Post-surgical meningitis due to multiresistant Acinetobacter baumannii. Effective treatment with intravenous and/or intraventricular colistin and therapeutic dilemmas

Post-surgical meningitis and/or ventriculitis caused by Gram-negative bacteria may be difficult to treat due to the emergence of multiresistant strains. Two patients with multiresistant Acinetobacter baumannii central nervous system infection, successfully treated with either intravenous and/or intraventricular colistin are presented. Unresolved issues such as dose and duration of intraventricular colistin are discussed.     

Source, carriers, and management of a Serratia marcescens outbreak on a pulmonary unit

An outbreak of Serratia marcescens was seen on a pulmonary ward from September 1999 until September 2000. During this period, there were two distinct clusters of S. marcescens isolation. In the first episode, September–October 1999, S. marcescens isolates with the same resistance pattern were isolated in 10 patients. PFGE (pulsed-field gel electrophoresis) following digestion with SpeI confirmed that these isolates were identical. After an initial decline in the number of isolates, the incidence rose again in March 2000. The resistance pattern of these isolates differed from that in 1999. PFGE showed that most of the isolates in 2000 were identical and had replaced the previous strain (strain 1). In the second episode, January–August 2000, 26 patients were colonized with the subsequent strain (strain 2). Three of these patients had serious clinical problems due to S. marcescens, two had bacteraemia and one empyema. In September 2000, strain 2 was also detected in stock solutions for inhalation therapy. After discontinuation of the use of stock solutions and emphasizing hygienic measures, the outbreak resolved. The majority (68%) of the patients positive for S. marcescens suffered from COPD (chronic obstructive pulmonary disease). PFGE results suggest that several COPD patients were carriers of the same strain of S. marcescens for a prolonged time. Re-admission of these patients could have lead to re-introduction of the epidemic strains.     

Outbreak of Salmonella infantis gastroenteritis among people who had eaten at a hash house in southern Italy

Objectives

To describe an outbreak of acute gastroenteritis in people who had eaten at a hash house in southern Italy.

Study design

Case–control study.

Methods

A clinical case of gastroenteritis was defined as a person who had eaten at the hash house from 29 August to 4 September 2011 and who experienced defined gastrointestinal symptoms within 72 hours, or a person with a laboratory-confirmed salmonella infection without symptoms. A convenience sample was enrolled as the control group. Environmental and human samples were collected, and Salmonella infantis was identified by polymerase chain reaction. Univariate analysis was performed for each food type, and multivariate analysis was performed for each food type and demographic variable (gender, age).

Results

Twenty-three cases of gastroenteritis were notified between 1 and 4 September 2011, two of which were admitted to the local hospital. Multivariate analysis showed that porchetta [odds ratio (OR) 22.0, 95% confidence interval (CI) 3.2–152.6, z = 3.13, P = 0.002] and roasted meat (OR 14.4, 95% CI 1.7–122.0, z = 2.45, P = 0.014) were associated with gastrointestinal symptoms. Environmental and human isolates exhibited the same sequence type (ST 32).

Conclusions

This experience highlighted that, in the control of a foodborne outbreak, integrated epidemiological and laboratory surveillance enables rapid identification of the source of infection, thus reducing the risk of an epidemic.     

Outbreaks of Serratia marcescens in neonatal and pediatric intensive care units: Clinical aspects,risk factors and management

The following recommendations are derived from a systematic analysis of 34 Serratia marcescens outbreaks described in 27 publications from neonatal and pediatric intensive care units (NICU, PICU), in which genotyping methods were used to confirm or exclude clonality.     

Malaria attacks due to P. vivax or P. ovale in two French military teaching hospitals (2000 to 2009)

Context

Non-falciparum malaria is less studied than Plasmodium falciparum malaria, both in endemic and non-endemic zones.

Patients and method

A retrospective study was made of the medical files of patients managed for attacks of malaria due to Plasmodium vivax or Plasmodium ovale, between 2000 and 2009, in two French military teaching hospitals.

Results

Seventy-five percent of attacks occurred after a stay in French Guiana, in the Comoros Archipelago, or in the Ivory Coast Republic. The most frequent symptoms two months after coming back were a flu-like syndrome with headaches, and occasional digestive symptoms, without any difference between the first attack and recurrence. One third of patients presented with anemia, 78% with thrombocytopenia, and 12% with liver dysfunction.

Discussion

This study was the most important made in France on imported non-falciparum malaria. Military patients and immigrants accounted for a majority of patients due to the specificity of military hospitals and local recruitment. Clinical and biological features were not specific and did not allow guiding the diagnosis. Diagnostic tools were less sensitive for P. ovale.

Conclusion

Patient management could be optimized by more efficient diagnostic tools, specific guidelines for the diagnostic and therapeutic management, and a dedicated medical training for family practitioners as well as hospitals practice.