Population-Based Surveillance for HypermucoviscosityKlebsiella pneumoniaeCausing Community-Acquired Bacteremia in Calgary, Alberta

The characteristics of hypermucoviscosity isolates amongKlebsiella pneumoniaecausing community-acquired bacteremia were investigated. The hypermucoviscous phenotype was present in 8.2% ofK pneumoniaeisolates, and was associated with rmpA and the K2 serotype; liver abscesses were the most common clinical presentation. The present analysis represents the first population-based surveillance study of hypermucoviscosity amongK pneumoniaecausing bacteremia.

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Incidence of paediatric 10-fold medication errors in Wales

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-319130 ◽

2020 ◽

pp. archdischild-2020-319130

Author(s):

Yincent Tse ◽

David Tuthill

Keyword(s):

Medication Errors ◽

Reporting System ◽

Patient Characteristics ◽

Population Based ◽

Population Surveillance ◽

Near Miss ◽

Surveillance Study ◽

High Resource ◽

Improvement Strategies ◽

Iatrogenic Harm

ObjectivesTo estimate the incidence, characteristics and outcomes of 10-fold or greater or a tenth or less medication errors in children aged <16 years in Wales.DesignPopulation-based surveillance study July 2017 to June 2019. Cases were identified by paediatricians and hospital pharmacists using monthly electronic Welsh Paediatric Surveillance Unit (WPSU) reporting system.Patients‘Definite’ incident occurred when children received all or any of the incorrect dose of medication. ‘Near miss’ was where the prescribed, prepared or dispensed medication was not administered to the child.Main outcome measuresIncidence, patient characteristics, setting, drug characteristics, outcome, harm and enabling or preventive factors.ResultsIn total, 50 10-fold errors were reported; 20 definite and 30 near miss cases. This yields a minimum annual incidence of 1 per 3797 admissions, or 4.6/100 000 children. Of these, 43 were overdoses and 7 underdoses. 33 incidents occurred in children <5 years of age. Overall, 37 different medications were involved with the majority, 31 cases, being administered enterally. Of these 31 enteral medication errors, all definite cases (10) had received liquid preparations. Temporary harm occurred in 5/20 (25%) definite cases with one requiring intensive care; all fully recovered.ConclusionsIn this first ever population surveillance study in a high-resource healthcare system, 10-fold errors in children were rare, sometimes prevented and uncommonly caused harm. We recommend country-wide improvements be made to reduce iatrogenic harm. Understanding the enabling and preventive factors may help national improvement strategies to reduce these errors.

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Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates

Tropical Diseases Travel Medicine and Vaccines ◽

10.1186/s40794-021-00140-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hussam Mousa ◽

Ghada Salameh Mohammed Al-Bluwi ◽

Zainab Fathi Mohammed Al Drini ◽

Huda Imam Gasmelseed ◽

Jamal Aldeen Alkoteesh ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

United Arab Emirates ◽

Liver Abscess ◽

Hospital Admissions ◽

Indian Subcontinent ◽

Pyogenic Liver Abscess ◽

Primary Diagnosis ◽

Incidence Rates ◽

Liver Abscesses ◽

Potential Risk Factors

Abstract Background There is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes. Methods We retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period. Results Amongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35–52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2–48.0) and 5.9/100,000 inhabitants (95% CI 4.3–7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1–60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7–8.5) than in PLA (14 days, IQR 9–17). No deaths were recorded within 30 days of hospitalisation. Conclusions ALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.

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A Case of Multiple Chemical Sensitivities: Cognitive Therapy for Somatization Disorder and Metaworry

Journal of Cognitive Psychotherapy ◽

10.1891/jcop.17.3.267.52532 ◽

2003 ◽

Vol 17 (3) ◽

pp. 267-277 ◽

Cited By ~ 1

Author(s):

Scott Temple

Keyword(s):

Cognitive Therapy ◽

Unusual Case ◽

Clinical Presentation ◽

Somatization Disorder ◽

Case Conceptualization ◽

Marital Problems ◽

Multiple Chemical Sensitivities ◽

Common Clinical Presentation ◽

History Of ◽

Multiple Chemical

“Multiple chemical sensitivities” has become an increasingly common clinical presentation to physicians, though it is infrequently seen by psychotherapists. This case report describes a 61-year-old woman who presents with a long history of chemical sensitivities, that led to a somatization disorder with debilitating agoraphobia, depression, and marital problems. Features of a variety of anxiety disorders are present, as are metacognitions that required an unusual case conceptualization. A cognitive therapy case conceptualization and treatment are described, which address the highly idiosyncratic clinical presentation of this patient.

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A protracted mumps outbreak in Western Australia despite high vaccine coverage: a population-based surveillance study

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(18)30498-5 ◽

2019 ◽

Vol 19 (2) ◽

pp. 177-184 ◽

Cited By ~ 18

Author(s):

Darren W Westphal ◽

Ashley Eastwood ◽

Avram Levy ◽

Jane Davies ◽

Clare Huppatz ◽

...

Keyword(s):

Western Australia ◽

Vaccine Coverage ◽

Population Based ◽

Surveillance Study

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Have we left some behind? Trends in socio-economic inequalities in breastfeeding initiation: A population-based epidemiological surveillance study

Can J Public Health ◽

10.17269/cjph.105.4499 ◽

2014 ◽

Vol 105 (5) ◽

pp. e362-e368 ◽

Cited By ~ 12

Author(s):

Nathan C. Nickel ◽

◽

Patricia J. Martens ◽

Dan Chateau ◽

Marni D. Brownell ◽

...

Keyword(s):

Population Based ◽

Surveillance Study ◽

Epidemiological Surveillance ◽

Breastfeeding Initiation ◽

Economic Inequalities

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Occult Liver Abscess Following Clinically Unsuspected Ingestion of Foreign Bodies

Canadian Journal of Gastroenterology ◽

10.1155/1997/815876 ◽

1997 ◽

Vol 11 (5) ◽

pp. 445-448 ◽

Cited By ~ 27

Author(s):

Ban CH Tsui ◽

J Mossey

Keyword(s):

Foreign Body ◽

Preoperative Diagnosis ◽

Foreign Bodies ◽

Clinical Presentation ◽

Computed Tomographic ◽

Liver Abscesses ◽

Computed Tomographic Scan ◽

History Of ◽

Variable Clinical Presentation

Two uncommon cases of foreign body (a wooden clothespin and a toothpick) perforation of the gut with associated pyogenic liver abscesses are presented. These cases illustrate the difficulties of preoperative diagnosis. The lack of history of ingestion of foreign bodies, variable clinical presentation of the conditions and radiolucent natures of the foreign bodies all play a role in impeding the diagnosis preoperatively. This report emphasizes the role of ultrasound and computed tomographic scan in evaluating similar cases. Any patient with known risk factors for ingestion of foreign body should arouse suspicion and be investigated further.

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Effects of iron on the growth, biofilm formation and virulence of Klebsiella pneumoniae causing liver abscess

10.21203/rs.2.15636/v5 ◽

2020 ◽

Author(s):

Tao Chen ◽

Guofeng Dong ◽

Siqin Zhang ◽

Xiucai Zhang ◽

Yajie Zhao ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Liver Abscess ◽

Biofilm Formation ◽

Iron Chelator ◽

Infection Model ◽

Invasive Infection ◽

Liver Abscesses ◽

Severe Infections ◽

Lower Expression ◽

Additional Iron

Abstract Background: Klebsiella pneumoniae is considered the most clinically relevant species of Enterobacteriaceae, known to cause severe infections including liver abscesses. To the best of our knowledge, a large proportion of iron in the human body is accumulated and stored in the liver. We hypothesize that increased iron availability is an important factor driving liver abscess formation and we therefore aim to understand the effects of iron on K. pneumoniae causing liver abscesses. Results: All tested K. pneumoniae clinical isolates, including those isolated from liver abscesses and other abdominal invasive infection sites, grew optimally when cultured in LB broth supplemented with 50 μM iron and exhibited the strongest biofilm formation ability under those conditions. Decreased growth and biofilm formation ability were observed in all tested strains when cultured with an iron chelator (P<0.05). The infection model of G. mellonella larvae indicated the virulence of liver abscess-causing K. pneumoniae (2/3) cultured in LB broth with additional iron was significantly higher than those under iron-restricted conditions (P<0.05). The relative expression levels of the four siderophore genes (iucB, iroB, irp1, entB) in K. pneumoniae strains isolated from liver abscesses cultured with additional iron were lower than those under iron-restricted conditions (P<0.05). Conclusions: It is suggested by our research that iron in the environment can promote growth, biofilm formation and enhance virulence of K. pneumoniae causing liver abscesses. A lower expression of siderophore genes correlates with increased virulence of liver abscess-causing K. pneumoniae. Further deeper evaluation of these phenomena is warranted.

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