Online-Only Abstract: Population-based burden of bloodstream infections in Finland

Bloodstream infections (BSI) are a major cause of mortality, morbidity and medical cost, but few population-based studies have concomitantly evaluated BSI incidence and mortality. Data on BSI episodes reported to national, population-based surveillance by all clinical microbiology laboratories in Finland during 2004-07 were linked to vital statistics. Age-, sex and microbe-specific incidence and mortality rates were calculated. During 2004-07, 33 473 BSI episodes were identified; BSI incidence increased from 147 to 168 per 100 000 population (average annual increase, 4.4%; p <0.001). Rates were highest among persons ±65 years and <1 year, and higher among male patients than female patients (166 versus 152 per 100 000). The most common aetiologies were Escherichia coli (27%) and Staphylococcus aureus (13%). Among male patients, 52% of BSI were caused by gram-positive bacteria compared with 42% among female patients (p <0.001). The overall 30-day case-fatality was 13%. Of the deaths, 32% occurred within 2 days, 70% were among people aged 65 years or more and 33% were caused by E. coli or S. aureus infections. The BSI mortality rate increased from 19 to 22 per 100 000 (average annual increase: 4.0%, p 0.01). Among people aged 25 years or more, the mortality rate was 1.4-fold higher in men than women (34 versus 25 per 100 000 population). Overall excess annual mortality from BSI in the population was 18 per 100 000. The substantial BSI burden among the elderly and among adult men highlights the need for developing and implementing effective interventions, particularly for BSI caused by E. coli and S. aureus. One-third of BSI deaths occurred early, emphasizing the importance of early identification and treatment.     

Online-Only Abstract: Population-based burden of bloodstream infections in Finland

Hand, foot and mouth disease (HFMD) and herpangina (HA) are frequently caused by several distinct serotypes belonging to the human enterovirus A species (HEVA). Enterovirus 71 is considered as a significant public health threat because of rare but fatal neurological complications. A sentinel surveillance system involving paediatricians from Clermont-Ferrand (France) was set up to determine the clinical and epidemiological characteristics of HFMD/HA associated with enterovirus infections. A standardized report form was used to collect demographic and clinical data. Throat or buccal specimens were obtained prospectively and tested for the presence of enteroviruses. The frequency of HEVA serotypes was determined by genotyping. Phylogenetic relationships were analysed to identify potential new virus variants. From 1 April to 31 December 2010, a total of 222 children were enrolled. The predominant clinical presentation was HA (63.8%) and this was frequently associated with clinical signs of HFMD (48%). An enterovirus infection was diagnosed in 143 (64.4%) patients and serotype identification was achieved in 141/143 (98.6%). The predominant serotypes were coxsackievirus A10 (39.9%) and A6 (28%), followed by coxsackievirus A16 (17.5%) and enterovirus 71 (6.3%). Fever was observed in 115 (80.4%) children. No patient had neurological complications. Coxsackievirus A10 and A6 strains involved in the outbreak were consistently genetically related with those detected earlier in Finland and constituted distinct European lineages. Although several enterovirus serotypes have been involved in HFMD/HA cases, the outbreak described in this population survey was caused by coxsackievirus A6 and coxsackievirus A10, the third dual outbreak in Europe in the last 3 years.     

Online-Only Abstract: Population-based burden of bloodstream infections in Finland

We assessed the comparative efficacy of empirical therapy with beta-lactam plus macrolide vs. beta-lactam plus doxycycline for the treatment of community-acquired pneumonia (CAP) among patients in the Australian Community-Acquired Pneumonia Study. Both regimens demonstrated similar outcomes against CAP due to either ‘atypical’ (Chlamydophila, Legionella or Mycoplasma spp.) or typical bacterial pathogens.     

Online-Only Abstracts: Population-based burden of bloodstream infections in Finland

To estimate endemic areas for Crimean-Congo haemorrhagic fever (CCHF) in Greece, a country-wide seroepidemiological study was conducted, and 1611 human sera were prospectively collected along with data regarding possible risk factors for acquisition of infection, and tested for CCHF virus IgG antibodies by ELISA. The overall seroprevalence was 4.2%, with significant differences among prefectures, ranging from 0 to 27.5%. Multivariate analysis revealed that slaughtering and agricultural activities were significant risk factors for CCHFV seropositivity. The significantly high seroprevalence in specific prefectures, together with the extremely low number of CCHF cases, suggest that this phenomenon might be strain-related.

Comparison of anidulafungin's and fluconazole's in vivo activity in neutropenic and non-neutropenic models of invasive candidiasis

N. P. Wiederhold^1,2L. K. Najvar^2,3R. Bocanegra^2,3W. R. Kirkpatrick^2,3T. F. Patterson^2,31) University of Texas at Austin College of Pharmacy, Austin, TX2) University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Infectious Diseases3) South Texas Veterans Health Care System, San Antonio, TX, USAOriginal Submission: 17 August 2011; Revised Submission: 25 October 2011; Accepted: 30 October 2011Editor: E. RoilidesArticle published online: 3 November 2011Clin Microbiol Infect 2012; 18: E20–E2310.1111/j.1469-0691.2011.03712.x

Abstract

We compared the rate and extent of anidulafungin's and fluconazole's activity in neutropenic and non-neutropenic mice with Candida albicans invasive candidiasis. In immunocompetent mice, anidulafungin significantly improved survival vs. controls and fluconazole, and significant reductions in (1 → 3)-β-D-glucan and fungal burden were observed. In neutropenic animals, the highest doses of anidulafungin (5 mg/kg) and fluconazole (10 mg/kg) also improved survival and reduced fungal burden. However, there were no differences in survival between these antifungals as anidulafungin's activity was attenuated in this model. These results demonstrate that the extent of anidulafungin in vivo efficacy may be dependent on host immune status.

Characterization of clinical strains of Aspergillus terreus complex: molecular identification and antifungal susceptibility to azoles and amphotericin B

P. Escribano^1,2,3T. Peláez^1,2,3,4S. Recio^1,2E. Bouza^1,2,3,4J. Guinea^1,2,3,41) Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid2) Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid3) CIBER de Enfermedades Respiratorias (CIBER RES CD06/06/0058), Palma de Mallorca4) Department of Microbiology, School of Medicine, Universidad Complutense de Madrid, Madrid, SpainOriginal Submission: 20 July 2011; Revised Submission: 31 October 2011; Accepted: 1 November 2011Editor: E. RoilidesArticle published online: 7 November 2011Clin Microbiol Infect 2012; 18: E24–E2610.1111/j.1469-0691.2011.03714.x

Abstract

We used molecular techniques to analyse 87 (n = 70 patients) Aspergillus terreus complex isolates, all of which were identified as A. terreus sensu stricto. The antifungal susceptibilities determined with CLSI M38-A2 (and Etest for amphotericin B) and expressed as mg/L for range of MIC/MIC₉₀/geometric mean were as follows: itraconazole, 0.25–2/2/1.097; voriconazole, 0.125–2/2/1.176; posaconazole, 0.25–1/1/0.836; amphotericin B CLSI, 4–32/16/9.689; and Etest, 0.75–64/6/3.106. The MICs for amphotericin B were significantly higher than those found for the triazoles.

Candidaemia in a European Paediatric University Hospital: a 10-year observational study

A. Tragiannidis^1,2W. Fegeler³G. Rellensmann⁴V. Debus⁵V. Müller⁶I. Hoernig-Franz⁴K. Siam⁷Z.-D. Pana²H. Jürgens¹A. H. Groll¹1) Department of Paediatric Haematology/Oncology, University Children's Hospital Münster, Münster, Germany2) 2nd Department of Paediatrics, Aristotle University, AHEPA Hospital, Thessaloniki, Greece3) Department of Medical Microbiology, University Hospital Münster4) General Paediatrics5) Paediatric Cardiology6) Paediatric Surgery, University Children's Hospital Münster7) Medical Controlling, University Hospital Münster, Münster, GermanyOriginal Submission: 26 July 2011; Revised Submission: 20 October 2011; Accepted: 30 October 2011Editor: E. RoilidesArticle published online: 23 November 2011Clin Microbiol Infect 2012; 18: E27–E3010.1111/j.1469-0691.2011.03720.x

Abstract

In this retrospective observational study covering 1998 to 2008, 32 patients (mean age: 7.50 years) were identified that had 35 episodes of candidaemia (0.47 cases/1000 hospital discharges). Cancer/allogeneic haematopoietic stem cell transplantation (43%) and congenital malformations/syndromes (21%) were the predominant underlying conditions. Central venous catheterization (90%), a history of antibacterial therapy (69%) and previous bacteraemia (54%) were frequent comorbidities. Candida albicans (46%) was most common, followed by Candida parapsilosis (17%) and Candida glabrata (14%). Resistance was infrequent and limited to non-albicans Candida spp. The 30-day and 100-day mortality rates were 11.4%.

Which anatomical sites should be sampled for screening of methicillin-resistant Staphylococcus aureus carriage by culture or by rapid PCR test?

L. SennP. BassetI. NahimanaG. ZanettiD. S. BlancService of Hospital Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, SwitzerlandOriginal Submission: 29 June 2011; Revised Submission: 3 October 2011; Accepted: 10 November 2011Editor: G. LinaArticle published online: 17 November 2011Clin Microbiol Infect 2012; 18: E31–E3310.1111/j.1469-0691.2011.03724.x

Abstract

The nose is the anatomical site usually recommended for methicillin-resistant Staphylococcus aureus (MRSA) screening. Other sites are also recommended, but are more controversial. We showed that the sensitivities of MRSA detection from nasal swabs alone were 48% and 62% by culture or by rapid PCR test, respectively. These percentages increased to 79% and 92% with the addition of groin swabs, and to 96% and 99% with the addition of groin and throat swabs. In conclusion, neither by culture nor by rapid PCR test is nose sampling alone sufficient for MRSA detection. Additional anatomical sites should include at least the groin and throat.

NDM-2 carbapenemase-producing Acinetobacter baumannii in the United Arab Emirates

A. Ghazawi¹Á. Sonnevend¹R. A. Bonnin²L. Poirel²P. Nordmann²R. Hashmey³T. A. Rizvi¹M. B Hamadeh³T. Pál¹1) Department of Microbiology and Immunology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates,2) Department of Microbiology, INSERM U914 ‘Emerging Resistance to Antibiotics', Hospital Bicětre, South-Paris Medical School, K.-Bicětre, France3) Tawam Hospital, Al Ain, United Arab EmiratesOriginal Submission: 25 September 2011; Revised Submission: 7 November 2011; Accepted: 9 November 2011Editor: R. CantónArticle published online: 17 November 2011Clin Microbiol Infect 2012; 18: E34–E3610.1111/j.1469-0691.2011.03726.x

Abstract

Screening 155 carbapenem non-susceptible Acinetobacter baumannii strains recovered in Abu Dhabi hospitals identified two metallo-β-lactamase bla_NDM gene-carrying isolates. They were isolated 4 months apart from the urine of a cancer patient previously treated in Egypt, Lebanon and in the United Arab Emirates. They were clonally related and carried the bla_NDM-2 gene recently identified in A. baumannii in Egypt and Israel. Sequences surrounding the bla_NDM-2 gene showed significant similarities with those associated with bla_NDM-1 in Enterobacteriaceae and A. baumannii. Repeated isolation of bla_NDM-2-positive A. baumannii in the Middle East raises the possibility of the local emergence and spread of a unique clone.     

Online-Only Abstracts: Population-based burden of bloodstream infections in Finland

Medical residents are particularly exposed to the risk of occupational infection. We aimed to determine the vaccination coverage in residents with an anonymous self-reporting electronic questionnaire. A total of 250 residents took part in this survey. Vaccination rates were particularly high for mandatory vaccinations (diphtheria, tetanus, poliomyelitis, hepatitis B virus and tuberculosis). Regarding recommended vaccinations (influenza, 45.6%; pertussis, 65.2%; measles, 62.8%; varicella, 62.8%), rates were insufficient to prevent hospital epidemics, but higher than those reported in other healthcare workers. Further immunization programmes should target residents, and not only senior healthcare workers, with a critical role for occupational medicine departments.

Prolonged and mixed non-O157 Escherichia coli infection in an Australian household

M. Staples, R. M. A. Graham, C. J. Doyle, H. V. Smith, A. V. JennisonPublic Health Microbiology, Communicable Disease, Queensland Health Forensic and Scientific Services, Brisbane, Qld, AustraliaOriginal Submission: 28 November 2011; Revised Submission: 16 January 2012; Accepted: 24 January 2012Editor: P. TassiosArticle published online: 1 February 201210.1111/j.1469-0691.2012.03790.x

AbstractAn Australian family was identified through a Public Health follow up on a Shiga-toxigenic Escherichia coli (STEC) positive bloody diarrhoea case, with three of the four family members experiencing either symptomatic or asymptomatic STEC shedding. Bacterial isolates were submitted to stx sequence sub-typing, multi-locus variable number tandem repeat analysis (MLVA), multi-locus sequence typing (MLST) and binary typing. The analysis revealed that there were multiple strains of STEC being shed by the family members, with similar virulence gene profiles and the same serogroup but differing in their MLVA and MLST profiles. This study illustrates the potentially complicated nature of non-O157 STEC infections and the importance of molecular epidemiology in understanding disease clusters.

NDM-1, OXA-48 and OXA-181 carbapenemase-producing Enterobacteriaceae in Sultanate of Oman

L. Dortet¹, L. Poirel¹, F. Al Yaqoubi², P. Nordmann¹1) Service de Bactériologie-Virologie, INSERM U914 ‘Emerging Resistance to Antibiotics', Hôpital de Bicětre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine Paris Sud, Le Kremlin-Bicětre Cedex, France and 2) Department of Microbiology, Royal Hospital, Sultanate of Oman, Muscat, OmanOriginal Submission: 17 January 2012; Revised Submission: 16 February 2012; Accepted: 30 January 2012Editor: R. CantónArticle published online: 3 February 201210.1111/j.1469-0691.2012.03796.x

AbstractTwenty-two carbapenem-resistant enterobacterial isolates were recovered from patients hospitalized between October 2010 and March 2011 at the Royal Hospital of Muscat, Sultanate of Oman. Eleven NDM-1, five OXA-48 and one NDM-1 plus OXA-181 producers of diverse ST types were recovered from clinical samples. All carbapenemase genes were located on self-conjugative plasmids and were nearly always associated with other resistance determinants, including extended-spectrum β-lactamases and the ArmA methylase encoding resistance to aminoglycosides. This work highlights the dissemination of NDM-1 and OXA-48-type producers in the Middle East.

     

Online-Only Abstracts: Population-based burden of bloodstream infections in Finland

A serological survey was performed to determine the prevalence of antibodies against human bocavirus in an Apulian population. Anti-hBoV IgG antibodies were analysed in 1206 inhabitants (age range, 1 month–84 years) using a standardized ELISA test based on the use of recombinant hBoV VP2 virus-like particles. In total, 1075 (89.1%) of 1206 participants (mean age 32 ± 24.8 years) displayed anti-hBoV-IgG. The seroprevalence increased significantly (p < 0.0001) in children from 2–4 years (64.2%) to 5–9 years (96.4%). A similar trend was observed in both male and female subjects. In conclusion, our results show that hBoV infection is common in this population, especially in children.

Screening and detection of human enterovirus 71 infection by a real-time RT-PCR assay in Marseille, France, 2009–2011

C. Y. Q. Tan¹, G. Gonfrier², L. Ninove^1,2, C. Zandotti², A. Dubot-Pérès¹, X. de Lamballerie^1,2, R. N. Charrel^1,21) UMRI90 Emergence des Pathologies Virales, Aix-Marseille Université, Institut de Recherche pour le Développement, EHESP French School of Public Health, Marseille and 2) Fédération de Microbiologie, Assistance Publique-Hôpitaux de Marseille, Marseille, FranceOriginal Submission: 10 November 2011; Revised Submission: 3 January 2012 Accepted 9 January 2012Editor: L. KaiserArticle published online: 13 January 2012Clin Microbiol Infect 2012; 18: E77–E80

Abstract

Enterovirus-positive samples diagnosed in Marseille (January 2009 to September 2011) were screened for EV71 by real-time RT-PCR. EV71 was detected in three children below the age of 2 years with no history of overseas travel; two of these cases were associated with severe clinical presentation. Viruses demonstrated genetic similarity to other European genogroup C2 strains. Strain MRS/09/3663 complete sequencing revealed 97.6% identity across the entire genome with a 2008 Singapore isolate, without signs of possible recombination events. To our knowledge, this is the first detection of EV71 infection in Marseille, France, that confirms the current circulation of EV71 in France.

Evaluation of the Xpert Flu test and comparison with in-house real-time RT-PCR assays for detection of influenza virus from 2008 to 2011 in Marseille, France

N. Salez¹, L. Ninove^1,2, L. Thirion¹, C. Gazin², C. Zandotti², X. de Lamballerie^1,2, R. N. Charrel^1,21) UMRI90 ‘Emergence des Pathologies Virales'(Aix-Marseille Univ –- Institute of Research for Development –- EHESP French School of Public Health), Marseille, France and 2) Federation of Clinical Microbiology, AP-HM Timone, Marseille, FranceOriginal Submission: 2 December 2011; Revised Submission: 17 January 2012 Accepted 29 January 2012Editor: L. KaiserArticle published online: 23 February 2012Clin Microbiol Infect 2012; 18: E81–E83

Abstract

Rapid documentation of respiratory specimens can have an impact on the management of patients and their relatives in terms of preventive and curative measures. We compared the results of the Xpert® Flu assay (Cepheid) with three real-time RT-PCR assays using 127 nasopharyngeal samples, of which 75 were positive for influenza A (with 52 identified as A/HINI-2009) and 52 were positive for influenza B. The Xpert® Flu assay presented a quasi-absence of non-interpretable tests, and showed sensitivity and specificity of 100% and 100% for Flu A, 98.4% and 100% for A/HINI-2009, and 80.7% and 100% for Flu B.     

Online-Only Abstracts: Population-based burden of bloodstream infections in Finland

Survival of hepatitis A virus (HAV) and hepatitis E virus (HEV) in soil samples spiked with respective viruses was analysed using real-time PCR. Virus-spiked soil samples were incubated at environmental temperature (ET) and 37°C and processed weekly. Both HAV and HEV were less stable at fluctuating ET than at 37°C. Of the 403 soil samples collected in the vicinity of Mutha river, India, 19.1% and 4.9% were found to be contaminated with HAV and HEV, respectively.

Emergence of carbapenem-resistant Enterobacteriaceae in Austria, 2001–2010

G. Zarfel¹, M Hoenigl², BWürstl³, E Leitner¹, H J. F. Salzer², T Valentin², J Posch¹, R Krause², A J. Grisold¹1) Institute of Hygiene, Microbiology and Environmental Medicine, 2) Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University Graz, Graz, Austria and 3) Max von Pettenkofer-Institute, Ludwig-Maximilians-University of Munich, Munich, GermanyOriginal Submission: 6 June 2011; Revised Submission: 27 July 2011; Accepted: 21 August 2011Editor: R. CantónArticle published online: 26 August 2011Clin Microbiol Infect 2011; 17: E5–E810.1111/j.1469-0691.2011.03659.x

Abstract

We report the emergence of carbapenem-resistant Enterobacteriaceae in Austria. Over a 10-year period, carbapenem-resistant Enterobacteriaceae isolates were obtained from 13 hospitalized patients, with the first isolation in the year 2005 and a remarkable increase in the number of involved patients in 2010. Carbapenem-resistant Enterobacteriaceae comprise eight Klebsiella pneumoniae isolates, four Klebsiella oxytoca isolates, and one Escherichia coli isolate. The detected carbapenemases were the metallo-β-lactamases New Delhi β-lactamase, VIM and IMP, and the serin-β-lactamase Klebsiella pneumoniae carbapenemase.

Colonization and infection by colistin-resistant Gram-negative bacteria in a cohort of critically ill patients

F. Kontopidou¹, D Plachouras¹, E Papadomichelakis², G Koukos¹, I Galani¹, G Poulakou¹, G Dimopoulos², A Antoniadou¹, A Armaganidis², H Giamarellou¹1) 4th Department of Internal Medicine and 2) 2nd Critical Care Department, University of Athens, Medical School, Athens, GreeceOriginal Submission: 20 April 2011; Revised Submission: 10 August 2011; Accepted: 10 August 2011Editor: L. PoirelArticle published online: 18 August 2011Clin Microbiol Infect 2011; 17: E9–E11

Abstract

In recent years there has been renewed interest in colistin for the treatment of infections by multidrug-resistant Gram-negative bacteria, causing concern that increasing use may be accompanied by the emergence of resistance. This is a retrospective cohort study of colonization and infection by colistin-resistant (CR) gram-negative bacteria in critically ill patients. Colonization data were based on surveillance culture results. Among 150 patients, 78 (52%) were colonized by CR Gram-negative bacteria. Among them, 30 (20%) were colonized by Klebsiella pneumoniae isolates and 51 (34%) were colonized by intrinsically resistant to colistin (CIR) enterobacteriaceae. Seven cases of infection were caused by CR K. pneumoniae and 12 cases by CIR strains. The main risk factor for colonization by CR pathogens was colistin treatment.

Characterization of Acinetobacter baumannii from intensive care units and home care patients in Palermo, Italy

C. Mammina¹, C Bonura², A Aleo¹, C Calà², G Caputo³, M C. Cataldo³, A Di Benedetto⁴, S Distefano², T Fasciana², M Labisi⁴, C Sodano⁵, D M. Palma⁶, A Giammanco²1) Department of Sciences for Health Promotion ‘G. D'Alessandro’, Section of Hygiene, University, Palermo, 2) Department of Sciences for Health Promotion ‘G. D'Alessandro’, Section of Microbiology, University, Palermo, 3) Geriatric Assessment and Integrated Home Care Unit, District 10, Local Health Agency, Palermo, 4) General Hospital ‘G.F. Ingrassia’, Local Health Agency Palermo, Palermo, 5) Laboratory of Microbiology, General Hospital ARNAS ‘Civico, Di Cristina & Benfratelli’, Palermo and 6) II Intensive Care Unit, General Hospital ARNAS ‘Civico, Di Cristina & Benfratelli’, Palermo, ItalyOriginal Submission: 17 May 2011; Revised Submission: 16 July 2011; Accepted: 10 August 2011Editor: L. PoireArticle published online: 31 August 2011Clin Microbiol Infect 2011; 17: E12–E15

Abstract

In this study 45 isolates of Acinetobacter baumannii identified from patients in intensive care units of three different hospitals and from pressure ulcers in home care patients in Palermo, Italy, during a 3-month period in 2010, were characterized. All isolates were resistant to at least three classes of antibiotics, but susceptible to colistin and tygecycline. Forty isolates were non-susceptible to carbapenems. Eighteen and two isolates, respectively, carried the bla_OXA-23-like and the bla_OXA-58-like genes. One strain carried the VIM-4 gene. Six major rep-PCR subtype clusters were defined, including isolates from different hospitals or home care patients. The sequence type/pulsed field gel electrophoresis group ST2/A included 33 isolates, and ST78/B the remaining 12. ST2 clone proved to be predominant, but a frequent involvement of the ST78 clone was evident.

EUCAST technical note on posaconazole

M. C. Arendrup¹, M Cuenca-Estrella², J P. Donnelly³, W Hope⁴, C Lass-Flörl⁵, J-L. Rodriguez-Tudela² and The European committee on antimicrobial susceptibility testing – subcommittee on antifungal susceptibility testing (EUCAST-AFST)1) Unit of Mycology, Department of Microbiological Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark, 2) Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, 3) Department of Haematology, Radboud University Nijmegen Medical Center & Nijmegen University Center for Infectious Diseases, Radboud University Nijmegen, the Netherlands, 4) The University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK and 5) Division of Hygiene and Microbiology, Innsbruck Medical University, Innsbruck, AustriaOriginal Submission: 9 June 2011; Revised Submission: 28 July 2011; Accepted: 8 August 2011Editor: E. RoilidesArticle published online: 17 August 2011Clin Microbiol Infect 2011; 17: E16–E1710.1111/j.1469-0691.2011.03646.x

Abstract

The European Committee on Antimicrobial Susceptibility Testing-Subcommittee on Antifungal Susceptibility Testing (EUCAST-AFST) has determined breakpoints for posaconazole for Candida spp. This Technical Note is based on the EUCAST posaconazole rationale document (available on the EUCAST website: http://www.eucast.org). Species-specific breakpoints for C. albicans, C. parapsilosis and C. tropicalis are S: MIC ≤0.06 mg/L, R: MIC >0.06 mg/L. There are insufficient data to set breakpoints for C. glabrata and C. krusei as well as non-species-related breakpoints. The breakpoints are based upon pharmacokinetic data, epidemiological cut-off values and clinical experience. Breakpoints will be reviewed regularly.

EUCAST technical note on anidulafungin

M. C. Arendrup¹, J-L. Rodriguez-Tudela², C Lass-Flörl³, M Cuenca-Estrella², J P. Donnelly⁴, W Hope⁵ and The European committee on antimicrobial susceptibility testing - subcommittee on antifungal susceptibility testing (EUCAST-AFST)1) Unit of Mycology, Department of Microbiological Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark, 2) Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain, 3) Division of Hygiene and Microbiology, Innsbruck Medical University, Innsbruck, Austria, 4) Department of Haematology, Radboud University Nijmegen Medical Centre & Nijmegen University Centre for Infectious Diseases, Radboud University, Nijmegen, the Netherlands and 5) The University of Manchester, Manchester, UKOriginal Submission: 31 May 2011; Revised Submission: 28 July 2011; Accepted: 8 August 2011Editor: E. RoilidesArticle published online: 17 August 2011Clin Microbiol Infect 2011; 17: E18–E20

Abstract

The European Committee on Antimicrobial Susceptibility Testing-Subcommittee on Antifungal Susceptibility Testing has determined breakpoints for anidulafungin for Candida spp. This Technical Note is based on the EUCAST anidulafungin rationale document (Available at: http://www.eucast.org). Species-specific breakpoints for C. albicans are S ≤0.03 mg/L and R >0.03 mg/L and for C. glabrata, C. tropicalis and C. krusei S ≤0.06 mg/L and R >0.06 mg/L. C. parapsilosis was not regarded a good target for anidulafungin. There are insufficient data to set breakpoints for other species. The breakpoints are based upon pharmacokinetic data, epidemiological cut-off values and clinical experience. Breakpoints will be reviewed regularly.     

Online-Only Abstracts: Population-based burden of bloodstream infections in Finland

Since 2003, outbreaks of lymphogranuloma venereum (LGV) have been reported in European countries, North America, and Australia. Current LGV cases have been caused by Chlamydia trachomatis serovar L2. This sexually transmitted infection is predominantly found among men who have sex with men, specifically men who are seropositive for human immunodeficiency virus and have clinical signs of proctitis. The current outbreak has been almost exclusively attributed to a new variant, designated L2b. Although urogenital cases of LGV have been described in the heterosexual population, we report the first case of C. trachomatis L2b proctitis in a woman.

European dissemination of a single OXA-48-producing Klebsiella pneumoniae clone

A. Potron¹J. Kalpoe²L. Poirel¹P. Nordmann¹1) Service de Bactériologie-Virologie, INSERM U914 «Emerging Resistance to Antibiotics», Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris Faculté de Médecine et Université Paris-Sud, K. Bicêtre, France2) Department of Medical Microbiology and Infection Prevention, Slotervaart Hospital, Amsterdam, the NetherlandsOriginal Submission: 27 July 2011; Revised Submission: 1 September 2011; Accepted: 3 September 2011Editor: R. CantónArticle published online: 8 September 2011

Abstract

A Klebsiella pneumoniae isolate with decreased susceptibility to carbapenems was isolated in April 2011 in a hospital in Amsterdam (the Netherlands) and later found to be the source of an important outbreak in a Rotterdam hospital. The strain, belonging to sequence type (ST) 395, carried the bla_OXA-48 gene located onto a c 62-kb conjugative plasmid, together with the extended-spectrum β-lactamase gene bla_CTX-M-15. It was closely related or identical to other OXA-48-positive Klebsiella pneumoniae isolates belonging to the same ST type and identified in France and Morocco. This study sheds light on the European dissemination of a single OXA-48 K. pneumoniae clone.

EUCAST Technical note on Amphotericin B

C. Lass-Flö rl¹M. C. Arendrup²J.-L. Rodriguez-Tudela³M. Cuenca-Estrella³P. Donnelly⁴W. Hope⁵The European Committee on Antimicrobial Susceptibility Testing – Subcommittee on Antifungal Susceptibility Testing (EUCAST-AFST)^*1) Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria2) Unit of Mycology, Department of Mictobiological Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark3) Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos Ill, Majadahonda, Spain4) Department of Haematology, Radboud University Nijmegen Medical Centre & Nijmegan University Centre for Infectious Diseases Radboud University, Nijmegen, The Netherlands5) The University of Manchester, Manchester, UKOriginal Submission: 8 June 2011; Revised Submission: 28 July 2011; Accepted: 28 July 2011Editor: E. RoilidesArticle published online: 4 August 2011

Abstract

The European Committee on Antimicrobial Susceptibility Testing-Subcommittee on Antifungal Susceptibility Testing (EUCAST-AFST) has determined breakpoints for amphotericin B for Candida spp. This Technical Note is based on the EUCAST amphotericin B rationale document (available on the EUCAST website: http://www.eucast.org). Species-specific breakpoints for C. albicans, C. glabrata, C. krusei, C. parapsilosis and C. tropicalis are S: MIC ≤1 mg/L, R: MIC > 1 mg/L. There are insufficient data to set breakpoints for other species. The breakpoints are based upon pharmacokinetic data, epidemiological cut-ff values and clinical experience. Breakpoints will be reviewed regularly.

High genetic diversity including potential new subtypes of hepatitis C virus genotype 6 in Lao People's Democratic Republic

J. M. Hübschen¹P. Jutavijittum²T. Thammavong³B. Samountry⁴A. Yousukh²K. Toriyama⁵A. Sausy¹C. P. Muller¹1) Institute of Immunology, Centre de Recherche Public – Santé/Laboratoire National de Santé, Luxembourg, Luxembourg2) Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand3) National Blood Transfusion Centre, Lao Red Cross, Vientiane, Lao PDR4) Department of Pathology, Faculty of Medical Sciences, University of Health Sciences, Vientiane, Lao PDR5) Department of Pathology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, JapanOriginal Submission: 20 April 2011; Revised Submission: 18 August 2011; Accepted: 30 August 2011Editor: G. AntonelliArticle published online: 2 September 2011

Abstract

Sera from 105 anti-HCV-positive first-time blood donors collected in 2004, 2005 and 2008 in different provinces in Laos were investigated by PCR. Forty-five samples were positive for HCV (42.86%); two belonged to subtype 1b (2/45, 4.4%) and all others to genotype 6 (43/45, 95.6%), including subtypes 6b, 6h, 6k, 6l, 6n and 6q. Three groups of sequences were not clearly attributable to any genotype 6 subtype, two of which may be regarded as candidates for new subtypes of genotype 6. Two samples were mixed infected with different subtypes or clusters of genotype 6 viruses.     

Online-Only Abstracts: Population-based burden of bloodstream infections in Finland

Limited data on relative fitness and virulence of antimicrobialresistant Acinetobacter baumannii are known. We aimed to study the virulence and fitness cost of ciprofloxacin-resistance in A. baumannii (CipR) compared with the susceptible parental wild-type strain (CipS). Human lung epithelial cells were infected with CipS and CipR for 24 h. Competition fitness was monitored in vitro and in vivo in a murine peritoneal sepsis model. We showed that CipR induced less cell death than CipS and CipR growth was slow when in competition with CipS. Altogether, acquisition of ciprofloxacin resistance confers a biological fitness cost and reduces virulence in A. baumannii.

Significance of cytomegalovirus infection in the failure of native arteriovenous fistulaM. Dzabic¹ K. Bojakowski^2,3 E. Kurzejamska¹ G. Styczynski³ P. Andziak² C. Söderberg-Nauclér¹ and P. Religa¹1) Department of Medicine, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden 2) Department of General, Vascular and Oncologic Surgery, Warsaw University of Medicine, Warsaw, Poland 3) Department of Internal Medicine and Hypertension, Warsaw University of Medicine, Warsaw, PolandOriginal Submission: 16 June 2011; Revised Submission: 14 September 2011; Accepted: 30 September 20111Editor: L. KaiserArticle published online: 5 October 2011Clin Microbiol Infect 2012; 18: E5-E7

Abstract

High cytomegalovirus (CMV) IgG levels have been identified as a risk factor for arteriovenous fistula (AVF) failure. None of the 68 patents in our study were CMV IgM positive, although 96% were CMV IgG positive. CMV antigens were detected in the radial artery or cephalic vein of 46% of patients who received an AVF. The presence of CMV antigens or high serum CMV IgG levels had no prognostic value for AVF failure.

Evaluation and use of NS1 IgM antibody detection for acute dengue virus diagnosis: report from an outbreak investigationS. Gowri Sankar¹ K. J. Dhananjeyan² R. Paramasivan² V. Thenmozhi² B. K. Tyagi² and S. John Vennison¹1) Department of Biotechnology, Anna University of Technology, Tiruchirappalli 2) Centre for Research in Medical Entomology (CRME), Indian Council of Medical Research, Chinna Chokkikulam, Madurai, Tamil Nadu, IndiaOriginal Submission: 18 June 2011; Revised Submission: 17 August 2011; Accepted: 4 October 2011Editor: T. A. ZupancArticle published online: 15 November 2011Clin Microbiol Infect 2012; 18: E8-E10

Abstract

The usefulness of detecting circulating non-structural protein 1 (NS1) IgM antibodies for diagnosing acute dengue virus infection was evaluated during an outbreak investigation along with other routinely used laboratory diagnostic methods. For the first time, the samples were also tested for NS1 antigen detection. NS1 IgM antibody detects all the serum samples that were positive for NS1 antigen detection within first 5 days of infection. The sensitivity of the NS1 IgM ELISA was higher when compared with RT-PCR and therefore, it could be used for early diagnosis.

Emergence of five kinds of aminoglycoside-modifying enzyme genes simultaneously in a strain of multidrugresistant Escherichia coli in ChinaZ. Wang-Sheng¹ M. Zu-Huang² and W. Xing-Bei³1) Department of Medical Laboratory, The First Affiliated Hospital of Nanjing Medical University, Nanjing 2) Department of Bioinformatics, Wuxi Clone Gen-Tech Institute, Wuxi 3) Department of Medical Laboratory, Ningbo First Hospital, Ningbo, Zhejiang, ChinaOriginal Submission: 2 October 2011; Revised Submission: 24 October 2011; Accepted: 25 October 2011Editor: J.-M. RolainArticle published online: 31 October 2011Clin Microbiol Infect 2012; 18: E11-E12

Abstract

A strain of Escherichia coli was positive for 5 aminoglycoside modifying enzyme genes (aac(3)-I, aac(6′)-Ib-cr, ant(3′)-I, aadA5, and aph(3′)-I) in PCR assays. And these positive genes confer resistance to aminoglycosides (gentamicin and tobramycin). This is the first report of emergence of five kinds of aminoglycoside-modifying enzymes genes simultaneously in E. coli worldwide.

Nosocomial urinary tract infection in the intensive care unit: when should Pseudomonas aeruginosa be suspected? Experience of the French national surveillance of nosocomial infections in the intensive care unit, Rea-RaisinA.-G. Venier^1,2 T. Lavigne³ P. Jarno⁴ F. L'heriteau⁵ B. Coignard⁶ A. Savey⁷ and A.-M. Rogues²1) CHU, CCLIN Sud-Ouest, Bordeaux 2) INSERM, U657, Bordeaux 3) CHU, CCLIN Est, Service d'Hygiène Hospitalière, Strasbourg 4) CHU, CCLIN Ouest, Rennes 5) CCLIN Paris-Nord, Paris 6) InVS, Saint Maurice 7) CHU, CCLIN Sud-Est, Lyon, FranceOriginal Submission: 30 May 2011; Revised Submission: 20 September 2011; Accepted: 21 September 2011Editor: M. PaulArticle published online: 28 September 2011Clin Microbiol Infect 2012; 18: E13-E15

Abstract

Individual and ward risk factors for P. aeruginosa-induced urinary tract infection in the case of nosocomial urinary tract infection in the intensive care unit were determined with hierarchical (multilevel) logistic regression. The 2004–2006 prospective French national intensive care unit nosocomial infection surveillance dataset was used and 3252 patients with urinary tract infection were included; 16% were infected by P. aeruginosa. Individual risk factors were male sex, duration of stay, antibiotics at admission and transfer from another intensive care unit. Ward risk factors were patient turnover and incidence of P. aeruginosa-infected patients.     

Population-based burden of bloodstream infections in Finland

Bloodstream infections (BSI) are a major cause of mortality, morbidity and medical cost, but few population-based studies have concomitantly evaluated BSI incidence and mortality. Data on BSI episodes reported to national, population-based surveillance by all clinical microbiology laboratories in Finland during 2004–07 were linked to vital statistics. Age-, sex and microbe-specific incidence and mortality rates were calculated. During 2004–07, 33 473 BSI episodes were identified; BSI incidence increased from 147 to 168 per 100 000 population (average annual increase, 4.4%; p <0.001). Rates were highest among persons ≥65 years and <1 year, and higher among male patients than female patients (166 versus 152 per 100 000). The most common aetiologies were Escherichia coli (27%) and Staphylococcus aureus (13%). Among male patients, 52% of BSI were caused by gram-positive bacteria compared with 42% among female patients (p <0.001). The overall 30-day case-fatality was 13%. Of the deaths, 32% occurred within 2 days, 70% were among people aged 65 years or more and 33% were caused by E. coli or S. aureus infections. The BSI mortality rate increased from 19 to 22 per 100 000 (average annual increase: 4.0%, p 0.01). Among people aged 25 years or more, the mortality rate was 1.4-fold higher in men than women (34 versus 25 per 100 000 population). Overall excess annual mortality from BSI in the population was 18 per 100 000. The substantial BSI burden among the elderly and among adult men highlights the need for developing and implementing effective interventions, particularly for BSI caused by E. coli and S. aureus. One-third of BSI deaths occurred early, emphasizing the importance of early identification and treatment.     

Online-Only Abstract: This article is available online at wileyonlinelibrary.com

Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p <0.001 and p <0.001, respectively). Bacteraemia was less frequent in pre-treated patients (p 0.01). The frequency of positive sputum culture and the sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP.     

Online-Only Abstract: This article is available online at wileyonlinelibrary.com

Group B Streptococcus (GBS) was the main causative organism of invasive infections in newborns due to vertical transmission from the colonized mothers. The study was undertaken to determine colonization rate, serotype distribution, genotypic characterization, antibiotic susceptibility profiles and molecular characteristics of erythromycin-resistant strains of GBS in pregnant women in Beijing, China. Vaginal rectal swabs were collected from a total of 2850 pregnant women at 35-37 weeks of gestation, in which 7.1% were GBS positive. Serotypes III, Ia and V predominated. All isolates were penicillin susceptible, whereas the resistance rates for erythromycin and clindamycin were strikingly high.     

Detection of bloodstream infections in children

A critical responsibility of the clinical microbiology laboratory serving clinicians who care for infected children is accurate and timely detection of bacteremia. Blood culture protocols which are suitable for processing adult specimens are not necessarily the first choice for processing pediatric specimens. In this review, the following aspects of detection of bacteremia in children are covered: obtaining blood culture specimens from children, including skin disinfection, specimen volume and timing of specimen collection; the array of blood culture methods available, focusing upon conventional, radiometric, infrared spectroscopic and manometric broth cultures, as well as biphasic agar/broth and lysis direct plating techniques; the strengths and weaknesses of the various methods; and recommendations to laboratories for selection of a blood culture method based upon the laboratory's staffing level.     

Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe

In this systematic review, we estimated the total number of episodes of bloodstream infection (BSI) and deaths from BSI per year in North America and Europe, using data from population-based settings. Then, we estimated the number of episodes and deaths from nosocomial BSI from population-based studies and nosocomial infection surveillance systems. We estimated 575 000–677 000 episodes of BSI per year in North America (536 000–628 000 in the USA and 40 000–49 000 in Canada) and 79 000–94 000 deaths (72 000–85 000 in the USA and 7000–9000 in Canada), using estimates from three population-based studies. We estimated over 1 200 000 episodes of BSI and 157 000 deaths per year in Europe, using estimates from one population-based study in each of the following countries: Denmark (9100 episodes and 1900 deaths), Finland (8700 episodes and 1100 deaths) and England (96 000 episodes and 12 000–19 000 deaths). There were substantial differences in estimates of nosocomial BSI between population-based and nosocomial infection surveillance data. BSI has a major impact on the morbidity and mortality of the general population, as it ranks among the top seven causes of death in all included countries in North America and Europe. However, it is difficult to obtain precise estimates of nosocomial BSI, owing to the limited number of studies. This review highlights the need for a greater focus on BSI research in order to reduce the overall burden of disease by improving the outcome of patients with BSI. It also emphasizes the role of infection control and prevention methods in reducing the burden of nosocomial BSI.     

Trends and outcome of nosocomial and community-acquired bloodstream infections due to Staphylococcus aureus in Finland, 1995–2001

In Finland, Staphylococcus aureus bloodstream infections are caused predominantly (>99%) by methicillin-sensitive strains. In this study, laboratory-based surveillance data on Staphylococcus aureus bloodstream infections occurring in Finland from 1995 to 2001 were analyzed. Preceding hospitalizations for all persons with Staphylococcus aureus bloodstream infections were obtained from the national hospital discharge registry, and data on outcome was obtained from the national population registry. An infection was defined as nosocomial when a positive blood culture was obtained more than 2 days after hospital admission or within 2 days of admission if there was a preceding hospital discharge within 7 days. A total of 5,045 cases were identified. The annual incidence of Staphylococcus aureus bloodstream infection rose by 55%, from 11 per 100,000 population in 1995 to 17 in 2001. The increase was detected in all adult age groups, though it was most distinct in patients >74 years of age. Nosocomial infections accounted for 51% of cases, a proportion that remained unchanged. The 28-day death-to-case ratio ranged from 1% in the age group 1–14 years to 33% in patients >74 years of age. The 28-day death-to-case ratios for nosocomial and community-acquired infections were 22% and 13%, respectively, and did not change over time. The increase in incidence among elderly persons resulted in an increase in the annual rate of mortality associated with Staphylococcus aureus bloodstream infections, from 2.6 to 4.2 deaths per 100,000 population per year. Staphylococcus aureus bloodstream infections are increasing in Finland, a country with a very low prevalence of methicillin resistance. While the increase may be due in part to increased reporting, it also reflects a growing population at risk, affected by such factors as high age and/or severe comorbidity.     

Advances in the therapy of bacterial bloodstream infections

BackgroundAdvances in the diagnostic and therapeutic management of patients with bloodstream infections (BSIs) have been achieved in the last years, improving clinical outcome. However, mortality associated with some pathogens, such as Staphylococcus aureus and Enterococcus spp., is still high. In addition, the spread of antibiotic resistance, mainly among Gram-negative bacteria, reduces treatment options in some circumstances. Therefore, interest in new drugs, combination regimens and optimal dosing schedules is rising.ObjectivesOur aim is to summarize the current evidence on available antibiotic regimens for patients with bacterial BSI, focusing on drug choice, combination regimens and optimal dosing schedules. We selected bacteria that are difficult to manage because of virulence factors (i.e. methicillin-susceptible S. aureus), tolerance to antibiotic activity (i.e. Enterococcus faecalis), and/or susceptibility patterns (i.e. methicillin-resistant S. aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii).SourcesMEDLINE search with English language and publication in the last 5 years as limits.Content and implicationsThe literature gaps on the use of new drugs, the uncertainties regarding the use of combination regimens, and the need to optimize dosing schedules in some circumstances (e.g. augmented renal clearance, renal replacement therapy, high inoculum BSI sources, and isolation of bacteria showing high MICs) have been revised.     

The diagnostic roles of neutrophil in bloodstream infections

Bloodstream infections remain a leading cause of death worldwide, despite advances in critical care and understanding of the pathophysiology and treatment strategies. No specific biomarkers or therapy are available for these conditions. Neutrophils play a critical role in controlling infection and it is suggested that their migration and antimicrobial activity are impaired during sepsis which contribute to the dysregulation of immune responses. Recent studies further demonstrated that interruption or reversal of the impaired migration and antimicrobial function of neutrophils improves the outcome of sepsis in animal models. In this review, we provide an overview of the associated diagnostic biomarkers involved neutrophils in sepsis, and discuss the potential of neutrophils as a target to specifically predict the outcome of sepsis.     

Socioeconomic burden of nosocomial infections

Nosocomial infection represents an important public health problem in developing countries as in developed ones. Economic concerns have taken on increasing importance in infection control since the mid 1970s in the USA, however there are few papers on the economics of NI in other countries. Studies on the costs of NI have used different methods, definitions and degrees of stringency when calculating indirect costs and there is therefore still uncertainty over their true economic impact on the community and on the workplace economy. Drug and especially antibiotic acquisition in addition to increased length of stay are the widely and well described parameters. Extra cost of NI include; bed, intensive care unit stay, hematological, biochemical, microbiological and radiological tests, antibiotics, other drugs, extra surgical procedures and working hours. In addition to high morbidity and mortality one of the well described parameters is the extra length of stay in the hospital. High mortality rates and economic expense which NI represents emphasizes the justification for measures of control of this entity. To estimate better the current personnel and financial resources necessary to support infection control activities and to prevent NI, it is imperative that those conducting studies of hospital epidemiology and healthcare outcomes research determine these current costs.