, the cytosolic ethanolamine-phosphate cytidylyltransferase (TbECT). Gene knockout indicates that TbECT is essential for growth and survival, thus highlighting the importance of the Kennedy pathway for the pathogenic stage of the African trypanosome. Phosphatiylserine decarboxylation, a potential salvage pathway, does not appear to be active in cultured bloodstream form T. brucei, and it is not upregulated even when the Kennedy pathway is disrupted. In vivo metabolic labelling and phospholipid composition analysis by ESI-MS/MS of the knockout cells confirmed a significant decrease in GPEtn species, as well as changes in the relative abundance of other phospholipid species. Reduction in GPEtn levels had a profound influence on the morphology of the mutants and it compromised mitochondrial structure and function, as well as glycosylphosphatidylinositol anchor biosynthesis. TbECT is therefore genetically validated as a potential drug target against the African trypanosome. PMID:19555461

  4. Multicellularity and Antibiotic Resistance in Klebsiella pneumoniae Grown Under Bloodstream-Mimicking Fluid Dynamic Conditions

    PubMed Central

    Thornton, Margaret M.; Chung-Esaki, Hangyul M.; Irvin, Charlene B.; Bortz, David M.; Solomon, Michael J.; Younger, John G.

    2012-01-01

    Background.?While the importance of fluid dynamical conditions is well recognized in the growth of biofilms, their role during bacteremia is unknown. We examined the impact of physiological fluid shear forces on the development of multicellular aggregates of Klebsiella pneumoniae. Methods.?Wild-type and O-antigen or capsular mutants of K. pneumoniae were grown as broth culture in a Taylor-Couette flow cell configured to provide continuous shear forces comparable to those encountered in the human arterial circulation (ie, on the order of 1.0 Pa). The size distribution and antibiotic resistance of aggregates formed in this apparatus were determined, as was their ability to persist in the bloodstream of mice following intravenous injection. Results.?Unlike growth in shaking flasks, bacteria grown in the test apparatus readily formed aggregates, a phenotype largely absent in capsular mutants and to a lesser degree in O-antigen mutants. Aggregates were found to persist in the bloodstream of mice. Importantly, organisms grown under physiological shear were found to have an antibiotic resistance phenotype intermediate between that of fully planktonic and biofilm states. Conclusions.?When grown under intravascular-magnitude fluid dynamic conditions, K. pneumoniae spontaneously develops into multicellular aggregates that are capable of persisting in the circulation and exhibit increased antibiotic resistance. PMID:22711903

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

    Microsoft Academic Search

    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

    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

  6. UCLA researchers and others find that new technology allows scientists to capture and preserve cancer cells circulating in the bloodstream

    Cancer.gov

    Scientists from the RIKEN Advanced Science Institute in Japan and University of California Los Angeles report a new nanoscale Velcro-like device that captures and releases tumor cells that have broken away from primary tumors and are circulating in the bloodstream.

  7. National Survey of Practices to Prevent Healthcare-Associated Infections in Thailand: The Role of Safety Culture and Collaboratives

    Microsoft Academic Search

    Anucha Apisarnthanarak; M. Todd Greene; Edward H. Kennedy; Thana Khawcharoenporn; Sarah Krein; Sanjay Saint

    2012-01-01

    Objective. To evaluate hospital characteristics and practices used by Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line–associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP), the 3 most common types of healthcare-associated infection (HAI) in Thailand.Design. Survey.Setting. Thai hospitals with an intensive care unit and 250 or more hospital bedsMethods. Between January 1, 2010, and October 31, 2010,

  8. Advances in the diagnosis and management of central venous access device infections in children.

    PubMed

    Bowen, Asha; Carapetis, Jonathan

    2011-01-01

    Infection is a well-known complication of central venous access device (CVAD) use, with an incidence of 3-6 bloodstream infections per 1,000 catheter days in children. Prevention of CVAD infections has improved with new strategies including the use of chlorhexidine antisepsis, bundles, maximal sterile barriers for insertion, prophylactic locks, antibiotic impregnated catheters and tunnelling of long-term devices. Despite these strategies, catheter-related bloodstream infections (CRBSIs) continue to be an important health problem. New approaches to diagnosis include differential time to positivity and quantification of blood cultures and molecular diagnostics. The management of CRBSIs includes techniques for line salvage including ethanol, antibiotic, hydrochloric acid, taurolidine and urokinase locks. When these fail, line removal and antimicrobial therapy are recommended. PMID:21120722

  9. JVG9, a benzimidazole derivative, alters the surface and cytoskeleton of Trypanosoma cruzi bloodstream trypomastigotes

    PubMed Central

    Díaz-Chiguer, Dylan L; Hernández-Luis, Francisco; Nogueda-Torres, Benjamín; Castillo, Rafael; Reynoso-Ducoing, Olivia; Hernández-Campos, Alicia; Ambrosio, Javier R

    2014-01-01

    Trypanosoma cruzi has a particular cytoskeleton that consists of a subpellicular network of microtubules and actin microfilaments. Therefore, it is an excellent target for the development of new anti-parasitic drugs. Benzimidazole 2-carbamates, a class of well-known broad-spectrum anthelmintics, have been shown to inhibit the in vitro growth of many protozoa. Therefore, to find efficient anti-trypanosomal (trypanocidal) drugs, our group has designed and synthesised several benzimidazole derivatives. One, named JVG9 (5-chloro-1H-benzimidazole-2-thiol), has been found to be effective against T. cruzi bloodstream trypomastigotes under both in vitro and in vivo conditions. Here, we present the in vitro effects observed by laser scanning confocal and scanning electron microscopy on T. cruzi trypomastigotes. Changes in the surface and the distribution of the cytoskeletal proteins are consistent with the hypothesis that the trypanocidal activity of JVG9 involves the cytoskeleton as a target. PMID:25317703

  10. The interactions between bloodstream and vascular structure on aortic dissecting aneurysmal model: A numerical study

    NASA Astrophysics Data System (ADS)

    Chen, Zeng-Sheng; Fan, Zhan-Ming; Zhang, Xi-Wen

    2013-06-01

    Stent-graft implantation is an important means of clinical treatment for aortic dissecting aneurysm (ADA). However, researches on fluid dynamics effects of stent were rare. Computer simulation was used to investigate the interactions between bloodstream and vascular structure in a stented ADA, which endures the periodic pulse velocity and pressure. We obtained and analyzed the flow velocity distribution, the wall displacement and wall stress in the ADA. By comparing the different results between a non-stented and a stented ADA, we found that the insertion of a vascular graft can make the location of maximum stress and displacement move from the aneurysm lumen wall to the artery wall, accompanied with a greatly decrease in value. These results imply that the placement of a stent-graft of any kind to occlude ADA will result in a decreased chance of rupture.

  11. Experimental and in silico analyses of glycolytic flux control in bloodstream form Trypanosoma brucei.

    PubMed

    Albert, Marie-Astrid; Haanstra, Jurgen R; Hannaert, Véronique; Van Roy, Joris; Opperdoes, Fred R; Bakker, Barbara M; Michels, Paul A M

    2005-08-01

    A mathematical model of glycolysis in bloodstream form Trypanosoma brucei was developed previously on the basis of all available enzyme kinetic data (Bakker, B. M., Michels, P. A. M., Opperdoes, F. R., and Westerhoff, H. V. (1997) J. Biol. Chem. 272, 3207-3215). The model predicted correctly the fluxes and cellular metabolite concentrations as measured in non-growing trypanosomes and the major contribution to the flux control exerted by the plasma membrane glucose transporter. Surprisingly, a large overcapacity was predicted for hexokinase (HXK), phosphofructokinase (PFK), and pyruvate kinase (PYK). Here, we present our further analysis of the control of glycolytic flux in bloodstream form T. brucei. First, the model was optimized and extended with recent information about the kinetics of enzymes and their activities as measured in lysates of in vitro cultured growing trypanosomes. Second, the concentrations of five glycolytic enzymes (HXK, PFK, phosphoglycerate mutase, enolase, and PYK) in trypanosomes were changed by RNA interference. The effects of the knockdown of these enzymes on the growth, activities, and levels of various enzymes and glycolytic flux were studied and compared with model predictions. Data thus obtained support the conclusion from the in silico analysis that HXK, PFK, and PYK are in excess, albeit less than predicted. Interestingly, depletion of PFK and enolase had an effect on the activity (but not, or to a lesser extent, expression) of some other glycolytic enzymes. Enzymes located both in the glycosomes (the peroxisome-like organelles harboring the first seven enzymes of the glycolytic pathway of trypanosomes) and in the cytosol were affected. These data suggest the existence of novel regulatory mechanisms operating in trypanosome glycolysis. PMID:15955817

  12. Epidemiology of Candidemia: 3Year Results from the Emerging Infections and the Epidemiology of Iowa Organisms Study

    Microsoft Academic Search

    D. J. Diekema; S. A. Messer; A. B. Brueggemann; S. L. Coffman; G. V. Doern; L. A. Herwaldt; M. A. Pfaller

    2002-01-01

    Bloodstream infections due to Candida species cause significant morbidity and mortality. Surveillance for candidemia is necessary to detect trends in species distribution and antifungal resistance. We performed prospective surveillance for candidemia at 16 hospitals in the State of Iowa from 1 July 1998 through 30 June 2001. Using U.S. Census Bureau and Iowa Hospital Association data to estimate a population

  13. Cloning and sequencing of a novel meta-cleavage dioxygenase gene whose product is involved in degradation of gamma-hexachlorocyclohexane in Sphingomonas paucimobilis.

    PubMed

    Miyauchi, K; Adachi, Y; Nagata, Y; Takagi, M

    1999-11-01

    Sphingomonas (formerly Pseudomonas) paucimobilis UT26 utilizes gamma-hexachlorocyclohexane (gamma-HCH), a halogenated organic insecticide, as a sole source of carbon and energy. In a previous study, we showed that gamma-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. Bacteriol. 180:1354-1359, 1998). In this study, we cloned and characterized a gene, designated linE, which is located upstream of linD and is directly involved in the degradation of CHQ. The LinE protein consists of 321 amino acids, and all of the amino acids which are reported to be essential for the activity of meta-cleavage dioxygenases are conserved in LinE. Escherichia coli overproducing LinE could convert both CHQ and HQ, producing gamma-hydroxymuconic semialdehyde and maleylacetate, respectively, with consumption of O(2) but could not convert catechol, which is one of the major substrates for meta-cleavage dioxygenases. LinE seems to be resistant to the acylchloride, which is the ring cleavage product of CHQ and which seems to react with water to be converted to maleylacetate. These results indicated that LinE is a novel type of meta-cleavage dioxygenase, designated (chloro)hydroquinone 1, 2-dioxygenase, which cleaves aromatic rings with two hydroxyl groups at para positions preferably. This study represents a direct demonstration of a new type of ring cleavage pathway for aromatic compounds, the hydroquinone pathway. PMID:10542173

  14. Healthcare-associated infections in the hospitalized neonate: a review.

    PubMed

    Hooven, Thomas A; Polin, Richard A

    2014-03-01

    Healthcare-associated infections in the neonatal intensive care unit add considerably to hospital stays and costs, and contribute to numerous adverse outcomes, including death. The relatively high prevalence of healthcare-associated infections among neonates is secondary to the newborn's underdeveloped immune system, the need for frequent invasive procedures, and generally prolonged hospitalization. Central line associated bloodstream infections (CLABSI) are the most common form of healthcare-associated infection, with coagulase-negative Staphylococcus species (CONS) being the most commonly cultured microorganism. Interpretation of culture results in the setting of any suspected healthcare-associated infection can be made difficult by the possibility that a recovered organism represents a commensal contaminant, rather than an actual cause of infection. This is especially true in the case of a blood culture that grows CONS during evaluation for suspected CLABSI. This article provides an overview of the epidemiology, diagnosis, prevention, and treatment of healthcare-associated infections in the NICU. PMID:24709456

  15. Blood transfusion and infection after cardiac surgery.

    PubMed

    Horvath, Keith A; Acker, Michael A; Chang, Helena; Bagiella, Emilia; Smith, Peter K; Iribarne, Alexander; Kron, Irving L; Lackner, Pamela; Argenziano, Michael; Ascheim, Deborah D; Gelijns, Annetine C; Michler, Robert E; Van Patten, Danielle; Puskas, John D; O'Sullivan, Karen; Kliniewski, Dorothy; Jeffries, Neal O; O'Gara, Patrick T; Moskowitz, Alan J; Blackstone, Eugene H

    2013-06-01

    Cardiac surgery is the largest consumer of blood products in medicine; although believed life saving, transfusion carries substantial adverse risks. This study characterizes the relationship between transfusion and risk of major infection after cardiac surgery. In all, 5,158 adults were prospectively enrolled to assess infections after cardiac surgery. The most common procedures were isolated coronary artery bypass graft surgery (31%) and isolated valve surgery (30%); 19% were reoperations. Infections were adjudicated by independent infectious disease experts. Multivariable Cox modeling was used to assess the independent effect of blood and platelet transfusions on major infections within 60 ± 5 days of surgery. Red blood cells (RBC) and platelets were transfused in 48% and 31% of patients, respectively. Each RBC unit transfused was associated with a 29% increase in crude risk of major infection (p < 0.001). Among RBC recipients, the most common infections were pneumonia (3.6%) and bloodstream infections (2%). Risk factors for infection included postoperative RBC units transfused, longer duration of surgery, and transplant or ventricular assist device implantation, in addition to chronic obstructive pulmonary disease, heart failure, and elevated preoperative creatinine. Platelet transfusion decreased the risk of infection (p = 0.02). Greater attention to management practices that limit RBC use, including cell salvage, small priming volumes, vacuum-assisted venous return with rapid autologous priming, and ultrafiltration, and preoperative and intraoperative measures to elevate hematocrit could potentially reduce occurrence of major postoperative infections. PMID:23647857

  16. New materials and devices for preventing catheter-related infections

    PubMed Central

    2011-01-01

    Catheters are the leading source of bloodstream infections for patients in the intensive care unit (ICU). Comprehensive unit-based programs have proven to be effective in decreasing catheter-related bloodstream infections (CR-BSIs). ICU rates of CR-BSI higher than 2 per 1,000 catheter-days are no longer acceptable. The locally adapted list of preventive measures should include skin antisepsis with an alcoholic preparation, maximal barrier precautions, a strict catheter maintenance policy, and removal of unnecessary catheters. The development of new technologies capable of further decreasing the now low CR-BSI rate is a major challenge. Recently, new materials that decrease the risk of skin-to-vein bacterial migration, such as new antiseptic dressings, were extensively tested. Antimicrobial-coated catheters can prevent CR-BSI but have a theoretical risk of selecting resistant bacteria. An antimicrobial or antiseptic lock may prevent bacterial migration from the hub to the bloodstream. This review discusses the available knowledge about these new technologies. PMID:21906266

  17. Freeze-fracture study of the bloodstream form of Trypanosoma brucei gambiense.

    PubMed

    Yoshikawa, H; Furuki, J; Takahashi, Y; Morioka, H; Yoshida, Y

    1990-01-01

    The ultrastructure of Trypanosoma brucei gambiense was investigated by the freeze-fracture method. Three different regions of the continuous plasma membrane; cell body proper, flagellar pocket, and flagellum were compared in density and distribution of the intramembranous particles (IMP's). The IMP-density was highest in the flagellar pocket membrane and lowest in flagellum. Intra membranous particles of the cell body membrane were distributed uniformly on both the protoplasmic (P) and exoplasmic (E) faces. On the P face of the flagellar membrane, a single row of IMP-clusters was seen along the juncture of the flagellum to the cell body. Since the spacing of the IMP-clusters was almost equal to the spacing of the paired rivet structures observed in thin section, these clusters likely are related to the junction of flagellum and cell body. At the neck of the flagellar pocket, several linear arrays of IMP's were found on the P face of the flagellar membrane, while on the E face rows of depressions were seen. At the flagellar base, the clusters of IMP's were only seen on the P face. On the flagellar pocket membrane, particle-rich depressions and linear particle arrays were also found on the P face, while on the E face such special particle arrangements were not recognized. These particle-rich depressions may correspond to the sites of pinocytosis of the bloodstream forms which have been demonstrated in thin sections. PMID:2304029

  18. The Krebs Cycle Enzyme ?-Ketoglutarate Decarboxylase Is an Essential Glycosomal Protein in Bloodstream African Trypanosomes.

    PubMed

    Sykes, Steven; Szempruch, Anthony; Hajduk, Stephen

    2015-03-01

    ?-Ketoglutarate decarboxylase (?-KDE1) is a Krebs cycle enzyme found in the mitochondrion of the procyclic form (PF) of Trypanosoma brucei. The bloodstream form (BF) of T. brucei lacks a functional Krebs cycle and relies exclusively on glycolysis for ATP production. Despite the lack of a functional Krebs cycle, ?-KDE1 was expressed in BF T. brucei and RNA interference knockdown of ?-KDE1 mRNA resulted in rapid growth arrest and killing. Cell death was preceded by progressive swelling of the flagellar pocket as a consequence of recruitment of both flagellar and plasma membranes into the pocket. BF T. brucei expressing an epitope-tagged copy of ?-KDE1 showed localization to glycosomes and not the mitochondrion. We used a cell line transfected with a reporter construct containing the N-terminal sequence of ?-KDE1 fused to green fluorescent protein to examine the requirements for glycosome targeting. We found that the N-terminal 18 amino acids of ?-KDE1 contain overlapping mitochondrion- and peroxisome-targeting sequences and are sufficient to direct localization to the glycosome in BF T. brucei. These results suggest that ?-KDE1 has a novel moonlighting function outside the mitochondrion in BF T. brucei. PMID:25416237

  19. Infection of a Ventriculoatrial Shunt with Phenotypically Variable Staphylococcus epidermidis Masquerading as Polymicrobial Bacteremia Due to Various Coagulase-Negative Staphylococci and Kocuria varians

    Microsoft Academic Search

    Ronen Ben-Ami; Shiri Navon-Venezia; David Schwartz; Yehuda Carmeli

    2003-01-01

    The diagnosis of bloodstream infection with coagulase-negative staphylococci is frequently based on the isolation of the same organism from more than one blood culture. Phenotypic variation is a common charac- teristic of pathogenic strains of Staphylococcus epidermidis which may affect species identification by the micro- biology laboratory. We describe a patient with a new onset of nephritis and gram-positive bacteremia.

  20. Crystal Structure of Haloalkane Dehalogenase LinB from Sphingomonas paucimobilis UT26 at 0.95 Å Resolution: Dynamics of Catalytic Residues

    SciTech Connect

    Oakley, Aaron J.; Klvana, Martin; Otyepka, Michal; Nagata, Yuji; Wilce, Matthew C.J.; Damborsky, Jiri (UWA); (Tohoku U); (Palacky U); (Masaryk U)

    2010-11-16

    We present the structure of LinB, a 33-kDa haloalkane dehalogenase from Sphingomonas paucimobilis UT26, at 0.95 {angstrom} resolution. The data have allowed us to directly observe the anisotropic motions of the catalytic residues. In particular, the side-chain of the catalytic nucleophile, Asp108, displays a high degree of disorder. It has been modeled in two conformations, one similar to that observed previously (conformation A) and one strained (conformation B) that approached the catalytic base (His272). The strain in conformation B was mainly in the C{sub {alpha}}-C{sub {beta}}-C{sub {gamma}} angle (126{sup o}) that deviated by 13.4{sup o} from the 'ideal' bond angle of 112.6{sup o}. On the basis of these observations, we propose a role for the charge state of the catalytic histidine in determining the geometry of the catalytic residues. We hypothesized that double-protonation of the catalytic base (His272) reduces the distance between the side-chain of this residue and that of the Asp108. The results of molecular dynamics simulations were consistent with the structural data showing that protonation of the His272 side-chain nitrogen atoms does indeed reduce the distance between the side-chains of the residues in question, although the simulations failed to demonstrate the same degree of strain in the Asp108 C{sub {alpha}}-C{sub {beta}}-C{sub {gamma}} angle. Instead, the changes in the molecular dynamics structures were distributed over several bond and dihedral angles. Quantum mechanics calculations on LinB with 1-chloro-2,2-dimethylpropane as a substrate were performed to determine which active site conformations and protonation states were most likely to result in catalysis. It was shown that His272 singly protonated at N{sub {delta}1} and Asp108 in conformation A gave the most exothermic reaction ({Delta}H = -22 kcal/mol). With His272 doubly protonated at N{sub {delta}1} and N{sub {epsilon}2}, the reactions were only slightly exothermic or were endothermic. In all calculations starting with Asp108 in conformation B, the Asp108 C{sub {alpha}}-C{sub {beta}}-C{sub {gamma}} angle changed during the reaction and the Asp108 moved to conformation A. The results presented here indicate that the positions of the catalytic residues and charge state of the catalytic base are important for determining reaction energetics in LinB.

  1. Prevention of health care-associated infections.

    PubMed

    Hsu, Vincent

    2014-09-15

    Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, and hand hygiene and isolation precautions. Prevention of central line- or catheter-associated infections begins with avoidance of unnecessary insertion, adherence to aseptic technique when inserting, and device removal when no longer necessary. Specific recommendations for preventing central line-associated bloodstream infections include use of chlorhexidine for skin preparation, as a component of dressings, and for daily bathing of patients in intensive care units. Catheter-associated urinary tract infections are the most common device-related health care-associated infection. Maintaining a closed drainage system below the patient reduces the risk of infection. To prevent ventilator-associated pneumonia, which is associated with high mortality, mechanically ventilated patients should be placed in the semirecumbent position and receive antiseptic oral care. Prevention of surgical site infections includes hair removal using clippers, glucose control, and preoperative antibiotic prophylaxis. Reducing transmission of Clostridium difficile and multidrug-resistant organisms in the hospital setting begins with hand hygiene and contact precautions. Institutional efforts to reduce unnecessary antibiotic prescribing are also strongly recommended. Reducing rates of methicillin-resistant Staphylococcus aureus infection can be achieved through active surveillance cultures and decolonization therapy with mupirocin. PMID:25251230

  2. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome

    Microsoft Academic Search

    Bin Du; Yun Long; Hongzhong Liu; Dechang Chen; Dawei Liu; Yingchun Xu; Xiuli Xie

    2002-01-01

    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

  3. Evaluation of Clinical Outcomes in Patients with Bloodstream Infections Due to Gram-Negative Bacteria According to Carbapenem MIC Stratification

    PubMed Central

    Esterly, John S.; Wagner, Jamie; McLaughlin, Milena M.; Postelnick, Michael J.; Qi, Chao

    2012-01-01

    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. PMID:22777044

  4. Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients

    PubMed Central

    2012-01-01

    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. PMID:22947496

  5. Fighting Infection by Clonal Selection

    NSDL National Science Digital Library

    Etsuko Uno (Walter and Eliza Hall Institute of Medical Research; )

    2008-09-26

    Etsuko Uno and colleagues at the Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, explain Burnet's clonal selection theory in an animation of the body's response to Streptococcus pyogenes, the bacterium that causes strep throat. Proteins from the invader enter the lymph node and grab the attention of one of billions of B cells. That B cell then clones itself thousands of times and sends antibodies via the bloodstream to the infection site. There, the antibodies bind to the strep bacteria, acting as a red flag that alerts other immune system cells to destroy the infectious agent. "We hope that the animation will pique people's interest in how the immune system works and that they will appreciate the impact of Burnet's clonal selection theory on our understanding of the immune system," Uno says.

  6. Antifungal Susceptibilities of Bloodstream Isolates of Candida Species from Nine Hospitals in Korea: Application of New Antifungal Breakpoints and Relationship to Antifungal Usage

    PubMed Central

    Won, Eun Jeong; Shin, Jong Hee; Choi, Min Ji; Lee, Wee Gyo; Park, Yeon-Joon; Uh, Young; Kim, Shine-Young; Lee, Mi-Kyung; Kim, Soo Hyun; Shin, Myung Geun; Suh, Soon Pal; Ryang, Dong Wook

    2015-01-01

    We applied the new clinical breakpoints (CBPs) of the Clinical and Laboratory Standards Institute (CLSI) to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI) isolates of Candida species in Korea, and determined the relationship between the frequency of antifungal-resistant Candida BSI isolates and antifungal use at hospitals. Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428) of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0%) showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC) ?4 ?g/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%). By Spearman’s correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ?4 ?g/ml) (r = 0.700; P = 0.036) at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI. PMID:25706866

  7. Mycoplasmal Upper Respiratory Infection Presenting as Leukocytoclastic Vasculitis

    PubMed Central

    Rao, Mana; Agrawal, Abhinav; Parikh, Manan; Banayat, Rikka; Thomas, Maria Joana; Guo, Tianhua; Lee, Andrew

    2015-01-01

    Mycoplasma is a virulent organism that is known to primarily infect the respiratory tract; however, affection of the skin, nervous system, kidneys, heart and bloodstream has been observed in various forms, which include Stevens Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, encephalitis, renal failure, conduction system abnormalities and hemolytic anemia. Small vessel vasculitis is a lesser-known complication of mycoplasma pneumonia infection. We report a case of mycoplasmal upper respiratory tract infection with striking cutaneous lesions as the presenting symptom. Mycoplasmal infection was confirmed by serology testing, skin biopsy was suggestive of leukocytoclastic vasculitis. This case brings forth an uncommon manifestation of mycoplasmal infection with extra-pulmonary affection, namely small vessel vasculitis.

  8. Reducing the risk of infection associated with vascular access devices through nanotechnology: a perspective

    PubMed Central

    Zhang, Li; Keogh, Samantha; Rickard, Claire M

    2013-01-01

    Intravascular catheter-related infections are still a major problem in health care and are associated with significant morbidity, mortality, and additional cost. The formation of microbial biofilm on catheters makes these infections particularly complicated, as microbial cells that detach from the biofilm can lead to infection, and because these microorganisms are highly resistant to many antimicrobial agents; thus, catheter removal is often required to successfully treat infection. To reduce the risks of catheter-related infections, many strategies have been applied, such as improvements in aseptic insertion and post-insertion care practices, implantation techniques, and antibiotic coated or impregnated materials. However, despite significant advances in using these methods, it has not been possible to completely eradicate biofilm infections. Currently, nanotechnology approaches seem to be among the most promising for preventing biofilm formation and resultant catheter-related bloodstream infection (especially with multi-resistant bacterial strains). In this review, current knowledge about catheter technology and design, the mechanisms of catheter-related bloodstream infection, and the insertion and care practices performed by medical staff, are discussed, along with novel, achievable approaches to infection prevention, based on nanotechnology. PMID:24293997

  9. Structure-Function Analysis of Dynein Light Chain 1 Identifies Viable Motility Mutants in Bloodstream-Form Trypanosoma brucei ? †

    PubMed Central

    Ralston, Katherine S.; Kisalu, Neville K.; Hill, Kent L.

    2011-01-01

    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

  10. In vivo observation of the hypo-echoic "black hole" phenomenon in rat arterial bloodstream: a preliminary Study.

    PubMed

    Nam, Kweon-Ho; Paeng, Dong-Guk

    2014-07-01

    The "black hole," a hypo-echoic hole at the center of the bloodstream surrounded by a hyper-echoic zone in cross-sectional views, has been observed in ultrasound backscattering measurements of blood with red blood cell aggregation in in vitro studies. We investigated whether the phenomenon occurs in the in vivo arterial bloodstream of rats using a high-frequency ultrasound imaging system. Longitudinal and cross-sectional ultrasound images of the rat common carotid artery (CCA) and abdominal aorta were obtained using a 40-MHz ultrasound system. A high-frame-rate retrospective imaging mode was employed to precisely examine the dynamic changes in blood echogenicity in the arteries. When the imaging was performed with non-invasive scanning, blood echogenicity was very low in the CCA as compared with the surrounding tissues, exhibiting no hypo-echoic zone at the center of the vessel. Invasive imaging of the CCA by incising the skin and subcutaneous tissues at the imaging area provided clearer and brighter blood echo images, showing the "black hole" phenomenon near the center of the vessel in longitudinal view. The "black hole" was also observed in the abdominal aorta under direct imaging after laparotomy. The aortic "black hole" was clearly observed in both longitudinal and cross-sectional views. Although the "black hole" was always observed near the center of the arteries during the diastolic phase, it dissipated or was off-center along with the asymmetric arterial wall dilation at systole. In conclusion, we report the first in vivo observation of the hypo-echoic "black hole" caused by the radial variation of red blood cell aggregation in arterial bloodstream. PMID:24785440

  11. A cultivation method for growing bloodstream forms of Trypanosoma brucei to higher cell density and for longer time.

    PubMed

    Ajoko, Chinenye; Steverding, Dietmar

    2015-04-01

    A novel cultivation technique using transwells allowing the growth of bloodstream forms of Trypanosoma brucei for longer periods of time and to higher cell densities is described. Trypanosomes cultured in transwells placed in cups of tissue culture plates containing sixfold excess of medium grew within 4 days to maximum cell densities of 2?×?10(7) parasites per milliliter. Compared to control cultures, the exponential growth of trypanosomes was 1 day longer and the maximum cell concentration was increased fourfold. The new culture system may be useful in drug screening assays and analysing the T. brucei secretome. PMID:25663067

  12. Trypanosoma brucei evansi: dyskinetoplasia and loss of infectivity after long-term in vitro cultivation.

    PubMed

    Zweygarth, E; Kaminsky, R; Webster, P

    1990-12-01

    Bloodstream forms of a stock of Trypanosoma brucei evansi were propagated in vitro for more than 14 months. After that period, all organisms were dyskinetoplastic and had lost their infectivity for mice. An increase in diminazene aceturate resistance in vitro was observed whereas the susceptibility to isometamidium chloride, quinapyramine sulphate and suramin was unaltered. Trypanosomes derived from the long term culture had a surface coat. PMID:1980574

  13. Advances in the Diagnosis and Management of Central Venous Access Device Infections in Children

    Microsoft Academic Search

    Asha Bowen; Jonathan Carapetis

    \\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

  14. Therapeutic strategy for pandrug-resistant Klebsiella pneumoniae severe infections: short-course treatment with colistin increases the in vivo and in vitro activity of double carbapenem regimen.

    PubMed

    Oliva, Alessandra; Mascellino, Maria T; Cipolla, Alessia; D'Abramo, Alessandra; De Rosa, Annalisa; Savinelli, Stefano; Ciardi, Maria Rosa; Mastroianni, Claudio M; Vullo, Vincenzo

    2015-04-01

    Infections due to carbapenemase-producing Klebsiella pneumoniae represent an emerging threat due to the high mortality rate and lack of valid antimicrobial combinations, especially when the strain is colistin-resistant. We report a case of bloodstream infection due to pandrug-resistant K. pneumoniae treated successfully with an innovative regimen comprising a combination of colistin plus double carbapenem, along with an in vitro analysis showing the synergistic and bactericidal effect. PMID:25597275

  15. 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

    Marta L Render; Rachael Hasselbeck; Ron W Freyberg; Timothy P Hofer; Anne E Sales; Peter L Almenoff

    2011-01-01

    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,

  16. Global Quantitative SILAC Phosphoproteomics Reveals Differential Phosphorylation Is Widespread between the Procyclic and Bloodstream Form Lifecycle Stages of Trypanosoma brucei

    PubMed Central

    2013-01-01

    We report a global quantitative phosphoproteomic study of bloodstream and procyclic form Trypanosoma brucei using SILAC labeling of each lifecycle stage. Phosphopeptide enrichment by SCX and TiO2 led to the identification of a total of 10096 phosphorylation sites on 2551 protein groups and quantified the ratios of 8275 phosphorylation sites between the two lifecycle stages. More than 9300 of these sites (92%) have not previously been reported. Model-based gene enrichment analysis identified over representation of Gene Ontology terms relating to the flagella, protein kinase activity, and the regulation of gene expression. The quantitative data reveal that differential protein phosphorylation is widespread between bloodstream and procyclic form trypanosomes, with significant intraprotein differential phosphorylation. Despite a lack of dedicated tyrosine kinases, 234 phosphotyrosine residues were identified, and these were 3–4 fold over-represented among site changing >10-fold between the two lifecycle stages. A significant proportion of the T. brucei kinome was phosphorylated, with evidence that MAPK pathways are functional in both lifecycle stages. Regulation of gene expression in T. brucei is exclusively post-transcriptional, and the extensive phosphorylation of RNA binding proteins observed may be relevant to the control of mRNA stability in this organism. PMID:23485197

  17. Probing the Metabolic Network in Bloodstream-Form Trypanosoma brucei Using Untargeted Metabolomics with Stable Isotope Labelled Glucose.

    PubMed

    Creek, Darren J; Mazet, Muriel; Achcar, Fiona; Anderson, Jana; Kim, Dong-Hyun; Kamour, Ruwida; Morand, Pauline; Millerioux, Yoann; Biran, Marc; Kerkhoven, Eduard J; Chokkathukalam, Achuthanunni; Weidt, Stefan K; Burgess, Karl E V; Breitling, Rainer; Watson, David G; Bringaud, Frédéric; Barrett, Michael P

    2015-03-01

    Metabolomics coupled with heavy-atom isotope-labelled glucose has been used to probe the metabolic pathways active in cultured bloodstream form trypomastigotes of Trypanosoma brucei, a parasite responsible for human African trypanosomiasis. Glucose enters many branches of metabolism beyond glycolysis, which has been widely held to be the sole route of glucose metabolism. Whilst pyruvate is the major end-product of glucose catabolism, its transamination product, alanine, is also produced in significant quantities. The oxidative branch of the pentose phosphate pathway is operative, although the non-oxidative branch is not. Ribose 5-phosphate generated through this pathway distributes widely into nucleotide synthesis and other branches of metabolism. Acetate, derived from glucose, is found associated with a range of acetylated amino acids and, to a lesser extent, fatty acids; while labelled glycerol is found in many glycerophospholipids. Glucose also enters inositol and several sugar nucleotides that serve as precursors to macromolecule biosynthesis. Although a Krebs cycle is not operative, malate, fumarate and succinate, primarily labelled in three carbons, were present, indicating an origin from phosphoenolpyruvate via oxaloacetate. Interestingly, the enzyme responsible for conversion of phosphoenolpyruvate to oxaloacetate, phosphoenolpyruvate carboxykinase, was shown to be essential to the bloodstream form trypanosomes, as demonstrated by the lethal phenotype induced by RNAi-mediated downregulation of its expression. In addition, glucose derivatives enter pyrimidine biosynthesis via oxaloacetate as a precursor to aspartate and orotate. PMID:25775470

  18. Probing the Metabolic Network in Bloodstream-Form Trypanosoma brucei Using Untargeted Metabolomics with Stable Isotope Labelled Glucose

    PubMed Central

    Creek, Darren J.; Mazet, Muriel; Achcar, Fiona; Anderson, Jana; Kim, Dong-Hyun; Kamour, Ruwida; Morand, Pauline; Millerioux, Yoann; Biran, Marc; Kerkhoven, Eduard J.; Chokkathukalam, Achuthanunni; Weidt, Stefan K.; Burgess, Karl E. V.; Breitling, Rainer; Watson, David G.; Bringaud, Frédéric; Barrett, Michael P.

    2015-01-01

    Metabolomics coupled with heavy-atom isotope-labelled glucose has been used to probe the metabolic pathways active in cultured bloodstream form trypomastigotes of Trypanosoma brucei, a parasite responsible for human African trypanosomiasis. Glucose enters many branches of metabolism beyond glycolysis, which has been widely held to be the sole route of glucose metabolism. Whilst pyruvate is the major end-product of glucose catabolism, its transamination product, alanine, is also produced in significant quantities. The oxidative branch of the pentose phosphate pathway is operative, although the non-oxidative branch is not. Ribose 5-phosphate generated through this pathway distributes widely into nucleotide synthesis and other branches of metabolism. Acetate, derived from glucose, is found associated with a range of acetylated amino acids and, to a lesser extent, fatty acids; while labelled glycerol is found in many glycerophospholipids. Glucose also enters inositol and several sugar nucleotides that serve as precursors to macromolecule biosynthesis. Although a Krebs cycle is not operative, malate, fumarate and succinate, primarily labelled in three carbons, were present, indicating an origin from phosphoenolpyruvate via oxaloacetate. Interestingly, the enzyme responsible for conversion of phosphoenolpyruvate to oxaloacetate, phosphoenolpyruvate carboxykinase, was shown to be essential to the bloodstream form trypanosomes, as demonstrated by the lethal phenotype induced by RNAi-mediated downregulation of its expression. In addition, glucose derivatives enter pyrimidine biosynthesis via oxaloacetate as a precursor to aspartate and orotate. PMID:25775470

  19. A mouse model of food borne Listeria monocytogenes infection

    PubMed Central

    Bou Ghanem, Elsa N.; Myers-Morales, Tanya

    2014-01-01

    Listeria monocytogenes cause foodborne disease in humans that ranges in severity from mild, self-limiting gastroenteritis to life-threatening systemic infections of the blood, brain, or placenta. The most commonly used animal model of listeriosis is intravenous infection of mice. This systemic model is highly reproducible, and thus, useful for studying cell-mediated immune responses against an intracellular bacterial pathogen, but it completely bypasses the gastrointestinal phase of L. monocytogenes infection. Intragastric inoculation of L. monocytogenes produces more variable results and may cause direct bloodstream invasion in some animals. The food borne transmission model described here does not require specialized skills to perform and results in infections that more closely mimic human disease. This natural feeding model can be used to study both the host and pathogen-derived factors that govern susceptibility or resistance to orally acquired L. monocytogenes. PMID:24510293

  20. Nosocomial infections in dialysis access.

    PubMed

    Schweiger, Alexander; Trevino, Sergio; Marschall, Jonas

    2015-01-01

    Nosocomial infections in patients requiring renal replacement therapy have a high impact on morbidity and mortality. The most dangerous complication is bloodstream infection (BSI) associated with the vascular access, with a low BSI risk in arteriovenous fistulas or grafts and a comparatively high risk in central venous catheters. The single most important measure for preventing BSI is therefore the reduction of catheter use by means of early fistula formation. As this is not always feasible, prevention should focus on educational efforts, hand hygiene, surveillance of dialysis-associated events, and specific measures at and after the insertion of catheters. Core measures at the time of insertion include choosing the optimal site of insertion, the use of maximum sterile barrier precautions, adequate skin antisepsis, and the choice of catheter type; after insertion, access care needs to ensure hub disinfection and regular dressing changes. The application of antimicrobial locks is reserved for special situations. Evidence suggests that bundling a selection of the aforementioned measures can significantly reduce infection rates. The diagnosis of central line-associated BSI (CLABSI) is based on clinical signs and microbiological findings in blood cultures ideally drawn both peripherally and from the catheter. The prompt installation of empiric antibiotic treatment covering the most commonly encountered organisms is key regarding CLABSI treatment. Catheter removal is recommended in complicated cases or if cultures yield Staphylococcus aureus, enterococci, Pseudomonas or fungi. In other cases, guide wire exchange or catheter salvage strategies with antibiotic lock solutions may be acceptable alternatives. © 2015 S. Karger AG, Basel. PMID:25676304

  1. Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected children and infants in northern Tanzania

    PubMed Central

    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

    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. PMID:21470347

  2. DNA Microarray Genotyping and Virulence and Antimicrobial Resistance Gene Profiling of Methicillin-Resistant Staphylococcus aureus Bloodstream Isolates from Renal Patients ?

    PubMed Central

    McNicholas, Sinead; Shore, Anna C.; Coleman, David C.; Humphreys, Hilary; Hughes, Deirdre Fitzgerald

    2011-01-01

    Thirty-six methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates from renal patients were genetically characterized by DNA microarray analysis and spa typing. The isolates were highly clonal, belonging mainly to ST22-MRSA-IV. The immune evasion and enterotoxin gene clusters were found in 29/36 (80%) and 33/36 (92%) isolates, respectively. PMID:21940465

  3. Comparative In Vitro Activities of Ciprofloxacin, Gemifloxacin, Grepafloxacin, Moxifloxacin, Ofloxacin, Sparfloxacin, Trovafloxacin, and Other Antimicrobial Agents against Bloodstream Isolates of Gram-Positive Cocci

    Microsoft Academic Search

    DWIGHT HARDY; DANIEL AMSTERDAM; LIONEL A. MANDELL; COLEMAN ROTSTEIN

    2000-01-01

    The in vitro activity of gemifloxacin against 316 bloodstream isolates of staphylococci, pneumococci, and enterococci was compared with the activities of six fluoroquinolones and three other antimicrobial agents. Of the antimicrobial agents tested, gemifloxacin was the most potent against penicillin-intermediate and -resis- tant pneumococci, methicillin-susceptible and -resistant Staphylococcus epidermidis isolates, and coagulase- negative staphylococci. Due to the increasing penicillin resistance

  4. Extended-Spectrum  -Lactamases in Klebsiella pneumoniae Bloodstream Isolates from Seven Countries: Dominance and Widespread Prevalence of SHV- and CTX-M-Type  -Lactamases

    Microsoft Academic Search

    David L. Paterson; Kristine M. Hujer; Andrea M. Hujer; Bethany Yeiser; Michael D. Bonomo; Louis B. Rice; Robert A. Bonomo

    2003-01-01

    A huge variety of extended-spectrum -lactamases (ESBLs) have been detected during the last 20 years. The majority of these have been of the TEM or SHV lineage. We have assessed ESBLs occurring among a collection of 455 bloodstream isolates of Klebsiella pneumoniae, collected from 12 hospitals in seven countries. Multiple -lactamases were produced by isolates with phenotypic evidence of ESBL

  5. Antifungal susceptibility of 1000 Candida bloodstream isolates to 5 antifungal drugs: results of a multicenter study conducted in São Paulo, Brazil, 1995–2003

    Microsoft Academic Search

    Daniel Archimedes da Matta; Leila Paula de Almeida; Antônia Maria Machado; Ana Carolina Azevedo; Elisa Junko Ura Kusano; Norma Fracalanza Travassos; Reinaldo Salomão; Arnaldo Lopes Colombo

    2007-01-01

    We evaluated all Candida sp. bloodstream isolates obtained from patients admitted to 4 tertiary care hospitals between 1995 and 2003 in the city of São Paulo, Brazil. Susceptibility to amphotericin B, 5-fluorocytosine, fluconazole (FCZ), itraconazole (ITZ), and voriconazole (VCZ) was determined using the Clinical Laboratory Standards Institute broth microdilution method. We tested a total of 1000 strains, including 400 strains

  6. Taurolidine-citrate lock solution (TauroLock) significantly reduces CVAD-associated grampositive infections in pediatric cancer patients

    Microsoft Academic Search

    Arne Simon; Roland A Ammann; Gertrud Wiszniewsky; Udo Bode; Gudrun Fleischhack; Mette M Besuden

    2008-01-01

    BACKGROUND: Taurolidin\\/Citrate (TauroLock™), a lock solution with broad spectrum antimicrobial activity, may prevent bloodstream infection (BSI) due to coagulase-negative staphylococci (CoNS or 'MRSE' in case of methicillin-resistant isolates) in pediatric cancer patients with a long term central venous access device (CVAD, Port- or\\/Broviac-\\/Hickman-catheter type). METHODS: In a single center prospective 48-months cohort study we compared all patients receiving anticancer chemotherapy

  7. Trypanosoma brucei: five commonly used trypanocides assayed in vitro with a mammalian feeder layer system for cultivation of bloodstream forms.

    PubMed

    Borowy, N K; Fink, E; Hirumi, H

    1985-12-01

    The in vitro activity of five commonly used trypanocides on bloodstream forms of Trypanosoma brucei brucei TC 221 was examined in 24-well culture plates in the presence of bovine fibroblast feeder layer cells. The minimum effective concentrations determined were as follows: Berenil 1.0 microgram/ml; Samorin 10.0 micrograms/ml; Antrycide dimethylsulfate 0.1 microgram/ml; Arsobal 0.01 microgram/ml; Naganol 1.0 microgram/ml. Contrary to values obtained with other in vitro assays, minimum effective concentrations obtained here were within the range of drug levels reached in blood, plasma, or serum of humans and animals after treatment with curative doses. The trypanocidal activity of Naganol in this assay was of particular interest, since Naganol has been hitherto considered to be inactive in vitro. PMID:4076388

  8. Surveillance programme for multidrug-resistant bacteria in healthcare-associated infections: an urban perspective in South Brazil.

    PubMed

    Toledo, P V M; Arend, L N; Pilonetto, M; Costa Oliveira, J C; Luhm, K R

    2012-04-01

    Multidrug-resistant bacteria (MDRB) have emerged as a public health problem and the World Health Organization recommends actions to control MDRB in healthcare-associated infections (HCAIs). This study describes a surveillance programme for MDRB in HCAIs at Curitiba, Brazil. MDRB in pneumonia, bloodstream, urinary tract and surgical site infections has been surveyed since January 2010. Carbapenem-resistant Acinetobacter baumannii and third generation resistant Klebsiella pneumoniae were the most frequent MDRB in HCAIs. Infection control strategies enrolling hospitals and public health have been developed. The data presented describe MDRB prevalence and the feasibility of this municipal MDRB surveillance programme in Brazil. PMID:22382275

  9. A Descriptive Study of Nosocomial Infections in an Adult Intensive Care Unit in Fiji: 2011-12

    PubMed Central

    Nabose, Ilisapeci; Ram, Sharan; Viney, Kerri; Graham, Stephen M.

    2014-01-01

    Nosocomial infections in an intensive care unit (ICU) are common and associated with a high mortality but there are no published data from the Oceania region. A retrospective study in Fiji's largest ICU (2011-12) reported that 114 of a total 663 adult ICU admissions had bacteriological culture-confirmed nosocomial infection. The commonest sites of infection were respiratory and bloodstream. Gram negative bacteria were the commonest pathogens isolated, especially Klebsiella pneumoniae (extended-spectrum ?-Lactamase-producing), Acinetobacter, and Pseudomonas species. Mortality for those with a known outcome was 33%. Improved surveillance and implementation of effective preventive interventions are needed. PMID:25309601

  10. The glycosylphosphatidylinositol (GPI) biosynthetic pathway of bloodstream-form Trypanosoma brucei is dependent on the de novo synthesis of inositol

    PubMed Central

    Martin, Kirstee L.; Smith, Terry K.

    2013-01-01

    Summary In bloodstream-form Trypanosoma brucei (the causative agent of African sleeping sickness) the glycosylphosphatidylinositol (GPI) anchor biosynthetic pathway has been validated genetically and chemically as a drug target. The conundrum that GPI anchors could not be in vivo labelled with [3H]-inositol led us to hypothesize that de novo synthesis was responsible for supplying myo-inositol for phosphatidylinositol (PI) destined for GPI synthesis. The rate-limiting step of the de novo synthesis is the isomerization of glucose 6-phosphate to 1-d-myo-inositol-3-phosphate, catalysed by a 1-d-myo-inositol-3-phosphate synthase (INO1). When grown under non-permissive conditions, a conditional double knockout demonstrated that INO1 is an essential gene in bloodstream-form T. brucei. It also showed that the de novo synthesized myo-inositol is utilized to form PI, which is preferentially used in GPI biosynthesis. We also show for the first time that extracellular myo-inositol can in fact be used in GPI formation although to a limited extent. Despite this, extracellular inositol cannot compensate for the deletion of INO1. Supporting these results, there was no change in PI levels in the conditional double knockout cells grown under non-permissive conditions, showing that perturbation of growth is due to a specific lack of de novo synthesized myo-inositol and not a general inositol-less death. These results suggest that there is a distinction between de novo synthesized myo-inositol and that from the extracellular environment. PMID:16824097

  11. First reported case of Staphylococcus condimenti infection associated with catheter-related bacteraemia

    PubMed Central

    Misawa, Y.; Yoshida, A.; Okugawa, S.; Moriya, K.

    2014-01-01

    We report a case of a patient who experienced a catheter-related bloodstream infection caused by Staphylococcus condimenti, which was first isolated from soy sauce mash. This is the first reported case of human infection. Although blood culture isolates and the catheter tip tube did not reveal coagulase or clumping factor, false-positive results were obtained from latex agglutination tests for clumping factor and protein A due to self-agglutination. Care is needed when performing only latex agglutination test without a coagulase test. Further studies are needed to determine the pathogenic potential of S. condimenti based on appropriate identification. PMID:25755886

  12. Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília

    PubMed Central

    Conterno, Lucieni Oliveira; Toni, Silvana Martins Dias; Konkiewitz, Rubiana Gonçalves; Guedes, Elaine Salla; de Barros, Rubens Tofano; Tiveron, Marcos Gradim

    2014-01-01

    Objective this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa de Misericórdia de Marília. Results 351 nosocomial infections were diagnosed (17%), 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%), urinary tract infection (2.8%), pneumonia (2.3%), and bloodstream infection (1.7%). The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31), ICU stay > 2 days (OR 5, 49, 95% CI 2.98 to 10, 09), mechanical ventilation > 2 days (OR11, 93, 95% CI 6.1 to 23.08), use of urinary catheter > 3 days (OR 4.85 95% CI 2.95 -7.99). Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24). Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0), use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0), insulin use (OR 1.8; 95% CI 1.2 to 2.8), surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0) pneumonia (OR 4.3; 95% CI 2.1 to 8.9) and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2). Conclusion Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality. PMID:25140466

  13. Novel Approaches to the Diagnosis, Prevention and Treatment of Medical Device-Associated Infections

    PubMed Central

    Vergidis, Paschalis; Patel, Robin

    2011-01-01

    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. PMID:22284383

  14. Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals.

    PubMed

    Gravel, D; Taylor, G; Ofner, M; Johnston, L; Loeb, M; Roth, V R; Stegenga, J; Bryce, E; Matlow, Anne

    2007-07-01

    A survey of adult patients 19 years of age and older was conducted in February 2002 in hospitals across Canada to estimate the prevalence of healthcare-associated infections (HAIs). A total of 5750 adults were surveyed; 601 of these had 667 HAIs, giving a prevalence of 10.5% infected patients and 11.6% HAIs. Urinary tract infections (UTI) were the most frequent HAI, shown by 194 (3.4%) of the patients surveyed. Pneumonia was found in 175 (3.0%) of the patients, surgical site infections (SSI) in 146 (2.5%), bloodstream infections (BSI) in 93 (1.6%) and Clostridium difficile-associated diarrhoea (CDAD) in 59 (1%). In this first national point prevalence study in Canada, the prevalence of HAI was found to be similar to that reported by other industrialized countries. PMID:17574304

  15. Salmonella typhimurium disseminates within its host by manipulating the motility of infected cells.

    PubMed

    Worley, Micah J; Nieman, George S; Geddes, Kaoru; Heffron, Fred

    2006-11-21

    The mammalian host has a number of innate immune mechanisms designed to limit the spread of infection, yet many bacteria, including Salmonella, can cause systemic disease. Salmonella typhimurium-infected phagocytes traverse the gastrointestinal (GI) epithelium and enter the bloodstream within minutes after ingestion, thereby spreading throughout its host. Here, we provide a cellular and molecular basis for this phenomenon. We demonstrate that S. typhimurium manipulates the migratory properties of infected GI phagocytes with a type III secretion system. We show that one secreted effector, SrfH, interacts with the host protein TRIP6, a member of the zyxin family of adaptor proteins that regulate motility. SrfH promotes phagocyte motility in vitro and accelerates the systemic spread of infection away from the lumen of the intestine in the mouse. This is a previously uncharacterized mechanism by which an intracellular pathogen overcomes host defenses designed to immobilize infected cells. PMID:17095609

  16. Invasive Trichosporon infection in solid organ transplant patients: a report of two cases identified using IGS1 ribosomal DNA sequencing and a review of the literature.

    PubMed

    Almeida Júnior, J N; Song, A T W; Campos, S V; Strabelli, T M V; Del Negro, G M; Figueiredo, D S Y; Motta, A L; Rossi, F; Guitard, J; Benard, G; Hennequin, C

    2014-02-01

    Trichosporon species are rare etiologic agents of invasive fungal infection in solid organ transplant (SOT) recipients. We report 2 well-documented cases of Trichosporon inkin invasive infection in SOT patients. We also conducted a detailed literature review of Trichosporon species infections in this susceptible population. We gathered a total of 13 cases of Trichosporon species infections. Any type of organ transplantation can be complicated by Trichosporon infection. Bloodstream infections and disseminated infections were the most common clinical presentations. Liver recipients with bloodstream or disseminated infections had poor prognoses. Although the most common species was formerly called Trichosporon beigelii, this species name should no longer be used because of the changes in the taxonomy of this genus resulting from the advent of molecular approaches, which were also used to identify the strains isolated from our patients. Antifungal susceptibility testing highlights the possibility of multidrug resistance. Indeed, Trichosporon has to be considered in cases of breakthrough infection or treatment failure under echinocandins or amphotericin therapy. Voriconazole seems to be the best treatment option. PMID:24383613

  17. Improved Sensitivity for Molecular Detection of Bacterial and Candida Infections in Blood

    PubMed Central

    Bacconi, Andrea; Richmond, Gregory S.; Baroldi, Michelle A.; Laffler, Thomas G.; Blyn, Lawrence B.; Carolan, Heather E.; Frinder, Mark R.; Toleno, Donna M.; Metzgar, David; Gutierrez, Jose R.; Massire, Christian; Rounds, Megan; Kennel, Natalie J.; Rothman, Richard E.; Peterson, Stephen; Carroll, Karen C.; Wakefield, Teresa; Ecker, David J.

    2014-01-01

    The rapid identification of bacteria and fungi directly from the blood of patients with suspected bloodstream infections aids in diagnosis and guides treatment decisions. The development of an automated, rapid, and sensitive molecular technology capable of detecting the diverse agents of such infections at low titers has been challenging, due in part to the high background of genomic DNA in blood. PCR followed by electrospray ionization mass spectrometry (PCR/ESI-MS) allows for the rapid and accurate identification of microorganisms but with a sensitivity of about 50% compared to that of culture when using 1-ml whole-blood specimens. Here, we describe a new integrated specimen preparation technology that substantially improves the sensitivity of PCR/ESI-MS analysis. An efficient lysis method and automated DNA purification system were designed for processing 5 ml of whole blood. In addition, PCR amplification formulations were optimized to tolerate high levels of human DNA. An analysis of 331 specimens collected from patients with suspected bloodstream infections resulted in 35 PCR/ESI-MS-positive specimens (10.6%) compared to 18 positive by culture (5.4%). PCR/ESI-MS was 83% sensitive and 94% specific compared to culture. Replicate PCR/ESI-MS testing from a second aliquot of the PCR/ESI-MS-positive/culture-negative specimens corroborated the initial findings in most cases, resulting in increased sensitivity (91%) and specificity (99%) when confirmed detections were considered true positives. The integrated solution described here has the potential to provide rapid detection and identification of organisms responsible for bloodstream infections. PMID:24951806

  18. 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 ...

  19. Trypanosoma brucei DMC1 does not act in DNA recombination, repair or antigenic variation in bloodstream stage cells.

    PubMed

    Proudfoot, Chris; McCulloch, Richard

    2006-02-01

    Homologous recombination acts in the repair of cellular DNA damage and can generate genetic variation. Some of this variation provides a discrete purpose in the cell, although it can also be genome-wide and contribute to longer-term natural selection. In Trypanosoma brucei, a eukaryotic parasite responsible for sleeping sickness disease in sub-Saharan Africa, homologous recombination acts to catalyse antigenic variation, an immune evasion strategy involving switches in variant surface glycoprotein. In addition, T. brucei can undergo genetic exchange by homologous recombination in the tsetse vector, and some evidence suggests that this occurs by meiosis. Here, we show that T. brucei, Trypanosoma cruzi and Leishmania major each contain a single copy gene whose product is highly related to the eukaryotic meiosis-specific protein Dmc1, which is structurally and functionally related to Rad51. We show that T. brucei DMC1 is transcribed in the bloodstream stage of the parasite, where the gene can be mutated by reverse genetic disruption. DMC1 mutation does not, however, result in detectable alterations in DNA repair, recombination or antigenic variation efficiency in this life cycle stage. PMID:16289356

  20. Three Mitochondrial DNA Polymerases Are Essential for Kinetoplast DNA Replication and Survival of Bloodstream Form Trypanosoma brucei ? †

    PubMed Central

    Bruhn, David F.; Sammartino, Mark P.; Klingbeil, Michele M.

    2011-01-01

    Trypanosoma brucei, the causative agent of human African trypanosomiasis, has a complex life cycle that includes multiple life cycle stages and metabolic changes as the parasite switches between insect vector and mammalian host. The parasite's single mitochondrion contains a unique catenated mitochondrial DNA network called kinetoplast DNA (kDNA) that is composed of minicircles and maxicircles. Long-standing uncertainty about the requirement of kDNA in bloodstream form (BF) T. brucei has recently eroded, with reports of posttranscriptional editing and subsequent translation of kDNA-encoded transcripts as essential processes for BF parasites. These studies suggest that kDNA and its faithful replication are indispensable for this life cycle stage. Here we demonstrate that three kDNA replication proteins (mitochondrial DNA polymerases IB, IC, and ID) are required for BF parasite viability. Silencing of each polymerase was lethal, resulting in kDNA loss, persistence of prereplication DNA monomers, and collapse of the mitochondrial membrane potential. These data demonstrate that kDNA replication is indeed crucial for BF T. brucei. The contributions of mitochondrial DNA polymerases IB, IC, and ID to BF parasite viability suggest that these and other kDNA replication proteins warrant further investigation as a new class of targets for the development of antitrypanosomal drugs. PMID:21531873

  1. Pneumococcal Infections

    MedlinePLUS

    ... My Cart Healthy Children > Health Issues > Vaccine Preventable Diseases > Pneumococcal Infections Health Issues Listen Pneumococcal Infections Article Body Pneumococcus (Streptococcus pneumoniae) is a type of bacteria that can ...

  2. [Critical role of clinical laboratories in hospital infection control].

    PubMed

    Yagi, Tetsuya

    2010-11-01

    The hospital infection control and prevention is recognized to be more and more important according to the advances in modern medical treatment and care. Clinical microbiology laboratory play critical roles in the hospital infection control as a member of infection control team (ICT). They are the first in a hospital to identify outbreak of MRSA in NICU and molecular epidemiological analysis of the isolates lead proper intervention of ICT to the concerned ward. From a viewpoint of infectious disease specialist, rapid and precise microbiological information is essential for the appropriate diagnosis and treatment of infectious diseases. Each medical technologist need to make efforts to understand the characteristics of the examinations for infectious diseases and send out information useful for clinical practices. In our hospital, with the participation of all members of medical technologists, rapid reporting system was developed for blood culture examinations, which greatly contribute to the appropriate treatment of bloodstream infections. Collaborations of clinical microbiology laboratory with other members of ICT realize high quality hospital infection control. They also need to be aware of themselves as good practitioners of infection control measures to prevent hospital infections. PMID:21229708

  3. Beta-interferon inhibits cell infection by Trypanosoma cruzi

    NASA Technical Reports Server (NTRS)

    Kierszenbaum, F.; Sonnenfeld, G.

    1984-01-01

    Beta interferon has been shown to inhibit the capacity of bloodstream forms of the flagellate Trypanosoma cruzi, the causative agent of Chagas' disease, to associate with and infect mouse peritoneal macrophages and rat heart myoblasts. The inhibitory effect was abrogated in the presence of specific antibodies to the interferon. Pretreatment of the parasites with interferon reduced their infectivity for untreated host cells, whereas pretreament of either type of host cell did not affect the interaction. The effect of interferon on the trypanosomes was reversible; the extent of the inhibitory effect was significantly reduced afer 20 min, and was undetectable after 60 min when macrophages were used as host cells. For the myoblasts, 60 min elapsed before the inhibitory effect began to subside and 120 min elapsed before it became insignificant or undetectable.

  4. New developments in the prevention of intravascular catheter associated infections.

    PubMed

    Hewlett, Angela L; Rupp, Mark E

    2012-03-01

    Central line-associated bloodstream infections (CLA-BSI) are one of the leading causes of healthcare-associated infections, resulting in significant morbidity and substantial excess cost. There is a growing recognition that most CLA-BSIs are preventable. Elimination of preventable CLA-BSI is the focus of a recently released CDC Guideline. Universal preventative measures include collaborative performance improvement using checklists and bundles, education of persons who insert and maintain catheters, maximal sterile barrier precautions, and chlorhexidine skin preparation. Technologic innovations including coated catheters, antimicrobial impregnated dressings, and antimicrobial lock solutions should be considered if the rate of CLA-BSI is not acceptable after application of universal precautions. PMID:22284372

  5. [Prophylaxis of infective complications of central venous catheters].

    PubMed

    Gómez Luque, A; Huertas Simonet, N; Viciana Ramos, M I; Moreno Palacios, M; Hernández Pardo, P E

    2002-01-01

    Infections related to central venous cannulation present first-magnitude problems in recovery rooms and intensive care units. Catheter-related bloodstream infection (CRBSI) is the most serious complication because of its high frequency and a mortality rate that averages around 3%. Although infections arise for various reasons, point-of-insertion contamination is the main cause when catheters are implanted for periods of less than 10 days. Contaminating microorganisms (especially Staphyloccocus epidermidis) find refuge from the host's defenses in a biofilm that covers the catheter. Several factors participate in the formation of this biofilm, such as catheter composition, proteins of the host or type of microorganism. Biofilm bacteria are resistant to both antibiotics and the host's own defenses (e.g. phagocytes and antibodies). The microorganism can then begin to reproduce, possibly leading to bloodstream infection. The measures designed to prevent this process include recommendations for both catheter insertion and maintenance. Recent meta-analyses have led to certain conclusions but no unanimity among authors. Thus, there is agreement on the adoption of strict aseptic technique during catheter insertion, on the use of chlorhexidine as a skin antiseptic and on choice of the subclavian vein. Such measures significantly decrease the frequency of CRBSI. Maintenance techniques that have been shown to be effective are the use of connectors impregnated with antiseptic, catheters impregnated with antiseptics or antibiotics, and permeable dressings. Additionally, building an experienced infusion-therapy team to insert and maintain central venous catheters has been shown to be one of the most effective measures for preventing CRBSI. PMID:11898444

  6. Urine as a Specimen to Diagnose Infections in Twenty-First Century: Focus on Analytical Accuracy

    PubMed Central

    Tuuminen, Tamara

    2012-01-01

    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. PMID:22566927

  7. Infection control in the intensive care unit: progress and challenges in systems and accountability.

    PubMed

    Patterson, Jan E; Malani, Preeti N; Maragakis, Lisa L

    2010-08-01

    Attention to the improvement of safety in healthcare lately has focused on healthcare-associated infections, including many that occur in the intensive care unit, such as catheter-related bloodstream infections and ventilator-associated pneumonias. Great strides have been made in decreasing the rates of intensive care unit hospital-acquired infections in the past decade. This is attributable to a number of factors, including standardization of care, technological advances, provider payment reform, and consumer activism. Teamwork and communication remain the most important facets in patient safety. The papers in this supplement examine the roles of human factors and process engineering, survey a spectrum of infection control and safety challenges encountered by critical care practitioners, and assess the future challenges for continued improvement in our systems of care. PMID:20647783

  8. Predictive Factors for Metastatic Infection in Patients With Bacteremia Caused by Methicillin-Sensitive Staphylococcus aureus

    PubMed Central

    Sato, Fumiya; Hosaka, Yumiko; Hoshina, Tokio; Tamura, Kumi; Nakaharai, Kazuhiko; Kato, Tetsuro; Nakazawa, Yasushi; Yoshida, Masaki; Hori, Seiji

    2015-01-01

    Abstract: Background: Metastatic infections such as infective endocarditis and psoas abscess are serious complications of Staphylococcus aureus bacteremia because failure to identify these infections may result in bacteremia relapse or poor prognosis. In the present study, we determined the predictive factors for metastatic infection due to methicillin-sensitive S. aureus bacteremia. Methods: A retrospective cohort study was conducted among patients with methicillin-sensitive S. aureus bacteremia at the Jikei University Hospital between January 2008 and December 2012. Factors analyzed included the underlying disease, initial antimicrobial treatment and primary site of infection. Results: During the 5-year study period, 73 patients met the inclusion criteria and were assessed. The most common primary site of bacteremia was catheter-related bloodstream infection (25/73 [34.2%]). Metastatic infection occurred in 14 of 73 patients (19.2%) (infective endocarditis [3], septic pulmonary abscess [3], spondylitis [4], psoas abscess [4], epidural abscess [3] and septic arthritis [1]). Six patients had multiple metastatic infections. Multivariate analysis revealed that the predictive factors associated with the development of metastatic infection were a delay in appropriate antimicrobial treatment of >48 hours, persistent fever for >72 hours after starting antibiotic treatment and lowest C-reactive protein levels of >3 mg/dL during 2 weeks after the onset of bacteremia. Conclusions: This study demonstrated that additional diagnostic tests should be conducted to identify metastatic infection, particularly in patients with delayed antimicrobial treatment, persistent fever and persistently high C-reactive protein levels. PMID:25250988

  9. Developing discriminate model and comparative analysis of differentially expressed genes and pathways for bloodstream samples of diabetes mellitus type 2

    PubMed Central

    2014-01-01

    Background Diabetes mellitus of type 2 (T2D), also known as noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, is a common disease. It is estimated that more than 300 million people worldwide suffer from T2D. In this study, we investigated the T2D, pre-diabetic and healthy human (no diabetes) bloodstream samples using genomic, genealogical, and phonemic information. We identified differentially expressed genes and pathways. The study has provided deeper insights into the development of T2D, and provided useful information for further effective prevention and treatment of the disease. Results A total of 142 bloodstream samples were collected, including 47 healthy humans, 22 pre-diabetic and 73 T2D patients. Whole genome scale gene expression profiles were obtained using the Agilent Oligo chips that contain over 20,000 human genes. We identified 79 significantly differentially expressed genes that have fold change ? 2. We mapped those genes and pinpointed locations of those genes on human chromosomes. Amongst them, 3 genes were not mapped well on the human genome, but the rest of 76 differentially expressed genes were well mapped on the human genome. We found that most abundant differentially expressed genes are on chromosome one, which contains 9 of those genes, followed by chromosome two that contains 7 of the 76 differentially expressed genes. We performed gene ontology (GO) functional analysis of those 79 differentially expressed genes and found that genes involve in the regulation of cell proliferation were among most common pathways related to T2D. The expression of the 79 genes was combined with clinical information that includes age, sex, and race to construct an optimal discriminant model. The overall performance of the model reached 95.1% accuracy, with 91.5% accuracy on identifying healthy humans, 100% accuracy on pre-diabetic patients and 95.9% accuract on T2D patients. The higher performance on identifying pre-diabetic patients was resulted from more significant changes of gene expressions among this particular group of humans, which implicated that patients were having profound genetic changes towards disease development. Conclusion Differentially expressed genes were distributed across chromosomes, and are more abundant on chromosomes 1 and 2 than the rest of the human genome. We found that regulation of cell proliferation actually plays an important role in the T2D disease development. The predictive model developed in this study has utilized the 79 significant genes in combination with age, sex, and racial information to distinguish pre-diabetic, T2D, and healthy humans. The study not only has provided deeper understanding of the disease molecular mechanisms but also useful information for pathway analysis and effective drug target identification. PMID:25559614

  10. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009.

    PubMed

    Rosenthal, Victor D; Maki, Dennis G; Jamulitrat, Silom; Medeiros, Eduardo A; Todi, Subhash Kumar; Gomez, David Yepes; Leblebicioglu, Hakan; Abu Khader, Ilham; Miranda Novales, María Guadalupe; Berba, Regina; Ramírez Wong, Fernando Martín; Barkat, Amina; Pino, Osiel Requejo; Dueñas, Lourdes; Mitrev, Zan; Bijie, Hu; Gurskis, Vaidotas; Kanj, S S; Mapp, Trudell; Hidalgo, Rosalía Fernández; Ben Jaballah, Nejla; Raka, Lul; Gikas, Achilleas; Ahmed, Altaf; Thu, Le Thi Anh; Guzmán Siritt, María Eugenia

    2010-03-01

    We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP). PMID:20176284

  11. Infection and Cardiovascular Disease

    ClinicalTrials.gov

    2005-06-23

    Cardiovascular Diseases; Coronary Disease; Cerebrovascular Accident; Heart Diseases; Myocardial Infarction; Infection; Chlamydia Infections; Cytomegalovirus Infections; Helicobacter Infections; Atherosclerosis

  12. Essential components of an infection prevention program for outpatient hemodialysis centers.

    PubMed

    Hess, Sally; Bren, Virginia

    2013-01-01

    Infections are a significant complication for dialysis patients. The CDC estimates that 37,000 central line-related bloodstream infections occurred in hemodialysis patients in 2008 and dialysis-associated outbreaks of hepatitis C continue to be reported. While established hospital-based infection prevention programs have existed since the 1970s, few dialysis facilities have an established in-center program, unless the dialysis facility is hospital-associated. This review focuses on essential core components required for an effective infection prevention program, extrapolating from acute-care programs and building on current dialysis guidelines and recommendations. An effective infection prevention program requires infrastructure, including leaders who place infection prevention as a top priority, active involvement from a multidisciplinary team, surveillance of outcomes and processes with feedback, staff and patient education, and consistent use of evidence-based practices. The program must be integrated into the existing Quality Assessment and Performance Improvement program. Best practice recommendations for the prevention of infection, specific to dialysis, continue to evolve as the epidemiology of dialysis-associated infections is further researched and new evidence is gathered. A review of case studies illustrates that with an effective program in place, infection prevention becomes part of the culture, reduces infection risk, and improves patient safety. PMID:23808676

  13. Smart central venous port for early detection of bacterial biofilm related infections.

    PubMed

    Paredes, J; Alonso-Arce, M; Schmidt, C; Valderas, D; Sedano, B; Legarda, J; Arizti, F; Gómez, E; Aguinaga, A; Del Pozo, J L; Arana, S

    2014-06-01

    Central venous catheters (CVC) are commonly used in clinical practice to improve a patient's quality of life. Unfortunately, there is an intrinsic risk of acquiring an infection related to microbial biofilm formation inside the catheter lumen. It has been estimated that 80 % of all human bacterial infections are biofilm-associated. Additionally, 50 % of all nosocomial infections are associated with indwelling devices. Bloodstream infections account for 30-40 % of all cases of severe sepsis and septic shock, and are major causes of morbidity and mortality. Diagnosis of bloodstream infections must be performed promptly so that adequate antimicrobial therapy can be started and patient outcome improved. An ideal diagnostic technology would identify the infecting organism(s) in a timely manner, so that appropriate pathogen-driven therapy could begin promptly. Unfortunately, despite the essential information it provides, blood culture, the gold standard, largely fails in this purpose because time is lost waiting for bacterial or fungal growth. This work presents a new design of a venous access port that allows the monitoring of the inner reservoir surface by means of an impedimetric biosensor. An ad-hoc electronic system was designed to manage the sensor and to allow communication with the external receiver. Historic data recorded and stored in the device was used as the reference value for the detection of bacterial biofilm. The RF communication system sends an alarm signal to the external receiver when a microbial colonization of the port occurs. The successful in vitro analysis of the biosensor, the electronics and the antenna of the new indwelling device prototype are shown. The experimental conditions were selected in each case as the closest to the clinical working conditions for the smart central venous catheter (SCVC) testing. The results of this work allow a new generation of this kind of device that could potentially provide more efficient treatments for catheter-related infections. PMID:24515846

  14. Streptococcal Infections

    MedlinePLUS

    ... syndrome Cellulitis and necrotizing fasciitis (flesh-eating disease) Group B strep can cause blood infections, pneumonia and meningitis in ... save your baby's life. Adults can also get group B strep infections, especially if they are elderly or already ...

  15. Opportunistic Infections

    MedlinePLUS

    ... worsen instead of improving over time, you should contact your care provider immediately. Additional Resources AIDSinfo â?? Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents AIDSinfo â?? Guidelines for Prevention and ...

  16. Fighting Infection.

    ERIC Educational Resources Information Center

    Cozza, Richard J., Jr.

    1991-01-01

    The Ashtabula County Board of Mental Retardation and Developmental Disabilities in Ohio has developed 27 new procedures for infection control that follow a comprehensive study of infection control and disease transmission. Many of these procedures are applicable to schools. (MLF)

  17. Dentoalveolar infections.

    PubMed

    Lypka, Michael; Hammoudeh, Jeffrey

    2011-08-01

    Dentoalveolar infections represent a wide spectrum of conditions, from simple localized abscesses to deep neck space infections. The initial assessment of the patient with a dentoalveolar infection requires considerable clinical skill and experience, and determines the need for further airway management or emergent surgical therapy. Knowledge of head and neck fascial space anatomy is essential in diagnosing, understanding spread, and surgically managing these infections. Oral and maxillofacial surgeons must make use of their wide spectrum of clinical skill and knowledge to effectively evaluate and treat patients with dentoalveolar infections. PMID:21602052

  18. TORCH infections.

    PubMed

    Neu, Natalie; Duchon, Jennifer; Zachariah, Philip

    2015-03-01

    TORCH infections classically comprise toxoplasmosis, Treponema pallidum, rubella, cytomegalovirus, herpesvirus, hepatitis viruses, human immunodeficiency virus, and other infections, such as varicella, parvovirus B19, and enteroviruses. The epidemiology of these infections varies; in low-income and middle-income countries, TORCH infections are major contributors to prenatal, perinatal, and postnatal morbidity and mortality. Evidence of infection may be seen at birth, in infancy, or years later. For many of these pathogens, treatment or prevention strategies are available. Early recognition, including prenatal screening, is key. This article covers toxoplasmosis, parvovirus B19, syphilis, rubella, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. PMID:25677998

  19. Monocyte recruitment during infection and inflammation

    Microsoft Academic Search

    Chao Shi; Eric G. Pamer

    2011-01-01

    Monocytes originate from progenitors in the bone marrow and traffic via the bloodstream to peripheral tissues. During both homeostasis and inflammation, circulating monocytes leave the bloodstream and migrate into tissues where, following conditioning by local growth factors, pro-inflammatory cytokines and microbial products, they differentiate into macrophage or dendritic cell populations. Recruitment of monocytes is essential for effective control and clearance

  20. In vitro cultivation of animal-infective forms of a West African Trypanosoma vivax stock.

    PubMed

    Brun, R; Moloo, S K

    1982-06-01

    Animal-infective forms of a West African Trypanosoma vivax stock were grown in culture for three months using Minimum Essential Medium (MEM) with Earle's salts, supplemented with 20% inactivated goat serum over fibroblast-like cell lines isolated from the embryo of Microtus montanus or of an East African Galla crossbred goat at 36.5 degrees C and in 4% CO2 - 96% air. The bloodstream trypanosomes used to initiate the culture had been isolated from an infected goat. The cultured organisms grown in this system could be subcultured, were infective for mammalian hosts, retained their morphological characteristics and virulence, and could be readily established in Glossina morsitans centralis from goats injected with the cultured T. vivax. PMID:6126095

  1. A cell-body groove housing the new flagellum tip suggests an adaptation of cellular morphogenesis for parasitism in the bloodstream form of Trypanosoma brucei

    PubMed Central

    Hughes, Louise; Towers, Katie; Starborg, Tobias; Gull, Keith; Vaughan, Sue

    2013-01-01

    Summary Flagella are highly conserved organelles present in a wide variety of species. In Trypanosoma brucei the single flagellum is necessary for morphogenesis, cell motility and pathogenesis, and is attached along the cell body. A new flagellum is formed alongside the old during the cell division cycle. In the (insect) procyclic form, the flagella connector (FC) attaches the tip of the new flagellum to the side of the old flagellum, ensuring faithful replication of cell architecture. The FC is not present in the bloodstream form of the parasite. We show here, using new imaging techniques including serial block-face scanning electron microscopy (SBF-SEM), that the distal tip of the new flagellum in the bloodstream form is embedded within an invagination in the cell body plasma membrane, named the groove. We suggest that the groove has a similar function to the flagella connector. The groove is a mobile junction located alongside the microtubule quartet (MtQ) and occurred within a gap in the subpellicular microtubule corset, causing significant modification of microtubules during elongation of the new flagellum. It appears likely that this novel form of morphogenetic structure has evolved to withstand the hostile immune response in the mammalian blood. PMID:24127564

  2. The essential neutral sphingomyelinase is involved in the trafficking of the variant surface glycoprotein in the bloodstream form of Trypanosoma brucei

    PubMed Central

    Young, Simon A; Smith, Terry K

    2010-01-01

    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. PMID:20398210

  3. [Epidemiology of nosocomial bacterial infection in neonatal intensive care unit in Morocco].

    PubMed

    Maoulainine, F-M-R; Elidrissi, N-S; Chkil, G; Abba, F; Soraa, N; Chabaa, L; Amine, M; Aboussad, A

    2014-09-01

    In neonatal intensive care units, the incidence of nosocomial infection is high. This study aimed to determine the epidemiology of a nosocomial bacterial infection in the neonatal intensive care unit of Mohamed VI university hospital. A total of 702 newborns were included in this study. Of the 702 neonates studied, 91 had developed a nosocomial infection. The incidence rate was 13% and incidence density was 21.2 per 1000 patient-days. The types of infection were: bloodstream infections (89%), pneumonia (6.6%), meningitis (3.3%), and urinary tract infections (1.1%). Nosocomial infection was particularly frequent in cases of low birth weight, prematurity, young age at admission, umbilical venous catheter, and mechanical ventilation. Multiresistant bacteria included enterobacteria producing betalactamase (76.9%), especially enterobacteria that were dominated by Klebsiella pneumoniae (39.7%). The mortality rate was 52.7% in nosocomial infections, 19 (20.87%) of whom had septic shock. The results of this study show that nosocomial infection is an intrahospital health problem that could be remedied by a prevention strategy. PMID:24993147

  4. Fatal skin and soft tissue infection of multidrug resistant Acinetobacter baumannii: A case report

    PubMed Central

    Ali, Aqsa; Botha, John; Tiruvoipati, Ravindranath

    2014-01-01

    INTRODUCTION Acinetobacter baumannii is usually associated with respiratory tract, urinary tract and bloodstream infections. Recent reports suggest that it is increasingly causing skin and soft tissue infections. It is also evolving as a multidrug resistant organism that can be difficult to treat. We present a fatal case of multidrug resistant A. baumannii soft tissue infection and review of relevant literature. PRESENTATION OF CASE A 41 year old morbidly obese man, with history of alcoholic liver disease presented with left superficial pre-tibial abrasions and cellulitis caused by multidrug resistant (MDR) A. baumannii. In spite of early antibiotic administration he developed extensive myositis and fat necrosis requiring extensive and multiple surgical debridements. He deteriorated despite appropriate antibiotic therapy and multiple surgical interventions with development of multi-organ failure and died. DISCUSSION Managing Acinetobacter infections remains difficult due to the array of resistance and the pathogens ability to develop new and ongoing resistance. The early diagnosis of necrotizing soft tissue infection may be challenging, but the key to successful management of patients with necrotizing soft tissue infection are early recognition and complete surgical debridement. CONCLUSION A. baumannii is emerging as an important cause of severe, life-threatening soft tissue infections. Multidrug resistant A. baumannii soft tissue infections may carry a high mortality in spite of early and aggressive treatment. Clinicians need to consider appropriate early empirical antibiotic coverage or the use of combination therapy to include MDR A. baumannii as a cause of skin and soft tissue infections. PMID:25016080

  5. 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

    Kyle J. Popovich; Bala Hota; Robert Hayes; Robert A. Weinstein; Mary K. Hayden

    2010-01-01

    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

  6. 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

    C. Logghe; Ch. Van Ossel; W. D'Hoore; H. Ezzedine; G. Wauters; J. J. Haxhe

    1997-01-01

    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

  7. Infection prevention in the intensive care unit: review of the recent literature on the management of invasive devices.

    PubMed

    Di Filippo, Alessandro; Casini, Andrea; de Gaudio, Angelo Raffaele

    2011-04-01

    Over the last 5 y, clinical trials investigating products, procedures, and treatments aimed at preventing infections in the intensive care unit have been described. The findings of these studies appear to confirm the effectiveness of certain preventive procedures. With regard to ventilator-associated pneumonia, the efficacies of decontamination of the oral cavity, continuous suction of subglottic secretions, positioning of the patient, selective decontamination of the digestive tract, and (for higher-risk patients) endotracheal tubes coated with silver, have been demonstrated. Medicated catheters and chlorhexidine-based dressings have been found useful for catheter-related bloodstream infections, and medical catheters have also been shown to be efficacious against urinary tract infections. All these procedures can be incorporated into departmental protocols for the prevention of nosocomial infections in the intensive care unit. PMID:21265584

  8. Detection of Circulating Parasite-Derived MicroRNAs in Filarial Infections

    PubMed Central

    Tritten, Lucienne; Burkman, Erica; Moorhead, Andrew; Satti, Mohammed; Geary, James; Mackenzie, Charles; Geary, Timothy

    2014-01-01

    Filarial nematodes cause chronic and profoundly debilitating diseases in both humans and animals. Applications of novel technology are providing unprecedented opportunities to improve diagnosis and our understanding of the molecular basis for host-parasite interactions. As a first step, we investigated the presence of circulating miRNAs released by filarial nematodes into the host bloodstream. miRNA deep-sequencing combined with bioinformatics revealed over 200 mature miRNA sequences of potential nematode origin in Dirofilaria immitis-infected dog plasma in two independent analyses, and 21 in Onchocerca volvulus-infected human serum. Total RNA obtained from D. immitis-infected dog plasma was subjected to stem-loop RT-qPCR assays targeting two detected miRNA candidates, miR-71 and miR-34. Additionally, Brugia pahangi-infected dog samples were included in the analysis, as these miRNAs were previously detected in extracts prepared from this species. The presence of miR-71 and miR-34 discriminated infected samples (both species) from uninfected samples, in which no specific miRNA amplification occurred. However, absolute miRNA copy numbers were not significantly correlated with microfilaraemia for either parasite. This may be due to the imprecision of mf counts to estimate infection intensity or to miRNA contributions from the unknown number of adult worms present. Nonetheless, parasite-derived circulating miRNAs are found in plasma or serum even for those species that do not live in the bloodstream. PMID:25033073

  9. Infection associated with asplenia: risks, mechanisms, and prevention.

    PubMed

    Styrt, B

    1990-05-01

    The risk of overwhelming sepsis in asplenic patients has been recognized increasingly over the past several decades, but the underlying mechanisms are not fully understood, and there is controversy over the true magnitude of risk and the value of specific interventions. Review of recent series indicates that postsplenectomy sepsis is more likely after splenectomy in childhood than after splenectomy in adulthood but may occur after splenectomy at any age. In some cases, sepsis has been documented many years after surgery. The pneumococcus remains the predominant organism, and the characteristic course is rapid progression to multisystem involvement with high morbidity and mortality. Predisposition to pneumococcal sepsis and to other infections reflects the role of the spleen in mechanical filtration of particulate material in the bloodstream, generation of opsonins and other soluble mediators of phagocytosis, and anatomic juxtaposition of different elements of the immune system. Whereas pneumococcal vaccine is indicated in asplenic patients, the value of other interventions requires further evaluation. PMID:2114797

  10. Epidemiological Monitoring of Nosocomial Infections Caused by Acinetobacter Baumannii

    PubMed Central

    Custovic, Amer; Smajlovic, Jasmina; Tihic, Nijaz; Hadzic, Sadeta; Ahmetagic, Sead; Hadzagic, Haris

    2014-01-01

    Introduction: Acinetobacter baumannii is a frequent cause of infections in hospitals around the world, which is very difficult to control and treat. It is particularly prevalent in intensive care wards. Aim: The main objective of the research was to establish the application of epidemiological monitoring of nosocomial infections (NIs) caused by A. baumannii in order to determine: the type and distribution of NIs, and to investigate antimicrobial drug resistance of A. baumannii. Material and Methods: 855 patients treated at the Clinic of Anesthesiology and Reanimation, University Clinical Center Tuzla during 2013 were followed prospectively for the development of NIs. Infections caused by A. baumannii were characterized by the anatomical site and antibiotics resistance profile. Results: NIs were registered in 105 patients (12.3%; 855/105). The predominant cause of infection was A. baumannii with an incidence of 51.4% (54/105), followed by ESBL-producing Klebsiella pneumoniae with 15.2% (16/105) of cases, methicillin-resistant Staphylococcus aureus with 8.6% (9/105), and ESBL-producing Proteus mirabilis with 7.6% (8/105). According to the anatomical site, and type of NIs caused by A. baumannii, the most frequent were respiratory infections (74.1%; 40/54). Infections of surgical sites were registered in 11.1% (6/54) of cases, while bloodstream infections in 9.2% (5/54). A. baumannii isolates tested resistant against most antibiotics examined, but showed a high degree of susceptibility to tobramycin (87%; 47/54) and colistin (100%; 54/54). Conclusion: The increasing incidence of multi- and extensively drug-resistant Acinetobacter spp. emphasizes the importance of administration of an adequate antibiotic strategy and the implementation of strict monitoring of the measures for controlling nosocomial infections. PMID:25648217

  11. Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy

    Microsoft Academic Search

    Robert A Cherry; Cheri E West; Maria C Hamilton; Colleen M Rafferty; Christopher S Hollenbeak; Gregory M Caputo

    2011-01-01

    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

  12. Revisiting the Central Metabolism of the Bloodstream Forms of Trypanosoma brucei: Production of Acetate in the Mitochondrion Is Essential for Parasite Viability

    PubMed Central

    Mazet, Muriel; Morand, Pauline; Biran, Marc; Bouyssou, Guillaume; Courtois, Pierrette; Daulouède, Sylvie; Millerioux, Yoann; Franconi, Jean-Michel; Vincendeau, Philippe; Moreau, Patrick; Bringaud, Frédéric

    2013-01-01

    Background The bloodstream forms of Trypanosoma brucei, the causative agent of sleeping sickness, rely solely on glycolysis for ATP production. It is generally accepted that pyruvate is the major end-product excreted from glucose metabolism by the proliferative long-slender bloodstream forms of the parasite, with virtually no production of succinate and acetate, the main end-products excreted from glycolysis by all the other trypanosomatid adaptative forms, including the procyclic insect form of T. brucei. Methodology/Principal Findings A comparative NMR analysis showed that the bloodstream long-slender and procyclic trypanosomes excreted equivalent amounts of acetate and succinate from glucose metabolism. Key enzymes of acetate production from glucose-derived pyruvate and threonine are expressed in the mitochondrion of the long-slender forms, which produces 1.4-times more acetate from glucose than from threonine in the presence of an equal amount of both carbon sources. By using a combination of reverse genetics and NMR analyses, we showed that mitochondrial production of acetate is essential for the long-slender forms, since blocking of acetate biosynthesis from both carbon sources induces cell death. This was confirmed in the absence of threonine by the lethal phenotype of RNAi-mediated depletion of the pyruvate dehydrogenase, which is involved in glucose-derived acetate production. In addition, we showed that de novo fatty acid biosynthesis from acetate is essential for this parasite, as demonstrated by a lethal phenotype and metabolic analyses of RNAi-mediated depletion of acetyl-CoA synthetase, catalyzing the first cytosolic step of this pathway. Conclusions/Significance Acetate produced in the mitochondrion from glucose and threonine is synthetically essential for the long-slender mammalian forms of T. brucei to feed the essential fatty acid biosynthesis through the “acetate shuttle” that was recently described in the procyclic insect form of the parasite. Consequently, key enzymatic steps of this pathway, particularly acetyl-CoA synthetase, constitute new attractive drug targets against trypanosomiasis. PMID:24367711

  13. Mycobacterial Infections

    MedlinePLUS

    ... times, they can cause lung symptoms similar to tuberculosis: Cough Weight loss Coughing up blood or mucus Weakness or fatigue Fever and chills Night sweats Lack of appetite and weight loss Medicines can treat these infections, but often more than one is needed to cure the infection.

  14. Cytomegalovirus Infections

    MedlinePLUS

    ... in a person's body, it stays there for life. CMV is spread through close contact with body fluids. Most people with CMV don't get sick and don't know that they've been infected. But infection with ...

  15. Cytomegalovirus infection.

    PubMed

    Plosa, Erin J; Esbenshade, Jennifer C; Fuller, M Paige; Weitkamp, Jörn-Hendrik

    2012-04-01

    Although commonly asymptomatic, congenital CMV infection is the leading cause of nonhereditary SNHL. Other sequelae that may be evident only after the neonatal period can include chorioretinitis, neurodevelopmental delay with mental or motor impairment, and microcephaly. (13) • Congenital CMV infection is confirmed by detection of the virus in urine, blood, or saliva within the first 3 weeks of life by culture or polymerase chain reaction. A positive test does not necessarily confirm symptomatic CMV disease or need for treatment. (13) • Postnatal CMV infections transmitted through human milk have been reported and may be clinically relevant in extremely premature infants; however, the risk-benefit ratio of pasteurizing human milk for the prevention of postnatal CMV infection is unclear. • Ganciclovir, valganciclovir, foscarnet, cidofovir, and CMV hyperimmune globulin are effective in treating or preventing CMV infections in the immunocompromised host, but require close monitoring for associated toxicities. Treatment for congenital CMV is associated with significant toxicity and uncertain effectiveness. • Based on strong evidence, anticipatory guidance for congenital CMV infection should include hearing tests and neurodevelopmental assessments until school age. (3) In patients with symptomatic congenital CMV infection, lifelong ophthalmologic screening should be included. (4) • Based primarily on consensus, owing to lack of relevant clinical studies, it is not recommended to withhold human milk produced by CMV-seropositive mothers from healthy term infants. (5)(6) • Based on some research evidence, as well as consensus, treatment for congenital CMV is recommended only in symptomatic infants with central nervous system involvement. (9) PMID:22474112

  16. Biofilms formed by Candida albicans bloodstream isolates display phenotypic and transcriptional heterogeneity that are associated with resistance and pathogenicity

    PubMed Central

    2014-01-01

    Background Candida albicans infections have become increasingly recognised as being biofilm related. Recent studies have shown that there is a relationship between biofilm formation and poor clinical outcomes in patients infected with biofilm proficient strains. Here we have investigated a panel of clinical isolates in an attempt to evaluate their phenotypic and transcriptional properties in an attempt to differentiate and define levels of biofilm formation. Results Biofilm formation was shown to be heterogeneous; with isolates being defined as either high or low biofilm formers (LBF and HBF) based on different biomass quantification. These categories could also be differentiated using a cell surface hydrophobicity assay with 24 h biofilms. HBF isolates were more resistance to amphotericin B (AMB) treatment than LBF, but not voriconazole (VRZ). In a Galleria mellonella model of infection HBF mortality was significantly increased in comparison to LBF. Histological analysis of the HBF showed hyphal elements intertwined indicative of the biofilm phenotype. Transcriptional analysis of 23 genes implicated in biofilm formation showed no significant differential expression profiles between LBF and HBF, except for Cdr1 at 4 and 24 h. Cluster analysis showed similar patterns of expression for different functional classes of genes, though correlation analysis of the 4 h biofilms with overall biomass at 24 h showed that 7 genes were correlated with high levels of biofilm, including Als3, Eap1, Cph1, Sap5, Plb1, Cdr1 and Zap1. Conclusions Our findings show that biofilm formation is variable amongst C. albicans isolates, and categorising isolates depending on this can be used to predict how pathogenic the isolate will behave clinically. We have shown that looking at individual genes in less informative than looking at multiple genes when trying to categorise isolates at LBF or HBF. These findings are important when developing biofilm-specific diagnostics as these could be used to predict how best to treat patients infected with C. albicans. Further studies are required to evaluate this clinically. PMID:24996549

  17. Obstetric infections.

    PubMed

    Lapinsky, Stephen E

    2013-07-01

    Sepsis accounts for approximately 10% of all maternal deaths. Pregnant women are susceptible to certain infections because of alterations in their cell-mediated immunity. Obstetric sepsis requires early broad-spectrum antibiotic therapy and may necessitate surgical intervention. Group A streptococcal infection may produce necrotizing fasciitis and toxic shock. Pyelonephritis remains a common cause of sepsis during pregnancy, and associated acute respiratory distress syndrome occurs more commonly than in the nonpregnant population. Severe pneumonitis caused by influenza virus and varicella zoster infection may occur. Malaria may be more severe in the pregnant woman, and carries significant risk to both mother and fetus. PMID:23830651

  18. Campylobacter Infections

    MedlinePLUS

    ... MORE ON THIS TOPIC Amebiasis Diarrhea E. Coli Food Poisoning Giardiasis Shigella Infections Why Is Hand Washing So ... My Hands? E. Coli Word! Diarrhea Belly Pain Food Poisoning Dehydration E. Coli Food Poisoning Shigellosis Travel Tips ...

  19. Staphylococcal Infections

    MedlinePLUS

    ... shock syndrome, scalded skin syndrome, and staphylococcal-related food poisoning. In fact, staphylococcal bacteria are the leading cause of food poisoning. Some of the childhood infections associated with Staphylococcus ...

  20. Campylobacter infection

    MedlinePLUS

    Food poisoning - campylobacter enteritis; Infectious diarrhea - campylobacter enteritis; Bacterial diarrhea; Campy ... of the many causes of traveler's diarrhea or food poisoning . People most often get infected by eating or ...

  1. Campylobacter Infections

    MedlinePLUS

    ... household pets , most often puppies, cats, hamsters and birds. Infection can also spread by person-to-person ... with the feces of dogs, cats, hamsters, and birds. Wash your hands carefully after touching the underclothes ...

  2. Giardia infection

    MedlinePLUS

    ... with suspected enteric infection. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: ... with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: ...

  3. Hantavirus Infections

    MedlinePLUS

    Hantavirus pulmonary syndrome (HPS) is a rare but deadly viral infection. It is spread by mice and rats. They shed the virus in ... cannot catch it from people. Early symptoms of HPS include Fatigue Fever Muscle aches, especially in the ...

  4. Norovirus Infections

    MedlinePLUS

    ... get it if you touch a contaminated surface. Norovirus can be serious, especially for young children and older adults. The most common symptoms of norovirus infection are Diarrhea Nausea and vomiting Stomach pain ...

  5. Staph Infections

    MedlinePLUS

    ... most commonly causes skin infections like folliculitis, boils, impetigo, and cellulitis that are limited to a small ... with a carbuncle may feel ill and feverish. Impetigo (pronounced: im-puh-TIE-go) is a superficial ...

  6. Neonatal Infections

    MedlinePLUS

    ... the hospital. Listeriosis What is it? Infection with Listeria monocytogenes bacteria can lead to diseases such as ... be caused by viruses, fungi, and bacteria, including Listeria , GBS, and E. coli . Newborns can pick up ...

  7. Postpartum Infections

    MedlinePLUS

    ... Sections Symptoms Multimedia Table Index In This Topic Women's Health Issues Postdelivery Period Postpartum Infections Back to Top ... Older People's Health Issues Skin Disorders Special Subjects Women's Health Issues Chapters in Women's Health Issues Biology of ...

  8. Shigella Infections

    MedlinePLUS

    ... MORE ON THIS TOPIC Adenovirus Amebiasis Cholera Diarrhea E. Coli Giardiasis Rotavirus Why Is Hand Washing So Important? ... Do I Need to Wash My Hands? Cholera E. Coli Salmonellosis Shigellosis Gastrointestinal Infections and Diarrhea Contact Us ...

  9. Opportunistic Infections

    MedlinePLUS

    ... any CD4 cell count. See Fact Sheet 508. Malaria is common in the developing world. It is ... aidsinfo.nih.gov/Guidelines/ and choosing "Prevention and Treatment of Opportunistic Infections Guidelines." Strong antiretroviral drugs can ...

  10. Hand Infections

    MedlinePLUS

    ... spread to others. Necrotizing Fasciitis, or “Flesh-Eating Bacteria” Necrotizing fasciitis is a very rare but severe infection. Streptococcus pyogenes or other “flesh-eating bacteria” enter the body through a cut. Bacteria toxins ...

  11. Factors associated with variation in estimates of the cost of resistant infections

    PubMed Central

    Larson, Elaine

    2010-01-01

    Background Existing estimates of the costs of antimicrobial resistance exhibit broad variability and the contributing factors are not well understood. This study examines factors that contribute to variation in these estimates. Methods Studies of the costs of resistant infections (1995-2009) were identified, abstracted, and stated in comparable terms (e.g., converted to 2007 U.S. dollars). Linear regressions were conducted to assess how costs incurred by patients with resistant infections vs. those incurred by uninfected or susceptible-organism-infected controls varied according to (1) costs incurred by control subjects; (2) study population characteristics; (3) methodological factors (e.g. matching); and (4) length of stay. Results Estimates of difference in costs incurred by patients with resistant infections vs. patients without resistant infections varied between -$27,609 (control costs exceeded case costs) and $126,856. Differences were greater when the costs incurred by control subjects were higher (i.e. when the underlying cost of care was high). Study-adjusted cost differences were greater for bloodstream infections (vs. any other infection site), for studies that reported median (vs. mean) costs, for studies that reported total (vs. post-infection or infection-associated) costs, for studies that used uninfected (vs. susceptible-organism-infected) controls, and for studies that did not match or adjust for length of stay prior to infection. Conclusion The cost of antimicrobial resistance appears to vary with the underlying cost of care. Increased costs of resistance are partially explained by longer length of stay for patients with resistant infections. Further research is needed to assess whether interventions should be differentially targeted at the highest cost cases. PMID:20706168

  12. Fungal Infections

    Microsoft Academic Search

    Carol A. Kauffman

    Older adults are at increased risk of developing opportunistic fungal infections because organ transplantation, intensive\\u000a cancer chemotherapy regimens, and anti-tumor necrosis factor agents are now used more commonly, and because admission to an\\u000a intensive care unit, which carries many risk factors for fungal infection, has become commonplace in this group.\\u000a \\u000a \\u000a Candida species are the most common cause of opportunistic fungal

  13. Ear Infections in Children

    MedlinePLUS

    ... Ear Infections, and Deafness Ear Infections in Children Ear Infections in Children On this page: What is ... can I get more information? What is an ear infection? An ear infection is an inflammation of ...

  14. Prevention of nosocomial infections in neonatal intensive care units.

    PubMed

    Manzoni, Paolo; De Luca, Daniele; Stronati, Mauro; Jacqz-Aigrain, Evelyne; Ruffinazzi, Giulia; Luparia, Martina; Tavella, Elena; Boano, Elena; Castagnola, Elio; Mostert, Michael; Farina, Daniele

    2013-02-01

    Neonatal sepsis causes a huge burden of morbidity and mortality and includes bloodstream, urine, cerebrospinal, peritoneal, and lung infections as well as infections starting from burns and wounds, or from any other usually sterile sites. It is associated with cytokine - and biomediator-induced disorders of respiratory, hemodynamic, and metabolic processes. Neonates in the neonatal intensive care unit feature many specific risk factors for bacterial and fungal sepsis. Loss of gut commensals such as Bifidobacteria and Lactobacilli spp., as occurs with prolonged antibiotic treatments, delayed enteral feeding, or nursing in incubators, translates into proliferation of pathogenic microflora and abnormal gut colonization. Prompt diagnosis and effective treatment do not protect septic neonates form the risk of late neurodevelopmental impairment in the survivors. Thus prevention of bacterial and fungal infection is crucial in these settings of unique patients. In this view, improving neonatal management is a key step, and this includes promotion of breast-feeding and hygiene measures, adoption of a cautious central venous catheter policy, enhancement of the enteric microbiota composition with the supplementation of probiotics, and medical stewardship concerning H2 blockers with restriction of their use. Additional measures may include the use of lactoferrin, fluconazole, and nystatin and specific measures to prevent ventilator associated pneumonia. PMID:23292914

  15. Evaluation of nosocomial infections and risk factors in critically ill patients

    PubMed Central

    Ozer, Burcin; Akkurt, Cagla Ozbak?s; Duran, Nizami; Onlen, Yusuf; Savas, Lutfu; Turhanoglu, Selim

    2011-01-01

    Summary Background Nosocomial infections are one of the most serious complications in intensive care unit patients because they lead to high morbidity, mortality, length of stay and cost. The aim of this study was to determine the nosocomial infections, risk factors, pathogens and the antimicrobial susceptibilities of them in intensive care unit of a university hospital. Material/Methods The patients were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory. Results 20.1% of the patients developed a total of 40 intensive care unit-acquired infections for a total of 988 patient-days. The infection sites were the lower respiratory tract, urinary tract, bloodstream, wound, and the central nervous system. The respiratory deficiency, diabetes mellitus, usage of steroid and antibiotics were found as the risk factors. The most common pathogens were Enterobacteriaceae, Staphylococcus aureus, Candida species. No vancomycin resistance was determined in Gram positive bacteria. Imipenem and meropenem were found to be the most effective antibiotics to Enterobacteriaceae. Conclusions Hospital infection rate in intensive care unit is not very high. The diabetes mellitus, length of stay, usage of steroids, urinary catheter and central venous catheter were determined as the risk factors by the final logistic regression analysis. These data, which were collected from a newly established intensive care unit of a university hospital, are important in order to predict the infections and the antimicrobial resistance profile that will develop in the future. PMID:21358613

  16. Antifungal susceptibility of 262 bloodstream yeast isolates from a mixed cancer and non-cancer patient population: is there a correlation between in-vitro resistance to fluconazole and the outcome of fungemia?

    Microsoft Academic Search

    Gabriela Kovacicova; Yvetta Krupova; Marcela Lovaszova; Alena Roidova; Jan Trupl; Anna Liskova; Juraj Hanzen; Peter Milosovic; Maria Lamosova; Lubica Macekova; Zuzana Szovenyiova; Anna Purgelova; Tanya Obertik; Jacques Bille; Vladimir Krcmery

    2000-01-01

    The aim of this study was to test the antifungal susceptibility of 262 bloodstream yeast isolates (164 Candida albicans strain, 88 non-albicans Candida spp. and 10 non-Candida yeasts) recovered from 169 surgical, neonatal, critically ill intensive care unit patients (ICU), and cancer patients (mixed\\u000a patient population) to amphotericin B (AmB), fluconazole (FLU), 5-flucytosine (5-FC), itraconazole (ITRA), ketoconazole (KETO),\\u000a miconazole (MICO),

  17. Polo-like kinase is expressed in S/G2/M phase and associated with the flagellum attachment zone in both procyclic and bloodstream forms of Trypanosoma brucei.

    PubMed

    Umeyama, Takashi; Wang, Ching C

    2008-09-01

    Trypanosoma brucei, the etiologic agent of African sleeping sickness, divides into insect (procyclic) and bloodstream forms. These two forms are subject to distinct cell cycle regulations, with cytokinesis controlled primarily by basal body/kinetoplast segregation in the procyclic form but by mitosis in the bloodstream form. Polo-like kinases (PLKs), known to play essential roles in regulating both mitosis and cytokinesis among eukaryotes, have a homologue in T. brucei, TbPLK, which regulates only cytokinesis. In our previous study, overexpressed triply hemagglutinin-tagged TbPLK (TbPLK-3HA) in the procyclic form localized to a mid-dorsal point and the anterior tip of the cell along the flagellum attachment zone (FAZ). In our current study, TbPLK-3HA expressed at the endogenous level was identified at the same dorsal location of both procyclic and bloodstream forms, albeit it was no longer detectable at the anterior tip of the cell. Endogenously expressed TbPLK fused with an enhanced yellow fluorescent protein (EYFP) localized to the same dorsal location along the FAZs in living procyclic and bloodstream cells. Fluorescence-activated cell sorter analysis of hydroxyurea-synchronized procyclic cells revealed that TbPLK-EYFP emerges during S phase, persists through G(2)/M phase, and vanishes in G(1) phase. An indicated TbPLK-EYFP association with the FAZs of G(2)/M cells may thus represent a timely localization to a potential initiation site of cytokinesis, which agrees with the recognized role of TbPLK in cytokinetic initiation. PMID:18621923

  18. Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients.

    PubMed

    Freire, M P; Pierrotti, L C; Filho, H H C; Ibrahim, K Y; Magri, A S G K; Bonazzi, P R; Hajar, L; Diz, M P E; Pereira, J; Hoff, P M; Abdala, E

    2015-02-01

    Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) is an emergent pathogen in healthcare-associated infections (HAIs). The aim of this study was to describe HAIs due to KPC-Kp, as well as identify mortality risk factors in cancer patients. In patients diagnosed with HAIs due to KPC-Kp between January 2009 and July 2013, we evaluated only the first infection episode of each patient, analyzing mortality separately for patients treated for??48 h with at least one antimicrobial agent proven to display in vitro activity against KPC-Kp. We evaluated variables related to the malignancy, the severity and characteristics of the HAI, and the antimicrobial therapy. We identified 83 HAIs due to KPC-Kp. The 30-day mortality was 57.8 % for all infections and 72.7 % for bacteremic infections. Of the 83 patients, 60 patients received??48 h of appropriate treatment and 44 (53 %) developed bacteremia. Ten patients (12 %) were neutropenic at HAI diagnosis and 33 (39.8 %) had infection at the tumor site. The most common HAI was urinary tract infection, seen in 26 patients (31.3 %), followed by primary bloodstream infection, seen in 24 patients (28.9 %). Forty-four patients (73.3 %) received combination antimicrobial therapy, most often including polymyxin (68.3 %). Risk factors for 30-day mortality are high sequential organ failure assessment (SOFA) score, need for intensive care stay at diagnosis of infection, and acute kidney injury; the removal of invasive devices related to infection and treatment with effective antibiotics for KPC-Kp are protective factors. In cancer patients, high mortality is associated with HAI due to KPC-Kp and mortality risk factors are more often related to acute infection than to the underlying disease. PMID:25169967

  19. [Infective endocarditis].

    PubMed

    Horstkotte, D; Piper, C

    2015-04-01

    Colonization of native cardiac valves or polymer implants, e.g. valves, conduits, rings, electrode leads and polymer-associated endocarditis (PIE), by microorganisms, primarily gram-positive bacteria (infective endocarditis), constitutes a severe, prognostically unfavorable disease. Fever and in the majority of cases development of a valve regurgitant murmur are clinical landmark findings. The white blood cell count, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are regularly elevated. With a normal CRP level, infective endocarditis is extremely unlikely. Irrespective of body temperature, at least three blood cultures (aerobic and anaerobic) should be taken and if initiation of antimicrobial therapy is urgent, 1 h apart before therapy is initiated. Identification of the pathogen to the species level and testing antimicrobial susceptibility to antibiotics by a quantitative hemodilution test, not with agar diffusion tests, are obligatory. A minimum inhibitory concentration should be administered for antibiotics and usual combinations of antibiotics with an expected synergistic potential. Streptococci, staphylococci and enterococci are the most frequent causative organisms. Immediate initiation of transthoracic echocardiography (TTE) is mandatory followed by transesophageal echocardiography if imaging quality is poor, involvement of intracardiac implants is possible or TTE is insufficient to establish the diagnosis. An insufficiently long antimicrobial therapy promotes recurrent infections, thus a 4-week treatment is standard, while in special cases (e.g. PIE) treatment for 6 weeks should be the rule. If typical complications of infective endocarditis, such as uncontrolled local infection, systemic thromboembolism, central nervous involvement, development of a severe valve incompetence or mitral kissing vegetation in primary aortic valve endocarditis occur, urgent surgical intervention should be considered. If cardiac implants are involved, early surgical removal followed by a 6-week antimicrobial treatment is the rule. Adequate and timely diagnosis and treatment are the key to improve the overall prognosis. PMID:25822422

  20. The de novo and salvage pathways of GDP-mannose biosynthesis are both sufficient for the growth of bloodstream-form Trypanosoma brucei

    PubMed Central

    Kuettel, Sabine; Wadum, Majken C T; Güther, Maria Lucia S; Mariño, Karina; Riemer, Carolin; Ferguson, Michael A J

    2012-01-01

    Summary The sugar nucleotide GDP-mannose is essential for Trypanosoma brucei. Phosphomannose isomerase occupies a key position on the de novo pathway to GDP-mannose from glucose, just before intersection with the salvage pathway from free mannose. We identified the parasite phosphomannose isomerase gene, confirmed that it encodes phosphomannose isomerase activity and localized the endogenous enzyme to the glycosome. We also created a bloodstream-form conditional null mutant of phosphomannose isomerase to assess the relative roles of the de novo and salvage pathways of GDP-mannose biosynthesis. Phosphomannose isomerase was found to be essential for parasite growth. However, supplementation of the medium with low concentrations of mannose, including that found in human plasma, relieved this dependence. Therefore, we do not consider phosphomannose isomerase to be a viable drug target. We further established culture conditions where we can control glucose and mannose concentrations and perform steady-state [U-13C]-d-glucose labelling. Analysis of the isotopic sugar composition of the parasites variant surface glycoprotein synthesized in cells incubated in 5 mM [U-13C]-d-glucose in the presence and absence of unlabelled mannose showed that, under physiological conditions, about 80% of GDP-mannose synthesis comes from the de novo pathway and 20% from the salvage pathway. PMID:22375793

  1. In vitro activity of mersacidin (M87-1551), an investigational peptide antibiotic tested against gram-positive bloodstream isolates.

    PubMed

    Barrett, M S; Wenzel, R P; Jones, R N

    1992-01-01

    We measured the in vitro activity of mersacidin (formerly M87-1551) against 183 clinical isolates (vancomycin susceptible) and 12 additional vancomycin-resistant strains of Gram-positive bacteria. The activity for mersacidin increased an average twofold (range, 1.7- to 7.6-fold) in a calcium-enriched medium. The minimum inhibitory concentration (MIC)90 for mersacidin was 8-32 times higher than vancomycin for staphylococci, 4-64 times higher for enterococci, and up to 32 times higher for other organisms tested. The MIC90 for MDL 62873, a comparison compound, was less than or equal to 0.5 micrograms/ml for all species except Staphylococcus haemolyticus (MIC90, 4 micrograms/ml), and it was greater than or equal to 4-fold more active than vancomycin. Against selected vancomycin-resistant strains, mersacidin had MICs greater than or equal to 16 micrograms/ml for enterococci, 4-32 micrograms/ml for Pediococcus, and less than or equal to 2 micrograms/ml for Leuconostoc species. Mersacidin may have some clinical utility in documented infections caused by staphylococci, nonenteric streptococci, Pediococcus, and Leuconostoc. PMID:1424522

  2. Nonfermenting Gram-negative Bacilli other than Pseudomonas aeruginosa and Acinetobacter Spp. Causing Respiratory Tract Infections in a Tertiary Care Center

    PubMed Central

    Chawla, Kiran; Vishwanath, Shashidhar; Munim, Frenil C

    2013-01-01

    Background: Nonfermenting gram-negative bacilli have emerged as important healthcare-associated pathogens. It is important to correctly identify all clinically significant nonfermenting gram-negative bacilli considering the intrinsic multidrug resistance exhibited by these bacteria. Materials and Methods: A retrospective study was undertaken to identify the various nonfermenting gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. isolated from respiratory samples (n = 9363), to understand their clinical relevance and to analyze their antibiotic susceptibility pattern. Results: Nonfermenting gram-negative bacilli were isolated from 830 (16.4%) samples showing significant growth. Thirty-three (4%) isolates constituted nonfermenting gram-negative bacilli other than P. aeruginosa and Acinetobacter spp. Stenotrophomonas maltophilia (15, 45.5%) was the most common isolate followed by Burkholderia cepacia (4, 12.1%), Sphingomonas paucimobilis (3, 9.1%), and Achromobacter xylosoxidans (3, 9.1%). On the basis of clinicomicrobiological correlation, pathogenicity was observed in 69.7% (n = 23) isolates. Timely and correct treatment resulted in clinical improvement in 87.9% cases. Conclusion: Any nonfermenting gram-negative bacilli isolated from respiratory tract infection should not be ignored as mere contaminant, but correlated clinically for its pathogenic potential and identified using standard methods so as to institute appropriate and timely antibiotic coverage. PMID:24672175

  3. Vaginal Yeast Infections

    MedlinePLUS

    ... infection from your sexual partner. Condoms and dental dams may help prevent getting or passing yeast infections ... infection from your sexual partner. Condoms and dental dams may help prevent getting or passing yeast infections ...

  4. Who Gets Fungal Infections?

    MedlinePLUS

    ... infections can also happen in people without weak immune systems Fungal infections that are not life-threatening, such ... likely to cause an infection. People with weak immune systems Infections that happen because a person’s immune system ...

  5. Additive roles for MCP-1 and MCP-3 in CCR2-mediated recruitment of inflammatory monocytes during Listeria monocytogenes infection.

    PubMed

    Jia, Ting; Serbina, Natalya V; Brandl, Katharina; Zhong, Maggie X; Leiner, Ingrid M; Charo, Israel F; Pamer, Eric G

    2008-05-15

    Chemokine receptor-mediated recruitment of inflammatory cells is essential for innate immune defense against microbial infection. Recruitment of Ly6C(high) inflammatory monocytes from bone marrow to sites of microbial infection is dependent on CCR2, a chemokine receptor that responds to MCP-1 and MCP-3. Although CCR2(-/-) mice are markedly more susceptible to Listeria monocytogenes infection than are wild-type mice, MCP-1(-/-) mice have an intermediate phenotype, suggesting that other CCR2 ligands contribute to antimicrobial defense. Herein, we show that L. monocytogenes infection rapidly induces MCP-3 in tissue culture macrophages and in serum, spleen, liver, and kidney following in vivo infection. Only cytosol invasive L. monocytogenes induce MCP-3, suggesting that cytosolic innate immune detection mechanisms trigger chemokine production. MCP-3(-/-) mice clear bacteria less effectively from the spleen than do wild-type mice, a defect that correlates with diminished inflammatory monocyte recruitment. MCP-3(-/-) mice have significantly fewer Ly6C(high) monocytes in the spleen and bloodstream, and increased monocyte numbers in bone marrow. MCP-3(-/-) mice, like MCP-1(-/-) mice, have fewer TNF- and inducible NO synthase-producing dendritic cells (Tip-DCs) in the spleen following L. monocytogenes infection. Our data demonstrate that MCP-3 and MCP-1 provide parallel contributions to CCR2-mediated inflammatory monocyte recruitment and that both chemokines are required for optimal innate immune defense against L. monocytogenes infection. PMID:18453605

  6. Additive Roles for MCP-1 and MCP-3 in CCR2-mediated Recruitment of Inflammatory Monocytes During Listeria monocytogenes Infection

    PubMed Central

    Jia, Ting; Serbina, Natalya V.; Brandl, Katharina; Zhong, Maggie X.; Leiner, Ingrid M.; Charo, Israel F.; Pamer, Eric G.

    2008-01-01

    Chemokine receptor mediated recruitment of inflammatory cells is essential for innate immune defense against microbial infection. Recruitment of Ly6Chi inflammatory monocytes from bone marrow to sites of microbial infection is dependent on CCR2, a chemokine receptor that responds to MCP-1 and MCP-3. While CCR2-/- mice are markedly more susceptible to L. monocytogenes infection than wild type mice, MCP-1-/- mice have an intermediate phenotype, suggesting that other CCR2 ligands contribute to antimicrobial defense. Herein, we show that L. monocytogenes infection rapidly induces MCP-3 in tissue culture macrophages and in serum, spleen, liver and kidney following in vivo infection. Only cytosol invasive L. monocytogenes induce MCP-3, suggesting that cytosolic innate immune detection mechanisms trigger chemokine production. MCP-3-/- mice clear bacteria less effectively from the spleen than WT mice, a defect that correlates with diminished inflammatory monocyte recruitment. MCP-3-/- mice have significantly fewer Ly6Chi monocytes in the spleen and bloodstream, and increased monocyte numbers in bone marrow. MCP-3-/- mice, like MCP-1-/- mice, have fewer TNF- and iNOS-producing dendritic cells (Tip-DCs) in the spleen following L. monocytogenes infection. Our data demonstrate that MCP-3 and MCP-1 provide parallel contributions to CCR2-mediated inflammatory monocyte recruitment and that both chemokines are required for optimal innate immune defense against L. monocytogenes infection. PMID:18453605

  7. Selection of the vascular catheter: can it minimise the risk of infection?

    PubMed

    Bouza, E; Guembe, M; Muñoz, P

    2010-12-01

    Data regarding the prevention of catheter-related bloodstream infection (CRBSI) by making the correct decisions about when to place a central line, the appropriate selection of catheter composition and the size and number of lumens, a suitable choice of insertion site and the technique used are not well reported in recent medical literature. There is no clear evidence that the composition of the catheters presently on the market makes a significant difference to the risk of infection. Several prospective studies suggest that femoral vein location represents the highest risk of infection, followed by jugular vein and subclavian vein positioning, however, most articles do not correct for basic confounding variables. Several papers have reported that arterial catheters have a similar risk of infection as central venous catheters (CVCs). The slight increase in infection risk when using multi-lumen catheters is probably offset by their improved convenience. Current evidence does not support routine tunnelling of short-term catheters until its efficacy is evaluated at different placement sites, using specific catheters and situations and in relation to other preventive interventions. Cuffing is usually applied only to long-term tunnelled catheters. The available evidence suggests that chlorhexidine-silver sulfadiazine, minocycline-rifampicin CVCs and antifungal-coated catheters are useful in decreasing the incidence of CRBSI when other measures are not effective. PMID:21130605

  8. Genetic Variability of Candida albicans Sap8 Propeptide in Isolates from Different Types of Infection

    PubMed Central

    Carvalho-Pereira, Joana; Vaz, Catarina; Carneiro, Catarina; Pais, Célia; Sampaio, Paula

    2015-01-01

    The secreted aspartic proteases (Saps) are among the most studied virulence determinants in Candida albicans. These proteins are translated as pre-pro-enzymes consisting of a signal sequence followed by a propeptide and the mature enzyme. The propeptides of secreted proteinases are important for the correct processing, folding/secretion of the mature enzyme. In this study, the DNA sequences of C. albicans Saps were screened and a microsatellite was identified in SAP8 propeptide region. The genetic variability of the repetitive region of Sap8 propeptide was determined in 108 C. albicans independent strains isolated from different types of infection: oral infection (OI), oral commensal (OC), vulvovaginal candidiasis (VVC), and bloodstream infections (BSI). Nine different propeptides for Sap8 processing were identified whose frequencies varied with the type of infection. OC strains presented the highest gene diversity while OI isolated the lowest. The contribution of the Saps to mucosal and systemic infections has been demonstrated and recently Sap8 has been implicated in the cleavage of a signalling glycoprotein that leads to Cek1-MAPK pathway activation. This work is the first to identify a variable microsatellite in the propeptide of a secreted aspartic protease and brings new insights into the variability of Sap8. PMID:25734055

  9. Prevention of central venous catheter-related infection in the neonatal unit: a literature review.

    PubMed

    Taylor, Jacqueline E; McDonald, Susan J; Tan, Kenneth

    2014-09-26

    Abstract Central venous catheter infections are the leading cause of healthcare-associated bloodstream infections and contribute significantly to mortality and morbidity in neonatal intensive care units. Moreover, infection poses significant economic consequence which increased hospital costs and increased length of hospital stay. Prevention strategies are detailed in guidelines published by the Centers for Disease Control and Prevention (CDC) in the United States; nevertheless, recent surveys in neonatal units in the United States, and Australia and New Zealand demonstrate these are not always followed. This review discusses the numerous evidence-based strategies to prevent catheter infections including hand hygiene, maximal sterile barriers during insertion, skin disinfection, selection of insertion site, dressings, aseptic non-touch technique, disinfection of catheter hubs/ports, administration set management, prompt removal of catheter, antibiotic locks, systemic antibiotic prophylaxis and chlorhexidine bathing. Furthermore, it will describe different strategies that can be implemented into clinical practice to reduce infection rates. These include the use of care bundles including checklists, education and the use of CVC teams. PMID:25076387

  10. Infective endocarditis

    Microsoft Academic Search

    Yok-Ai Que; Philippe Moreillon

    2011-01-01

    Infective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease—mostly chronic rheumatic heart disease—IE now tends to affect older patients and new at-risk

  11. Local and Remote Sequelæ of Infection in the Parodontal Sulcus

    PubMed Central

    Fish, E. Wilfred

    1937-01-01

    (1) It is shown in this paper that the infecting organisms in the parodontal sulcus are confined to the surface, but may be forced into the blood and lymph stream by traumatic interference. 2. Local and general disturbances may therefore arise both as a result of the absorption of soluble toxic matter from the pocket into the tissues and also as a result of this traumatic introduction of organisms into the blood-stream. 3. The effect of toxic absorption on the local tissues is destruction of the attachment of the tooth-pyorrhœa. 4. The remote effects of toxic absorption may be a similar destruction of the connective tissue generally-arthritis and fibrositis. The liver and kidney may suffer since they excrete the toxic matter, and other susceptible tissues may also be involved. 5. Traumatic bacteræmia may produce local bone necrosis or “dry” socket. Acute suppurative lymphangitis produces the “pyorrhœtic abscess”. 6. The remote effect of bacteræmia may be to produce osteomyelitis (e.g. of the tibia) or to convert a simple endocarditis into the bacterial type. 7. The mechanism of bone absorption and deposition in response to irritation is discussed. 8. Methods of eliminating parodontal infection are referred to and the importance of complete elimination is stressed. It is shown to be not incompatible with the conservation of the teeth. ImagesFig. 1AFig. 2Fig. 6Fig. 7Fig. 1Fig. 3Fig. 4Figs. 4A, B and CFig. 5Fig. 5A PMID:19991210

  12. Immune response to a Trichinella spiralis infection in house mice from lines selectively bred for high voluntary wheel running.

    PubMed

    Dlugosz, Elizabeth M; Schutz, Heidi; Meek, Thomas H; Acosta, Wendy; Downs, Cynthia J; Platzer, Edward G; Chappell, Mark A; Garland, Theodore

    2013-11-15

    Four lines of mice bred for high voluntary wheel running (HR lines) have high baseline circulating corticosterone levels and increased daily energy expenditure as compared with four non-selected control (C) lines. High corticosterone may suppress immune function and competing energy demands may limit ability to mount an immune response. We hypothesized that HR mice have a reduced immune response and therefore a decreased ability to fight an infection by Trichinella spiralis, an ecologically relevant nematode common in mammals. Infections have an acute, intestinal phase while the nematode is migrating, reproducing and traveling throughout the bloodstream, followed by a chronic phase with larvae encysted in muscles. Adult males (generation 55 of the selection experiment) were sham-infected or infected by oral gavage with ~300 J1 T. spiralis larvae. During the chronic phase of infection, mice were given wheel access for 6 days, followed by 2 days of maximum aerobic performance trials. Two weeks post-infection, infected HR had significantly lower circulating immunoglobulin E levels compared with infected C mice. However, we found no statistical difference between infected HR and C mice in numbers of encysted larvae within the diaphragm. As expected, both voluntary running and maximum aerobic performance were significantly higher in HR mice and lower in infected mice, with no line type-by-infection interactions. Results complement those of previous studies suggesting decreased locomotor abilities during the chronic phase of T. spiralis infection. However, despite reduced antibody production, breeding for high voluntary wheel exercise does not appear to have a substantial negative impact on general humoral function. PMID:23948476

  13. A mathematical model for Chagas disease with infection-age-dependent infectivity

    E-print Network

    Inaba, Hisashi

    follows the invasion of the bloodstream by the protozoan parasite Trypanosoma cruzi. This stage lasts from animals) of the protozoan parasite. In this paper, we formulate a structured population model for the s

  14. Health care-associated infections in children after cardiac surgery.

    PubMed

    Turcotte, Rebecca F; Brozovich, Ava; Corda, Rozelle; Demmer, Ryan T; Biagas, Katherine V; Mangino, Diane; Covington, Lisa; Ferris, Anne; Thumm, Brian; Bacha, Emile; Smerling, Art; Saiman, Lisa

    2014-12-01

    Few recent studies have assessed the epidemiology of health care-associated infections (HAIs) in the pediatric population after cardiac surgery. A retrospective cohort study was performed to assess the epidemiology of several types of HAIs in children 18 years of age or younger undergoing cardiac surgery from July 2010 to June 2012. Potential pre-, intra-, and postoperative risk factors, including adherence to the perioperative antibiotic prophylaxis regimen at the authors' hospital, were assessed by multivariable analysis using Poisson regression models. Microorganisms associated with HAIs and their susceptibility patterns were described. Overall, 634 surgeries were performed, 38 (6 %) of which were complicated by an HAI occurring within 90 days after surgery. The HAIs included 7 central line-associated bloodstream infections (CLABSIs), 12 non-CLABSI bacteremias, 6 episodes of early postoperative infective endocarditis (IE), 9 surgical-site infections (SSIs), and 4 ventilator-associated pneumonias (VAPs). Mechanical ventilation (rate ratio [RR] 1.07 per day; 95 % confidence interval [CI] 1.03-1.11; p = 0.0002), postoperative transfusion of blood products (RR 3.12; 95 %, CI 1.38-7.06; p = 0.0062), postoperative steroid use (RR 3.32; 95 % CI 1.56-7.02; p = 0.0018), and continuation of antibiotic prophylaxis longer than 48 h after surgery (RR 2.56; 95 % CI 1.31-5.03; p = 0.0062) were associated with HAIs. Overall, 66.7 % of the pathogens associated with SSIs were susceptible to cefazolin, the perioperative antibiotic prophylaxis used by the authors' hospital. In conclusion, HAIs occurred after 6 % of cardiac surgeries. Bacteremia and CLABSI were the most common. This study identified several potentially modifiable risk factors that suggest interventions. Further studies should assess the role of improving adherence to perioperative antibiotic prophylaxis, the age of transfused red blood cells, and evidence-based guidelines for postoperative steroids. PMID:24996642

  15. Infective Endocarditis

    Microsoft Academic Search

    Vinod K. Dhawan

    Age is an important risk factor for infective endocarditis (IE) with the incidence ratio of those age 65 and older vs. those\\u000a less than 65 being approximately 9:1.\\u000a \\u000a Approximately 80% of IE cases in the elderly are caused by Staphylococcus aureus, Streptococcus spp., and enterococci.\\u000a \\u000a \\u000a \\u000a Clinical manifestations of IE in older adults may be nonspecific, atypical, and resemble aging changes

  16. Real-world experience with echinocandin MICs against Candida species in a multicenter study of hospitals that routinely perform susceptibility testing of bloodstream isolates.

    PubMed

    Eschenauer, Gregory A; Nguyen, M Hong; Shoham, Shmuel; Vazquez, Jose A; Morris, Arthur J; Pasculle, William A; Kubin, Christine J; Klinker, Kenneth P; Carver, Peggy L; Hanson, Kimberly E; Chen, Sharon; Lam, Simon W; Potoski, Brian A; Clarke, Lloyd G; Shields, Ryan K; Clancy, Cornelius J

    2014-01-01

    Reference broth microdilution methods of Candida echinocandin susceptibility testing are limited by interlaboratory variability in caspofungin MICs. Recently revised Clinical and Laboratory Standards Institute (CLSI) breakpoint MICs for echinocandin nonsusceptibility may not be valid for commercial tests employed in hospital laboratories. Indeed, there are limited echinocandin susceptibility testing data from hospital laboratories. We conducted a multicenter retrospective study of 9 U.S., Australian, and New Zealand hospitals that routinely tested Candida bloodstream isolates for echinocandin susceptibility from 2005 to 2013. Eight hospitals used Sensititre YeastOne assays. The Candida spp. were C. albicans (n=1,067), C. glabrata (n=911), C. parapsilosis (n=476), C. tropicalis (n=185), C. krusei (n=104), and others (n=154). Resistance and intermediate rates were ?1.4% and ?3%, respectively, for each echinocandin against C. albicans, C. parapsilosis, and C. tropicalis. Resistance rates among C. glabrata and C. krusei isolates were ?7.5% and ?5.6%, respectively. Caspofungin intermediate rates among C. glabrata and C. krusei isolates were 17.8% and 46.5%, respectively, compared to ?4.3% and ?4.4% for other echinocandins. Using CLSI breakpoints, 18% and 19% of C. glabrata isolates were anidulafungin susceptible/caspofungin nonsusceptible and micafungin susceptible/caspofungin nonsusceptible, respectively; similar discrepancies were observed for 38% and 39% of C. krusei isolates. If only YeastOne data were considered, interhospital modal MIC variability was low (within 2 doubling dilutions for each agent). In conclusion, YeastOne assays employed in hospitals may reduce the interlaboratory variability in caspofungin MICs against Candida species that are observed between reference laboratories using CLSI broth microdilution methods. The significance of classifying isolates as caspofungin intermediate and anidulafungin/micafungin susceptible will require clarification in future studies. PMID:24395235

  17. Monocyte Trafficking to Hepatic Sites of Bacterial Infection Is Chemokine Independent and Directed by Focal Intercellular Adhesion Molecule-1 Expression

    PubMed Central

    Shi, Chao; Velázquez, Peter; Hohl, Tobias M.; Leiner, Ingrid; Dustin, Michael L.; Pamer, Eric G.

    2010-01-01

    Recruitment of CCR2+Ly6Chigh monocytes to sites of infection is essential for efficient clearance of microbial pathogens. Although CCR2-mediated signals promote monocyte emigration from bone marrow, the contribution of CCR2 to later stages of monocyte recruitment remains unresolved. In this article, we show that CCR2 deficiency markedly worsens hepatic Listeria monocytogenes infection because Ly6Chigh monocytes are retained in the bone marrow. Intravenously transferred, CCR2-deficient Ly6Chigh monocytes traffic normally to hepatic foci of infection and contribute to bacterial clearance. Pertussis toxin treatment of adoptively transferred monocytes does not impair their intrahepatic trafficking, suggesting that chemokine signaling, once CCR2+ Ly6Chigh monocytes emigrate from the bone marrow, is not required for monocyte localization to sites of bacterial infection in the liver. Expression of ICAM-1 is induced in close proximity to foci of bacterial infection in the liver, including on CD31+ endothelial cells, and blockade of CD11b and CD44 diminishes monocyte localization to these hepatic foci. Our studies demonstrated that Ly6Chigh monocyte recruitment from the bloodstream to the L. monocytogenes-infected liver does not require chemokine receptor-mediated signals but instead is principally dependent on integrin- and extracellular matrix-mediated monocyte adhesion. PMID:20435926

  18. Surveillance Programme for Healthcare Associated Infections in the State of São Paulo, Brazil. Implementation and the first three years' results.

    PubMed

    Padoveze, M C; Assis, D B; Freire, M P; Madalosso, G; Ferreira, S A; Valente, M G; Fortaleza, C M C B

    2010-12-01

    Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. PMID:20884080

  19. Characterization of Post-Hospital Infections in Adults Requiring Home Parenteral Nutrition

    PubMed Central

    Zhao, Vivian M.; Griffith, Daniel P.; Blumberg, Henry M.; Dave, Nisha J.; Battey, Cynthia H.; McNally, Therese A.; Easley, Kirk A.; Galloway, John R.; Ziegler, Thomas R.

    2012-01-01

    Background Limited data are available on the incidence and risk factors for infection among patients requiring home parenteral nutrition (HPN). Methods Retrospective study of 101 consecutive adults (63 female, 38 male) discharged on HPN from Emory University Hospital, Atlanta, GA. New bloodstream infections (BSI) requiring re-hospitalization and other infections were evaluated. Results Most infections (75%) developed during the initial 6 months after hospital discharge; rates of BSI were particularly high during the first four months. A total of 56 patients (55.4%) developed a total of 102 BSIs (11.5 BSI/1000 catheter-days). Most BSIs were attributed to Gram positive organisms (46%) including coagulase-negative staphylococcus, staphylococcus aureus, enterococcus species, and others, followed by Candida species (20%) and Gram negative organisms (13%). Twenty-one percent of BSIs were polymicrobial. The BSI incidence rate ratio (IRR) was significantly increased for patients with mean pre-hospital discharge blood glucose (BG) concentrations in the highest quartile versus the lowest quartile; IRR 2.4; P = 0.017). Patients with a peripherally inserted central catheter (PICC) versus non-PICC central venous catheters had significantly higher rates of BSI (p = 0.018). Thirty-nine (38.6%) patients developed 81 non-BSI infections, including pneumonia, urinary tract infections, and surgical site infections. Post-discharge PN dextrose, lipid, and total calorie doses were unrelated to BSI but variably related to the rate of non-BSI. Conclusions Adult HPN patients exhibit a very high incidence of post-hospital infections. Higher mean BG levels during pre-discharge hospitalization and use of PICCs at discharge are associated with an increased risk of BSI in the post-discharge home setting. PMID:22858199

  20. Perioperative Bacterial Infections in Deceased Donor and Living Donor Liver Transplant Recipients

    PubMed Central

    Varghese, Joy; Gomathy, Narasimhan; Rajashekhar, Perumalla; Venugopal, Kota; Olithselvan, Arikichenin; Vivekanandan, Shanmugam; Naresh, Shanmugam; Sujatha, Chandrasekaran; Vijaya, Srinivasan; Jayanthi, Venkataraman; Rela, Mohamed

    2012-01-01

    Background Deceased donor (DDLT) and living donor (LDLT) liver transplant (LT) is in vogue in several centers in India. Most centers are resorting to LDLT as a preferred surgery due to shortage of deceased donor liver. The risk of infection and its effect on survival in both groups of recipients from the Indian subcontinent are not known. The study was conducted to compare the bacterial infection rates among LDLT and DDLT recipients and their impact on survival at a tertiary referral center. Methods Retrospective data on 67 LT recipients were reviewed. Data on pre-, per-, and postoperative bacterial infection rates and the common isolates were obtained. Results Thirty-five patients had LDLT and 32 had DDLT. The prevalence of pre-operative bacterial infection and the isolates was similar in both groups. The perioperative bacterial infection rates were significantly higher in DDLT recipients (P < 0.01) (relative risk: 1.44 95% confidence interval 1.04–1.9). In both LDLT and DDLT, the common source was urinary tract followed by bloodstream infection. The common bacterial isolates in either transplant were Klebsiella followed by Escherichia coli, Pseudomonas spp. and nonfermenting gram-negative bacteria. Six patients (four LDLT; two DDLT) were treated for tuberculosis. Among the risk factors, cold ischemic time, and duration of stay in the intensive care unit was significantly higher for DDLT (p < 0.01). The death rates were not significantly different in the two groups. However, the odds for death were significantly high at 26.8 (p < 0.05) for postoperative bacterial infection and 1.8 (p < 0.001) for past alcohol. Conclusion Liver transplant recipients are at high-risk for bacterial infection irrespective of type of transplant, more so in DDLT.

  1. Expression of late viral proteins is restricted in nasal mucosal leucocytes but not in epithelial cells during early-stage equine herpes virus-1 infection.

    PubMed

    Gryspeerdt, Annick C; Vandekerckhove, Annelies P; Baghi, Hossein Bannazadeh; Van de Walle, Gerlinde R; Nauwynck, Hans J

    2012-08-01

    Equine herpes virus (EHV)-1 replicates in the epithelial cells of the upper respiratory tract and reaches the lamina propria and bloodstream in infected mononuclear cells. This study evaluated expression of the late viral proteins gB, gC, gD and gM in respiratory epithelial and mononuclear cells using: (1) epithelial-like rabbit kidney cells and peripheral blood mononuclear cells infected with EHV-1 in vitro; (2) an equine ex vivo nasal explant system; and (3) nasal mucosa tissue of ponies infected in vivo. The viral proteins were expressed in all late-infected epithelial cells, whereas expression was not observed in infected leucocytes where proteins gB and gM were expressed in 60-90%, and proteins gC and gD in only 20% of infected cells, respectively. The results indicate that expression of these viral proteins during early-stage EHV-1 infection is highly dependent on the cell type infected. PMID:22425309

  2. Long-term catheterization: current approaches in the diagnosis and treatment of port-related infections

    PubMed Central

    Bustos, Cesar; Aguinaga, Aitziber; Carmona-Torre, Francisco; Del Pozo, Jose Luis

    2014-01-01

    Since the first description in 1982, totally implanted venous access ports have progressively improved patients’ quality of life and medical assistance when a medical condition requires the use of long-term venous access. Currently, they are part of the standard medical care for oncohematologic patients. However, apart from mechanical and thrombotic complications, there are also complications associated with biofilm development inside the catheters. These biofilms increase the cost of medical assistance and extend hospitalization. The most frequently involved micro-organisms in these infections are gram-positive cocci. Many efforts have been made to understand biofilm formation within the lumen catheters, and to resolve catheter-related infection once it has been established. Apart from systemic antibiotic treatment, the use of local catheter treatment (ie, antibiotic lock technique) is widely employed. Many different antimicrobial options have been tested, with different outcomes, in clinical and in in vitro assays. The stability of antibiotic concentration in the lock solution once instilled inside the catheter lumen remains unresolved. To prevent infection, it is mandatory to perform hand hygiene before catheter insertion and manipulation, and to disinfect catheter hubs, connectors, and injection ports before accessing the catheter. At present, there are still unresolved questions regarding the best antimicrobial agent for catheter-related bloodstream infection treatment and the duration of concentration stability of the antibiotic solution within the lumen of the port. PMID:24570595

  3. Emergence of a novel subpopulation of CC398 Staphylococcus aureus infecting animals is a serious hazard for humans

    PubMed Central

    van der Mee-Marquet, Nathalie L.; Corvaglia, Anna; Haenni, Marisa; Bertrand, Xavier; Franck, Jean-Baptiste; Kluytmans, Jan; Girard, Myriam; Quentin, Roland; François, Patrice

    2014-01-01

    Until recently, Staphylococcus aureus from clonal complex (CC)398 were mostly described as colonizing asymptomatic raised pigs and pig-farmers. Currently, the epidemiology of the CC398 lineage is becoming more complex. CC398 human-adapted isolates are increasingly being identified in bloodstream infections in humans living in animal-free environments. In addition, CC398 isolates are increasingly responsible for invasive infections in various animals. CC398 isolates that colonize asymptomatic pigs and the isolates that infect humans living in animal-free environments (human-adapted isolates) both lack several clinically important S. aureus–associated virulence factors but differ on the basis of their prophage content. Recent findings have provided insight into the influence of a ?MR11-like helper prophage on the ability of CC398 isolates to infect humans. To assess the recent spread of the CC398 lineage to various animal species and to investigate the links between the ?MR11-like prophage and the emergence of CC398 isolates infecting animals, we studied 277 isolates causing infections in unrelated animals. The prevalence of CC398 isolates increased significantly between 2007 and 2013 (p < 0.001); 31.8% of the animal isolates harbored the ?MR11-like prophage. High-density DNA microarray experiments with 37 representative infected-animal isolates positive for ?MR11-like DNA established that most infected-animal isolates carried many genetic elements related to antimicrobial resistance and virulence genes, and a ?3 prophage encoding immune-modulating proteins and associated with animal-to-human jumps. Our findings suggest recent clonal expansion and dissemination of a new subpopulation of CC398 isolates, responsible for invasive infections in various animals, with a considerable potential to colonize and infect humans, probably greater than that of human-adapted CC398 isolates, justifying active surveillance. PMID:25538688

  4. How People Are Infected

    MedlinePLUS

    ... person’s chances of getting infected. Working with infected animals or animal products Most people who get sick from anthrax ... skin. Eating raw or undercooked meat from infected animals People who eat raw or undercooked meat from ...

  5. Photos of MRSA Infections

    MedlinePLUS

    ... Methicillin-resistant Staphylococcus aureus (MRSA) Infections Share Compartir Photos of MRSA Infections In the community, most MRSA ... Educational Resources Environmental Cleaning & Disinfecting Athletic Facilities Laundry Photos of MRSA Infections MRSA in Healthcare Settings Patients ...

  6. The Burden of Invasive Bacterial Infections in Pemba, Zanzibar

    PubMed Central

    Thriemer, Kamala; Ley, Benedikt; Ame, Shaali; von Seidlein, Lorenz; Pak, Gi Deok; Chang, Na Yoon; Hashim, Ramadhan; Schmied, Wolfgang Hellmut; Busch, Clara Jana-Lui; Nixon, Shanette; Morrissey, Anne; Puri, Mahesh K.; Ali, Mohammad; Ochiai, R. Leon; Wierzba, Thomas; Jiddawi, Mohammad S.; Clemens, John D.; Ali, Said M.; Deen, Jaqueline L.

    2012-01-01

    Background We conducted a surveillance study to determine the leading causes of bloodstream infection in febrile patients seeking treatment at three district hospitals in Pemba Island, Zanzibar, Tanzania, an area with low malaria transmission. Methods All patients above two months of age presenting to hospital with fever were screened, and blood was collected for microbiologic culture and malaria testing. Bacterial sepsis and malaria crude incidence rates were calculated for a one-year period and were adjusted for study participation and diagnostic sensitivity of blood culture. Results Blood culture was performed on 2,209 patients. Among them, 166 (8%) samples yielded bacterial growth; 87 (4%) were considered as likely contaminants; and 79 (4%) as pathogenic bacteria. The most frequent pathogenic bacteria isolated were Salmonella Typhi (n?=?46; 58%), followed by Streptococcus pneumoniae (n?=?12; 15%). The crude bacteremia rate was 6/100,000 but when adjusted for potentially missed cases the rate may be as high as 163/100,000. Crude and adjusted rates for S. Typhi infections and malaria were 4 and 110/100,000 and 4 and 47/100,000, respectively. Twenty three (51%), 22 (49%) and 22 (49%) of the S.Typhi isolates were found to be resistant toward ampicillin, chloramphenicol and cotrimoxazole, respectively. Multidrug resistance (MDR) against the three antimicrobials was detected in 42% of the isolates. Conclusions In the presence of very low malaria incidence we found high rates of S. Typhi and S. pneumoniae infections on Pemba Island, Zanzibar. Preventive measures such as vaccination could reduce the febrile disease burden. PMID:22363426

  7. Stenotrophomonas maltophilia Infections in a General Hospital: Patient Characteristics, Antimicrobial Susceptibility, and Treatment Outcome

    PubMed Central

    Samonis, George; Karageorgopoulos, Drosos E.; Maraki, Sofia; Levis, Panagiotis; Dimopoulou, Dimitra; Spernovasilis, Nikolaos A.; Kofteridis, Diamantis P.; Falagas, Matthew E.

    2012-01-01

    Introduction Stenotrophomonas maltophilia is acquiring increasing importance as a nosocomial pathogen. Methods We retrospectively studied the characteristics and outcome of patients with any type of S. maltophilia infection at the University Hospital of Heraklion, Crete, Greece, between 1/2005–12/2010. S. maltophilia antimicrobial susceptibility was tested with the agar dilution method. Prognostic factors for all-cause in-hospital mortality were assessed with multivariate logistic regression. Results Sixty-eight patients (median age: 70.5 years; 64.7% males) with S. maltophilia infection, not related to cystic fibrosis, were included. The 68 patients were hospitalized in medical (29.4%), surgical (26.5%), hematology/oncology departments (23.5%), or the intensive care units (ICU; 20.6%). The most frequent infection types were respiratory tract (54.4%), bloodstream (16.2%), skin/soft tissue (10.3%), and intra-abdominal (8.8%) infection. The S. maltophilia-associated infection was polymicrobial in 33.8% of the cases. In vitro susceptibility was higher to colistin (91.2%), trimethoprim/sulfamethoxazole and netilmicin (85.3% each), and ciprofloxacin (82.4%). The empirical and the targeted treatment regimens were microbiologically appropriate for 47.3% and 63.6% of the 55 patients with data available, respectively. Most patients received targeted therapy with a combination of agents other than trimethoprim/sulfamethoxazole. The crude mortality and the mortality and the S. maltophilia infection-related mortality were 14.7% and 4.4%, respectively. ICU hospitalization was the only independent prognostic factor for mortality. Conclusion S. maltophilia infection in a general hospital can be associated with a good prognosis, except for the patients hospitalized in the ICU. Combination reigmens with fluoroquinolones, colistin, or tigecycline could be alternative treatment options to trimethoprim/sulfamethoxazole. PMID:22624022

  8. International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008.

    PubMed

    Rosenthal, Victor D; Maki, Dennis G; Mehta, Ajita; Alvarez-Moreno, Carlos; Leblebicioglu, Hakan; Higuera, Francisco; Cuellar, Luis E; Madani, Naoufel; Mitrev, Zan; Dueñas, Lourdes; Navoa-Ng, Josephine Anne; Garcell, Humberto Guanche; Raka, Lul; Hidalgo, Rosalía Fernández; Medeiros, Eduardo A; Kanj, Souha S; Abubakar, Salisu; Nercelles, Patricio; Pratesi, Ricardo Diez

    2008-11-01

    We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from 2002 through 2007 in 98 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance System (NNIS) definitions for device-associated health care-associated infection, we collected prospective data from 43,114 patients hospitalized in the Consortium's hospital ICUs for an aggregate of 272,279 days. Although device utilization in the INICC ICUs was remarkably similar to that reported from US ICUs in the CDC's National Healthcare Safety Network, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infections (CLABs) in the INICC ICUs, 9.2 per 1000 CL-days, is nearly 3-fold higher than the 2.4-5.3 per 1000 CL-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia was also far higher, 19.5 vs 1.1-3.6 per 1000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 6.5 versus 3.4-5.2 per 1000 catheter-days. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (80.8% vs 48.1%), Enterobacter species to ceftriaxone (50.8% vs 17.8%), and Pseudomonas aeruginosa to fluoroquinolones (52.4% vs 29.1%) were also far higher in the Consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 14.3% (CLABs) to 27.5% (ventilator-associated pneumonia). PMID:18834725

  9. Kinetics of Uropathogenic Escherichia coli Metapopulation Movement during Urinary Tract Infection

    PubMed Central

    Walters, Matthew S.; Lane, M. Chelsea; Vigil, Patrick D.; Smith, Sara N.; Walk, Seth T.; Mobley, Harry L. T.

    2012-01-01

    ABSTRACT The urinary tract is one of the most frequent sites of bacterial infection in humans. Uropathogenic Escherichia coli (UPEC) strains are the leading cause of urinary tract infections (UTIs) and are responsible for greater than 80% of uncomplicated cases in adults. Infection of the urinary tract occurs in an ascending manner, with colonization of the bladder leading to possible kidney infection and bacteremia. The goal of this study was to examine the population dynamics of UPEC in vivo using a murine model of ascending UTI. To track individual UPEC lineages within a host, we constructed 10 isogenic clones of UPEC strain CFT073 by inserting unique signature tag sequences between the pstS and glmS genes at the attTn7 chromosomal site. Mice were transurethrally inoculated with a mixture containing equal numbers of unique clones. After 4 and 48 h, the tags present in the bladders, kidneys, and spleens of infected mice were enumerated using tag-specific primers and quantitative real-time PCR. The results indicated that kidney infection and bacteremia associated with UTI are most likely the result of multiple rounds of ascension and dissemination from motile UPEC subpopulations, with a distinct bottleneck existing between the kidney and bloodstream. The abundance of tagged lineages became more variable as infection progressed, especially after bacterial ascension to the upper urinary tract. Analysis of the population kinetics of UPEC during UTI revealed metapopulation dynamics, with lineages that constantly increased and decreased in abundance as they migrated from one organ to another. PMID:22318320

  10. Are national targets the right way to improve infection control practice?

    PubMed

    Millar, M

    2009-12-01

    The 'right way to improve infection control practice' should be cost-effective and lead to a fair distribution of infection control resources. Cost-effectiveness is a measure of aggregate 'good', and fairness emphasises similar treatment for individuals under similar circumstances. The UK national meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) target encourages National Health Service trusts to prioritise strategies aimed at MRSA BSI prevention. Under resource-limited conditions, the MRSA BSI target inevitably encourages deprioritisation of patients at risk of non-target healthcare-associated infection (HCAI), some of which are associated with an equal or larger burden of adverse outcome. Established healthcare improvement strategies, such as the Plan, Do, Study, Act (PDSA) cycle advocated by the Health Foundation, require the setting of aims (or targets). If we are to improve infection control practice then we need to decide on what to measure, how to measure it, and what the improvement (target) should be. In selecting targets for infection prevention, account should be taken of the contribution of HCAI to adverse health outcomes overall. Human risk compensation behaviour and microbial adaptation may both counteract the overall benefit of infection targets isolated from overall outcomes. Risk taking is part of a healthy healthcare system. We must be careful not to isolate HCAI outcomes from overall outcomes or to isolate 'risk takers' from 'risk controllers'. We must try to limit the scope for human risk compensation and we must watch out for microbial adaptation. Targets should be set locally, taking account of fairness and cost-effectiveness. Locally relevant information is key; positive incentives work best. PMID:19699553

  11. Chlamydia Pneumoniae Infections

    MedlinePLUS

    ... Chest & Lungs > Chlamydia Pneumoniae Infections Health Issues Listen Chlamydia Pneumoniae Infections Article Body When you hear the word chlamydia, you might think of the sexually transmitted disease ( ...

  12. Fungus Infections: Preventing Recurrence

    MedlinePLUS

    ... Favorite Name: Category: Share: Yes No, Keep Private Fungus Infections: Preventing Recurrence Share | Doctors have excellent treatments for skin fungus infections that occur on the feet, nails, groin, ...

  13. Infections Caused by Non-Tuberculous Mycobacteria in Recipients of Hematopoietic Stem Cell Transplantation

    PubMed Central

    Al-Anazi, Khalid Ahmed; Al-Jasser, Asma M.; Al-Anazi, Waleed Khalid

    2014-01-01

    Non-tuberculous mycobacteria (NTM) are acid-fast bacteria that are ubiquitous in the environment and can colonize soil, dust particles, water sources, and food supplies. They are divided into rapidly growing mycobacteria such as Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus as well as slowly growing species such as Mycobacterium avium, Mycobacterium kansasii, and Mycobacterium marinum. About 160 different species, which can cause community acquired and health care-associated infections, have been identified. NTM are becoming increasingly recognized in recipients of hematopoietic stem cell transplantation (HSCT) with incidence rates ranging between 0.4 and 10%. These infections are 50–600 times commoner in transplant recipients than in the general population and the time of onset ranges from day 31 to day 1055 post-transplant. They have been reported following various forms of HSCT. Several risk factors predispose to NTM infections in recipients of stem cell transplantation and these are related to the underlying medical condition and its treatment, the pre-transplant conditioning therapies as well as the transplant procedure and its complications. Clinically, NTM may present with: unexplained fever, lymphadenopathy, osteomyelitis, soft tissue and skin infections, central venous catheter infections, bacteremia, lung, and gastrointestinal tract involvement. However, disseminated infections are commonly encountered in severely immunocompromised individuals and bloodstream infections are almost always associated with catheter-related infections. It is usually difficult to differentiate colonization from true infection, thus, the threshold for starting therapy remains undetermined. Respiratory specimens such as sputum, pleural fluid, and bronchoalveolar lavage in addition to cultures of blood, bone, skin, and soft tissues are essential diagnostically. Susceptibility testing of mycobacterial isolates is a basic component of optimal care. Currently, there are no guidelines for the treatment of NTM infections in recipients of stem cell transplantation, but such infections have been successfully treated with surgical debridement, removal of infected or colonized indwelling intravascular devices, and administration of various combinations of antimicrobials. Monotherapy can be associated with development of drug resistance due to new genetic mutation. The accepted duration of treatment is 9?months in allogeneic stem cell transplantation and 6?months in autologous setting. Unfortunately, eradication of NTM infections may be impossible and their treatment is often complicated by adverse effects and interactions with other transplant-related medication. PMID:25426446

  14. Zebrafish embryos as a model host for the real time analysis of Salmonella typhimurium infections.

    PubMed

    van der Sar, Astrid M; Musters, René J P; van Eeden, Fredericus J M; Appelmelk, Ben J; Vandenbroucke-Grauls, Christina M J E; Bitter, Wilbert

    2003-09-01

    Bacterial virulence is best studied in animal models. However, the lack of possibilities for real time analysis and the need for laborious and invasive sample analysis limit the use of experimental animals. In the present study 28 h-old zebrafish embryos were infected with DsRed-labelled cells of Salmonella typhimurium. Using multidimensional digital imaging microscopy we were able to determine the exact location and fate of these bacterial pathogens in a living vertebrate host during three days. A low dose of wild-type S. typhimurium resulted in a lethal infection with bacteria residing and multiplying both in macrophage-like cells and at the epithelium of blood vessels. Lipopolysaccharide (LPS) mutants of S. typhimurium, known to be attenuated in the murine model, proved to be non-pathogenic in the zebrafish embryos and were partially lysed in the bloodstream or degraded in macrophage-like cells. However, injection of LPS mutants in the yolk of the embryo resulted in uncontrolled bacterial proliferation. Heat-killed, wild-type bacteria were completely lysed extracellularly within minutes after injection, which shows that the blood of these zebrafish embryos does already contain lytic activity. In conclusion, the zebrafish embryo model allows for rapid, non-invasive and real time analysis of bacterial infections in a vertebrate host. PMID:12925130

  15. Diagnostic accuracy of semi-quantitative and quantitative culture techniques for the diagnosis of catheter-related infections in newborns and molecular typing of isolated microorganisms

    PubMed Central

    2014-01-01

    Background Catheter-related bloodstream infections (CR-BSIs) have become the most common cause of healthcare-associated bloodstream infections in neonatal intensive care units (ICUs). Microbiological evidence implicating catheters as the source of bloodstream infection is necessary to establish the diagnosis of CR-BSIs. Semi-quantitative culture is used to determine the presence of microorganisms on the external catheter surface, whereas quantitative culture also isolates microorganisms present inside the catheter. The main objective of this study was to determine the sensitivity and specificity of these two techniques for the diagnosis of CR-BSIs in newborns from a neonatal ICU. In addition, PFGE was used for similarity analysis of the microorganisms isolated from catheters and blood cultures. Methods Semi-quantitative and quantitative methods were used for the culture of catheter tips obtained from newborns. Strains isolated from catheter tips and blood cultures which exhibited the same antimicrobial susceptibility profile were included in the study as positive cases of CR-BSI. PFGE of the microorganisms isolated from catheters and blood cultures was performed for similarity analysis and detection of clones in the ICU. Results A total of 584 catheter tips from 399 patients seen between November 2005 and June 2012 were analyzed. Twenty-nine cases of CR-BSI were confirmed. Coagulase-negative staphylococci (CoNS) were the most frequently isolated microorganisms, including S. epidermidis as the most prevalent species (65.5%), followed by S. haemolyticus (10.3%), yeasts (10.3%), K. pneumoniae (6.9%), S. aureus (3.4%), and E. coli (3.4%). The sensitivity of the semi-quantitative and quantitative techniques was 72.7% and 59.3%, respectively, and specificity was 95.7% and 94.4%. The diagnosis of CR-BSIs based on PFGE analysis of similarity between strains isolated from catheter tips and blood cultures showed 82.6% sensitivity and 100% specificity. Conclusion The semi-quantitative culture method showed higher sensitivity and specificity for the diagnosis of CR-BSIs in newborns when compared to the quantitative technique. In addition, this method is easier to perform and shows better agreement with the gold standard, and should therefore be recommended for routine clinical laboratory use. PFGE may contribute to the control of CR-BSIs by identifying clusters of microorganisms in neonatal ICUs, providing a means of determining potential cross-infection between patients. PMID:24886379

  16. What Counts? An Ethnographic Study of Infection Data Reported to a Patient Safety Program

    PubMed Central

    Dixon-Woods, Mary; Leslie, Myles; Bion, Julian; Tarrant, Carolyn

    2012-01-01

    Context Performance measures are increasingly widely used in health care and have an important role in quality. However, field studies of what organizations are doing when they collect and report performance measures are rare. An opportunity for such a study was presented by a patient safety program requiring intensive care units (ICUs) in England to submit monthly data on central venous catheter bloodstream infections (CVC-BSIs). Methods We conducted an ethnographic study involving ?855 hours of observational fieldwork and 93 interviews in 17 ICUs plus 29 telephone interviews. Findings Variability was evident within and between ICUs in how they applied inclusion and exclusion criteria for the program, the data collection systems they established, practices in sending blood samples for analysis, microbiological support and laboratory techniques, and procedures for collecting and compiling data on possible infections. Those making decisions about what to report were not making decisions about the same things, nor were they making decisions in the same way. Rather than providing objective and clear criteria, the definitions for classifying infections used were seen as subjective, messy, and admitting the possibility of unfairness. Reported infection rates reflected localized interpretations rather than a standardized dataset across all ICUs. Variability arose not because of wily workers deliberately concealing, obscuring, or deceiving but because counting was as much a social practice as a technical practice. Conclusions Rather than objective measures of incidence, differences in reported infection rates may reflect, at least to some extent, underlying social practices in data collection and reporting and variations in clinical practice. The variability we identified was largely artless rather than artful: currently dominant assumptions of gaming as responses to performance measures do not properly account for how categories and classifications operate in the pragmatic conduct of health care. These findings have important implications for assumptions about what can be achieved in infection reduction and quality improvement strategies. PMID:22985281

  17. Déjà vu: Ralstonia mannitolilytica infection associated with a humidifying respiratory therapy device, Israel, June to July 2011.

    PubMed

    Block, C; Ergaz-Shaltiel, Z; Valinsky, L; Temper, V; Hidalgo-Grass, C; Minster, N; Weissman, C; Benenson, S; Jaffe, J; Moses, A E; Bar-Oz, B

    2013-01-01

    Following a bloodstream infection in June 2011 with Ralstonia mannitolilytica in a premature infant treated with a humidifying respiratory therapy device, an investigation was initiated at the Hadassah Medical Centres in Jerusalem. The device delivers a warmed and humidified mixture of air and oxygen to patients by nasal cannula. The investigation revealed colonisation with R. mannitolilytica of two of 15 patients and contamination of components of five of six devices deployed in the premature units of the Hadassah hospitals. Ten isolates from the investigation were highly related and indistinguishable from isolates described in an outbreak in 2005 in the United States (US). Measures successful in containing the US outbreak were not included in user instructions provided to our hospitals by the distributor of the device. PMID:23725776

  18. Shewanella putrefaciens infective endocarditis.

    PubMed

    Constant, Jonathan; Chernev, Ivan; Gomez, Eric

    2014-01-01

    Shewanella putrefaciens rarely causes infection in humans. In the last few decades a growing number of cases have been described. The following report outlines the case of a 40-year-old immunocompetent white man with S. putrefaciens infective endocarditis. This is the first known case of infective endocarditis due to an apparently monomicrobial S. putrefaciens infection, and the second known case of S. putrefaciens-related infective endocarditis worldwide. PMID:24994567

  19. Shiga toxin production and translocation during microaerobic human colonic infection with Shiga toxin-producing E.?coli?O157:H7 and O104:H4

    PubMed Central

    Tran, Seav-Ly; Billoud, Lucile; Lewis, Steven B; Phillips, Alan D; Schüller, Stephanie

    2014-01-01

    Summary Haemolytic uraemic syndrome caused by Shiga toxin-producing E.?coli (STEC) is dependent on release of Shiga toxins (Stxs) during intestinal infection and subsequent absorption into the bloodstream. An understanding of Stx-related events in the human gut is limited due to lack of suitable experimental models. In this study, we have used a vertical diffusion chamber system with polarized human colon carcinoma cells to simulate the microaerobic (MA) environment in the human intestine and investigate its influence on Stx release and translocation during STEC O157:H7 and O104:H4 infection. Stx2 was the major toxin type released during infection. Whereas microaerobiosis significantly reduced bacterial growth as well as Stx production and release into the medium, Stx translocation across the epithelial monolayer was enhanced under MA versus aerobic conditions. Increased Stx transport was dependent on STEC infection and occurred via a transcellular pathway other than macropinocytosis. While MA conditions had a similar general effect on Stx release and absorption during infection with STEC O157:H7 and O104:H4, both serotypes showed considerable differences in colonization, Stx production, and Stx translocation which suggest alternative virulence strategies. Taken together, our study suggests that the MA environment in the human colon may modulate Stx-related events and enhance Stx absorption during STEC infection. PMID:24612002

  20. Implementation of infection control best practice in intensive care units throughout Europe: a mixed-method evaluation study

    PubMed Central

    2013-01-01

    Background The implementation of evidence-based infection control practices is essential, yet challenging for healthcare institutions worldwide. Although acknowledged that implementation success varies with contextual factors, little is known regarding the most critical specific conditions within the complex cultural milieu of varying economic, political, and healthcare systems. Given the increasing reliance on unified global schemes to improve patient safety and healthcare effectiveness, research on this topic is needed and timely. The ‘InDepth’ work package of the European FP7 Prevention of Hospital Infections by Intervention and Training (PROHIBIT) consortium aims to assess barriers and facilitators to the successful implementation of catheter-related bloodstream infection (CRBSI) prevention in intensive care units (ICU) across several European countries. Methods We use a qualitative case study approach in the ICUs of six purposefully selected acute care hospitals among the 15 participants in the PROHIBIT CRBSI intervention study. For sensitizing schemes we apply the theory of diffusion of innovation, published implementation frameworks, sensemaking, and new institutionalism. We conduct interviews with hospital health providers/agents at different organizational levels and ethnographic observations, and conduct rich artifact collection, and photography during two rounds of on-site visits, once before and once one year into the intervention. Data analysis is based on grounded theory. Given the challenge of different languages and cultures, we enlist the help of local interpreters, allot two days for site visits, and perform triangulation across multiple data sources. Qualitative measures of implementation success will consider the longitudinal interaction between the initiative and the institutional context. Quantitative outcomes on catheter-related bloodstream infections and performance indicators from another work package of the consortium will produce a final mixed-methods report. Conclusion A mixed-methods study of this scale with longitudinal follow-up is unique in the field of infection control. It highlights the ‘Why’ and ‘How’ of best practice implementation, revealing key factors that determine success of a uniform intervention in the context of several varying cultural, economic, political, and medical systems across Europe. These new insights will guide future implementation of more tailored and hence more successful infection control programs. Trial registration Trial number: PROHIBIT-241928 (FP7 reference number) PMID:23421909