Cutaneous nocardiosis with discharging sinus clinically mimicking tuberculosis diagnosed by cytology

Nocardiosis is primarily a pulmonary infection commonly seen in immunocompromised individuals. However, lymphocutaneous nocardiosis is observed in immunocompetent individuals often after trauma. The clinical and cytomorphological features of lymphocutaneous nocardiosis closely mimic the most common infections in India such as tuberculosis and mycetoma (very common cutaneous infection with discharging sinus). As it is crucial to differentiate nocardiosis from tuberculosis, to avoid unnecessary antitubercular treatment, special stains like modified Ziehl–Neelsen stain and Gram stain can be employed to differentiate the morphology of Nocardia from tuberculosis. Fine‐needle cytology from these cutaneous lesions helps in yielding adequate material for rapid and accurate diagnosis of immediate specific antibiotic treatment. We report a rare case that presented with clinical diagnosis of tuberculosis but turned out to be nocardiosis on cytomorphology with simple and most feasible fine‐needle aspiration method of tissue diagnosis and scrape cytology.     

Comparative Evaluation of MicroScan Walkaway 96 Plus ID/AST System and Mikrolatest Broth Microdilution Kit in Assessing In vitro Colistin Susceptibility of Carbapenem-Resistant Clinical Gram-negative Bacterial Isolates: Experience from a Tertiary Care Teaching Hospital in Rishikesh,Uttarakhand

Context: As reports on colistin resistance are slowly emerging from different parts of the world, it is imperative that the clinical microbiology laboratories should generate accurate in vitro colistin susceptibility results. Aim: The aim is to generate preliminary data on the diagnostic utility of MicroScan WalkAway 96 Plus Identification ID/Antimicrobial susceptibility testing AST system in determining in vitro colistin susceptibility of carbapenem-resistant clinical Gram-negative bacterial isolates. Settings and Design: A pilot study was conducted in a tertiary care teaching hospital located in Rishikesh, Uttarakhand, between May and June 2019. Materials and Methods: Thirty-four carbapenem-resistant Escherichia coli, Pseudomonas aeruginosa and Acinetobacter spp. isolated from various non-repetitive clinical samples during the study period, were subjected to antibiotic susceptibility testing using MicroScan ID/AST system. Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry was used to confirm identity of these isolates. Additional colistin susceptibility testing of all test isolates was performed using Mikrolatest minimum inhibitory concentration antibiotic susceptibility testing kit (reference method), which is based on broth micro dilution (BMD) principle. Statistical Analysis Used: Fisher’s exact test. Results: 11.8% (4/34) of the test isolates (100% [2/2] Acinetobacter junii, 10% [1/10] E. coli and 14.3% [1/7] P. aeruginosa respectively) exhibited in vitro colistin resistance by BMD method. Categorical agreement between MicroScan ID/AST system and Mikrolatest kit w. r. t in vitro colistin susceptibility test results was as follows: 71.4% (Acinetobacter baumannii), 85.7% (P. aeruginosa) and 100% (A. junii, A. johnsonii, E. coli and Klebsiella pneumoniae), respectively. Two major errors (MEs) for A. baumannii and one very ME for P. aeruginosa respectively were observed. Conclusions: Data generated by this study will be of help to the clinicians who are often faced with the dilemma of treating multi drug resistant infections with limited treatment options.     

Gel clot LAL assay in the initial management of peritoneal dialysis patients with peritonitis: a retrospective study.

BACKGROUND: Indiscriminate use of broad-spectrum antibiotic treatment of peritonitis in peritoneal dialysis patients may have either unwanted side-effects or contribute to the development of antibiotic resistance. This may be avoided by improved diagnosis at presentation. The Limulus amoebocyte lysate assay is a convenient test detecting bacterial endotoxins or fungal beta glucans. This study evaluates a qualitative Limulus amoebocyte lysate test as a diagnostic tool used at presentation of a peritoneal dialysis patient with peritonitis. METHODS: One-hundred and eleven episodes of peritonitis in peritoneal dialysis patients have been analysed retrospectively. Limulus amoebocyte lysate results at presentation were compared with culture results. A Limulus amoebocyte lysate assay was performed using a commercial kit by incubating a mixture of dialysate effluent and Limulus amoebocyte lysate reagent at 37 degrees C. The development of a stable solid clot was considered positive. The specificity and sensitivity of the test were calculated. RESULTS: The specificity of the Limulus amoebocyte lysate assay was found to be 98% and the sensitivity 74%. Limulus amoebocyte lysate assay was false-negative in 13 cases of Gram-negative peritonitis (22%). Limulus amoebocyte lysate was positive in three of seven cases of fungal peritonitis. The study included one case each with false-positive Limulus amoebocyte lysate and with culture-negative peritonitis. CONCLUSIONS: The Limulus amoebocyte lysate assay is a convenient and valuable diagnostic tool for excluding Gram-positive peritonitis in peritoneal dialysis patients. This allows more specific antibiotic treatment at presentation and may avoid the development of bacterial resistance. A negative Limulus amoebocyte lysate test is not reliable for the exclusion of Gram-negative peritonitis. In the absence of a positive culture result 48 h after presentation, accompanied by a delayed response to treatment, a positive Limulus amoebocyte lysate assay may indicate the presence of fungus. This justifies early empiric antifungal treatment before definitive culture results are made available. Routine Limulus amoebocyte lysate assay of dialysate effluent from continuous ambulatory peritoneal dialysis patients presenting with peritonitis is recommended.     

我院2005～2006年医院感染病原菌分布及其耐药性研究

目的:了解我院近2年医院感染病原菌的分布及其耐药性。方法:采用回顾性调查方法,对4653株病原菌进行统计分析。结果:真菌709株,占15.2%;革兰阳性(G+)球菌1078株,占23.2%;革兰阴性(G-)杆菌2866株,占61.6%。产超广谱β-内酰胺酶大肠杆菌和肺炎克雷伯菌2年平均检出率分别为36.5%、27.9%。G+球菌对青霉素、苯唑西林、头孢唑啉、阿莫西林/克拉维酸、红霉素、复方新诺明、环丙沙星的2年平均耐药率达84.5%;G-杆菌对氨苄西林2年平均耐药率达96.0%,对头孢噻肟、头孢吡肟、庆大霉素、复方新诺明、环丙沙星、氨曲南的2年平均耐药率达52.7%。结论:2年来,医院感染病原菌G-杆菌增加,G+球菌不变,真菌感染有逐年降低趋势。细菌耐药性不断增强,临床应加强对抗菌药物使用的干预。     

慢性阻塞性肺疾病伴社区获得性肺炎60例病原菌及其耐药性分析

目的 对COPD伴社区获得性肺炎病原菌和耐药情况进行分析,为临床合理用药提供依据.方法 对60例COPD伴社区获得性肺炎患者的痰液标本进行病原菌检测和药敏性试验.结果 病原菌以肺炎链球菌为主24例（40％）,其次为肺炎克雷伯菌10例（13.3％）、流感嗜血杆菌8例（16.7％）、肺炎支原体6例（8.3％）、甲型溶血性链球菌5例（6.7％）、金黄色葡萄球菌4例（3.3％）、嗜肺军团菌2例（3.3％）、其它1例（1.67％）;药敏试验显示革兰阴性菌具有较高的耐药率.流感嗜血杆菌、肺炎链球菌、嗜肺军团菌体对青霉素具有较高的耐药率.肺炎支原体、肺炎克雷伯菌对阿奇霉素表现出一定的耐药率.金黄色葡萄球菌、甲型溶血性链球菌对头孢噻吩表现出耐药性.结论 COPD伴社区获得性肺炎患者感染病菌情况主要以革兰阴性菌抗生素耐药较为严重.在之后的临床使用抗生素选择其它类的抗生素,提高临床药物抗菌疗效.     

应用蒙特卡罗模拟优化哌拉西林/他唑巴坦的给药方案

目的：评价哌拉西林/他唑巴坦的延长输注和持续输注给药方案对革兰阴性杆菌的药效学。方法：测定本院2008年1月至2008年6月4种革兰阴性杆菌（大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌及铜绿假单胞菌）的MIC,应用10000例蒙特卡罗模拟（MCS）分析比较哌拉西林/他唑巴坦的延长输注（PI）、持续输注（CI）与传统给药方案的药效学目标到达。结果：对于大肠埃希菌和肺炎克雷伯菌,只有4.5gq6h（PI）的给药方案能达到90%以上的累积反应分数（CFR）,分别为98.4%、91.0%。对于鲍曼不动杆菌和铜绿假单胞菌,没有一种给药方案能达到最佳的CFR。持续输注给药方案9.0gCI与传统给药方案4.5gq8h相比,获得更高的CFR。4.5gq8h（PI）、4.5gq6h（PI）与传统给药方案相比,对4种革兰阴性杆菌获得更高的CFR。结论：哌拉西林/他唑巴坦延长输注及持续输注方案较常规方案更优,可作为临床的经验给药方案。     

2012—2015年1380株肝移植术后感染病原菌的分布及耐药性分析

目的了解江苏省人民医院肝移植术后感染病原菌的分布及耐药性,为临床合理用药提供参考。方法对2012年1月—2015年1月江苏省人民医院肝移植术后感染病原菌的分布及耐药性进行统计分析。结果共分离出病原菌1 380株,主要来源于痰液标本。病原菌分布以革兰阴性菌为主,占69.57%,革兰阳性菌和真菌分别占20.07%、10.36%;其中革兰阴性菌以鲍曼不动杆菌、肺炎克雷伯菌为主,革兰阳性菌以溶血葡萄球菌为主;革兰阴性菌对美罗培南、阿米卡星、亚胺培南较为敏感,耐药率均低于30%,对头孢曲松、氨曲南等的耐药率均较高;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁较为敏感,耐药率均低于20%,对氨苄西林、诺氟沙星等耐药率均较高。结论肝移植术后感染病原菌的构成主要是鲍曼不动杆菌、肺炎克雷伯菌和溶血葡萄球菌,临床选择抗菌药物时建议选用病原菌表现较低耐药性的美罗培南、阿米卡星、万古霉素、利奈唑胺等药物。     

成都医学院第一附属医院2013年病原菌的分布与耐药性分析

目的了解成都医学院第一附属医院病原菌的分布与耐药性,为临床合理使用抗菌药物提供依据。方法回顾性分析成都医学院第一附属医院2013年病原菌的鉴定及药敏结果。结果共分离出病原菌3 805株,其中革兰阴性菌2 484株(65.3%),主要包括大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌肺炎亚种;革兰阳性菌928株(24.4%),以金黄色葡萄球菌为主;真菌393株(10.3%),主要为白假丝酵母菌。药物敏感试验显示,革兰阴性菌中大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌肺炎亚种仍均对碳青霉烯类及青霉素、头孢菌素类/β-内酰胺酶抑制剂保持着较高的敏感率,而鲍曼不动杆菌的耐药现象较严重,仅对多黏菌素E高度敏感;革兰阳性菌均对万古霉素保持着高度敏感率,而对红霉素等大环内酯类及青霉素的耐药现象较严重;真菌中白假丝酵母对5-氟胞嘧啶、氟康唑、伏力康唑、两性霉素B、伊曲康唑的敏感率均较高。结论应定期统计分析本院病原菌的分布及药敏情况,使临床医生依此合理使用抗菌药物,从而提高感染治愈率和延缓耐药菌的产生。     

E试验监测重症监护病房中400株革兰氏阴性杆菌的耐药性

目的 调查我院监护病房革兰氏阴性杆菌耐药状况及超广谱β—内酰胺酶(ESBLs)菌株的发生率，了解四年来革兰氏阴性菌对抗菌药物的耐药性变迁。方法 用E试验法测定400株革兰氏阴性杆菌对11种抗生素的最低抑菌浓度(MIC)。并用头孢他啶／头孢他啶 克拉维酸E试验酶试条检阅细菌产ESBL的情况。结果 亚胺培南对所有受试菌保持最高抗菌活性，细菌耐药率仅为7．5％；头孢哌酮／舒巴坦、阿米卡星、哌拉西林／三唑巴坦、头孢吡肟和头孢他啶仍有较高抗菌活性，耐药率分别为16．0％、20．0％、22．5％、23％和26．8％；其它抗生素耐药率在42．8％—46.8％之间。用头孢他啶／头孢他啶 克拉维酸筛选大肠埃希氏菌和肺炎克雷伯氏菌ESBLs产生菌27株，检出率分别为40．9％和27．3％。体外抗菌活性最强的是亚胺培南，所有大肠埃希氏菌和肺炎克雷伯氏菌ESBLs菌株都对之敏感。含酶抑制剂抗生素哌拉西林／三唑巴坦和头孢哌酮／舒巴坦对产ESBLs株保持较高体外抗菌活性，但2001年分离菌耐药率有所增加。四年资料相比，所测细菌对头孢哌酮／舒巴坦耐药率由1998—2000年的11％—14％增加至2001年的26％，大肠埃希氏菌对环丙沙星耐药率由1998—1999年的45.2％上升至2000—2001年的79.6％，细菌对其它抗菌药物耐药率变化不大。结论 亚胺培南抑菌率最高，对ESBLs产生菌有较强的抗菌活性，而抗菌药物(尤其是加酶抑制剂抗生素和喹诺酮类药物)的滥用，已造成细菌对其耐药率升高，且对付产酶耐药株感染逐渐失去优势。     

临床常见革兰阴性杆菌分布及耐药性分析

目的 了解医院临床常见革兰阴性杆菌的菌种分布及对抗菌药物的耐药性,为临床合理使用抗菌药物提供依据.方法 收集2011年1-12月医院临床各科室送检标本分离的革兰阴性杆菌,采用细菌鉴定仪ATBExpression系统鉴定细菌,纸片扩散法(K-B法)测定抗菌药物的敏感性,用CLSI推荐的双纸片确证试验检测大肠埃希菌和肺炎克雷伯菌的产超广谱β-内酰胺酶(ESBLs)发生率.结果 临床分离率居前5位的革兰阴性杆菌依次为大肠埃希菌250株占25.36％、铜绿假单胞菌226株占22.92％、肺炎克雷伯菌149株占15.11％、鲍氏不动杆菌107株占10.85％和阴沟肠杆菌51株占5.17％,其中3种肠杆菌科细菌中未发现耐亚胺培南和美罗培南的菌株,但对氨苄西林的耐药率均＞90.0％;产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别为50.8％和32.9％;铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为16.4％和18.6％;鲍氏不动杆菌中未发现耐头孢哌酮/舒巴坦菌株,对亚胺培南的耐药率为4.7％.结论 加强对临床感染常见革兰阴性杆菌的检测和耐药性监测,对指导临床合理使用抗菌药物、有效控制感染具有重要意义.