Mycobacterium neoaurum bacteremia in a hemodialysis patient.

Bacteremia due to Mycobacterium neoaurum, a rapidly growing mycobacterium, is described in a diabetic woman on hemodialysis. This is the first reported case of M neoaurum bacteremia in Canada. The organism initially grew on standard BacT/Alert SA aerobic blood cultures, and was subsequently positively identified using 16S rRNA sequence analysis. The present case serves to reinforce the need for a high index of clinical suspicion of infections caused by unusual microorganisms in the context of an immunocompromised host.     

The acquired immunodeficiency syndrome and Mycobacterium avium-intracellulare bacteremia in a patient with hemophilia

A 27-year-old previously healthy man with hemophilia presented with Pneumocystis carinii pneumonia. The patient had several episodes of oral candidiasis followed by disseminated infection with Mycobacterium avium-intracellulare. He was not homosexual nor did he take illicit drugs, but he had been self-administering two to four monthly infusions of factor VIII concentrate for 7 years. In-vitro lymphocyte studies showed findings consistent with the acquired immunodeficiency syndrome that had previously been reported only in homosexual men, drug addicts, and Haitian refugees. The cause of this syndrome is unknown, but the possibility that it is associated with a transmissible agent acquired through the use of blood products such as factor VIII concentrate must be considered.     

Mycobacterium tuberculosis bacteremia in a university hospital.

SETTING: Patients with blood cultures positive for Mycobacterium tuberculosis between 1988 and 1999. OBJECTIVE: To study the clinical and microbiological characteristics of patients with tuberculous bacteremia, including data about evolution and management. DESIGN: Retrospective review of the clinical charts and microbiological records of patients with culture-proven tuberculous bacteremia between 1988-1999. RESULTS: During the study period, 19 patients with culture-proven M. tuberculosis bacteremia were detected (1.42 isolates/patient, 4.7% of all patients with blood cultures for mycobacteria). Four patients were non-infected with the human immunodeficiency virus and 15 were HIV-infected. In four patients blood was the only positive sample. Five patients were diagnosed simultaneously with tuberculosis and HIV infection. Only 13 had a temperature higher than 37.5 degrees C. Most patients had symptoms or signs of respiratory tract involvement, and 11 patients died (10 from tuberculosis). The average time for detection of positive blood cultures was 33.25 days for lysis-centrifugation cultures and 26.46 days for BACTEC cultures. The incidence of M. tuberculosis bacteremia remained stable during the study period. CONCLUSIONS: Although blood cultures are useful for definitive diagnosis of disseminated tuberculosis, the long incubation times made them of limited usefulness in the clinical management of patients. Mortality remains high in these patients.     

Mycobacterium neoaurum causing prosthetic valve endocarditis: a case report and review of the literature

Mycobacterium neoaurum is a rare cause of bacteremia, and infection usually occurs in an immunocompromised host in the setting of an indwelling catheter. Prosthetic valve endocarditis due to non-tuberculous mycobacteria typically carries a dismal prognosis; we report a case of M. neoaurum prosthetic valve endocarditis with favorable response to antimicrobial therapy without surgical intervention.     

Helicobacter canis bacteremia in a renal transplant patient

Here we present a case report of a 41‐year‐old woman suffering from high fever and bacteremia due to Helicobacter canis, 11 months after kidney transplantation. Identification of H. canis was achieved by 16s rDNA sequence analysis of a positive blood culture. The patient was restored fully to health after antibiotics therapy (cefuroxime and ciprofloxacin). Until now, only 4 human clinical cases have been described with H. canis bacteremia. This study describes for the first time, to our knowledge, an infection with H. canis in a kidney transplant patient.     

Catheter-associated bacteremia by Mycobacterium senegalense in Korea

Background  

Rapidly growing mycobacteria is recognized as one of the causative agents of catheter-related infections, especially in immunocompromised hosts. To date, however, Mycobacterium senegalense, which was known as the principal pathogen of bovine farcy, has not been reported in human infection.     

Pulmonary infection with Mycobacterium neoaurum identified by 16S ribosomal DNA sequence

Mycobacterium neoaurum infection has rarely been found in humans, and only a limited number of cases have been reported. We describe the first case of pulmonary infection with M. neoaurum. We speculate that unrecognized aspiration and long-term corticosteroid therapy predisposed our patient to this rare mycobacterial infection.     

Stent migration in a hemodialysis patient

Haemodialysis is the most frequently used treatment of chronic renal failure which cannot be performed with out vascular access, of which arteriovenous fistula is the most frequently used. One of the complication of arteriovenous fistula is venous stenosis. Its treatment is usually percutaneous angioplasty associated or not with stent. Rare cases of migration of stent have been reported.     

An outbreak of hemodialysis catheter-related bacteremia with sepsis caused by Streptococcus agalactiae in a hemodialysis unit

BackgroundRates of invasive group B Streptococcus (GBS; Streptococcus agalactiae) disease in adults are on the rise. Invasive GBS disease can be community- or healthcare-associated. We report an outbreak of GBS catheter-related bacteremia in a hemodialysis (HD) unit.Materials and methodsTwo patients undergoing HD at the same outpatient HD unit were admitted on the same day (within a few hours of each other) with catheter-related GBS bacteremia. A retrospective study was undertaken at the HD unit to address risk factors for febrile illness on the last HD session day. A detailed questionnaire was completed by all HD patients treated on the same day as the two GBS patients and by all members of the nursing and medical staff. Medical and nursing records of the HD unit were reviewed, as well as infection control and catheter care practices. Patients and staff members submitted swabs for culture.ResultsNo rectal or vaginal culture of any HD patient or staff member was positive for GBS. The development of recent febrile disease was significantly associated with the presence of a hemodialysis catheter (p = 0.028) and care for more than 30 min by a specific nurse during the last two HD sessions (p = 0.007).ConclusionsWe speculate that the GBS strain was transmitted from one patient to the other through the hands of medical personnel. No such outbreak has ever been reported in HD patients. The importance of strict infection control practices in HD units and the avoidance of catheters for long-term HD should be emphasized.     

Blood culture isolates in hemodialysis vascular catheter-related bacteremia

Hemodialysis requires reliable and recurrent access to the central circulation and arteriovenous fistulas or grafts are the preferred modes of vascular access. However, in many patients the use of external tunneled vascular catheters may be necessary. The major complication of tunneled catheters is infection. Understanding local epidemiologic patterns of dialysis catheter-related bacteremia may help in the management of these patients. To address this issue, we reviewed the 5-year microbiologic culture results from all bacteremic hemodialysis patients with tunneled catheters at our institution. During this period, there were 203 organisms isolated from 153 positive blood cultures. Gram-positive, Gram-negative, and fungal species represented 55.7%, 43.3%, and 1% of isolates, respectively. Positive blood cultures classified according to the presence of a single Gram-positive or single Gram-negative organism, single fungus, or polymicrobial organisms, accounted for 41.8%, 29.4%, 0.6% and 28.1% of infectious events. From 2000-2004, there was a numerical trend toward a decrease in Gram-positive infection (64.3% versus 34.8% respectively, P = 0.12) and a numerical trend toward an increase in Gram-negative and polymicrobial bacteremias (17.9 versus 21.7, P = 0.07 and 17.9 versus 43.5, P = 0.09, respectively). These data indicate that bacteremic events in hemodialysis patients with vascular catheters are commonly due to a single Gram-positive organism, but the incidence of Gram-negative and polymicrobial bacteremia may be increasing. If confirmed in a prospective trial, adjustment of empiric antibiotic regimens for suspected catheter-associated bacteremia may be indicated.     

Mycotic aneurysm of the abdominal aorta in a patient undergoing hemodialysis: an unusual complication of Staphylococcus aureus bacteremia.

When Staphylococcus aureus is repeatedly positive in blood cultures even under effective antibiotics therapy (vancomycin, teicoplanin, or rifampin), computed tomography scan and sonography should be performed early to exclude mycotic aneurysm of the deeply seated arteries, especially in patients with abdominal aortic calcification. Before 1990, the most common causative organism of suprarenal aortic mycotic aneurysm was Salmonella; since 1990, it has been gram-positive cocci (i.e., Streptococcus and Staphylococcus) rather than gram-negative bacilli (i.e., Salmonella), possibly because of the more invasive procedures performed in clinical settings, but this hypothesis needs further investigation.