Comparative analysis of midgut bacterial communities of Aedes aegypti mosquito strains varying in vector competence to dengue virus

Differences in midgut bacterial communities of Aedes aegypti, the primary mosquito vector of dengue viruses (DENV), might influence the susceptibility of these mosquitoes to infection by DENV. As a first step toward addressing this hypothesis, comparative analysis of bacterial communities from midguts of mosquito strains with differential genetic susceptibility to DENV was performed. 16S rRNA gene libraries and real-time PCR approaches were used to characterize midgut bacterial community composition and abundance in three Aedes aegypti strains: MOYO, MOYO-R, and MOYO-S. Although Pseudomonas spp.-related clones were predominant across all libraries, some interesting and potentially significant differences were found in midgut bacterial communities among the three strains. Pedobacter sp.- and Janthinobacterium sp.-related phylotypes were identified only in the MOYO-R strain libraries, while Bacillus sp. was detected only in the MOYO-S strain. Rahnella sp. was found in MOYO-R and MOYO strains libraries but was absent in MOYO-S libraries. Both 16S rRNA gene library and real-time PCR approaches confirmed the presence of Pedobacter sp. only in the MOYO-R strain. Further, real-time PCR-based quantification of 16S rRNA gene copies showed bacterial abundance in midguts of the MOYO-R strain mosquitoes to be at least 10–100-folds higher than in the MOYO-S and MOYO strain mosquitoes. Our study identified some putative bacteria with characteristic physiological properties that could affect the infectivity of dengue virus. This analysis represents the first report of comparisons of midgut bacterial communities with respect to refractoriness and susceptibility of Aedes aegypti mosquitoes to DENV and will guide future efforts to address the potential interactive role of midgut bacteria of Aedes aegypti mosquitoes in determining vectorial capacity for DENV.     

Microbial profile of the vitreous aspirates in culture proven exogenous endophthalmitis: A 10-year retrospective study

Purpose: To describe the microbiological profile and clinical outcome in the eyes with culture-proven exogenous endophthalmitis. Methods: A retrospective analysis of 495 eyes diagnosed as exogenous endophthalmitis was performed over a period of 10 years. In all, aseptically collected aqueous and vitreous aspirates were cultured for bacteria and fungus using standard microbiological techniques. Gram-stain and KOH preparation of the specimens were also performed. The antibiotic susceptibility testing for bacterial isolates was performed by Kirby–Bauer disk diffusion method. The treatment was modified according to the antibiotic sensitivity profile. The final clinical ocular condition was divided into improved, stable or deteriorated. Results: Of 148 culture-proven endophthalmitis eyes, 137 (92.57%) were referred from elsewhere, and 11 (7.43%) belonged to our institute. Aetiologically, 76 (51.35%) eyes were post-cataract surgery, 61 (41.22%) were post-traumatic, 5 (3.38%) eyes post-intravitreal anti-vascular endothelial growth factor injection, 5 associated with corneal diseases and 1 bleb-related endophthalmitis. In 31 (20.95%) eyes, primary intravitreal antibiotics were given outside. The cultures revealed monomicrobial growth in 92.57% (n = 137) and polymicrobial growth in 7.43% (n = 11). Among the bacteria (n = 121, 81.76%), Pseudomonas species dominated overall (n = 32, 27.11%) and post-operative (n = 26, 38.23%) endophthalmitis group. Staphylococcus epidermidis (n = 14, 28%) was prominent in post-traumatic endophthalmitis group. Ninety-two percent (n = 108 isolates) of bacteria were sensitive to vancomycin. In 78 (52.7%) eyes, the clinical ocular condition improved or remained stable while deteriorated in 51 (34.46%). Conclusion: A bacterial predominance was observed among causative organisms of exogenous endophthalmitis with Pseudomonas species being the most common. The appropriate surgical intervention improved or stabilised the visual acuity in nearly 50% eyes.     

Infections caused by Gordonia species at a medical centre in Taiwan, 1997 to 2008

The inability of conventional identification systems to accurately identify Gordonia spp. often results in the misdiagnosis of infections by these rare pathogens, which require genomic sequencing for precise identification. In the present study, we describe nine cases of the various types of infection caused by Gordonia spp. From 1997 to 2008, 66 isolates (from 30 patients) initially identified as Rhodoccus spp. by conventional biochemical methods, by the Bacteriology Laboratory of National Taiwan University Hospital, were retrospectively analysed to assess the accuracy of species identification. Fifteen of these isolates (from nine patients) were later found to be Gordonia spp. by two molecular methods: PCR-restriction fragment length polymorphism for heat shock protein gene (hsp65) and the 16S rRNA gene sequencing analysis. Gordonia sputi (n = 8) was the most common species, followed by Gordonia terrae (n = 7). Most of the isolates were isolated from blood (n = 11), followed by soft tissue (n = 2) and eye (n = 2). Five patients presented with bacteraemia and two of these had catheter-related bloodstream infection. Two patients had soft tissue infections and another two patients had infective keratitis and conjunctivitis. The random amplified polymorphic DNA patterns for isolates from different patients were different, indicating that they were genetically unrelated. Accurate identification with molecular methods is required if the role of Gordonia spp. in causing infection is to be recognized.     

Species-Level Identification of Actinomyces Isolates Causing Invasive Infections: Multiyear Comparison of Vitek MS (Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry) to Partial Sequencing of the 16S rRNA Gene

Actinomyces species are uncommon but important causes of invasive infections. The ability of our regional clinical microbiology laboratory to report species-level identification of Actinomyces relied on molecular identification by partial sequencing of the 16S ribosomal gene prior to the implementation of the Vitek MS (matrix-assisted laser desorption ionization–time of flight mass spectrometry [MALDI-TOF MS]) system. We compared the use of the Vitek MS to that of 16S rRNA gene sequencing for reliable species-level identification of invasive infections caused by Actinomyces spp. because limited data had been published for this important genera. A total of 115 cases of Actinomyces spp., either alone or as part of a polymicrobial infection, were diagnosed between 2011 and 2014. Actinomyces spp. were considered the principal pathogen in bloodstream infections (n = 17, 15%), in skin and soft tissue abscesses (n = 25, 22%), and in pulmonary (n = 26, 23%), bone (n = 27, 23%), intraabdominal (n = 16, 14%), and central nervous system (n = 4, 3%) infections. Compared to sequencing and identification from the SmartGene Integrated Database Network System (IDNS), Vitek MS identified 47/115 (41%) isolates to the correct species and 10 (9%) isolates to the correct genus. However, the Vitek MS was unable to provide identification for 43 (37%) isolates while 15 (13%) had discordant results. Phylogenetic analyses of the 16S rRNA sequences demonstrate high diversity in recovered Actinomyces spp. and provide additional information to compare/confirm discordant identifications between MALDI-TOF and 16S rRNA gene sequences. This study highlights the diversity of clinically relevant Actinomyces spp. and provides an important typing comparison. Based on our analysis, 16S rRNA gene sequencing should be used to rapidly identify Actinomyces spp. until MALDI-TOF databases are optimized.     

Speciation and susceptibility of Nocardia isolated from ocular infections

Twenty Nocardia spp. isolated from ocular infections were identified by 16S rRNA gene sequencing and susceptibility was determined using the E-test (AB Biodisk, Sweden). Species distribution among the 20 isolates was as follows: Nocardia levis (n = 7), Nocardia farcinica (n = 3), Nocardia abscessus (n = 2), Nocardia brasiliensis (n = 2), Nocardia amamiensis (n = 2), Nocardia puris (n = 1), Nocardia beijingensis (n = 1), Nocardia otitidiscaviarum (n = 1) and Nocardia thailandica (n = 1). All isolates were sensitive to amikacin. Eighteen (90%) isolates were sensitive to tobramycin, 11 (55%) to ciprofloxacin and gatifloxacin, and seven (35%) to azithromycin and clarithromycin. Molecular methods are useful for the identification and for the detection of Nocardia species that have not so far been reported in human infections.     

Aerobic and Anaerobic Microbiology of Surgical-Site Infection Following Spinal Fusion

The aerobic and anaerobic microbiology of surgical-site infections (SSI) following spinal fusion was retrospectively studied. This was done by reviewing the clinical and microbiological records at the Naval Hospital in Bethesda, Md., from 1980 to 1992. Aspirates of pus from 25 infection sites showed bacterial growth. Aerobic bacteria only were recovered from 9 (36%) specimens, anaerobic bacteria only were recovered from 4 (16%), and mixed aerobic and anaerobic bacteria were recovered from 12 (48%). Sixty isolates were recovered: 38 aerobes (1.5 isolates per specimen) and 22 anaerobes (0.9 isolate per specimen). The predominant aerobes were Escherichia coli (n = 8) and Proteus sp. (n = 7). The predominant anaerobes were Bacteroides fragilis group (n = 9) and Peptostreptococcus sp. (n = 6) isolates. An increase in recovery of E. coli and B. fragilis was noted in patients with bowel or bladder incontinence. This study highlights the polymicrobial nature of SSI and the importance of anaerobic bacteria in SSI following spinal fusion.     

Detection and Molecular Typing of Campylobacter Isolates from Human and Animal Faeces in Coastal Belt of Odisha,India

Introduction: Campylobacter-mediated diarrhoea is one of the major causes of gastroenteritis globally. A majority of the Campylobacter spp. that cause disease in humans have been isolated from animals. Faecal contamination of food and water is the identified frequent cause of human campylobacteriosis. Methodology: In the present study, faecal samples from patients with symptoms of acute diarrhoea (n = 310) and domestic animals including cows (n = 60), sheep (n = 45) and goats (n = 45) were collected from the same localities in the peri-urban Bhubaneswar city. Genomic DNA isolation followed by polymerase chain reaction and sequencing was employed to analyse Campylobacter spp.-positive samples. Results: Of the 460 faecal samples, 16.77% of human samples and 25.33% of animal samples were found to be positive for Campylobacter spp. Among animals, the isolation rate was highest in sheep followed by cows and goats with 9.33%, 8.66% and 7.33%, respectively. The highest number of Campylobacter-positive cases was diagnosed in infants of 2–5 years age. Concurrent infection of other pathogens in addition to Campylobacter spp. was frequently detected in the samples. Conclusion: The present study showed the incidence of Campylobacter infections in human and different animal species in and around Bhubaneswar, Odisha. The analysis suggested that domestic animals can be the potential sources for human campylobacteriosis in the region.     

Microbiological Features and Clinical Factors Associated with Empirical Antibiotic Resistance in Febrile Patients with Upper Urinary Tract Calculi

BackgroundTo investigate the clinical and microbiological features of febrile patients with upper urinary tract calculi and factors that affect empirical antibiotic resistance.MethodsA retrospective analysis was performed on 203 febrile patients hospitalized between January 2011 and December 2016 with antibiotic treatment for urinary tract infections and upper urinary tract calculi at three institutions. We collected and analyzed data, including patients'' age, sex, body mass index, underlying diseases, stone-related factors, and the results of urine and blood culture examinations and antibiotic sensitivity tests.ResultsThe male-to-female ratio was 1:2.3. Bacteria were identified in 152 of the 203 patients (74.9%). The most commonly cultured microorganisms included Escherichia coli (44.1%), followed by Enterococci spp. (11.8%), Proteus spp. (8.6%), Streptococcus agalactiae (6.6%), Klebsiella spp. (5.3%), Pseudomonas spp. (4.6%), coagulase-negative Staphylococcus (4.0%), Staphylococcus epidermidis (4.0%), Serratia spp. (2.6%), Enterobacter spp. (0.7%), Acinetobacter spp. (0.7%), and mixed infections (7.2%). Cultured bacterial species showed sex-specific differences. Multivariate analysis revealed that calculi''s multiplicity was an independent predictive factor for quinolone resistance (P = 0.008). Recurrent infections were a significant predictor of cefotaxime resistance during multivariable analysis (P = 0.041).ConclusionBased on the present study results, quinolone was not recommended as the empirical treatment in febrile patients with upper urinary tract calculi. Combination antibiotic therapy is recommended in cases of recurrent infections due to the possible occurrence of cefotaxime resistance.     

Epidemiology of urinary tract infections,bacterial species and resistances in primary care in France

General practitioners often have to manage urinary tract infections (UTI) with probabilistic treatments, although bacterial resistances are increasing. Therefore, the French Society of Infectious Diseases published new guidelines in 2014. The aim of this study was to investigate the bacterial epidemiology of UTI in the general population in primary care and analyse risk factors for Escherichia coli resistance to antibiotics. A cross-sectional study was conducted in 12 ambulatory laboratories. Patients over 18 years of age coming for urinalysis were included. Risk factors for UTI were collected using a questionnaire and the laboratory records. Bacteria meeting criteria for UTI were analysed. A positive urinalysis was found in 1119 patients, corresponding to 1125 bacterial isolates. The bacterial species were: E. coli (73 %), Enterococcus spp. (7 %), Klebsiella spp. (6 %), Proteus spp. (4 %), Staphylococcus spp. (3 %) and Pseudomonas spp. (2 %). Regardless of the bacteria, the most common resistance was that to co-trimoxazole: 27 % (95 % confidence interval [CI]?=?[0.24; 0.30]), followed by ofloxacin resistance: 16 % [0.14; 0.18]. Escherichia coli resistances to co-trimoxazole, ofloxacin, cefixime, nitrofurantoin and fosfomycin were, respectively, 25.5 % [0.23; 0.28], 17 % [0.14; 0.20], 5.6 % [0.04; 0.07], 2.2 % [0.01; 0.03] and 1.2 % [0.005; 0.02]. Independent risk factors for E. coli resistance to ofloxacin were age over 85 years (odds ratio [OR]?=?3.08; [1.61; 5.87]) and a history of UTI in the last 6 months (OR?=?2.34; [1.54; 3.52]). Our findings support the guidelines recommending fluoroquinolone sparing. The scarcity of E. coli resistance to fosfomycin justifies its use as a first-line treatment in acute cystitis. These results should be reassessed in a few years to identify changes in the bacterial epidemiology of UTI.     

Candidaemia with uncommon Candida species: predisposing factors, outcome, antifungal susceptibility, and implications for management

The risk factors for and clinical features of bloodstream infection with uncommon Candida spp. (species other than C. albicans, C. glabrata, C. parapsilosis, C. tropicals and C. krusei) are incompletely defined. To identify clinical variables associated with these species that might guide management, 57 cases of candidaemia resulting from uncommon Candida spp. were analysed in comparison with 517 episodes of Candida albicans candidaemia (2001–2004). Infection with uncommon Candida spp. (5.3% of candidaemia cases), as compared with C. albicans candidaemia, was significantly more likely to be outpatient-acquired than inpatient-acquired (15 of 57 vs. 65 of 517 episodes, p 0.01). Prior exposure to fluconazole was uncommon (n = 1). Candida dubliniensis was the commonest species (n = 22, 39%), followed by Candida guilliermondii (n = 11, 19%) and Candida lusitaniae (n = 7, 12%). C. dubliniensis candidaemia was independently associated with recent intravenous drug use (p 0.01) and chronic liver disease (p 0.03), and infection with species other than C. dubliniensis was independently associated with age <65 years (p 0.02), male sex (p 0.03) and human immunodeficiency virus infection (p 0.05). Presence of sepsis at diagnosis and crude 30-day mortality rates were similar for C. dubliniensis-related, non-C. dubliniensis-related and C. albicans-related candidaemia. Haematological malignancy was the commonest predisposing factor in C. guilliermondii (n = 3, 27%) and C. lusitaniae (n = 3, 43%) candidaemia. The 30-day mortality rate of C. lusitaniae candidaemia was higher than the overall death rate for all uncommon Candida spp. (42.9% vs. 25%, p not significant). All isolates were susceptible to amphotericin B, voriconazole, posaconazole, and caspofungin; five strains (9%) had fluconazole MIC values of 16–32 mg/L. Candidaemia due to uncommon Candida spp. is emerging among hospital outpatients; certain clinical variables may assist in recognition of this entity.     

Molecular Characterization of Methicillin-Susceptible Staphylococcus aureus Clinical Isolates in the United States, 2004 to 2010

While much is known about the geographic distribution of different clonal types of methicillin-resistant Staphylococcus aureus (MRSA), few studies have assessed the molecular epidemiology of methicillin-susceptible S. aureus (MSSA), despite its continued clinical importance. In each U.S. Census region, reference laboratories collected successive MSSA isolates from patients with invasive or superficial staphylococcal infections for use in the Tigecycline Evaluation and Surveillance Trial. All isolates from the periods of 2004 to 2005 and 2009 to 2010 underwent antimicrobial susceptibility testing and characterization of their staphylococcal protein A (spa) type. Of the 708 isolates analyzed, 274 spa types were identified and divided into 15 genetic clusters. The most common clones were spa t002 (n = 63, 8.9%) and t008 (n = 56, 7.9%). While the distribution of the predominant spa types did not differ by U.S. Census region or time period, spa t008 was nearly twice as common in community skin and soft tissue infections than in nosocomial bloodstream infections (11.1% versus 5.6%, respectively; P = 0.008). Despite such differences, both community and nosocomial settings had diverse staphylococcal clonal types representing all major spa clusters. In contrast to those of MRSA, MSSA infectious isolates show wide genetic diversity without clear geographical or temporal clustering. Notably, the prevalent MSSA strains (spa t002 and spa t008) are analogous to the predominant MRSA clones, further demonstrating the importance of both lineages.     

Skin and soft-tissue infections caused by Aeromonas species

This study investigated the clinical characteristics of patients with skin and soft-tissue infections (SSTIs) due to Aeromonas species. Patients with SSTIs caused by Aeromonas species during the period from January 2009 to December 2011 were identified from a computerized database of a regional hospital in southern Taiwan. The medical records of these patients were retrospectively reviewed. A total of 129 patients with SSTIs due to Aeromonas species were identified. A. hydrophila (n?=?77, 59.7 %) was the most common pathogen, followed by A. veronii biovar sobria (n?=?22, 17.1 %), A. veronii biovar veronii (n?=?20, 15.5 %), A. caviae (n?=?9, 7.0 %), and A. schubertii (n?=?1, 0.8 %). The most common isolates obtained from patients with polymicrobial infections were Klebsiella species (n?=?33), followed by Enterococcus spp. (n?=?24), Enterobacter spp. (n?=?21), Escherichia coli (n?=?17), Staphylococcus spp. (n?=?17), Streptococcus spp. (n?=?17), and Acinetobacter spp. (n?=?15). Liver cirrhosis and concomitant bacteremia were more common among patients with monomicrobial Aeromonas SSTIs than among patients with polymicrobial SSTIs. Nine (7 %) patients required limb amputations. The in-hospital mortality rate was 1.6 %. In conclusion, Aeromonas species should be considered as important causative pathogens of SSTIs, and most infections are polymicrobial. In addition, the clinical presentation differs markedly between patients with monomicrobial and those with polymicrobial Aeromonas SSTIs.     

In vitro activity of the novel siderophore cephalosporin,cefiderocol, in Gram-negative pathogens in Europe by site of infection

ObjectivesWe assessed the activity of the novel siderophore cephalosporin, cefiderocol and selected other antibacterial agents against Gram-negative bacterial isolates in Europe.MethodsIsolates were obtained between 2013 and 2018 from European countries participating in the SIDERO-WT and SIDERO-Proteeae multinational surveillance studies. Isolates were categorised by infection site, focusing on bloodstream infections, hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP), complicated intra-abdominal infections and complicated urinary tract infections. Cefiderocol activity was compared with ceftazidime–avibactam, ceftolozane–tazobactam, colistin and meropenem using standard susceptibility testing methods. European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints were used to interpret susceptibility data.ResultsIsolates (n = 20 911) were collected from 145 sites in 24 countries in Europe, the highest proportion (34%) being from patients with HABP/VABP. Enterobacterales (66.6% of isolates) were more frequent than glucose non-fermenting species (33.4%) overall, with some differences between infection sites. Across all infection sites, the MIC₅₀/MIC₉₀ for cefiderocol was ≤0.5/≤2 mg/L for Enterobacter spp., ≤0.25/<2 mg/L for Klebsiella spp., 0.12/2 mg/L for Acinetobacter spp., ≤0.25/1 mg/L for Pseudomonas aeruginosa and ≤0.12/≤0.5 mg/L for Stenotrophomonas maltophilia. Across all infection sites, cefiderocol MICs were ≤2 mg/L for ≥96% of Enterobacter spp., ≥95% of Klebsiella spp., ≥90% of Acinetobacter spp. and ≥99% of Pseudomonas aeruginosa and Stenotrophomonas maltophilia isolates. Cefiderocol maintained high activity in carbapenem-resistant isolates, and the difference in activity between carbapenem-resistant (percentage susceptibility at EUCAST breakpoint: E. coli 77.8%, Klebsiella spp. 69.2%, Pseudomonas aeruginosa 97.5%, Acinetobacter spp. 90.7%, Stenotrophomonas maltophilia 99.6%) and carbapenem-susceptible (percentage susceptibility at EUCAST breakpoint: E. coli 99.4%, Klebsiella spp. 98.0%, Pseudomonas aeruginosa 99.7%, Acinetobacter spp. 94.9%) isolates was lower for cefiderocol than other agents.ConclusionsCefiderocol had excellent activity against all Gram-negative species, independent of key infection site and carbapenem MIC. Cefiderocol is a useful addition to the therapeutic options available for these difficult-to-treat infections.     

Clinical and microbiological features of bacteraemia with Gram-positive anaerobic cocci: a population-based retrospective study

ObjectivesGram-positive, anaerobic cocci (GPAC) can cause infections in humans. Only a few cases of bacteraemia with GPAC have been reported. We describe the clinical and microbiological characteristics of GPAC bacteraemia.MethodsA retrospective population-based study of GPAC bacteraemia 2012–2016 in southern Sweden was performed. GPAC were identified using matrix-associated laser desorption ionization time-of-flight mass spectrometry or 16S rRNA gene sequencing. Etests were used to determine antibiotic susceptibilities. Data on patient and infection characteristics, treatment, and outcome were collected from the medical records.ResultsA total of 226 episodes of GPAC bacteraemia in adults were studied; this corresponds to an annual incidence of 3.4 cases per 100,000 persons per year. The bacteria identified were Anaerococcus spp. (n = 43), Atopobium spp. (n = 7), Blautia spp. (n = 1), Finegoldia spp. (n = 15), Parvimonas spp. (n = 100), Peptoniphilus spp. (n = 52), Peptostreptococcus spp. (n = 2), and Ruminococcus spp. (n = 9) of which 200 isolates were identified to the species level. Resistance to imipenem and piperacillin was not identified, whereas resistance among the 229 isolates to penicillin was detected in four, to metronidazole in six, and clindamycin in 16 isolates. The median age of patients was 73 years (55–83, IQR), 57% were male and comorbidities were common. Fifty-one per cent of infections were polymicrobial. In 60% of cases a focus of infection was identified. Forty per cent of patients had either organ dysfunction or shock. The 30-day mortality was 11%, and nosocomial infections were over-represented among the deceased.ConclusionsGPAC bacteraemia is much more common than previously reported. GPAC-bacteraemia is a condition with significant mortality mainly affecting elderly persons with comorbidities.     

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.     

Removal of waterborne pathogens from liver transplant unit water taps in prevention of healthcare-associated infections: a proposal for a cost-effective,proactive infection control strategy

Hospital water supplies often contain waterborne pathogens, which can become a reservoir for healthcare-associated infections (HAIs). We surveyed the extent of waterborne pathogen contamination in the water supply of a Liver Transplant Unit. The efficacy of point-of-use (POU) water filters was evaluated by comparative analysis in routine clinical use. Our baseline environmental surveillance showed that Legionella spp. (28%, 38/136), Pseudomonas aeruginosa (8%, 11/136), Mycobacterium spp. (87%, 118/136) and filamentous fungi (50%, 68/136) were isolated from the tap water of the Liver Transplant Unit. 28.9% of Legionella spp.-positive water samples (n = 38) showed high-level Legionella contamination (≥10³ CFU/L). After installation of the POU water filter, none of these pathogens were found in the POU filtered water samples. Furthermore, colonizations/infections with Gram-negative bacteria determined from patient specimens were reduced by 47% during this period, even if only 27% (3/11) of the distal sites were installed with POU water filters. In conclusion, the presence of waterborne pathogens was common in the water supply of our Liver Transplant Unit. POU water filters effectively eradicated these pathogens from the water supply. Concomitantly, healthcare-associated colonization/infections declined after the POU filters were installed, indicating their potential benefit in reducing waterborne HAIs.     

Quantitation of Bacteria in Blood of Typhoid Fever Patients and Relationship between Counts and Clinical Features, Transmissibility, and Antibiotic Resistance

Salmonella typhi was isolated from 369 and Salmonella paratyphi A was isolated from 6 of 515 Vietnamese patients with suspected enteric fever. Compared with conventional broth culture of blood, direct plating of the buffy coat had a diagnostic sensitivity of 99.5% (95% confidence interval [CI], 97.1 to 100%). Blood bacterial counts were estimated by the pour plate method. The median S. typhi count in blood was 1 CFU/ml (range, <0.3 to 387 CFU/ml), of which a mean of 63% (95% CI, 58 to 67%) were intracellular. The mean number of bacteria per infected leukocyte was 1.3 (interquartile range [IQR], 0.7 to 2.4) CFU/cell (n = 81). Children (<15 years old; n = 115) had higher median blood bacterial counts than adults (n = 262): 1.5 (range, <0.3 to 387) versus 0.6 (range, <0.3 to 17.7) CFU/ml (P = 0.008), and patients who excreted S. typhi in feces had higher bacteremias than those who did not: a median of 3 (range, <0.3 to 32) versus 1 (range, <0.3 to 68) CFU/ml (P = 0.02). Blood bacterial counts declined with increasing duration of illness (P = 0.002) and were higher in infections caused by multidrug-resistant S. typhi (1.3 [range, <0.3 to 387] CFU/ml; n = 313) than in infections caused by antibiotic-sensitive S. typhi (0.5 [range, <0.3 to 32] CFU/ml; n = 62) (P = 0.006). In a multivariate analysis this proved to be an independent association, suggesting a relationship between antibiotic resistance and virulence in S. typhi.     

Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

The Arctic Investigations Program (AIP) began surveillance for invasive group A streptococcal (GAS) infections in Alaska in 2000 as part of the invasive bacterial diseases population-based laboratory surveillance program. Between 2001 and 2013, there were 516 cases of GAS infection reported, for an overall annual incidence of 5.8 cases per 100,000 persons with 56 deaths (case fatality rate, 10.7%). Of the 516 confirmed cases of invasive GAS infection, 422 (82%) had isolates available for laboratory analysis. All isolates were susceptible to penicillin, cefotaxime, and levofloxacin. Resistance to tetracycline, erythromycin, and clindamycin was seen in 11% (n = 8), 5.8% (n = 20), and 1.2% (n = 4) of the isolates, respectively. A total of 51 emm types were identified, of which emm1 (11.1%) was the most prevalent, followed by emm82 (8.8%), emm49 (7.8%), emm12 and emm3 (6.6% each), emm89 (6.2%), emm108 (5.5%), emm28 (4.7%), emm92 (4%), and emm41 (3.8%). The five most common emm types accounted for 41% of isolates. The emm types in the proposed 26-valent and 30-valent vaccines accounted for 56% and 78% of all cases, respectively. GAS remains an important cause of invasive bacterial disease in Alaska. Continued surveillance of GAS infections will help improve understanding of the epidemiology of invasive disease, with an impact on disease control, notification of outbreaks, and vaccine development.     

Parasitic infections detected by FLOTAC in zoo mammals from Warsaw,Poland

The aim of this study was to estimate the occurrence of intestinal parasites in groups of mammals kept in the Warsaw zoological garden (Poland). 71 pools of fecal samples were analyzed using the FLOTAC techniques. 48% of animals were positive and 47% of positivities showed multiple infections. Toxocara cati (71.4%) was found in felines; marsupials were infected with Coccidia (90%). Giardia spp. (24.0%), Blastocystis spp. (12.3%), Iodamoeba spp. (10.0%), Enterobius vermicularis (6.0%) and Entamoeba coli (3.3%) were found in primates. Gastrointestinal strongyles (60.5%) were prevalent in ruminants which resulted positive also to Coccidia (Eimeria spp. = 50.0%), Trichuris spp. (25.0%) and Nematodirus (14.0%). Strongyles (34.0%) were the most frequent parasites in monogastric herbivores, followed by Parascaris equorum (17.0%). None of the animals showed any symptom associated with gastrointestinal parasitic infections. According to our results the need to prevent, diagnose, control, and treat intestinal parasitism trough specific control programs is mandatory for animal welfare in order to limit the spread of parasitic infections in animals and humans.     

Gastrointestinal parasite fauna of Emperor Penguins (Aptenodytes forsteri) at the Atka Bay,Antarctica

In general, the knowledge on parasites infecting Antarctic birds is scarce. The present study intends to extend the knowledge on gastrointestinal parasites of Emperor Penguins (Aptenodytes forsteri) at the Atka Bay, Antarctica. Fecal samples of 50 individual Emperor Penguins were collected at the Atka Bay and analyzed using the sodium-acetate-formaldehyde (SAF) method for the identification of intestinal helminth eggs and/or protozoan parasite stages. In addition, coproantigen ELISAs were performed to detect Cryptosporidium and Giardia infections. Overall, 13 out of 50 penguins proved parasitized (26 %). The following stages of gastrointestinal parasites were identified: One Capillaria sp. egg, Tetrabothrius spp. eggs, Diphyllobothrium spp. eggs, and proglottids of the cestode Parorchites zederi. The recorded Capillaria infection represents a new host record for Emperor Penguins. All coproantigen ELISAs for the detection of Cryptosporidium spp. and Giardia spp. were negative. This paper provides current data on parasites of the Emperor Penguin, a protected endemic species of the Antarctica.