Results of a multicentre European survey in 1991 of metronidazole resistance inHelicobacter pylori

In 1991 a multicentre survey on the prevalence of metronidazole resistance inHelicobacter pylori in vitro was carried out in 12 hospitals in 11 different European countries. The susceptibility ofHelicobacter pylori to metronidazole was determined in each centre by measuring the MIC on agar with the PDM E-test (AB Biodisk) according to a standard procedure. Overall, 122 of 443 (27.5 %) strains tested were resistant to metronidazole (MIC>8 µg/ml). The level of resistance to metronidazole varied markedly between centres (from 7 % to 49 %) and was found to be substantially higher in Africans and other non-Caucasian subjects than in natives from European countries. The overall rate of resistance to metronidazole was higher in females (34.7 %) than in males (23.9 %), and varied according to the age group, being highest among women aged 20 to 39 (50 %). Previous use of metronidazole was reported in only 16 patients, 11 of whom (68.8 %) harboured resistantHelicobacter pylori strains. Although differences in the rate of metronidazole resistance inHelicobacter pylori most probably relate to variations in use of this drug in different populations, such use may frequently go unrecognized. This study emphasises the importance of monitoring the drug resistance ofHelicobacter pylori on a local basis. Standardisation of the methods for testing the susceptibility ofHelicobacter pylori in vitro is clearly needed for this purpose.Y. Glupczynski (responsible author), Department of Clinical Microbiology, Brugmann University Hospital, 4 Place A. Van Gehuchten, B-1020 Brussels, Belgium; W. Langenberg, J. Dankert, L. Noach, E. Rauws, Department of Medical Microbiology and Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands; A. Mentis, Department of Bacteriology, Hellenic Pasteur Institute, Athens, Greece; F. Mégraud, H. Lamouliatte, Department of Microbiology and Department of Gastroenterology, Hôpital des Enfants, Bordeaux, France; D.S. Tompkins, Bradford Royal Infirmary, Bradford, UK; H. Xia, M. Daw, C. Keane, C. O'Morain, Department of Clinical Microbiology and Department of Gastroenterology, University of Dublin, Ireland; C.A.M. McNulty, Public Health Laboratory Service, Gloucester, UK; H. Gnarpe, C. Blomqvist, P. Unge, Department of Bacteriology, Gävle Hospital and Department of Medicine, Sandviken Hospital, Sweden; H. Rautelin, T. Kosunen, Department of Bacteriology and Immunology, University of Helsinki, Finland; J. Cabrita, I. Ribeiro Pires, Instituto Nacional de Saude, Lisboa, Portugal; M. Lopez-Brea, Department of Clinical Microbiology, Hospital de la Princesa, Madrid, Spain; N. Figura, Department of Microbiology, University of Siena, Italy.     

Disease Presentation in Relation to Infection Foci for Non-Pregnancy-Associated Human Listeriosis in England and Wales, 2001 to 2007

Listeriosis is a rare but severe food-borne disease, affecting unborn or newly delivered infants, the elderly, and the immunocompromised. The epidemiology of listeriosis in England and Wales changed between 2001 and 2007, with more patients ≥60 years old presenting with bacteremia (but without central nervous system [CNS] involvement). In order to explain this increase and understand the altered disease presentation, clinical, microbiological, and seasonal data on bacteremic cases of Listeria monocytogenes infection identified through national surveillance were compared with those for patients with CNS infections. Logistic regression analysis was applied while controlling for age. Bacteremic patients, who presented more frequently with gastrointestinal symptoms, were more likely to have underlying medical conditions than CNS patients. This was most marked in patients with malignancies, particularly digestive organ malignancies. Treatment to reduce stomach acid secretion modified the effect of nonmalignant underlying conditions on outcome, i.e., patients with an underlying condition who were not taking acid-suppressing medication were equally likely to have a bacteremic or a CNS infection. However, this type of therapy did not modify the effect of malignancies on the likelihood of having a bacteremic or a CNS infection. The increase in the incidence of human listeriosis among patients ≥60 years old in England and Wales between 2001 and 2007 appears to have occurred in those with cancer or other conditions whose treatment included acid-suppressing medication. Therefore, this vulnerable patient group needs specific dietary advice on avoiding risk factors for listeriosis.Listeria monocytogenes is an opportunistic bacterial pathogen that causes listeriosis and most often affects the immunocompromised, the elderly, pregnant woman, and their unborn or newly delivered infants. The disease is transmitted predominantly via contaminated food and is estimated to be the greatest cause of food-related deaths in the United Kingdom (7). A large outbreak of listeriosis, affecting mostly pregnant women and associated with the consumption of imported pâté, occurred in the United Kingdom in the late 1980s (16). Consequently, specific advice provided to pregnant women and immunocompromised individuals on foods to avoid in order to minimize the risk (Department of Health, Advice to vulnerable groups on pâté stands, press release 189/369, 1989; Department of Health and Social Security, Advice from the Chief Medical Officer: listeriosis and food, DHSS PL/CMO 89, 1989), has subsequently been reiterated and preferentially targeted at pregnant woman (Food Standards Agency, http://www.eatwell.gov.uk/agesandstages/pregnancy/?lang=en).The epidemiology of listeriosis in England and Wales changed between 1990 and 2007 (9). The incidence almost doubled (an average of 191 cases were reported annually between 2001 and 2007 versus 110 between 1990 and 1999), with the increase occurring mainly among patients aged ≥60 years presenting with bacteremia in the absence of central nervous system (CNS) infection (Fig. ​(Fig.1).1). These changes are independent of recognized outbreaks, gender, season, ethnicity, socioeconomic status, region, or L. monocytogenes subtype and are not thought to be artifactual. Similar patterns have been reported subsequently in other European countries (4, 10).Open in a separate windowFIG. 1.Trends in human listeriosis in England and Wales, 1990 to 2007 (Health Protection Agency, unpublished data).The purpose of this study was to identify clinical and epidemiological factors that might explain this increased incidence and altered disease presentation by interrogating surveillance data for listeriosis cases reported in England and Wales between 2001 and 2007.     

Online-Only Abstracts

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of both healthcare-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) infections. Severe MRSA infections have been associated with the virulence factor Panton- Valentine leukocidin (PVL). The aim of this study was to investigate susceptibility patterns, the presence of toxin genes, including that encoding PVL, and clonality among MRSA isolates collected from patients in Greece over a 12-year period. MRSA isolates were collected from January 2001 to December 2012 from six different hospitals. Antibiotic susceptibility was determined with the disk diffusion method and the Etest. The presence of the toxic shock syndrome toxin-1 gene (tst), the enterotoxin gene cluster (egc) and the PVL gene was tested with PCR. The genotypic characteristics of the strains were analysed by SCCmec and agr typing, and clonality was determined with pulsed-field gel electrophoresis and multilocus sequence typing. An increasing rate of MRSA among S. aureus infections was detected up to 2008. The majority of PVL-positive MRSA isolates belonged to a single clone, sequence type (ST)80-IV, which was disseminated both in the community and in hospitals, especially during the warmest months of the year. Carriage of tst was associated with ST30-IV, whereas egc was distributed in different clones. CA-MRSA isolates were recovered mainly from skin and soft tissue infections, whereas HA-MRSA isolates were associated with surgical and wound infections. During the period 2001-2012, ST80-IV predominated in the community and infiltrated the hospital settings in Greece, successfully replacing other PVL-positive clones. The predominance of ST239-III in HA-MRSA infections was constant, whereas new clones have also emerged. Polyclonality was statistically significantly higher among CA-MRSA isolates and isolates from adult patients.

Risk factors for colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae on admission to rehabilitation centres

E. Bilavsky^1,2, E. Temkin¹, Y. Lerman³, A. Rabinovich³, J. Salomon⁴, C. Lawrence⁵, A. Rossini⁶, A. Salvia⁶, J. V. Samso⁷, J. Fierro⁷, M. Paul^2,8, J. Hart^2,8, M. Gniadkowski⁹, M. Hochman¹, M. Kazma¹, A. Klein¹, A. Adler^1,2, M. J. Schwaber^2,10, Y. Carmeli^1,2 on behalf of the MOSAR WP5 study team1) Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, 2) Sackler Faculty of Medicine, Tel Aviv University, 3) Geriatric Division, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel, 4) Institut Pasteur, Paris, 5) Department of Microbiology, Assistance Publique Hôpitaux de Paris, CHU Raymond Poincare, Hôpital Maritime de Berck, Garches, France, 6) Fondazione Santa Lucia, Rome, Italy, 7) Hospital de Neurorehabilitacio, Institut Guttmann, Barcelona, Spain, 8) Loewenstein Rehabilitation Hospital, Ra’anana, Israel, 9) Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland and 10) National Center for Infection Control, Ministry of Health, Tel Aviv, IsraelOriginal Submission: 21 November 2013; Revised Submission: 17 March 2014; Accepted: 22 March 2014Editor: E. TacconelliArticle published online: 27 March 2014Clin Microbiol Infect 2014; 20: O804-O810

Abstract

Patients newly admitted to rehabilitation centres are at high risk of colonization with multidrug-resistant bacteria because many of them have experienced prolonged stays in other healthcare settings and have had high exposure to antibiotics. We conducted a prospective study to determine the prevalence of and risk factors for colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in this population. Subjects were screened by rectal swab for ESBL-PE within 2 days of admission. Swabs were plated on chromagar ESBL plates and the presence of ESBL was verified by a central laboratory. A multilevel mixed effects model was used to identify risk factors for ESBL-PE colonization. Of 2873 patients screened, 748 (26.0%) were positive for ESBL-PE. The variables identified as independently associated with ESBL-PE colonization were: recent stay in an acute-care hospital for over 2 weeks (OR = I.34; 95% CI, I.12, I.6), history of colonization with ESBL-PE (OR = 2.97; 95% CI, I.99, 4.43), unconsciousness on admission (OR = 2.59; 95% CI, I.55, 4.34), surgery or invasive procedure in the past year (OR = I.49; 95% CI, I.2, I.86) and antibiotic treatment in the past month (OR = I.80; 95% CI, I.45, 2.22). The predictive accuracy of the model was low (area under the ROC curve 0.656). These results indicate that ESBL-PE colonization is common upon admission to rehabilitation centres. Some risk factors for ESBL-PE colonization are similar to those described previously; however, newly identified factors may be specific to rehabilitation populations. The high prevalence and low ability to stratify by risk factors may guide infection control and empirical treatment strategies in rehabilitation settings.

Genotyping, local prevalence and international dissemination of b-lactamase-producing Kingella kingae strains

R. Basmaci^1,2,3, S. Bonacorsi^1,2,3, P. Bidet^1,2,3, N. V. Balashova⁴, J. Lau⁴, C. Munoz-Almagro⁵, A. Gene⁵ P. Yagupsky⁶1) IAME, UMR 1137, INSERM, 2) IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cite, 3) AP-HP, Laboratoire de Microbiologie, Hopital Robert-Debré, Paris, France, 4) Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA, 5) Departamento de Microbiologia Molecular, Hospital Universitario Sant Joan de Déu, Barcelona, Spain and 6) Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, IsraelOriginal Submission: 9 December 2013; Revised Submission: 7 April 2014; Accepted: 10 April 2014Editor: P. TassiosArticle published online: 26 April 2014Clin Microbiol Infect 2014; 20: O811-O817

Abstract

β-lactamase production has been sporadically reported in the emerging Kingella kingae pathogen but the phenomenon has not been studied in-depth. We investigated the prevalence of β-lactamase production among K. kingae isolates from different geographical origins and genetically characterized β-lactamase-producing strains. Seven hundred and seventy-eight isolates from Iceland, the USA, France, Israel, Spain and Canada were screened for β-lactamase production and, if positive, were characterized by PFGE and MLST genotyping, as well as rtxA, por, bla_TEM and 16S rRNA sequencing. β-lactamase was identified in invasive strains from Iceland (n = 4/14, 28.6%), the USA (n = 3/15, 20.0%) and Israel (n = 2/190, 1.1%) and in carriage strains in the USA (n = 5/17, 29.4%) and Israel (n = 66/429, 15.4%). No French, Spanish or Canadian isolates were β-lactamase producers. Among β-lactamase producers, a perfect congruency between the different typing methods was observed. Surprisingly, all US and Icelandic β-lactamase-producing isolates were almost indistinguishable, belonged to the major international invasive PFGE clone K/MLST ST-6, but differed from the four genetically unrelated Israeli β-lactamase-producing clones. Representative strains of different genotypes produced the TEM-1 enzyme. K. kingae β-lactamase producers exhibit a clear clonal distribution and have dissimilar invasive potential. The presence of the enzyme in isolates belonging to the major worldwide invasive clone K/ST-6 highlights the possible spread of β-lactam resistance, and emphasizes the importance of routine testing of all K. kingae clinical isolates for β-lactamase production.

Molecular epidemiology and virulence factors of pyogenic liver abscess causing Klebsiella pneumoniae in China

Y. Luo¹, Y. Wang², L. Ye¹ J. Yang¹1) Department of Microbiology, Chinese PLA General Hospital, Beijing, China and 2) Clinical Laboratory, General Hospital of TISCO, Taiyuan, ChinaOriginal Submission: 1 January 2014; Revised Submission: 12 March 2014; Accepted: 2 May 2014Editor: M. GrobuschArticle published online: 8 May 2014Clin Microbiol Infect 2014; 20: O818-O824

Abstract

The molecular epidemiology and prevalence of virulence factors of isolates from patients with Klebsiella pneumoniae liver abscess (KLA) in mainland China are unknown. Klebsiella pneumoniae isolates were obtained from drainage samples aseptically collected from patients with pyogenic liver abscess (PLA). The genetic similarity of KLA isolates was analyzed by pulsed-field gel electrophoresis. The hypermucoviscosity (HV) phenotype was identified by a positive string test. The KI and K2 genotypes, the pLVPK-derived genetic loci, aerobactin gene, kfu and alls were detected by PCR amplification. The sequence types (STs) were identified by multilocus sequence typing. Among the 51 non-repetitive KLA isolates, 49 PFGE types have been identified. In total, 19 (37.2%) and 14 (27.4%) of the 51 KLA isolates belonged to clonal complex (CC) 23 and CC65, respectively, while the other 18 isolates (35.3%) were defined as other STs. CC23 consisted of only KI strains, while CC65 included only K2 strains. All non-KI/K2 strains were classified as STs other than CC23 and CC65. Approximately 70.6% (36/51) of KLA isolates exhibited an HV phenotype. Both KI and K2 isolates presented significantly higher prevalence of the pLVPK-derived loci than non-KI/K2 isolates. The KI isolates had a significantly higher prevalence of the kfu and allS genes than K2 and non-KI/K2 isolates, while the K2 isolates exhibited higher repA prevalence than KI and non-KI/K2 isolates. The majority of KLA isolates belonged to CC23^KI and CC65^K2, while other STs with non-KI/K2 capsular types have also been identified. The virulent factors exhibited diverse distribution among the different clones of KLA isolates.

High prevalence of erythromycin-resistant Bordetella pertussis in Xi’an, China

Z. Wang¹, Z. Cui², Y. Li³, T. Hou¹, X. Liu³, Y. Xi¹, Y. Liu¹, H. Li¹ Q. He⁴·⁵·⁶1) Xi'an Center for Disease Control and Prevention, Xi'an, 2) National Institute for Communicable Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, 3) No 1 Department of Infectious Diseases, Xi'an Children Hospital, Xi'an, 4) Department of Medical Microbiology, Capital Medical University, Beijing, China, 5) Department of Pediatrics, Turku University Hospital and 6) Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare (THL), Turku, FinlandOriginal Submission: 29 March 2014; Revised Submission: 4 May 2014; Accepted: 4 May 2014Editor: F. AllerbergerArticle published online: 11 may 2014Clin Microbiol Infect 2014; 20: O825-O830

Abstract

Resistance of Bordetella pertussis, the causative agent of pertussis, to erythromycin is rare. Recently, several Chinese isolates were found to be erythromycin resistant. This study aimed to investigate the occurrence of pertussis in children suffering persistent cough and the prevalence of B. pertussis resistance to erythromycin in Xi’an, China. Three hundred and thirteen patients with suspected pertussis admitted to Xi’an Children’s Hospital from January 2012 through to December 2013 were included and their nasopharyngeal (NP) swabs were taken for culture and PCRs (targeting IS48/ and ptx-Pr). PCR-based sequencing was used to identify the A2047G mutation of B. pertussis 23S rRNA directly from the NP samples. Sixteen (5.1%) and 168 (53.7%) patients were positive for culture and IS48/ PCR. Of the 168 samples positive for IS48/ PCR, 122 (72.6%) and 100 (59.5%) were positive for ptx-Pr and 23S rRNA PCRs, respectively. All culture-positive samples were also positive for the three PCRs. Fourteen (87.5%) of the 16 B. pertussis isolates were found to be resistant to erythromycin (MICs > 256 mg/L). All the 14 isolates were confirmed to have a homogeneous A2047G mutation of 23S rRNA. Of the 100 samples positive for 23S rRNA PCR, 85 (85.0%) were found to have the A2047G mutation by sequencing. Our results indicate that in Xi’an, China, pertussis remains endemic in young children, and the circulating B. pertussis strains are mostly erythromycin resistant.

In vitro and in vivo activities of piperacillin-tazobactam and meropenem at different inoculum sizes of ESBL-producing Klebsiella pneumoniae

Y. Harada^1,2, Y. Morinaga^1,2, N. Kaku^1,2, S. Nakamura², N. Uno¹, H. Hasegawa¹, K. Izumikawa², S. Kohno^2,3 K. Yanagihara^1,21) Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 2) Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences and 3) Global COE Program, Nagasaki University, Nagasaki, JapanOriginal Submission: 6 February 2014; Revised Submission: 7 May 2014; Accepted: 7 May 2014Editor: J.-M. RolainArticle published online: 11 may 2014Clin Microbiol Infect 2014; 20: O83I-O839

Abstract

The inoculum effect is a laboratory phenomenon in which the minimal inhibitory concentration (MIC) of an antibiotic is increased when a large number of organisms are exposed. Due to the emergence of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-Kpn) infections, the inoculum effect of ESBL-Kpn on β-lactams was studied in vitro and in vivo using an experimental model of pneumonia. The in vitro inoculum effect of 45 clinical ESBL-Kpn isolates on ß-lactams was evaluated at standard (10⁵ CFU/mL) and high (10⁷ CFU/mL) organism concentrations. The MIC₅₀ of piperacillin-tazobactam, cefotaxime and cefepime was increased eight-fold or more and that of meropenem was increased two-fold. The in vivo inoculum effect was evaluated in an ESBL-Kpn pneumonia mouse model treated with bacteriostatic effect-adjusted doses of piperacillin-tazobactam (1000 mg/kg four times daily, %T > MIC; 32.60%) or meropenem (100 mg/kg twice daily, %T > MIC; 28.65%) at low/standard (10⁴ CFU/mouse) and high (10⁶ CFU/mouse) inocula. In mice administered a low inoculum, no mice died after treatment with piperacillin-tazobactam or meropenem, whereas all the control mice died. In contrast, in the high inoculum model, all mice in the piperacillin-tazobactam-treated group died, whereas all meropenem-treated mice survived and had a decreased bacterial load in the lungs and no invasion into the blood. In conclusion, meropenem was more resistant to the inoculum effect of ESBL-Kpn than piperacillin-tazobactam both in vitro and in vivo. In the management of severe pneumonia caused by ESBL-Kpn, carbapenems may be the drugs of choice to achieve a successful outcome.

Typing of Panton-Valentine leukocidin-encoding phages carried by methicillin-susceptible and methicillin-resistant Staphylococcus aureus from Italy

A. Sanchini¹, M. Del Grosso¹, L. Villa¹, M. G. Ammendolia², F. Superti², M. Monaco¹ A. Pantosti¹1) Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, and 2) Department of Technology and Health, Istituto Superiore di Sanità, Rome, ItalyOriginal Submission: 30 December 2013; Revised Submission: 24 March 2014; Accepted: 12 May 2014Editor: G. LinaArticle published online: 16 may 2014Clin Microbiol Infect 2014; 20: O840-O846

Abstract

Panton-Valentine leukocidin (PVL) is the hallmark of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) but can also be found in methicillin-susceptible S. aureus (MSSA) sharing pathogenic and epidemiological characteristics of CA-MRSA. PVL is encoded by two co-transcribed genes that are carried by different staphylococcal bacteriophages. We applied an extended PCR-based typing scheme for the identification of two morphological groups (elongated-head group and icosahedral-head group I phages) and specific PVL phage types in S. aureus isolates recovered in Italy. We examined 48 PVL-positive isolates (25 MSSA and 23 MRSA) collected from different hospital laboratories from April 2005 to May 2011. spa typing, multilocus sequence typing and staphylococcal cassette chromosome mec typing were applied to categorize the isolates. Phage typeability was 48.0% in MSSA and 9I.3% in MRSA, highlighting the limitation of the PCR typing scheme when applied to PVL-positive MSSA. Five different PVL phages and two variants of a known phage were detected, the most prevalent being ΦSa2usa, recovered in I5 out of 48 (3I.2%) isolates, and carried by both MSSA and MRSA belonging to CC8 and CC5. The recently described Φ^Ι·^ was recovered in four isolates. A PVL phage ^Sa119) from an ST772 MRSA, that was not detected using the previous typing scheme, was sequenced, and new primers were designed for the identification of the icosahedral-head group 11 PVL phages present in ST772 and ST59 MRSA. A comprehensive PVL-phage typing can contribute to the understanding of the epidemiology and evolution of PVL-positive MSSA and MRSA.

Genitourinary brucellosis: results of a multicentric study

H. Erdem¹, N. Elaldi², O. Ak³, S. Gulsun⁴, R. Tekin⁵, M. Ulug⁶, F. Duygu⁷, M. Sunnetcioglu⁸, N. Tulek⁹, S. Guler¹⁰, Y. Cag³, S. Kaya⁴, N. Turker¹¹, E. Parlak¹², T. Demirdal¹¹, C. Ataman Hatipoglu⁹, A. Avci¹³, C. Bulut⁹, M. Avci¹⁴, A. Pekok¹⁵, U. Savasci¹⁶, S. Kaya¹⁷, H. Sozen¹⁸, M. Tasbakan¹⁹, T. Guven²⁰, S. Bolukcu²¹, S. Cesur²², E. Sahin-Horasan²³, E. Kazak²⁴, A. Denk²⁵, I. Gonen²⁶, G. Karagoz²⁷, A. Haykir Solay²⁸, O. Alici²⁹, C. Kader³⁰, G. Senturk³¹, S. Tosun¹⁴, H. Turan³², A. I. Baran⁸, D. Ozturk-Engin²¹, F. Bozkurt⁵, O. Deveci⁵, A. Inan²¹, A. Kadanali²⁷, M. S. Sayar³¹, B. Cetin³³, M. Yemisen³⁴, H. Naz³⁵, L. Gorenek¹ C. Agalar²⁹1) Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey, 2) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Cumhuriyet University, Sivas, Turkey, 3) Department of Infectious Diseases and Clinical Microbiology, Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey, 4) Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey, 5) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Dicle University, Diyarbakir, Turkey, 6) Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey, 7) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey, 8) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Yuzuncuyil University, Van, Turkey, 9) Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey, 10) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Sutcu Imam University, Kahramanmaras, Turkey, 11) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Katip Celebi University and Atatürk Training and Research Hospital, Izmir, Turkey, 12) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ataturk University, Erzurum, Turkey, 13) Department of Urology, Bingol Military Hospital, Bingol, Turkey, 14) Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey, 15) Department of Infectious Diseases and Clinical Microbiology, Private Erzurum Sifa Hospital, Erzurum, Turkey, 16) Department of Infectious Diseases and Clinical Microbiology, Sarikamis Military Hospital, Kars, Turkey, 17) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey, 18) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Sitki Kocman University, Mugla, Turkey, 19) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkey, 20) Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University, Ankara Ataturk Training &; Research Hospital, Ankara, Turkey, 21) Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey, 22) Division of Tuberculosis, Turkish Public Health Directorate, Ankara, Turkey, 23) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Mersin University, Mersin, Turkey, 24) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Uludag University, Bursa, Turkey, 25) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Firat University, Elazig, Turkey, 26) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Suleyman Demirel University, Isparta, Turkey, 27) Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey, 28) Department of Infectious Diseases and Clinical Microbiology, Igdir State Hospital, Igdir, Turkey, 29) Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, 30) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Bozok University, Yozgat, Turkey, 31) Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training &; Research Hospital, Ankara, Turkey, 32) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Baskent University, Konya, Turkey, 33) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Koc University, Istanbul, Turkey, 34) Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey and 35) Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, TurkeyOriginal Submission: 22 December 2013; Revised Submission: 12 May 2014; Accepted: 12 May 2014Editor: S. CutlerArticle published online: 16 May 2014Clin Microbiol Infect 2014; 20: O847-O853

Abstract

This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n = 327, 83.8%), as epididymo-orchitis (n = 204, 58%), orchitis (n = 112, 3I.8%) and epididymitis (n = 11, 3.1%). In female patients, pyelonephritis (n = 33/38, 86.8%) was significantly higher than in male patients (n = 11/352, 3.1%; p< 0.0001). The mean blood leukocyte count was 7530 ± 3115/mm³. Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p< 0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.     

Online-Only Original ArticlesBacteriology | Clinical Microbiology and Infection - Volume 18, Issue 6

The limited sensitivity of serological tests for mycobacterial antigens has encouraged the development of a nanoparticle probe specific for the extrapulmonary form of Mycobacterium tuberculosis (Mtb). We developed an innovative probe comprised of super-paramagnetic iron oxide (SPIO) nanoparticles conjugated with Mtb surface antibody (MtbsAb-nanoparticles) to provide ultrasensitive imaging of biomarkers involved in extrapulmonary Mtb infection. MtbsAb-nanoparticles were significantly conjugated with Mtb bacilli. The extent of contrast enhancement reduction on magnetic resonance imaging (MRI) for Mtb and human monocytic THP1 cells was proportional to the concentration of MtbsAb-nanoparticles. When MtbsAb-nanoparticles were intravenously injected into mice bearing Mtb granulomas, the granulomatous site showed a 14-fold greater reduction in signal intensity enhancement on T₂-weighted MR images compared with an opposing site that received PBS injection. Mtb sAb-nanoparticles represent a new non-invasive technology for the diagnosis of extrapulmonary Mtb.Nepalese origin of cholera epidemic in HaitiR. R. Frerichs¹, P. S. Keim^2,3, R. Barrais⁴ and R. Piarroux^5,61) Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA, 2) Division of Pathogens Genomics, Translational Genomics Research Institute (TGen), Flagstaff, AZ, USA, 3) Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, AZ, USA, 4) Ministry of Public Health and Population, Port-au-Prince, Haiti, 5) UMR-MD3, Aix-Marseille University, Marseille, France and 6) University Hospital la Timone, APHM, Marseille, FranceOriginal Submission: 11 January 2012; Revised Submission: 10 March 2012; Accepted: 12 March 2012Editor: D. RaoultArticle published online: 14 March 2012Clin Microbiol Infect 2012; 18: E158-E163

Abstract

Cholera appeared in Haiti in October 2010 for the first time in recorded history. The causative agent was quickly identified by the Haitian National Public Health Laboratory and the United States Centers for Disease Control and Prevention as Vibrio cholerae serogroup O1, serotype Ogawa, biotype El Tor. Since then, >500 000 government-acknowledged cholera cases and >7000 deaths have occurred, the largest cholera epidemic in the world, with the real death toll probably much higher. Questions of origin have been widely debated with some attributing the onset of the epidemic to climatic factors and others to human transmission. None of the evidence on origin supports climatic factors. Instead, recent epidemiological and molecular-genetic evidence point to the United Nations peacekeeping troops from Nepal as the source of cholera to Haiti, following their troop rotation in early October 2010. Such findings have important policy implications for shaping future international relief efforts.Carriage of methicillin-resistant Staphylococcus aureus on admission to European rehabilitation centres-a prospective studyE. Bilavsky^1,2, Y. Lerman³, A. Rabinovich³, J. Salomon⁴, C. Lawrence⁵, A. Rossini⁶, A. Salvia⁶, J. V. Samso⁷, J. Fierro⁷, M. Hochman¹, M. Kazma¹, A. Klein¹, M. J. Schwaber^1,2, Y. Carmeli^1,2, MOSAR WP5 study team1) Division of Epidemiology and Preventive Medicine, 2) Sackler Faculty of Medicine, 3) Geriatric Division, Tel-Aviv Sourasky Medical Centre, Tel Aviv University, Tel Aviv, Israel, 4) Pharmaco Epidemiology of Infectious Diseases, Inserm U657, Institut Pasteur, CNAM (CASER, SITI, R2S2), Paris, France, 5) Department of Microbiology, Assistance Publique Hôpitaux de Paris, CHU Raymond Poincaré, Hôpital maritime de Berck, Garches, France, 6) Fondazione Santa Lucia IRCCS, Rome, Italy and 7) Hospital de Neurorehabilitació, Institut Guttmann, Barcelona, SpainOriginal Submission: 21 December 2011; Revised Submission: 10 March 2012; Accepted: 14 May 2012Editor: G. LinaArticle published online: 24 March 2012

Abstract

This study aimed to determine the prevalence of and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) carriage among patients newly admitted to rehabilitation centres. It is a prospective study examining MRSA carriage on admission to seven rehabilitation wards in four countries. Risk factors for MRSA carriage were analysed using univariate and multivariate analyses. A total of 1204 patients were studied. Among them, 105 (8.7%) had a positive admission MRSA screening result. The MRSA carriers were more likely to be male, to have had a recent stay in another long-term-care facility or >2 weeks acute-care hospital stay, history of colonization with MRSA, reduced level of consciousness, peripheral vascular disease and pressure sores. In multivariable logistic regression male gender (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.4–3.6, p 0.001), history of MRSA positivity (OR 6.8, 95% CI 3.8–12.3, p <0.001), peripheral vascular disease (OR 2.5, 95% CI 1.2–5, p 0.013), recent stay in another long-term-care facility (OR 2.1, 95% CI 1.3–3.5, p 0.004), or long (>2 weeks) acute-care hospital stay (OR 1.9, 95% CI 1.2–3, p 0.004), remained significant risk factors for MRSA carriage. MRSA carriage is common on admission to rehabilitation centres but less so, than previously described in long-term-care facilities. Male gender, history of MRSA positivity, previous hospitalization and peripheral vascular disease may predict MRSA carriage, and may serve as indicators for using pre-emptive infection control measures.     

S2.Dengue. Surveillance spatiale et de la dengue. Conception d''outils d’acquisition, de cheminement, d’analyse et de prévision épidémiologique

Dengue is a mosquito-borne flavivirus that causes significant morbidity and mortality in tropical countries. Dengue is found in almost all tropical countries where Aedes aegypti circulates. An alarming increase in the incidence of this disease has been observed since the early 80's with both the distribution and frequency of dengue hemorrhagic disease and shock syndrome increasing. Therefore efficient prophylaxis is urgently required to protect billions of humans against this disease. Studies on dengue started about 90 years ago and the first vaccination with inactivated virus was described by G. Blanc, the Director of the Pasteur Institute in Athens. Since then and after numerous efforts, live attenuated dengue viruses have been produced by serial passages in cell culture and are under trials in Thailand. This type of vaccine may conceivably be used as the first generation of vaccine within the decade.

Online-Only Abstracts

A temocillin minimal inhibitory concentration ≥ 128 mg/L combined with the results of meropenem double disc synergy testing was used to (i) discriminate carbapenemase production from other resistance mechanisms leading to decreased carbapenem susceptibility; and (ii) differentiate Ambler classes in carbapenemase-producing enterobacteriaceae (CPE). The suggested test algorithm discriminated all extended spectrum ß-lactamase/AmpC from CPE isolates, which could further be divided correctly into Ambler classes A and B enzymes as well as OXA-48 in all cases. The algorithm is simple to implement as part of the daily routine in a standard microbiology laboratory with limited access to or resources for molecular biological tools.

Intrapatient emergence of OXA-247: a novel carbapenemase found in a patient previously infected with OXA-163-producing Klebsiella pneumoniae

S. Gomez^1,2 F. Pasteran¹ D. Faccone¹ M. Bettiol³ O. Veliz¹, D. De Belder¹, M. Rapoport¹ B. Gatti³ A. Petroni¹ A. Corso¹1) Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS-Dr Carlos G. Malbran, Buenos Aires, 2) Research Career, CONICET (Consejo Nacional de Investigaciones Cientýficas y Tecnológicas), Buenos Aires and 3) Hospital de Ni?nos Sor Marýa Ludovica - La Plata, ArgentinaOriginal Submission: 10 December 2012; Accepted: 28 December 2012Editor: R. CantónArticle published online: 3 January 2013Clin Microbiol Infect 2013; 19: E233–E235

Abstract

Two genetically related Klebsiella pneumoniae strains carrying OXA-type carbapenemases were isolated from a single patient 1 month apart. Kpn163 harboured OXA-163 and Kpn247 a new variant named OXA-247 that showed susceptibility to carbapenems and expanded-spectrum cephalosporins similar to OXA-48. Our epidemiological, biochemical and molecular results suggest the intrapatient emergence of bla_OXA-247 from bla_OXA-163.

Raoultella planticola bacteraemia secondary to gastroenteritis

S. Puerta-Fernandez¹ F. Miralles-Linares¹ M.V. Sanchez-Simonet¹ M.R. Bernal-Lopez^2,3 R. Gomez-Huelgas^3,41) Internal Medicine Department, Hospital Parque San Antonio, 2) Biomedical Research Laboratory, Endocrinology Department, Hospital Virgen de la Victoria, Malaga, 3) Ciber Fisiopatologýa de la Obesidad y la Nutricion, Instituto de Salud Carlos III, Madrid and 4) Internal Medicine Department, Hospital Carlos Haya, Malaga, SpainOriginal Submission: 13 September 2012; Revised Submission: 5 November 2012; Accepted: 7 November 2012Editor: M. DrancourtArticle published online: 15 November 2012Clin Microbiol Infect 2013; 19: E236–E237

Abstract

We present the first case of Raoultella planticola bacteria in human infections with a direct relationship between fish intake and enteric infection. The patient was treated with antibiotherapy (cefotaxime). It is important to consider this organism in the differential diagnosis of enteric fever and even more with previous ingestion of fish.     

Online-Only Abstracts

The rapid detection of extended-spectrum beta-lactamases (ESBLs) is a challenge for most clinical microbiology laboratories because inaccurate identification of ESBL producers has important clinical implications for both antibiotic treatment and infection control. The aim of our study was to develop a rapid detection assay of ESBL producers based upon flow cytometric analysis. Antimicrobial susceptibility testing followed by molecular characterization of bla_TEM, bla_SHV or bla_CTX-M genes was performed on clinical isolates (41 ESBL positive and 20 ESBL negative) and isolates expressing well-characterized beta-lactamases, including ESBLs (n = 13), plasmid AmpCs (n = 3), oxacillinases (n = 5) and carbapenemases (n = 3). Additionally, two ATCC strains recommended by CLSI for susceptibility testing were used as controls. The flow cytometry analysis protocol involved an incubation of bacterial cells with different concentrations of ceftazidime (1, 2 and 4 mg/L) and cefotaxime (4, 8 and 16 mg/L) for 1 and 2 hours, in the presence and absence of clavulanic acid; subsequently, cells were stained with the fluorescent dye Bis-(1,3-dibutylbarbituric acid) trimethine oxonol [DiBAC₄(3)], a lipophilic anion able to diffuse across depolarized membranes. Additionally, CFU counts were performed. Susceptible isolates displayed increased fluorescence after 1 hour of incubation; conversely, the increase of the depolarized population was only observed after incubation with clavulanic acid associated with ceftazidime or cefotaxime in ESBL producers. An excellent correlation was obtained between the number of non-depolarized bacteria quantified by flow cytometry and by conventional CFU assays. A novel, accurate and fast flow cytometric assay is available to detect the presence of ESBLs.

Epidemiology of methicillin-resistant Staphylococcus aureus carrying the novel mecC gene in Denmark corroborates a zoonotic reservoir with transmission to humans

A. Petersen¹, M. Stegger¹, O. Heltberg², J. Christensen², A. Zeuthen², L. K. Knudsen³, T. Urth⁴, M. Sorum¹, L. Schouls⁵, J. Larsen¹, R. Skov¹ and A. R. Larsen¹1) Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark, 2) Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark, 3) Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark, 4) Department of Clinical Microbiology, Aalborg Sygehus, Aalborg, Denmark and 5) National Institute for Public Health and the Environment, Bilthoven, the NetherlandsOriginal Submission: 30 March 2012; Revised Submission: 24 August 2012; Accepted: 30 August 2012Editor: G. LinaArticle published online: 15 September 2012Clin Microbiol Infect 2013; 19: E16-E22

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated (HA), community-associated (CA) and live-stock-associated (LA) infections. Recently, the discovery of human and bovine MRSA isolates carrying a new mecA gene homologue, mecA_LGA251 (now designated mecC), has caused concern because they are not detected by conventional, confirmatory tests for MRSA. Very little is known about their frequency, epidemiology and possible transmission between livestock and humans. In this study, the epidemiology of the mecC isolates in Denmark was investigated by screening the national collections of MRSA cases (from 1988 onwards) and S. aureus bacteraemia cases (from 1958 onwards). Isolates carrying mecC were only recovered infrequently before 2003 (n = 2) but now seem to be increasing, with 110 cases in 2003–2011. Clinical data on mecC-carrying MRSA demonstrated that mecC-MRSA were primarily community-acquired (CA-MRSA) and affected persons typically living in rural areas, being older than other CA-MRSA patients. Among 22 cases in Region Zealand, four reported contact with cattle and sheep. Two of these persons lived on farms with livestock positive for mecC-carrying MRSA, sharing spa type (t843), MLVA (MT429) and PFGE pattern with the human isolates. These observations indicate that mecC-carrying MRSA can be exchanged between humans and ruminants.

High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality

A. Capone¹, M. Giannella¹, D. Fortini², A. Giordano³, M. Meledandri⁴, M. Ballardini⁴, M. Venditti⁵, E. Bordi⁶, D. Capozzi⁷, M. P. Balice⁸, A. Tarasi⁹, G. Parisi¹⁰, A. Lappa¹⁰, A. Carattoli², N. Petrosillo¹ and on behalf of the SEERBIO-GRAB network²1) 2nd Division of Infectious Diseases, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy, 2) Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanitá, Rome, Italy, 3) Department of Microbiology, University “La Sapienza” Policlinico Umberto I, Rome, Italy, 4) Department of Microbiology, Azienda Ospedaliera San Filippo Neri, Rome, Italy, 5) Department of Infectious Diseases, University “La Sapienza” Policlinico Umberto I, Rome, Italy, 6) Department of Microbiology, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy, 7) Department of Microbiology, Azienda Ospedaliera Grassi Ostia, Rome, Italy, 8) Department of Microbiology, Santa Lucia Fundation, Rome, Italy, 9) Health-care Infectious Unit, Azienda Ospedaliera San Giovanni Addolorata, and 10) Microbiology and Heart Surgery ICU, Azienda Ospedaliera San Camillo-Forlanini, Rome, ItalyOriginal Submission: 2 July 2012; Revised Submission: 3 October 2012; Accepted: 4 October 2012Editor: R. CantonArticle published online: 18 October 2012Clin Microbiol Infect 2013; 19: E23-E30

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) is becoming a common cause of healthcare-associated infection in Italy, with high morbidity and mortality. Prevalent CR-KP clones and resistance mechanisms vary between regions and over time. Therapeutic approaches and their impact on mortality have to be investigated. We performed a prospective study of patients with CR-KP isolation, hospitalized in nine hospitals of Rome, Italy, from December 2010 to May 2011, to describe the molecular epidemiology, antibiotic treatment and risk factors for mortality. Overall, 97 patients (60% male, median age 69 years) were enrolled. Strains producing blaKPC-3 were identified in 89 patients, blaVIM in three patients and blaCTX-M-15 plus porin defects in the remaining five patients. Inter-hospital spread of two major clones, ST512 and ST258, was found. Overall, 36.1% and 20.4% of strains were also resistant to colistin and tigecycline, respectively. Infection was diagnosed in 91 patients who received appropriate antibiotic treatment, combination therapy and removal of the infectious source in 73.6%, 59.3% and 28.5% of cases, respectively. Overall, 23 different antibiotic regimens were prescribed. In-hospital mortality was 25.8%. Multivariate analysis adjusted for appropriate treatment, combination therapy and infectious-source removal, showed that Charlson comorbidity score, intensive-care unit onset of infection, bacteraemia and infection due to a colistin-resistant CR-KP strain were independent risk factors for mortality. The spread of clones producing K. pneumoniae carbapenemases, mainly ST258, is currently the major cause of CR-KP infection in central Italy. We observed a high rate of resistance to colistin that is independently associated with worse outcome.     

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.     

Book review

Coccidia and Intestinal Coccidiomorphs. Proceedings of the Vth International Coccidiosis Conference, Tours (France), October 17–20, 1989. P. Yvore (Ed.), 1989, Les Colloques de l'INRA, No 49, Institut National de la Recherche Agronomique, Paris. 696 pp. INRA Publications, Route de Saint‐Cyr, 78026 Versailles Cedex, France. Price 340,00 F. ISBN 2–7380–0164–5.

Disease and Threatened Birds. J.E. Cooper (Editor). International Council for Bird Preservation, Technical Publication No. 10. 200 pp. 1989. ISBN 0–946888–18–3, ISSN 0277–1330. £16.50     

Clinical Significance of Mycobacterium asiaticum Isolates in Queensland,Australia

Mycobacterium asiaticum was first reported as a cause of human disease in 1982, with only a few cases in the literature to date. This study aims to review the clinical significance of M. asiaticum isolates in Queensland, Australia. A retrospective review (1989 to 2008) of patients with M. asiaticum isolates was conducted. Data were collected through the Queensland TB Control Centre database. Disease was defined in accordance with the American Thoracic Society criteria. Twenty-four patients (13 female) had a positive culture of M. asiaticum, many residing around the Tropic of Capricorn. M. asiaticum was responsible for pulmonary disease (n = 2), childhood lymphadenitis (n = 1), olecranon bursitis (n = 1), 6 cases of possible pulmonary disease, and 2 possible wound infections. Chronic lung disease was a risk factor for pulmonary infection, and wounds/lacerations were a risk factor for extrapulmonary disease. Extrapulmonary disease responded to local measures. Pulmonary disease responded to ethambutol-isoniazid-rifampin plus pyrazinamide for the first 2 months in one patient, and amikacin-azithromycin-minocycline in another patient. While M. asiaticum is rare in Queensland, there appears to be an environmental niche. Although often a colonizer, it can be a cause of pulmonary and extrapulmonary disease. Treatment of pulmonary disease remains challenging. Extrapulmonary disease does not mandate specific nontuberculous mycobacterium (NTM) treatment.Nontuberculous mycobacteria (NTM) have been recognized as human pathogens since the 1950s (17, 30). Over recent decades the taxonomy has continued to evolve, and new species are being recognized. This is attributable to improved methods of identification, including chemotaxonomic and molecular methods (11).Mycobacterium asiaticum was first named by Weiszfeiler et al., who recognized it as a new slow-growing mycobacterium species with characteristics separate from those of Mycobacterium simiae and the other slow growers, Mycobacterium kansasii and Mycobacterium marinum (31). It was first reported in humans in Queensland (QLD), Australia, by Blacklock et al. in 1982, where M. asiaticum was thought to be responsible for pulmonary disease in 2 of 5 human cases (5). The first case report of pulmonary disease secondary to M. asiaticum in the United States was in 1990 (27). These reported patients with progressive pulmonary disease secondary to M. asiaticum mostly had an underlying chronic respiratory problem such as chronic obstructive pulmonary disease (COPD). M. asiaticum has also been reported to be responsible for extrapulmonary disease in humans, namely, flexor tenosynovitis (8), olecranon bursitis (6), and keratitis (7).Previous studies, with their limitations, have suggested climate as a factor responsible for the distribution of M. asiaticum, with an association noted between prevalence of M. asiaticum and subtropical climates, such as Queensland''s, particularly an area of northern Queensland near the Tropic of Capricorn (5). This association was noted in both animal and human studies (31).There are limited data about the antimicrobial susceptibilities of M. asiaticum and response to treatment. Weiszfeiler et al. reported that M. asiaticum in monkeys is resistant to streptomycin, isoniazid, p-aminosalicylate, and rifampin but susceptible to cycloserine (32). However the use of antituberculosis therapy, including agents such as isoniazid, rifampin, ethambutol, pyrazinamide, streptomycin, and capreomycin, yielded more-encouraging results in humans (5, 27), with clinical response not correlating with in vitro susceptibilities. Older fluoroquinolones, such as ofloxacin, have also been used, although M. asiaticum has higher mean inhibitory concentrations than other slow-growing mycobacteria (15).The aim of this study was to evaluate isolates of M. asiaticum in Queensland and describe the incidence and epidemiology of disease, risk factors, clinical and radiological spectrum, treatments, and outcome.     

The arcade of Fröhse : an anatomic study

Summary An anatomic study of the appearance and consistency of the upper arcade of the superficial layer of the supinator m. was carried out on 106 elbow-joint dissections. A classification of the structure was drawn up in order to discern the criteria for normality. An arcade of a tendinous nature (arcade of Fröhse) was encountered in the majority of cases (64.1%). At first sight, it could not be ascribed a compressive role affecting the posterior branch of the radial n. Macroscopic examination of the nerve prior to its entry under the supinator arcade revealed the presence of macroscopic lesions in 42.9% of cases. This high incidence does not permit any conclusions regarding the pathologic significance of this type of lesion.

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L'arcade de Fröhse: étude anatomique

Résumé Une étude anatomique de l'aspect et de la consistance de l'arcade supérieure du faisceau superficiel du m. supinateur a été réalisée sur 106 préparations de coudes. Une classification basée sur la structure a été établie afin de dégager des critères de normalité. Une arcade tendineuse (arcade de Fröhse) est rencontrée dans la majorité des cas (64.1%). On ne peut lui attribuer à priori un rôle de compression du rameau profond du n. radial. L'observation macroscopique du nerf avant son passage sous l'arcade du m. supinateur révèle la présence d'altérations macroscopiques dans 42.9% des cas. Cette incidence élevée ne nous permet pas de conclure à la signification pathologique de ce type d'altération.

     

Abnormal direct entry of the umbilical vein into the right atrium: antenatal detection,embryologic aspects

Summary Abnormal direct umbilical venous return into the right atrium was detected at obstetric ultrasonography in a 23 week fetus. This was an isolated anomaly; the growth of the fetus and size of the liver were normal, and the child was normal on examination at birth. Exclusion of the umbilico-placental circulation brought about closure of the umbilical vein. Growth and development of the child were normal 6 months after birth. Five other cases of abnormal umbilical venous entry into the right atrium have been reported in the literature, but associated with severe malformations, with situs ambiguous and heterotaxy. These cases have been grouped under the heading: persistence of the right umbilical vein. In view of recent findings relating to the organogenesis of the veins of the human liver, it seems preferable to label this anomaly: direct umbilical venous return into the right atrium.

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Retour veineux ombilical anormal direct dans l'atrium droit: découverte anténatale, interprétation embryologique

Résumé Un retour veineux ombilical anormal direct dans l'atrium droit a été reconnu à l'échographie obstétricale chez un ftus de 23 semaines. Cette anomalie était isolée, la croissance du ftus et la taille du foie étaient normales. A la naissance, l'examen de l'enfant était normal. L'exclusion de la circulation ombilico-placentaire a entraîné la fermeture de la veine ombilicale. La croissance et le développement de l'enfant sont normaux six mois après la naissance. Cinq autres cas de retour veineux ombilical anormal dans l'atrium droit ont déjà été rapportés dans la littérature mais associés à des malformations sévères, avec situs ambigu et hétérotaxie. Ces observations sont regroupées sous la dénomination: «persistance de la veine ombilicale droite». Compte tenu de données récentes concernant l'organogénèse des veines du foie humain, il semble préférable de dénommer cette anomalie: retour veineux ombilical direct dans l'atrium droit.

     

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

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.     

Neurohistological analysis of the lateral lobe in a weakly electric fish,Gymnotus carapo (Gymnotidae,Pisces)

Summary The cyto- and fiber architecture of the lateral lobe (LL) of Gymnotus carapo was investigated using Nissl, Golgi and reduced silver stains as well as 1 semi-thin sections. The neurons and fiber tracts are distributed in six layers. The first layer is subdivided into two sublayers: 1A where the primary afferent fibers run in rostro-caudal direction and 1B where these fibers terminate and the large multipolar neurons can be found. The 2nd layer consists of a single row of adendritic, pear-shaped neurons. The axons of these neurons enter the 4th layer and leave the lateral lobe in medial direction. The 3rd layer contains the granular cells of two different types: granular cells with two dendritic trunks directed into dorsal and ventral directions respectively, and granular cells in which, instead of the dendritic trunk, the axon emerges from the dorsal pole of the perikaryon. The axon can be followed up to the 6th layer. The 4th layer consists of bundles of nerve fibers. Beside the axons of the pear-shaped neurons the bundles contain also the axons of the pyramidal neurons (5th layer) leaving the lateral lobe. The 5th layer contains the perikarya of the pyramidal neurons. They have two separate dendritic arborizations, one directed ventrally and entering layer 1B and another directed dorsally and penetrating into the 6th layer. Their axons join the 4th layer and run in medial, rostro-medial or rostral direction depending upon the localization of the neurons in the lateral lobe. The 6th layer (crista cerebellaris) consists of three sublayers. Sublayer 6A contains fine myelinated fibers of unknown origin; sublayer 6B contains fine, mainly non-myelinated fibers originating from the mesencephalon, sublayer 6C is built up of non-myelinated fibers originating from the cerebellum. — A preliminary diagram of the neuron circuits and of the synaptic arrangements involved in the relay of lateral-line organ impulses is suggested.Supported by Research Grant No. 659440 accorded to Dr. T. Szabo by the Direction de Recherches et Moyens d'Essais (D. R. M. E.).Visiting investigator, aided by Institut national de la Santé et de la Recherche Médical (I. N. S. E. R. M.).Address: Groupe des Laboratoires du C. N. R. S. 91190 Gif-sur-Yvette, France.     

Frequency and clinical description of high-cost patients in 17 acute-care hospitals.

To assess the potential impact of national "catastrophic" health insurance on the medical-care system, the frequency and clinical characteristics of high-cost patients were surveyed at 17 acute-care hospitals in the San Francisco Bay Area. The percentage of patients whose yearly hospital charges exceeded $4000 in 1976 ranged from 4 at a community hospital to 24 at a referral hospital. Hospital costs charged to these patients ranged from 20 to 68 per cent of total billings, with the highest percentages generally occurring at large referral hospitals. Forty-seven per cent of adult high-cost patients had chronic medical conditions, and only one in six suffered from an acute medical "catastrophe." In addition, more than 13 per cent of high-cost patients died in the hospital. National catastrophic health insurance is likely to pay for much chronic illness and terminal care and divert resources toward acute-care hospitals.     

Online-Only Abstracts

Pseudomonas aeruginosa, the principal respiratory pathogen in cystic fibrosis (CF) patients, is ubiquitous in the environment. Initial P. aeruginosa isolates in CF patients are generally environmental in nature. However, little information regarding seasonality of P. aeruginosa acquisition is available. We conducted a retrospective study to evaluate the seasonality of initial P. aeruginosa acquisition in young children with CF in the USA using the Cystic Fibrosis Foundation National Patient Registry from 2003 to 2009. Additionally, we assessed whether seasonal acquisition varied by climate zone. A total of 4123 children met inclusion criteria and 45% (n = 1866) acquired P. aeruginosa during a mean 2.0 years (SD 0.2 years) of follow up. Compared with winter, increased P. aeruginosa acquisition was observed in summer (incidence rate ratio (IRR): 1.22; 95% CI: 1.07–1.40) and autumn (IRR: 1.34; 95% CI: 1.18–1.52), with lower acquisition observed in spring (IRR: 0.81; 95% CI: 0.70–0.94). Seasonal variations in P. aeruginosa acquisition rates in the temperate and continental climate zones were similar to those in the overall cohort. In contrast, no significant seasonal effect was observed in the dry climate zone. In a corresponding analysis, no seasonal difference was observed in the rate of acquisition of Staphylococcus aureus, another common CF respiratory pathogen. These results provide preliminary support that climatic factors may be associated with initial P. aeruginosa acquisition in CF patients. Investigation and identification of specific risk factors, as well as awareness of seasonal variation, could potentially inform clinical recommendations including increased awareness of infection control and prevention strategies.

Wastewater drainage system as an occult reservoir in a protracted clonal outbreak due to metallo-β-lactamase-producing Klebsiella oxytoca

S. Vergara-López¹ M. C. Domínguez² M.C. Conejo³ á. Pascual^3,4 J. Rodríguez-Baño^4,51) Internal Medicine Service, Hospital La Merced, 2) Laboratory of Microbiology, Hospital La Merced, Osuna, Seville, 3) Department of Microbiology, University of Seville, 4) Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena and 5) Department of Medicine, University of Seville, Seville, SpainEditor: J.-M. RolainArticle published online: 31 May 2013Clin Microbiol Infect 2013; 19: E490–E49810.1111/1469-0691.12288

Abstract

We describe the epidemiology of a protracted nosocomial clonal outbreak due to multidrug-resistant IMP-8 producing Klebsiella oxytoca (MDRKO) that was finally eradicated by removing an environmental reservoir. The outbreak occurred in the ICU of a Spanish hospital from March 2009 to November 2011 and evolved over four waves. Forty-two patients were affected. First basic (active surveillance, contact precautions and reinforcement of surface cleaning) and later additional control measures (nurse cohorting and establishment of a minimum patient/nurse ratio) were implemented. Screening of ICU staff was repeatedly negative. Initial environmental cultures, including dry surfaces, were also negative. The above measures temporarily controlled cross-transmission but failed to eradicate the epidemic MDRKO strain that reappeared two weeks after the last colonized patients in waves 2 and 3 had been discharged. Therefore, an occult environmental reservoir was suspected. Samples from the drainpipes and traps of a sink were positive; removal of the sink reduced the rate number but did not stop new cases that clustered in a cubicle whose horizontal drainage system was connected with the eliminated sink. The elimination of the horizontal drainage system finally eradicated the outbreak. In conclusion, damp environmental reservoirs (mainly sink drains, traps and the horizontal drainage system) could explain why standard cross-transmission control measures failed to control the outbreak; such reservoirs should be considered even when environmental cultures of surfaces are negative.