Moraxella catarrhalis bacteraemia associated with Mycoplasma pneumoniae infection and pneumonia

This report describes a case of severe pneumonia associated with Mycoplasma pneumoniae infection and Moraxella catarrhalis bacteraemia in a 44-y-old woman with undiagnosed breast carcinoma. M. pneumoniae is increasingly recognized as a co-pathogen but to the authors' knowledge this is the first reported case of M. catarrhalis bacteraemia associated with M. pneumoniae infection.     

Moraxella (Branhamella) catarrhalis bacteremia. A case report and literature review

Moraxella catarrhalis is increasingly recognized as a cause of pulmonary and upper airway disease, but bacteremia remains unusual. We treated a 71-year-old man who died of rapidly progressive bacteremic M catarrhalis bronchopneumonia. This case, and a review of the 27 previously reported M catarrhalis bacteremias in the literature, demonstrated that M catarrhalis can be a virulent organism capable of causing serious infection and death in both immunocompetent and compromised hosts.     

Survey of blood cultures from five community hospitals in south-western Sydney, Australia, 1993–1994

Background : Blood culture results have profound implications for patients. Comprehensive overviews of blood cultures have been uncommon, and focused on tertiary referral hospitals.
Aim : To present a review of blood culture results from a laboratory servicing community hospitals in Sydney, Australia.
Methods : Retrospective chart review of patients with positive blood cultures from 1 June 1993 to 31 May 1994.
Results : During the survey period there were 107,382 hospital admissions; 12,109 blood culture sets from 9292 patients were processed. Of these 1197 sets were positive, representing 974 febrile episodes in 923 patients. There were 476 episodes of contamination. Of the episodes of true bacteraemia, Escherichia coli was isolated in 139, Staphylococcus aureus in 91 (22 methicillin-resistant), other enterobacteriaceae in 60, and Streptococcus pneumoniae in 51. The diagnoses attributable to bacteraemia included intravenous catheter-related sepsis (122 episodes), urinary tract infection (88), bacteraemia from unknown source (79), intra-abdominal and biliary sepsis (91), pneumonia (35), and meningitis (21). Sixty-eight patients died directly due to bacteraemia. Multivariate analysis showed underlying disease (OR 3.97) or shock (OR 28.1) predicted death. Blood cultures confirmed clinical diagnoses in 258 episodes, but made a de novo diagnosis in 205 episodes.
Conclusions : This study describes the clinical and laboratory features of bacteraemias occurring in smaller public hospitals, as distinct from tertiary referral centres. It demonstrated that intravenous catheter-related sepsis was very common in smaller hospitals. The clinical diagnosis was frequently confirmed, and a de novo diagnosis was often established by a positive blood culture. Unfortunately nearly half the positive blood cultures represented contamination.     

Impact of antibiotic resistance on the treatment of sepsis

Antibiotics are essential to the treatment of bacterial sepsis as they reduce the bacterial burden. The impact of bacterial resistance has recently been studied and found to be important in a range of conditions. Resistance to antibiotics can be defined genotypically, phenotypically and clinically through pharmacokinetic/pharmacodynamic studies and their correlations with clinical outcomes. Although the kinetics of antibiotics has been shown to be favourably altered in sepsis, a range of studies in sepsis has revealed that for most pathogens resistance contributes to significant increases in mortality. This has been clearly demonstrated in bacteraemia, including community- and hospital-acquired infection, and with bacteraemia caused by vancomycin-resistant enterococci, methicillin-resistant staphylococci and extended-spectrum producing Gram-negative bacteria. Significant mortality increases have also been seen with ventilator-associated pneumonia and serious infections requiring admission to intensive care. Gentotypic and phenotypic resistance in coagulase-negative staphylococci causing bacteraemia, and in invasive pneumococcal disease has not shown differences in mortality. In the latter case, dosage regimens have to date been adequate to overcome laboratory-defined resistance. Early indications are that de-escalating therapy from broad-spectrum initial coverage after results of cultures and susceptibility tests become available does not jeopardize outcomes, and further prospective studies are warranted. There is now convincing evidence that broad-spectrum initial therapy to cover the likely pathogens and their resistances pending culture results is mandatory in sepsis to minimize adverse outcomes.     

Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response

RATIONALE: Moraxella catarrhalis is frequently present in the sputum of adults with chronic obstructive pulmonary disease (COPD). Little is known about the role of M. catarrhalis in this common disease. OBJECTIVE: To elucidate the burden of disease, the dynamics of carriage, and immune responses to M. catarrhalis in COPD. METHODS: Prospective cohort study of 104 adults with COPD in an outpatient clinic at the Buffalo Veterans Affairs Medical Center. MEASUREMENTS: Clinical information, sputum cultures, molecular typing of isolates, and immunoassays to measure antibodies to M. catarrhalis. MAIN RESULTS: Over 81 months, 104 patients made 3,009 clinic visits, 560 during exacerbations. Molecular typing identified 120 episodes of acquisition and clearance of M. catarrhalis in 50 patients; 57 (47.5%) of the acquisitions were associated with clinical exacerbations. No instances of simultaneous acquisition of a new strain of another pathogen were observed. The duration of carriage of M. catarrhalis was shorter with exacerbations compared with asymptomatic colonization (median, 31.0 vs. 40.4 days; p = 0.01). Reacquisition of the same strain was rare. The intensity of the serum IgG response was greater after exacerbations than asymptomatic colonization (p = 0.009). Asymptomatic colonization was associated with a greater frequency of a sputum IgA response than exacerbation (p = 0.009). CONCLUSIONS: M. catarrhalis likely causes approximately 10% of exacerbations of COPD, accounting for approximately 2 to 4 million episodes annually. The organism is cleared efficiently after a short duration of carriage. Patients develop strain-specific protection after clearance of M. catarrhalis from the respiratory tract.     

Mycoplasma hominis sternal wound infection and bacteraemia

Mycoplasma hominis is a rare cause of bacteraemia in adult males. We believe this report to be the first of Mycoplasma hominis bacteraemia and wound infection complicating cardiac surgery. Because of difficulties in isolating the organism, cases may be missed.Review of the literature on M. hominis bacteraemia in adult males reveals that infection is often mild and most often associated with urethral catheterisation. M. hominis is resistant to many antibiotics including erythromycin. If treatment is indicated, tetracycline or clindamycin is the drug of choice.     

Haemophilus influenzae survival during complement-mediated attacks is promoted by Moraxella catarrhalis outer membrane vesicles

Moraxella catarrhalis causes respiratory tract infections in children and in adults with chronic obstructive pulmonary disease. It is often isolated as a copathogen with Haemophilus influenzae. The underlying mechanism for this cohabitation is unclear. Here, in clinical specimens from a patient with M. catarrhalis infection, we document that outer membrane vesicles (OMVs) carrying ubiquitous surface protein (Usp) A1 and UspA2 (hereafter, UspA1/A2) were secreted. Further analyses revealed that OMVs isolated in vitro also contained UspA1/A2, which mediate interactions with, among other proteins, the third component of the complement system (C3). OMVs from M. catarrhalis wild-type clinical strains bound to C3 and counteracted the complement cascade to a larger extent than did OMVs without UspA1/A2. In contrast, UspA1/A2-deficient OMVs were significantly weaker inhibitors of complement-dependent killing of H. influenzae. Thus, our results suggest that a novel strategy exists in which pathogens collaborate to conquer innate immunity and that the M. catarrhalis vaccine candidates UspA1/A2 play a major role in this interaction.     

A Prospective study of septic complications of endoscopic retrograde cholangiopancreatography

Abstract Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). We prospectively performed blood cultures and surveyed patients for complications. The aims were first, to determine the incidence of bacteraemia associated with ERCP, second, to assess the incidence of clinical sepsis following the procedure and third, to evaluate the effectiveness of our antibiotic prophylaxis.
One hundred and fifty successive patients underwent 179 ERCP. Bacteraemia related to the procedure or the underlying pathology was found in nine procedures (5.2%). Bacteraemias were more likely to complicate therapeutic procedures ( P = 0.015), biliary obstruction ( P = 0.045) or underlying pathology ( P = 0.022).
Although 61% of ERCP received antibiotics, 22 septic events occurred. Five bacteraemic patients were septic despite antibiotics. Septic complications were associated with the same factors as bacteraemia.
It was concluded that patients with biliary obstruction and undergoing therapeutic endoscopic procedures are at greatest risk of bacteraemia. Single dose prophylactic antibiotics may not prevent sepsis in these patients and longer-acting drugs or repeated dosing may be necessary.     

Molecular epidemiological characterization of respiratory isolates of Moraxella catarrhalis in a pediatric intensive care unit

A perceived increase in the number of isolates of Moraxella catarrhalis from the respiratory secretions of patients intubated in the pediatric intensive care unit prompted a review of the clinical profiles of such patients and restriction enzyme analysis of the strains involved. Over two months, of 192 patients admitted to the unit, 154 were intubated. Of the 46 for whom endotracheal tube specimens were submitted to the laboratory, M catarrhalis was isolated in 12. M catarrhalis was not felt to be a significant respiratory pathogen by the attending medical staff in any of the patients from whom it was isolated. In only two patients (17%) could nosocomial acquisition be firmly invoked. Restriction enzyme analysis of the 12 strains ruled out the presence of an epidemic strain. Isolation of M catarrhalis from intubated children does not necessarily imply pathogenicity nor an outbreak situation.     

Immunization with the truncated adhesin moraxella catarrhalis immunoglobulin D-binding protein (MID764-913) is protective against M. catarrhalis in a mouse model of pulmonary clearance

Most Moraxella catarrhalis isolates express the outer membrane protein MID. In addition to its specific affinity for immunoglobulin D, MID functions as an adhesin and binds to human epithelium. The adhesive part is localized within MID(764-913). Two mid-deficient M. catarrhalis isolates were constructed and examined in a mouse model of pulmonary clearance. M. catarrhalis devoid of MID was cleared more efficiently, compared with the wild-type counterparts. Furthermore, mice immunized with MID(764-913) cleared M. catarrhalis much more efficiently, compared with mice immunized with bovine serum albumin. MID(764-913) is suggested as a promising candidate in a future M. catarrhalis vaccine.     

Neonatal bacteraemia: a population-based study

The aims of this study were to explore the incidence of neonatal bacteraemia and identify the risk factors among neonatal intensive care unit (NICU) patients. The study included 3339 neonates admitted to the NICU of Ioannina University Hospital, North-Western Greece, during the 10-y period 1989-98. Logistic regression was used to assess the contribution of different risk factors to bacteraemia. A diagnosis of bacteraemia was made in 90 neonates (2.7%), 10 of whom (11%) died. Gram-negative bacilli, coagulase-negative Staphylococci and Streptococci were the most common pathogens: 42%, 34% and 17%, respectively. Premature rupture of membranes was the main risk factor for early-onset sepsis (relative risk 6.28) and respiratory distress syndrome was the main risk factor for late-onset sepsis (relative risk 5.70). The relative size of neonates for their gestational age did not appear to influence the risk of infection. Case fatality was higher for early- than for late-onset sepsis (relative risk 6.59). In conclusion, certain conditions were confirmed to predispose patients to neonatal bacteraemia; neonatal morbidity and mortality can be reduced by intervening to control these predisposing factors.     

The respiratory pathogen Moraxella catarrhalis adheres to epithelial cells by interacting with fibronectin through ubiquitous surface proteins A1 and A2

Moraxella catarrhalis ubiquitous surface protein (Usp) A1 has been reported to bind fibronectin and is involved in adherence. In this study, using M. catarrhalis mutants derived from clinical isolates, we show that both UspA1 and UspA2 bind fibronectin. Recombinant truncated UspA1/A2 proteins, together with smaller fragments spanning the entire molecule, were tested for binding to fibronectin. Both UspA1 and UspA2 bound fibronectin, and the fibronectin-binding domains were located within UspA1(299-452) and UspA2(165-318). These 2 truncated proteins inhibited binding of M. catarrhalis to Chang conjunctival epithelial cells to an extent similar to that by anti-human fibronectin antibodies. Our observations show that both UspA1 and UspA2 are involved in adherence to epithelial cells via cell-associated fibronectin. The biologically active sites within UspA1(299-452) and UspA2(165-318) have therefore been suggested to be potential candidates to be included in a future vaccine against M. catarrhalis.     

A reservoir of Moraxella catarrhalis in human pharyngeal lymphoid tissue

BACKGROUND: Early exposure of infants and long-term immunity suggest that colonization with Moraxella catarrhalis is more frequent than is determined by routine culture. We characterized a reservoir of M. catarrhalis in pharyngeal lymphoid tissue. METHODS: Tissue from 40 patients (median age, 7.1 years) undergoing elective tonsillectomy and/or adenoidectomy was analyzed for the presence of M. catarrhalis by culture, real-time DNA and RNA polymerase chain reaction (PCR), immunohistochemical analysis (IHC), and fluorescent in situ hybridization (FISH). Histologic sections were double stained for M. catarrhalis and immune cell markers, to characterize the tissue distribution of the organism. Intracellular bacteria were identified using confocal laser scanning microscopy (CLSM). RESULTS: Twenty-nine (91%) of 32 adenoids and 17 (85%) of 20 tonsils were colonized with M. catarrhalis. Detection rates for culture, DNA PCR, RNA PCR, IHC, and FISH were 7 (13%) of 52, 10 (19%) of 52, 21 (41%) of 51, 30 (61%) of 49, and 42 (88%) of 48, respectively (P<.001). Histologic analysis identified M. catarrhalis in crypts, intraepithelially, subepithelially, and (using CLSM) intracellularly. M. catarrhalis colocalized with macrophages and B cells in lymphoid follicles. CONCLUSIONS: Colonization by M. catarrhalis is more frequent than is determined by surface culture, because the organism resides both within and beneath the epithelium and invades host cells.     

Central venous catheter exchange by guidewire for treatment of catheter-related bacteraemia in patients undergoing BMT or intensive chemotherapy

Current guidelines for the treatment of catheter-related bacteraemia (CRB) advise against central venous catheter (CVC) exchange because of the potential risk of prolonging infection. However, there are no consistent data proving this recommendation. We evaluated prospectively the usefulness of CVC exchange by guidewire for the treatment of CRB in patients undergoing BMT or intensive chemotherapy. CVC exchange was considered when fever and positive blood cultures persisted after 2 days of adequate antimicrobial therapy and no potential source of bacteraemia other than CVC could be identified. The guidewire exchange was preceded and followed by a slow infusion of adequate antimicrobial therapy. Bacteraemia was confirmed as catheter-related by demonstrating concordance between isolates from the tip and blood cultures by pulsed-field electrophoresis of genomic DNA. This procedure was performed in 19 episodes of bacteraemia during a 1-year period. Fourteen episodes (74%) were catheter-related and 71% of these were due to coagulase-negative staphylococci. Guidewire replacement was accomplished uneventfully 4 days after development of sepsis (range 3-6). In all cases, clinical signs of sepsis disappeared in less than 24 h after replacement. Definitive catheter withdrawal was carried out a median of 16 days (range 3-42) after guidewire exchange; in all cases, the tip culture was negative. We conclude that CVC replacement by guidewire under adequate antimicrobial therapy may be a reasonable option for the treatment of CRB when antimicrobial therapy alone has been unsuccessful.     

Evaluation of restriction endonuclease analysis of BRO beta-lactamases in clinical and carrier isolates of Moraxella catarrhalis

A rapid increase in the prevalance of beta-lactamase producing M. catarrhalis isolates has highlighted its pathogenic potential. In this study, we aimed to detect the BRO beta-lactamases of our clinical (n = 32) and carrier (n =32) strains of Moraxella catarrhalis and compare the relationship of the enzyme type in assesment of MIC results of the antibiotics tested. BRO beta-lactamases were differentiated by restriction endonuclease analysis. Antibiotic susceptibility was performed by the agar dilution method recommended by NCCLS (M7A5). The clinical isolates produced 96.9%, whereas the carrier strains produced 90.6% beta-lactamase positivity by the restriction enzyme analysis. BRO-1 was isolated as 90.6% (n =29) while the BRO-2 and non-beta-lactamase producers (NBLP) were isolated as 6.3% (n =2) and 3.1% (n =1) respectively among clinical isolates. The rate of BRO-1 in the carrier strains was 75.0% (n =24), BRO-2 was 15.6% (n =5) and NBLP was 9.4%, (n =3). The beta-lactamase production with nitrocefin test was 96.9% (31/32) in clinical isolates and 90.6% (29/32) in carrier strains. M. catarrhalis needs a continous monitoring of antibiotic susceptibility; in this era restriction endonuclease analysis could be useful to screen BRO beta-lactamase genes.     

Bacteriemia por Clostridium perfringens. Un análisis de 28 casos durante 10 años en un hospital universitario de Madrid

Bacteraemia caused by anaerobic bacteria is rare in the hospital setting. The Clostridium genus is the second most common cause of these infections, particularly Clostridium perfringens, which has a high mortality rate. However, reviews in the literature of these infections are scarce.The aim of this study was to retrospectively document the incidence, clinical characteristics and risk factors involved in the acquisition of bacteraemia caused by C. perfringens among patients treated at our hospital over a 10-year period.Twenty-eight patients with C. perfringens bacteraemia were included in the study. We evaluated pre-existing comorbidities, the source of bacteraemia, clinical features, the antimicrobial treatment administered and patient outcome.C. perfringens bacteraemia occurs rarely in our setting, but with a very high mortality rate. This rate is associated with old age and pre-existing, largely gastrointestinal malignancies. It presents with few specific symptoms but requires rapid and appropriate diagnosis and treatment to reduce the high mortality of this infection.     

Prevalence of liver disease in patients with Streptococcus bovis bacteraemia

BACKGROUND: The relationship between Streptococcus bovis bacteraemia and gastrointestinal disease (mainly colon cancer) is well known. Patients with advanced liver disease are prone to bacteraemia. Less attention has been paid to the association between liver disease and Streptococcus bovis bacteraemia in the literature. AIMS: To evaluate the prevalence of liver disease in patients with S. bovis bacteraemia. PATIENTS AND METHODS: Twenty-two episodes of S. bovis bacteraemia in 20 adults (13 males and seven females, with a median age of 61 years, range 32-94 years) were detected in a single hospital over a 7-year period. Ten of them had endocarditis. Patients' clinical records were reviewed, with special focus on underlying liver and gastrointestinal disease. RESULTS: Eleven patients (55%) had a chronic liver disease. Nine of them were cirrhotics. Ten patients had a history of chronic alcohol abuse, and four patients had hepatitis C virus antibodies (associated with alcohol abuse in three cases). Large bowel disease was present in six out of 13 evaluable patients (adenocarcinoma in three cases). Patients with liver disease were younger than patients without it. Mortality related to S. bovis bacteraemia was particularly high among patients with advanced liver disease (Child-Pugh state C). Bacteraemia recurred two times in one alcoholic cirrhotic, who was diagnosed as having a Dukes-B colon cancer 4.5 years after the first episode of S. bovis bacteraemia. CONCLUSIONS: In our area, S. bovis bacteraemia is frequently associated with chronic liver disease. Liver disease may be a predisposing factor for S. bovis bacteraemia.     

Clinical and laboratory variables identifying bacterial infection and bacteraemia in the emergency department

Abstract Background: While early antimicrobial treatment is of critical importance to patients with severe infections, excessive use of antibiotics has caused escalating bacterial resistance. Better diagnostic tools are needed to secure antibiotic stewardship. Methods: The diagnostic value of clinical and laboratory variables in predicting infections that require antibiotic treatment was evaluated in a prospective observational study of 404 adult patients admitted from the emergency department (ED) with suspected severe infections. We also investigated the association of these variables with bacteraemia and severe sepsis. Results: In a univariate analysis, increased levels of C-reactive protein (CRP), procalcitonin (PCT), interleukin 6 (IL-6), lipopolysaccharide binding protein (LBP), white blood cell count (WBC), neutrophils, respiratory rate (RR) (p ≤?0.001), and a decreased haemoglobin (Hb) level (p =?0.005) were associated with an indicated demand for antibiotics (n =?286). In a multivariate analysis, only WBC, Hb, RR, and CRP remained independent predictors. When compared to the clinician's ability to make accurate antibiotic decisions, all variables tested had inferior diagnostic accuracy except CRP. Increased levels of PCT, IL-6, LBP, CRP, bilirubin, and RR were significantly associated with bacteraemia (n =?68) (p ≤?0.001). Of these, PCT and IL-6 were also associated with severe sepsis (n =?156) (p 相似文献   

Bacteremia and septic arthritis caused by Moraxella catarrhalis

Moraxella catarrhalis was isolated from blood from a 41-year-old man who had a 24-hour history of increasing pain in and swelling of the left knee. No history of trauma, arthropathy, fever, chills, cough, or chest pain was noted. What is believed to be the first case of bacteremia caused by M. catarrhalis that was associated with septic arthritis is described in this report. The case presented suggests the pathophysiology of this rare condition. One previous case of septic arthritis caused by M. catarrhalis without documented bacteremia has been reported.     

Staphylococcus aureus is a major pathogen in acute bacterial rhinosinusitis: a meta-analysis.

BACKGROUND: Acute bacterial rhinosinusitis is a common health problem in the United States. Appropriate recommendations for the treatment of acute bacterial rhinosinusitis are based on the prevalence and expected antimicrobial susceptibilities of specific pathogens. METHODS: A meta-analysis was performed on the English language literature from the period 1990-2006, including prospective studies of antibiotic therapy for acute bacterial rhinosinusitis for which sinus cultures were required in the form of either maxillary sinus taps or middle meatal cultures. Weighted mean culture rates for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus were abstracted from the included articles and compared according to culture technique. RESULTS: Culture rates (i.e., the percentage of patients with positive culture results) were 32.7% for S. pneumoniae, 31.6% for H. influenzae, 10.1% for S. aureus, and 8.8% for M. catarrhalis. No statistically significant difference was seen between the culture rates for S. aureus and M. catarrhalis. Analysis of the effect of culture technique on the culture rates revealed no statistically significant difference. CONCLUSIONS: The prevalence of S. aureus among sinus cultures warrants its reconsideration as a major pathogen in acute bacterial rhinosinusitis. As a result, increasing trends of drug-resistant strains may complicate antibiotic recommendations.