Ecthyma gangrenosum without bacteremia in a 54‐year‐old woman with heart transplant

Ecthyma gangrenosum is a cutaneous manifestation of severe systemic pseudomonas infection and is commonly associated with bacteremia. It is common in immunocompromised patients with underlying neutropenia or leukopenia. We report a patient with heart transplant who developed a single lesion of ecthyma gangrenosum in the absence of bacteremia with a review of reported cases in solid organ transplant patients.     

Staphylococcus aureus Bacteremia in Patients with Hematological Malignancies and/or Agranulocytosis

ABSTRACT. A total of 6 253 cases of Staphylococcus aureus bacteremia, including 274 (4.4%) endocarditis cases, were registered in Denmark in the period 1975–1984. Patients with hematological malignancies and/or agranulocytosis accounted for 479 of the bacteremia cases. The incidence of endocarditis in this group of patients was only 0.4% as compared to 4.7% in other patients with staphylococcal bacteremia (p<0.01). The lower incidence of endocarditis complicating bacteremia in these patients may justify a shorter course of therapy than usually recommended for suspected endocarditis. Patients with hematological malignancies and other patients with agranulocytosis had a higher mortality (49 and 46%, respectively) than other patients with S. aureus bacteremia (33%). The highest mortality was found in patients with multiple myeloma (71%, p<0.01), the lowest in patients with acute lymphocytic leukemia (28%, p<0.01). The higher mortality in these patients may indicate that empiric antibiotic regimens in granulocytopenic patients should include a specific anti-staphylococcal agent.     

Treatments and limitations for methicillin-resistant Staphylococcus aureus: A review of current literature

Methicillin-resistant Staphylococcus aureus (MRSA) has remained a major threat to healthcare; in both hospital and community settings over the past five decades. With the current use of antibiotics for a variety of infections, including MRSA, emerging resistance is a major concern. Currently available treatments have restrictions limiting their use. These issues include, but are not limited to, side effects, cross-resistance, lack of understanding of pharmacokinetics and clinical pharmacodynamics, gradual increment in minimal inhibitory concentration over the period (MIC creep) and ineffectiveness in dealing with bacterial biofilms. Despite availability of various therapeutic options for MRSA, the clinical cure rates remain low with high morbidity and mortality. Given these challenges with existing treatments, there is a need for development of novel agents for MRSA. Along with prompt infection control strategies and strict implementation of antibiotic stewardship, cautious use of newer anti-MRSA agents will be of utmost importance. This article reviews the treatments and limitations of MRSA management and highlights the future path.     

Nucleolar immunofluorescence in bone marrow specimens of human hematological malignancies

Summary Leukemic cells and myeloma cells were studied in bone marrow of untreated patients with acute and chronic myeloid leukemia, chronic lymphocytic leukemia, and multiple myeloma to provide more information on the nucleolar immunofluorescence produced by antibodies to nucleoli of HeLa cells. The nucleolar immunofluorescence was mainly observed in myeloblasts of myeloid leukemias an in immature as well as mature cells of the plasmacytic or lymphocytic cell lines of multiple myeloma or chronic lymphocytic leukemia. With respect to the nucleolar immunofluorescence, both positive and negative populations of cells were noted in the specimens of all patients studied.These studies were supported in part by Cancer Research Grant CA-10893, awarded by the National Cancer Institute, Department of Health, Education, and Welfare; the Bristol-Myers Fund; the DeBakey Medical Foundation; the Pauline Sterne Wolff Memorial Foundation; and the William S. Farish Fund     

Ecthyma gangrenosum in a 3‐year‐old boy post‐heart transplantation

Ecthyma gangrenosum (EG) is a serious bacterial infection in immunocompromised patients. EG in transplant recipients is rarely reported and may go unrecognized, which may delay initiation of appropriate treatment. We report a case of EG in a pediatric heart transplant recipient who was treated successfully with antibiotics and surgical debridement.     

Treatment of methicillin-resistant Staphylococcus aureus infections:Importance of high vancomycin minumum inhibitory concentrations

Staphylococcus aureus(SA) infections remain a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics.This organism is responsible for both nosocomial and community-acquired infections ranging from relatively minor skin and soft tissue infections to life-threateningsystemic infections.The increasing incidence of methicillin-resistant strains has granted an increasing use of vancomycin causing a covert progressive increase of its minimum inhibitory concentration(MIC)(dubbed the MIC "creep").In this way,the emergence of vancomycinintermediate SA(VISA) strains and heteroresistantVISA has raised concern for the scarcity of alternative treatment options.Equally alarming,though fortunately less frequent,is the emergence of vancomycin-resistant SA.These strains show different mechanisms of resistance but have similar problems in terms of therapeutic approach.Ultimately,various debate issues have arisen regarding the emergence of SA strains with a minimum inhibitory concentration sitting on the superior limit of the sensitivity range(i.e.,MIC = 2 μg/mL).These strains have shown certain resilience to vancomycin and a different clinical behaviour regardless of vancomycin use,both in methicillin-resistant SA and in methicillin-sensitive SA.The aim of this text is to revise the clinical impact and consequences of the emergence of reduced vancomycin susceptibility SA strains,and the different optimal treatment options known.     

Candida krusei– a serious complication in patients with hematological malignancies: successful treatment with caspofungin

Abstract: Candida krusei infections are serious complications in neutropenic patients with hematological malignancies. We report the successful treatment of C. krusei infection with caspofungin in 3 allogeneic hematopoietic stem cell transplant recipients and 1 patient with induction chemotherapy for acute myeloid leukemia.     

Specific cutaneous infiltrate caused by Staphylococcus aureus in a patient with chronic myelomonocytic leukemia

We present a patient with chronic myelomonocytic leukemia who showed disseminated papules and nodules. Arguments in favor of leukemia cutis are the clinical appearance, the cyclic pattern with which the lesions appeared and disappeared, and the histologic features. The lesions reproducibly responded to treatment with antibiotics given for a Staphylococcus aureus infection. We speculate that at least in some patients, leukemic cells are recruited in the skin because of local infection and do not merely reflect autonomous growth but an inflammatory response. Received: 12 August 1999 / Accepted: 9 December 1999     

The characteristics and prognostic significance of the SET-CAN/NUP214 fusion gene in hematological malignancies: A systematic review

Background:The SET-CAN/NUP214 fusion gene resulting from chromosomal del(9)(q34.11q34.13) or t(9;9) (q34;q34) has been found in T-cell acute lymphoblastic leukemia (T-ALL), B-cell acute lymphoblastic leukemia (B-ALL), acute myeloid leukemia (AML) and myeloid sarcoma (MS). Furthermore, the SET-CAN/NUP214 fusion gene has been found in the T-ALL cell line LOUCY and the AML line MEGAL. The common features of these cases are insensitivity to chemotherapy and poor prognosis. We reviewed the characteristics and prognostic significance of the SET-CAN/NUP214 fusion gene in hematological malignancies.Methods:This systematic literature search was conducted using the PubMed, Web of Science, Embase, and Cochrane Library databases. With the inclusion and exclusion criteria, we summarized all of the papers and performed a statistical analyses.Results:In general, the SET-CAN/NUP214 fusion gene is very rare in adult acute leukemia, more frequently found in T-ALL than in other types of leukemia, and more often in males. Flow cytometry data indicated that the markers CD34, CD33, CD13, and CD7 were common in SET-CAN/NUP214 positive acute leukemia, including ALL. Fluorescence in situ hybridization and arrays are important methods for detecting the fusion gene in newly diagnosed patients and can detect chromosomal del(9)(q34) will be detected. The chromosomal karyotype may be normal or complex, and, in terms of survival analysis, transplantation results in a better prognosis than chemotherapy alone.Conclusions and implications of key findings:The presence of SET-CAN/NUP214 fusion gene may be a Minimal Residual Disease of early recurrence, and it might be a poor indicator of outcome.Limitations:The mechanism, clinical characteristics, therapy and prognosis of the SET-CAN/NUP214 fusion gene in hematological malignancies require further research.     

2011年医院金黄色葡萄球菌临床分布及耐药性研究

目的调查金黄色葡萄球菌(SA)和耐甲氧西林金黄色葡萄球菌(MRSA)临床分布情况及其对常用抗菌药物的耐药率。方法对我院2011年检出的SA和MRSA药敏结果分析。结果 2011年共检出SA 146株(其中MRSA 29株),菌株主要来源为痰液49株(33.56%),脓液37株(25.34%),泌尿生殖道分泌物11株(7.53%);菌株分布前三位的科室是神经外科36株(24.66%)、创伤外科24株(16.44%)、呼吸消化科17株(11.64%);其中MRSA 29株(19.8%)。分离的146株SA对万古霉素、利奈唑胺全部敏感,其中MRSA对红霉素、克林霉素、四环素和环丙沙星呈现较高的耐药率,达70%以上;MRSA对各种抗生素的耐药率均明显高于MSSA,并呈现多重耐药。结论通过对SA临床分布和耐药率的分析,有利于采取措施控制医院内MR-SA的感染及流行并能指导临床合理用药。     

夫西地酸治疗37例耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎临床观察

目的 观察夫西地酸治疗耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎临床疗效.方法 选择耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎患者37例.应用夫西地酸钠0.5 g加入0.9%氯化钠注射液250 ml中,静脉滴注,1次/8 h,60 min滴入,连用10～14 d,观察其临床疗效、细菌清除率、肝肾功能变化、不良反应.结果夫西地酸治疗耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎临床治愈率为67.6%,有效率为86.5%.细菌清除率为62.2%;治疗过程中对肝肾功能无明显影响;无明显不良反应.结论 夫西地酸作为一种安全性较高的药物,对耐甲氧西林金黄色葡萄球菌性呼吸机相关性肺炎效果较好.对于老年和(或)肾功能不良(或潜在不良)患者,可选择该药治疗.     

金黄色葡萄球菌检测方法的进展

金黄色葡萄球菌尤其是耐甲氧西林金黄色葡萄球菌的感染日益增多,对人类健康造成巨大威胁.传统检测方法存在局限性,本文从分子生物学和免疫学方法两方面对目前金黄色葡萄球菌检测方法的进展进行综述,分析比较了各类方法的优缺点.     

耐甲氧西林金黄色葡萄球菌对万古霉素敏感性的变迁

目的　通过对近年来耐甲氧西林金黄色葡萄球菌 (MRSA)临床分离株对万古霉素抑菌圈直径的分析 ,研究MRSA对万古霉素敏感性的变化。方法　药敏试验采用纸片扩散法 (K B法 ) ,抑菌圈直径的比较采用t检验。结果　 1994～ 2 0 0 0年每年收集的临床分离的MRSA菌株数分别为 2 18、187、2 92、2 37、35 1、886和 6 5 2 ,各年菌株对万古霉素抑菌圈的平均直径 (mm)分别为 19 9、19 1、18 6、17 4、18 4、18 2和 17 8。 2 0 0 0年的 6 5 2株MRSA对万古霉素抑菌圈的平均直径 (17 8mm)明显小于1994年 2 18株MRSA的平均直径 (19 9mm) ,差异有显著性 (P <0 0 0 1)。 2 0 0 0年分离的MRSA对氯霉素、环丙沙星、红霉素、庆大霉素、四环素和复方新诺明等常用抗生素的耐药率均很高 ,其耐药百分率分别为 44 0 %、73 7%、89 1%、6 5 7%、6 1 0 %和 6 7 0 %。结论　 1994年到 2 0 0 0年MRSA对万古霉素的敏感性在逐年降低 ,加强金黄色葡萄球菌对万古霉素敏感性的监测非常必要。     

低水平万古霉素耐药金黄色葡萄球菌的研究进展

近年来,万古霉素耐药的金黄色葡萄球菌不断增多,给临床抗感染治疗带来新的难题,正确认识万古霉素耐药的金黄色葡萄球菌对于临床医生及感染控制人员非常重要.本文对低水平万古霉素耐药金黄色葡萄球菌的流行病学、检测、耐药机制及治疗方面做简要综述.     

食品中金黄色葡萄球菌致病性研究进展

金黄色葡萄球菌作为一种重要的食源性致病菌,可通过多种途径污染食品产生毒素而使食用者出现葡萄球菌性食物中毒症状。但除引发食品安全问题外,金黄色葡萄球菌还会造成临床感染。对其致病性进行研究既有利于预防和控制食源性疾病的发生,也能为临床治疗提供新的切入点。本文分析了食品中常见菌株类型及其特性,总结了食品加工方式对菌株致病性的影响以及目前致病性研究的主要技术方法,以期为金黄色葡萄球菌致病性相关研究提供参考。     

脓毒症金黄色葡萄球菌感染监测及治疗体会

目的分析常见抗菌药物敏感性及对确诊金黄色葡萄球菌感染脓毒症患者目标性治疗情况。方法收集兰州军区兰州总医院2009年1—3月送检血液标本及2010年1—3月送检的多种标本(血液、痰、支气管肺泡灌洗液等)。筛选送检的阳性标本中2次或2次以上培养出同一种金黄色葡萄球菌的脓毒症患者72例,记录用药情况,病情转归。结果 2010年1—3月共收集各种微生物标本3153份,检出阳性标本1108份,分离出细菌和真菌1557株,其中金黄色葡萄球菌106株(6.81%),耐甲氧西林金黄色葡萄球菌(MRSA)61株,占金黄色葡萄球菌的57.55%;2009年及2010年血液标本中金黄色葡萄球菌检出率分别为8.33%和10.71%。MRSA对万古霉素、利奈唑胺敏感性相当,对万古霉素耐药率为4.92%。对确诊金黄色葡萄球菌感染患者进行目标性治疗,临床疗效较好。结论金黄色葡萄球菌是脓毒症患者重要致病菌之一,耐药率较高,2010年同期检出率高于2009年,利奈唑胺是治疗耐药金黄色葡萄球菌感染的良好选择。     

Abdominal ultrasound findings mimicking hematological malignancies in a study of 218 gaucher patients

Gaucher disease, the most prevalent sphingolipidosis, generally presents with splenomegaly, anemia, and thrombocytopenia. Hence, hematologists are often the specialists involved in diagnosis and management of these patients. We present ultrasonographic characteristics in a cohort of 218 consecutive Gaucher patients evaluated in our clinic during the past 5 years. Our data emphasize the high prevalence of lesions mimicking hematological malignancies in Gaucher disease. One fifth of 184 non-splenectomized patients had intra-splenic lesions, 6% of all patients had similar lesions in the liver, and 32% of 34 splenectomized patients (but none of the other patients) had marked retroperitoneal or peri-portal lymphadenopathy. The presence of splenic lesions correlated with age and splenic size, but not with extent of bone involvement or genotype. Interestingly, they were not affected by reduction in splenomegaly following enzyme replacement therapy. The importance of these findings is to include Gaucher disease in the differential diagnosis of splenic or hepatic lesions, especially in Ashkenazi Jews. Conversely, they are relevant for follow-up of all Gaucher patients, including asymptomatic individuals, because of the reported increased incidence of hematological malignancies in Gaucher disease. Am. J. Hematol. 55:28-34, 1997. © 1997 Wiley-Liss, Inc.     

Prolonged viremia in dengue virus infection in hematopoietic stem cell transplant recipients and patients with hematological malignancies

Fever, skin rash, headache, and thrombocytopenia are considered hallmarks of dengue infection. However, these symptoms are frequently observed in infectious and non‐infectious complications of hematopoietic stem cell transplant recipients and oncohematological patients. Thus, laboratory confirmation of dengue is relevant for prompt intervention and proper management of dengue in endemic and non‐endemic regions. Because no prospective study of dengue has been conducted in these populations, the actual morbidity and mortality of dengue is unknown. In the present series, we describe five cases of dengue in patients living in endemic areas, emphasizing the prolonged course of the disease and the occurrence of prolonged viremia.     

Effects of preoperative Staphylococcus aureus screening and targeted decolonization bundle protocols in cardiac surgery: a nine-year review of a regional cardiovascular center in China

BackgroundNosocomial infection (NI) prolongs hospital stay and heightens mortality among patients who underwent cardiac surgery. We constructed a retrospective study to explore the prevalence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (SA/MRSA) nasal colonization, as well as the effects of SA/MRSA decolonization bundle measures on SA/MRSA-related infection among Chinese cardiac patients.MethodsAfter reviewing the medical records, we divided cardiovascular surgery patients treated at our central campus into two groups: the baseline group (treated between January 2012 and December 2013) and the intervention group (treated between May 2014 and December 2020). Intervention measures consisted of preoperative nasal screening and targeted decolonization bundle therapy. The medical records of patients at our southern campus (treated between January 2017 and December 2020) were collected as an additional control group, since we did not implement SA intervention measures at this location. The incidences of SA/MRSA-related NI were then compared between the groups.ResultsThere were 794 patients in the baseline group and 2,826 in the intervention group. A total of 131 (4.6%) patients had SA nasal colonization, and among them, 33 patients (1.2%) were MRSA colonized. SA/MRSA was cleared in approximately 95% of the carriers. The total level of SA-related infection was significantly lower in the intervention group compared to the baseline group [0.354% vs. 1.133%, respectively; P=0.021; risk ratio (RR): 0.312; 95% confidence interval (CI): 0.127–0.766]. The incidence of MRSA-related infection followed the same trend (0.212% vs. 0.756%, respectively; P=0.030; RR: 0.281; 95% CI: 0.091–0.860). When compared to the southern campus, SA intervention measures at the central campus resulted in a significant reduction in total SA-related infection (1.132% vs. 0.284%, respectively; P=0.035; RR: 0.251; 95% CI: 0.077–0.820).ConclusionsThe prevalence of SA/MRSA colonization is relatively low among Chinese patients who received cardiovascular surgery. Targeted decolonization bundle therapy was associated with cleared colonization and reduced incidence of SA/MRSA-related infection.