Biliary tract infections caused by Aeromonas species

This study investigated the clinical and microbiological characteristics of patients with Aeromonas infections of the biliary tract. Patients with bile cultures positive for Aeromonas species during the period July 2004 to December 2011 were identified from a computerized database of a hospital in Taiwan. Patients with Aeromonas infections of the biliary tract were further identified. During the study period, a total of 1,142 isolates of Aeromonas species were obtained from 750 patients. Of those patients, 91 (12.1 %) had Aeromonas infections of the biliary tract. The annual incidence (episodes per 10,000 patient-days) of biliary tract infections caused by all Aeromonas species was 0.31 in 2007, 0.12 in 2010, and 0.27 in 2011. A. hydrophila was the most common species isolated (n?=?41, 45.1 %), followed by A. caviae (n?=?30, 33.0 %), A. veronii biovar sobria (n?=?15, 16.5 %), and A. veronii biovar veronii (n?=?5, 5.5 %). The majority of patients (n?=?77, 84.6 %) had polymicrobial infections. Hepatobiliary stones (n?=?50, 54.9 %) and hepatobiliary cancer (n?=?38, 41.8 %) were the most common underlying diseases, followed by diabetes mellitus (n?=?29, 31.9 %) and liver cirrhosis (n?=?7, 7.7 %). The in-hospital mortality rate was 8.8 %. Infection-related mortality was associated with underlying immunocompromised condition (p?=?0.044) and use of mechanical ventilation (p?=?0.004), but was not associated with inappropriate antibiotic usage or concomitant bacteremia (n?=?8, 8.8 %). In conclusion, biliary tract infections caused by Aeromonas species are not uncommon and can develop in both immunocompromised and immunocompetent patients; however, patients with underlying hepatobiliary diseases are particularly susceptible to these infections.     

Pneumonia caused by Aeromonas species in Taiwan, 2004–2011

We investigated the clinical characteristics of patients with pneumonia caused by Aeromonas species. Patients with pneumonia caused by Aeromonas species during the period 2004 to 2011 were identified from a computerized database of a regional hospital in southern Taiwan. The medical records of these patients were retrospectively reviewed. Of the 84 patients with pneumonia due to Aeromonas species, possible Aeromonas pneumonia was diagnosed in 58 patients, probable Aeromonas pneumonia was diagnosed in 18 patients, and pneumonia due to Aeromonas was conclusively diagnosed in 8 patients. Most of the cases of Aeromonas pneumonia developed in men and in patients of advanced age. A. hydrophila (n?=?50, 59.5 %) was the most common pathogen, followed by A. caviae (n?=?24, 28.6 %), A. veronii biovar sobria (n?=?7, 8.3 %), and A. veronii biovar veronii (n?=?3, 3.6 %). Cancer (n?=?37, 44.0 %) was the most common underlying disease, followed by diabetes mellitus (n?=?27, 32.1 %). Drowning-associated pneumonia developed in 6 (7.1 %) patients. Of 47 patients who were admitted to the intensive care ward, 42 patients developed acute respiratory failure and 24 of those patients died. The overall in-hospital mortality rate was significantly associated with liver cirrhosis, cancer, initial presentation of shock, and usage of mechanical ventilation. In conclusion, Aeromonas species should be considered as one of the causative pathogens of severe pneumonia, especially in immunocompromised patients, and should be recognized as a cause of drowning-associated pneumonia. Cirrhosis, cancer, and shock as the initial presenting symptom are associated with poor outcome.     

Clinical significance and outcome of <Emphasis Type="Italic">Aeromonas</Emphasis> spp. infections among 204 adult patients

The objectives of this investigation were to analyze the clinical patterns, risk groups, prognostic factors, and mortality of infections caused by Aeromonas spp. This was a retrospective study of adult patients with Aeromonas spp. isolates attended at the Hospital del Mar in Barcelona, Spain, between January 2006 and December 2012. Epidemiological data, antimicrobial susceptibility, clinical patterns, underlying illnesses, type of infection, admission to the intensive care unit (ICU), number of episodes, coinfection, antimicrobial therapy, and evolution were analyzed. A total of 221 clinical samples from 204 patients were positive for Aeromonas spp. The mean age of the patients was 67.6 years. The main clinical form of presentation was gastrointestinal (78.4%). Malignancy was the main risk group in 69 (33.8%) patients, and 48 (23.5%) were previously healthy. Twenty-one patients (10.3%) were admitted to the ICU. Infections were acquired in the hospital in 52.5% of the patients, and 28.9% were polymicrobial. The overall mortality (after 1 year of follow-up from the first positive culture) was 26.5%. Univariate analysis identified an association between increased mortality and the following variables: age ≥80 years, hospitalization, admission to the ICU, malignancy, extraintestinal infection, and appropriate antimicrobial therapy. In the multivariate analysis, age ≥80 years [odds ratio (OR), 4.37 [95% confidence interval (CI), 1.68–11.35; p?=?0.002]], admission to the ICU (OR, 6.59 [95% CI, 2.17–19.99; p?=?0.001]), and malignancy (OR, 3.62 [95% CI, 1.32–9.90; p?=?0.012]) were significantly associated with mortality. Aeromonas infections are mainly gastrointestinal. The 1-year follow-up mortality rate was high. Old age (age?≥80 years), admission to the ICU, and malignancy were identified as independent risk factors for mortality.     

Clinical outcomes and treatment approach for community-associated methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> (CA-MRSA) infections in Israel

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly documented worldwide. We recently identified two major CA-MRSA clones in Israel: USA300 and t991. Here, we assessed clinical outcomes by CA-MRSA clones and the physicians’ treatment approach to CA-MRSA infections. All community-onset, clinical MRSA isolates detected during 2011–2013 by Maccabi Healthcare Services were collected and characterized phenotypically and genotypically; data were collected retrospectively from electronic medical records. Of 309 patients with MRSA infections, 64 were identified as CA-MRSA (21 %). Of the CA-MRSA infections, 72 % had skin and soft tissue infections (SSTIs), 38 % were Panton–Valentine leukocidin (PVL)+, the major clone being USA300 (n?=?13, 54 %). Of PVL? isolates (n?=?40, 62 %), t991 was the major clone. Age was the only predictor for PVL+ CA-MRSA infection (p?<?0.001). Patients with PVL+ CA-MRSA had higher incidence of SSTI recurrences (1.061 vs. 0.647 events per patient/per year, p?<?0.0001) and were more likely to have the SSTI drained (64 % vs. 21 %, p?=?0.003) when compared to PVL? CA-MRSA. USA300 was more common among adults, while t991 was more common among children (p?=?0.002). The physician’s referral to culture results and susceptibility were the only predictors of appropriate antibiotic therapy (p?<?0.001). However, only a minority of physicians referred to culture results, regardless of subspecialties. PVL+ CA-MRSA isolates caused significantly more recurrences of SSTIs and increased the need for drainage compared with PVL? isolates. Physicians’ awareness of CA-MRSA as a cause of SSTIs in the community was suboptimal. Culturing of pus-producing SSTIs is crucial for providing adequate antimicrobials and elucidating MRSA epidemiology.     

Bacteraemia Caused by Non-Glucose-Fermenting Gram-Negative Bacilli and Aeromonas Species in Patients with Haematological Malignancies and Solid Tumours

 The clinical characteristics and outcome of bacteraemia caused by non-glucose-fermenting gram-negative bacilli and Aeromonas spp. were examined in 115 adults with haematological malignancies or solid tumours. The most aggressive pathogens were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Aeromonas spp., Acinetobacter spp. and Burkholderia cepacia, all of which caused either septic syndrome or pneumonia in more than 40% of cases. Pseudomonas aeruginosa was involved less often in catheter-related bacteraemia than other species. Polymicrobial bacteraemia (n=28) was more often catheter-related than monomicrobial bacteraemia and more often required catheter removal for definitive cure. The most important predictors of catheter-related bacteraemia and its outcome were polymicrobial infection, the presence of pneumonia or septic syndrome and the species involved.     

Clinical characteristics and outcomes of patients with pleural infections due to Stenotrophomonas maltophilia at a medical center in Taiwan, 2004–2012

Stenotrophomonas maltophilia can cause various clinical diseases; however, pleural infections due to S. maltophilia are rare. We evaluated the clinical characteristics and outcomes of patients with pleural infections (complicated parapneumonic effusion or empyema) due to S. maltophilia who were treated at a medical center in Taiwan from 2004 to 2012. During the study period, 40 patients were treated for pleural infections due to S. maltophilia. The incidence of S. maltophilia pleural infections ranged from 2.66 per 1,000,000 patient-days in 2009 to 12.44 per 1,000,000 patient-days in 2011. Most of the patients with S. maltophilia pleural infections were immunocompromised male adults and all of the infections were acquired in healthcare settings. The majority of patients had polymicrobial pleural infections (n?=?31, 77.5 %) and the most common pathogen was Pseudomonas aeruginosa (n?=?12). The causes of pleural infections due to S. maltophilia were pneumonia due to S. maltophilia in two patients (5 %), post-surgical/tube thoracostomy in 26 (65 %) patients, and fistula (bronchopleural, esophagopleural and biliopleural) in 12 (30 %) patients. The 14-day and 30-day mortality rates were 32.5 % and 42.5 %, respectively. Pleural infections due to S. maltophilia are most commonly the result of surgical procedures, thoracostomy, and underlying fistulas. These infections are associated with a high mortality rate, especially among immunocompromised patients.     

Bone and joint infections due to anaerobic bacteria: an analysis of 61 cases and review of the literature

The diagnosis of anaerobic bone and joint infections (BJI) were underestimated before the advent of molecular identification and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). We report 61 cases of anaerobic infections based on our 4-year experience with the management of BJI. A total of 75 % of cases were post-surgical infections, associated with osteosynthesis devices (65 %). Early infections occurred in 27 % of cases, delayed infections in 17.5 % of cases, and late infections in 55 % of cases. We recorded 36 species of 93 anaerobic strains using MALDI-TOF MS (91) and molecular methods (2). We identified 20 strains of Propionibacterium acnes, 13 of Finegoldia magna, six of Peptoniphilus asaccharolyticus, and six of P. harei. Polymicrobial infections occurred in 50 cases. Surgical treatment was performed in 93.5 % of cases. The antibiotic treatments included amoxicillin (30 %), amoxicillin–clavulanic acid (16 %), metronidazole (30 %), and clindamycin (26 %). Hyperbaric oxygen therapy was used in 17 cases (28 %). The relapse rate (27 %) was associated with lower limbs localization (p?=?0.001). P. acnes BJI was associated with shoulder (p?=?0.019), vertebra (p?=?0.021), and head flap localization (p?=?0.011), and none of these cases relapsed (p?=?0.007). F. magna BJI was associated with ankle localization (p?=?0.014). Anaerobic BJI is typically considered as a post-surgical polymicrobial infection, and the management of this infection combines surgical and medical treatments. MALDI-TOF MS and molecular identification have improved diagnosis. Thus, physicians should be aware of the polymicrobial nature of anaerobic BJI to establish immediate broad-spectrum antibiotic treatment during the post-surgical period until accurate microbiological results have been obtained.     

Symbiosis of Aeromonas veronii Biovar sobria and Hirudo medicinalis, the Medicinal Leech: a Novel Model for Digestive Tract Associations

Hirudo medicinalis, the medicinal leech, is applied postoperatively in modern medicine. Infections by Aeromonas occur in up to 20% of patients unless a preemptive antibiotic treatment is administered. The associated infections demonstrate the need for a better understanding of the digestive tract flora of H. medicinalis. Early studies reported the presence of a single bacterial species in the digestive tract and suggested that these bacteria were endosymbionts contributing to the digestion of blood. In this study, we cultivated bacteria from the digestive tract and characterized them biochemically. The biochemical test results identified the isolates as Aeromonas veronii biovar sobria. This species identification was supported by sequence comparison of a variable region of the genes coding for 16S rRNA. In a colonization assay, a rifampin-resistant derivative of a symbiotic isolate was fed in a blood meal to H. medicinalis. The strain colonized the digestive tract rapidly and reached a concentration similar to that of the native bacterial flora. For the first 12 h, the in vivo doubling time was 1.2 h at 23°C. After 12 h, at a density of 5 × 10⁷ CFU/ml, the increase in viable counts ceased, suggesting a dramatic reduction in the bacterial growth rate. Two human fecal isolates, identified as Aeromonas hydrophila and A. veronii biovar sobria, were also able to colonize the digestive tract. These data demonstrate that the main culturable bacterium in the crop of H. medicinalis is A. veronii biovar sobria and that the medicinal leech can be used as a model for digestive tract association of Aeromonas species.     

Medicinal leech therapy and <Emphasis Type="Italic">Aeromonas</Emphasis> spp. infection

While the use of medicinal leech therapy (MLT) in reconstructive and orthopaedic surgery is widely described, post-operative complications related to leeches remain a major concern. Aeromonas spp. strains are involved in the majority of reported cases. As surgical success rate is directly impacted, an adapted antibiotic prophylaxis should be instituted in order to minimize these complications. We assessed pharmaceutical process, microbiological control and related infections in order to provide data and choose the appropriate antibiotherapy for patients requiring MLT. We report a clinical and microbiological study over a 24-month period. Clinical data were collected from patients’ database, and microbiological analysis both on leeches’ tank water and crushed leeches were performed to characterize isolated strains and their susceptibility to antibiotics. A total of 595 leeches were used to treat 28 patients (12 in plastic surgery and 16 in orthopaedic surgery), and three documented cases of post-operative infections were reported. Aeromonas spp. isolates yielded from 62 % of analyzed batches (75 % of Aeromonas veronii). Eighteen Aeromonas spp. isolates yielded from 23 water samples and three crushed leeches. Isolates were similar in tank and crushed leeches. Strains were susceptible to fluoroquinolones, sulfamethoxazole/trimethoprim, aminosides, and third-generation cephalosporins but resistant to amoxicillin/clavulanic acid and second-generation cephalosporins. According to collected data, routine tank water microbiological analyses are mandatory in order to identify leeches’ batches containing resistant strains and to discard them. In this context, the surgeon is able to select an appropriated antibiotic prophylaxis in order to avoid MLT associated serious post-operative complications.     

Clinical and microbiological characteristics of peritoneal dialysis-related peritonitis caused by <Emphasis Type="Italic">Escherichia coli</Emphasis> in southern Taiwan

Peritonitis is a serious complication and major cause of treatment failure in patients undergoing peritoneal dialysis (PD). Escherichia coli is the major pathogen in extraintestinal Gram-negative infections, including PD-related peritonitis. The outcomes of E. coli peritonitis in PD varied from relatively favorable outcomes to a higher incidence of treatment failure. The aim of this study was to investigate the impact of bacterial virulence and host characteristics on the outcomes of PD-related peritonitis caused by E. coli. From January 2000 to June 2016, a total of 47 episodes of monomicrobial and 10 episodes of polymicrobial E. coli PD-related peritonitis, as well as 89 episodes of monomicrobial Gram-positive (56 Staphylococcus spp. and 33 Streptococcus spp.) PD-related peritonitis cases, were retrospectively enrolled. Clinical features, E. coli bacterial virulence, and outcomes were analyzed. Compared to Streptococcus spp. peritonitis, E. coli peritonitis had a higher peritoneal catheter removal rate (38 versus 12%; P =?0.0115). Compared to the monomicrobial group, patients in polymicrobial group were older and had higher peritoneal catheter removal rate (80 versus 38%; P =?0.0324). Treatment failure of E. coli peritonitis was associated with more polymicrobial peritonitis and immunocompromised comorbidity, longer duration of PD therapy, and more antimicrobial resistance. E. coli isolates with more iron-related genes had higher prevalence of phylogenetic group B2 and papG II, iha, ompT, and usp genes. This study demonstrates the important roles of clinical and bacterial characteristics in the outcomes of monomicrobial and polymicrobial E. coli PD-related peritonitis.     

Distribution of 13 virulence genes among clinical and environmental Aeromonas spp. in Western Australia

We evaluated the pathogenic potential of 98 clinical and 31 environmental Aeromonas isolates by detecting the presence of 13 virulence genes using a polymerase chain reaction (PCR)-based method. The majority (96 %) of the strains contained at least one of the virulence genes. The overall distribution was aerA/haem (77 %), alt (53 %), lafA (51 %), ast (39 %), flaA (32 %), aspA (29 %), vasH (26 %), ascV (16 %) and aexT (13 %). No amplification products were detected for the genes encoding a bundle-forming pilus (BfpA and BfpG) or a Shiga-like toxin (stx-1 and stx-2). Five or more virulence genes were detected in 42 % of environmental and 24 % of clinical isolates. Among the major species, 48 % of A. hydrophila and 42 % of A. dhakensis isolates harboured five or more virulence genes compared with 19 % in A. veronii bv. sobria and none in A. caviae isolates. Our results suggest that, in Western Australia, strains of A. dhakensis and A. hydrophila are potentially more virulent than those of A. veronii bv. sobria and A. caviae, although the pathogenic potential of Aeromonas spp. is probably strain- rather than species-dependent.     

Isolation and characterization of a novel,T7-like phage against <Emphasis Type="Italic">Aeromonas veronii</Emphasis>

A virulent Aeromonas veronii biovar sobria and the corresponding novel, lytic bacteriophage (VTCCBPA5) were isolated from village pond water. The phage was found to belong to family Podoviridae. PCR analysis of major capsid protein gene confirmed its classification to T7-like genus. The protein profiling by SDS-PAGE indicated the major structural protein to be ~ 45 kDa. The phage (VTCCBPA5) is host specific and is stable over a range of pH (6–10) and temperatures (4–45 °C). On the basis of restriction endonuclease analysis combined with prediction mapping, it was observed to vary significantly from previously reported podophages of Aeromonas sp., viz. phiAS7 and Ahp1. The phylogenetic analysis on the basis of PCR-amplified segment of DNA polymerase gene of phage revealed it being an outgroup from podophages of Klebsiella sp. and Pseudomonas sp. though a small internal fragment (359 bp) showed the highest identity (77%) with Vibrio sp. phages. Thus, this is the first report of a novel Podoviridae phage against A. veronii. It expands the assemblage of podophages against Aeromonas sp. and BPA5 could be potentially useful in biocontrol of environmentally acquired Aeromonas veronii infections.     

Assessment of PCR status of vector-borne pathogens in dogs presenting arrhythmias

Arrhythmias are frequent and can be caused by many diseases. Vector-borne diseases are increasing in importance as a cause of arrhythmias in veterinary medicine. The objective of the study was to evaluate dogs presenting arrhythmias of any aetiology and to assess the influence of polymerase chain reaction (PCR) status for vector-borne pathogens in the Mediterranean area of Spain. A total of 120 dogs presenting arrhythmias were prospectively selected, and PCR for several vector-borne pathogens (Leishmania infantum, Ehrlichia/Anaplasma spp., Babesia spp., Rickettsia spp., Mycoplasma spp., Hepatozoon canis and Bartonella spp.) were analysed in blood samples. Twenty-four (20 %) dogs had positive results for PCR. Found pathogens were Ehrlichia/Anaplasma spp. (n?=?10, 8.3 %), Babesia spp. (n?=?7, 5.8 %), Rickettsia spp. (n?=?5, 4.2 %), Leishmania spp. (n?=?4, 3.3 %), Mycoplasma spp. (n?=?4, 3.3 %), and H. canis (n?=?1, 0.8 %). No significant differences were found in relation to PCR status and type or cause of the arrhythmia. Although there is a clear association between some infectious diseases and cardiac diseases, this study could not find evidence of the role of infectious agents as triggers for arrhythmias in dogs. More studies are needed to further explore this association.     

Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

Combat trauma wounds with invasive fungal infections (IFIs) are often polymicrobial with fungal and bacterial growth, but the impact of the wound microbiology on clinical outcomes is uncertain. Our objectives were to compare the microbiological features between IFI and non-IFI wounds and evaluate whether clinical outcomes differed among IFI wounds based upon mold type. Data from U.S. military personnel injured in Afghanistan with IFI wounds were examined. Controls were matched by the pattern/severity of injury, including blood transfusion requirements. Wound closure timing was compared between IFI and non-IFI control wounds (with/without bacterial infections). IFI wound closure was also assessed according to mold species isolation. Eighty-two IFI wounds and 136 non-IFI wounds (63 with skin and soft tissue infections [SSTIs] and 73 without) were examined. The time to wound closure was longer for the IFI wounds (median, 16 days) than for the non-IFI controls with/without SSTIs (medians, 12 and 9 days, respectively; P < 0.001). The growth of multidrug-resistant Gram-negative rods was reported among 35% and 41% of the IFI and non-IFI wounds with SSTIs, respectively. Among the IFI wounds, times to wound closure were significantly longer for wounds with Mucorales growth than for wounds with non-Mucorales growth (median, 17 days versus 13 days; P < 0.01). When wounds with Mucorales and Aspergillus spp. growth were compared, there was no significant difference in wound closure timing. Trauma wounds with SSTIs were often polymicrobial, yet the presence of invasive molds (predominant types: order Mucorales, Aspergillus spp., and Fusarium spp.) significantly prolonged the time to wound closure. Overall, the times to wound closure were longest for the IFI wounds with Mucorales growth.     

Aeromonas sobria necrotizing fasciitis complicating neonatal sclerosing cholangitis

Aeromonas species can cause gastroenteritis, soft tissue infections, hepatobiliary tract and other infections. While most reported soft tissue infections have been attributed to Aeromonas hydrophila, we report a case of necrotizing fasciitis caused by Aeromonas veronii biovar sobria. Prompt and accurate diagnosis cum treatment could help save children with Aeromonas soft tissue infections from developing a bacteremia with extended morbidity and mortality.     

Tigecycline use in the outpatient parenteral antibiotic therapy setting

In the context of globally increasing antimicrobial resistance, tigecycline appears to be a useful therapeutic option. The need for prolonged courses for complex infections has prompted consideration of its use via outpatient parenteral antibiotic therapy (OPAT) programmes, although clinical outcomes when used in this setting remain unknown. We retrospectively reviewed the patient characteristics and outcomes of 11 patients who received tigecycline, most commonly delivered as 100 mg once daily, via OPAT at three tertiary Australian hospitals. Rates of co-morbidity and prior antibiotic use were high. Patients had a wide range of infections including bone and/or joint (n?=?5), intra-abdominal (n?=?3), lower respiratory tract (n?=?2) and parapharyngeal abscess (n?=?1). Mycobacterial species (n?=?5) were the most frequent pathogen, and multi-resistant organisms were common (n?=?4). The median OPAT duration was 14 days (IQR 6–30). Nausea was encountered in 45 % of cases. At completion of OPAT, 1 patient (9 %) was cured, 2 (18 %) had improved and 8 (73 %) failed therapy. Failure occurred due to either progression or non-response of infection (n?=?4), re-admission (n?=?3), premature cessation of tigecycline due to nausea (n?=?3) or death (n?=?1). Whilst OPAT delivery of tigecycline is a therapeutic option, when used as second-line therapy for complex, often multi-resistant infections in patients with multiple comorbidities, high rates of clinical failure, readmissions and adverse effects, especially nausea, should be anticipated.     

Dimorphic fungal osteoarticular infections

The objective of this investigation was to review the clinical manifestations, management, and outcome of osteoarticular infections caused by dimorphic fungi. We exhaustively reviewed reports of bone and joint infections caused by dimorphic fungi published between 1970 and 2012. Underlying conditions, microbiological features, histological characteristics, clinical manifestations, antifungal therapy, and outcome were analyzed in 222 evaluable cases. Among 222 proven cases (median age 41 years [interquartile range (IQR) 26–57]), 73 % had no predisposing condition. Histopathology performed in 128 (57 %) cases and culture in 170 confirmed diagnosis in 63 % and 98 % of the cases, respectively. Diagnosis was obtained from an extra-osteoarticular site in 16 cases. The median diagnostic time was 175 days (IQR 60–365). Sporothrix schenckii was the most frequent pathogen (n?=?84), followed by Coccidioides immitis (n?=?47), Blastomyces dermatitidis (n?=?44), Histoplasma capsulatum (n?=?18), Paracoccidioides brasiliensis (n?=?16), and Penicillium marneffei (n?=?13). Arthritis occurred in 87 (58 %) cases and osteomyelitis in 64 (42 %), including 19 vertebral osteomyelitis. Dissemination was reported in 123 (55 %) cases. Systemic antifungal agents were used in 216 (97 %) patients and in combination with surgery in 129 (60 %). Following the Infectious Diseases Society of America (IDSA) guidelines, a successful initial medical strategy was observed in 97/116 (84 %) evaluable cases. The overall mortality was 6 %, and was highest for P. marneffei (38.5 %). This study demonstrates that dimorphic osteoarticular infections have distinctive clinical presentations, occur predominantly in apparently immunocompetent patients, develop often during disseminated disease, and may require surgical intervention.     

Combination antibiotic treatment versus monotherapy for multidrug-resistant,extensively drug-resistant,and pandrug-resistant Acinetobacter infections: a systematic review

Controversy surrounds combination treatment or monotherapy against multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) Acinetobacter infections in clinical practice. We searched the PubMed and Scopus databases for studies reporting on the clinical outcomes of patients infected with MDR, XDR, and PDR Acinetobacter spp. with regard to the administered intravenous antibiotic treatment. Twelve studies reporting on 1,040 patients suffering from 1,044 infectious episodes of MDR Acinetobacter spp. were included. The overall mortality between studies varied from 28.6 to 70 %; from 25 to 100 % in the monotherapy arm and from 27 to 57.1 % in the combination arm. Combination treatment was superior to monotherapy in three studies, where carbapenem with ampicillin/sulbactam (mortality 30.8 %, p?=?0.012), carbapenem with colistin (mortality 23 %, p?=?0.009), and combinations of colistin with rifampicin, sulbactam with aminoglycosides, tigecycline with colistin and rifampicin, and tigecycline with rifampicin and amikacin (mortality 27 %, p?Acinetobacter spp. resistant at least to carbapenems. The benefit was not validated in the remaining studies. Clinical success varied from 42.4 to 76.9 % and microbiological eradication varied from 32.7 to 67.3 %. Adverse events referred mainly to polymixins nephrotoxicity that varied from 19 to 50 %. The emergence of resistance was noted with tigecycline regimens in off-label uses in three studies. The available data preclude a firm recommendation with regard to combination treatment or monotherapy. For the time being, combination treatment may be preferred for severely ill patients. We urge for randomized controlled trials examining the optimal treatment of infections due to MDR, XDR, and PDR Acinetobacter spp.     

Isavuconazole: A new broad-spectrum azole. Part 1: In vitro activity

Triazoles compounds are first-line agents for the treatment of invasive fungal diseases. Isavuconazole is the most recent triazole compound, approved in 2015 by the FDA and the EMA to treat invasive aspergillosis and mucormycosis. We reviewed here the in vitro activity of isavuconazole against a vast spectrum of species. Isavuconazole MICs were evaluated using CLSI, EUCAST or Etest methods, with no significant differences between the technics. Low MIC₅₀ and MIC₉₀ (< 1 μg/mL) were described for isavuconazole against the majority of Candida spp., except for C. glabrata and C. krusei. In vitro activity against Aspergillus spp. varied according to the species with an overall MIC₉₀ of 1 μg/mL ranging from 0.125 μg/mL (A. fumigatus) to 16 μg/mL (A. niger, A. tubingiensis). As for Aspergillus, the activity of isavuconazole against agents of mucormycosis varies upon genus and species, with an overall MIC₉₀ from 4 (Rhizopus spp.) to 16 μg/mL (Rhizomucor spp. and Mucor spp.). Recently, to help detecting non-wild-type isolates, EUCAST committee has proposed ECOFFs values for C. albicans, C. parapsilosis and C. tropicalis (0.03 μg/mL), for Aspergillus fumigatus (2 μg/mL), A. nidulans (0.25 μg/mL), A. terreus (1 μg/mL), A. flavus (2 μg/mL) and A. niger (4 μg/mL). Moreover, clinical breakpoints (susceptible/resistant) were defined for Aspergillus fumigatus (1 μg/mL), A. nidulans (0.25 μg/mL) and A. terreus (1 μg/mL). Using these breakpoints, isavuconazole showed activity against the vast majority of fungi.     

Aeromonas spp. infections: retrospective study in Nîmes University Hospital, 1997-2004

Objective

Retrospective study of patients presenting Aeromonas spp. infections admitted to Nîmes hospital from January 1997 to December 2004.

Patients and method

Aeromonas spp. infections were collected from the database of the bacteriology department. The Aeromonas species, suceptibility phenotype, epidemiological data, site and type (nosocomial or not) of infection, and evolution were collected from medical files.

Results

Thirty infections were notified corresponding to 22 male and eight female of 50.6 years old (mean) and a mean stay duration of 31 days. Skin and soft tissues (50%), digestive tract (26.7%), bones and articulations (10%), blood stream (6.7%), urinary tract (3.3%) and lymph nodes (3.3%) were the sites of infection. Ten infections were nosocomial, four were associated with medical leeches. All strains were resistants to amoxicillin and amoxicillin– clavulanic acid, whereas resistance rate to other β-lactams was under 10% and all were suceptible to fluoroquinolones and aminoglycosides. All patients received antibiotic treatment: 31% a single molecule, 69% an association and 62% needed a second line treatment. Strain was suceptible to the antibiotic in 78.5% of cases. Only one death occured not directly linked to Aeromonas infection.

Discussion

Most of Aeromonas spp. infection sites were cutaneous and digestive. Nosocomial infections associated with medical leeches are not so uncommon and strict conditions of storage and administration are necessary. According to the susceptibility phenotype of our strains which is similar to literature data, a third generation cephalosporin or a fluoroquinolone should be used evenly associated with an aminoglycoside.