Candida Glabrata and Candida Tropicalis in an Immunocompetent Patient

2015 ◽  
Vol 28 (3) ◽  
pp. 284-287 ◽  
Author(s):  
Leslie A. Hamilton ◽  
Nicholas R. Lockhart ◽  
Michael R. Crain
Keyword(s):  
Blood Culture ◽  
Bronchoalveolar Lavage ◽  
Candida Glabrata ◽  
The United States ◽  
Immunocompetent Patient ◽  
Hospital Acquired Pneumonia ◽  
Tract Infections ◽  
Hospital Acquired ◽  
Immunocompetent Patients ◽  
Candida Pneumonia

Objective: To report a case of Candida glabrata and tropicalis pneumonia in an immunocompetent patient. Case Summary: A 72-year-old male was transferred from an outside institution due to worsening respiratory status, acute kidney injury secondary to intravenous contrast media, sepsis, and pneumonia with fever and leukocytosis. Upon admission, he was initiated on treatment for hospital-acquired pneumonia, but was also concomitantly tested for many other opportunistic infections due to his recent month-long trip to Ecuador where he participated in a tribal treatment for neuropathy that involved direct exposure to dead guinea pigs. With completion of cultures and bronchoalveolar lavage, C. glabrata was identified in the blood culture and C. glabrata and C. tropicalis in the bronchoalveolar lavage specimen. One month later, he was admitted due to recurrent pneumonia. The patient unfortunately expired during the second admission, due to complications from chronic respiratory pulmonary disease and pneumonia. Discussion: Initially, this patient was treated for hospital-acquired pneumonia, but due to a recent trip to Ecuador, it was soon discovered that this patient had developed an invasive Candida pneumonia. His pulmonary biopsies showed growth of invasive C. glabrata and C. tropicalis, while his blood culture showed C. glabrata. Candida-related lower respiratory tract infections are exceptionally rare in immunocompetent patients and require histopathologic evidence to confirm the diagnosis. A second blood culture showed that the C. glabrata was still present and the patient had worsening leukocytosis, so micafungin was added to his antimicrobial therapy. Conclusion: It is understood that pneumonia is rarely caused by Candida species in patients who are admitted to the hospital. However, health care professionals should be aware that Candida pneumonia should be suspected as part of the differential diagnosis even in immunocompetent patients, particularly if they have recently traveled outside the United States.

scholarly journals Antimicrobial Activity of Ceftolozane–Tazobactam Tested against Contemporary (2012–2016) Enterobacteriaceae and Pseudomonas aeruginosa from ICU vs. non-ICU Isolates Collected in US Medical Centers

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S366-S366
Author(s):  
Dee Shortridge ◽  
Leonard R Duncan ◽  
Michael A Pfaller ◽  
Robert K Flamm
Keyword(s):  
Pseudomonas Aeruginosa ◽  
The United States ◽  
Icu Patients ◽  
Medical Centers ◽  
Hospital Acquired Pneumonia ◽  
Tract Infections ◽  
Abdominal Infections ◽  
Hospital Acquired ◽  
Lactamase Inhibitor ◽  
Research Grant

Abstract Background Ceftolozane-tazobactam (C-T) is a combination of a novel antipseudomonal cephalosporin and a well-described β-lactamase inhibitor. C-T was approved by the United States (US) Food and Drug Administration in 2014 for complicated urinary tract infections, including acute pyelonephritis and complicated intra-abdominal infections. C-T is currently in clinical trials for the treatment of hospital-acquired pneumonia. The Program to Assess Ceftolozane-Tazobactam Susceptibility (PACTS) monitors C-T resistance to gram-negative (GN) isolates worldwide. This study compares the activities of C-T and comparators against GN isolates from ICU patients and non-ICU patients. Methods A total of 3,100 GN ICU isolates and 3,271 isolates from non-ICU patients were collected from 30 US hospitals in 2012–2016. Isolates were tested for susceptibility (S) to C-T and comparators by CLSI broth microdilution methodology in a central monitoring laboratory. Other antibiotics tested included amikacin (AMK), cefepime (FEP), ceftazidime (CAZ), colistin (COL), meropenem (MER), and piperacillin-tazobactam (TZP). CLSI (2017) interpretive criteria were used for all except COL with Enterobacteriaceae (ENT), for which EUCAST (2017) criteria were used. Results The most common ENT species from ICU and non-ICU patients were similar. The 3 most common ENT for ICU and non-ICU isolates were Klebsiella pneumoniae, 24.1% and 25.8%; Escherichia coli, 19.4% and 18.2%; and Serratia marcescens, 14.7% and 14.3%, respectively. The most common non-enteric species was Pseudomonas aeruginosa (PSA) for ICU and non-ICU (72.7% and 78.2%). ICU ENT isolates generally had a lower %S than non-ICU (Table). ENT showed more variability than PSA for %S between ICU and non-ICU. Conclusion For ENT overall, MER and AMK were the most active, followed by C-T. Comparing ICU and non-ICU, MER and C-T were slightly more active vs. non-ICU ENT, while AMK %S was similar for both. For PSA, COL was the most active; C-T and AMK were similar. Activities between ICU and non-ICU isolates were similar for C-T and COL while AMK was more active vs. ICU isolates, and MER was more active vs. non-ICU. C-T showed potent activity against ICU and non-ICU isolates for ENT and PSA. Disclosures D. Shortridge, Merck: Research Contractor, Research grant; L. R. Duncan, Merck: Research Contractor, Research grant; M. A. Pfaller, Merck: Research Contractor, Research grant; R. K. Flamm, Merck: Research Contractor, Research grant

scholarly journals In Vitro Activity of Doripenem, a Carbapenem for the Treatment of Challenging Infections Caused by Gram-Negative Bacteria, against Recent Clinical Isolates from the United States

2008 ◽  
Vol 52 (12) ◽  
pp. 4388-4399 ◽  
Author(s):  
Chris M. Pillar ◽  
Mohana K. Torres ◽  
Nina P. Brown ◽  
Dineshchandra Shah ◽  
Daniel F. Sahm
Keyword(s):  
The United States ◽  
Clinical Isolates ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Coagulase Negative Staphylococci ◽  
Hospital Acquired Pneumonia ◽  
Abdominal Infections ◽  
Hospital Acquired ◽  
Gram Positive Cocci

ABSTRACT Doripenem, a 1β-methylcarbapenem, is a broad-spectrum antibiotic approved for the treatment of complicated urinary tract and complicated intra-abdominal infections. An indication for hospital-acquired pneumonia including ventilator-associated pneumonia is pending. The current study examined the activity of doripenem against recent clinical isolates for the purposes of its ongoing clinical development and future longitudinal analysis. Doripenem and comparators were tested against 12,581 U.S. clinical isolates collected between 2005 and 2006 including isolates of Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus pneumoniae, Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp. MICs (μg/ml) were established by broth microdilution. By MIC90, doripenem was comparable to imipenem and meropenem in activity against S. aureus (methicillin susceptible, 0.06; resistant, 8) and S. pneumoniae (penicillin susceptible, ≤0.015; resistant, 1). Against ceftazidime-susceptible Enterobacteriaceae, the MIC90 of doripenem (0.12) was comparable to that of meropenem (0.12) and superior to that of imipenem (2), though susceptibility of isolates exceeded 99% for all evaluated carbapenems. The activity of doripenem was not notably altered against ceftazidime-nonsusceptible or extended-spectrum β-lactamase screen-positive Enterobacteriaceae. Doripenem was the most potent carbapenem tested against P. aeruginosa (MIC90/% susceptibility [%S]: ceftazidime susceptible = 2/92%S, nonsusceptible = 16/61%S; imipenem susceptible = 1/98.5%S, nonsusceptible = 8/56%S). Against imipenem-susceptible Acinetobacter spp., doripenem (MIC90 = 2, 89.1%S) was twice as active by MIC90 as were imipenem and meropenem. Overall, doripenem potency was comparable to those of meropenem and imipenem against gram-positive cocci and doripenem was equal or superior in activity to meropenem and imipenem against Enterobacteriaceae, including β-lactam-nonsusceptible isolates. Doripenem was the most active carbapenem tested against P. aeruginosa regardless of β-lactam resistance.

Hospital-acquired pneumonia in Japan may have a better mortality profile than HAP in the United States: a retrospective study

2012 ◽  
Vol 18 (5) ◽  
pp. 734-740 ◽  
Author(s):  
Kentaro Iwata ◽  
Wataru Igarashi ◽  
Yuichiro Oba ◽  
Goh Ohji ◽  
Midori Honjo ◽  
...  
Keyword(s):  
United States ◽  
Retrospective Study ◽  
The United States ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

scholarly journals Efficacy of Blind Tracheal Aspirate in Comparison to Bronchoalveolar Lavage for Microbiological Diagnosis of Nosocomial Pneumonia in Patients on Ventilator

2016 ◽  
Vol 4 (2) ◽  
pp. 49-55
Author(s):  
ASM Areef Ahsan ◽  
Mohammad Omar Faruq ◽  
Kaniz Fatema ◽  
Fatema Ahmed ◽  
Shakera Binte Hassan
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bronchoalveolar Lavage ◽  
Acinetobacter Baumannii ◽  
Nosocomial Pneumonia ◽  
Tracheal Aspirate ◽  
Mechanical Ventilator ◽  
Microbiological Diagnosis ◽  
Hospital Acquired Pneumonia ◽  
Diagnostic Modalities ◽  
Hospital Acquired

Background and Objectives: For diagnosis of nosocomial pneumonia in patients on ventilator, invasive procedure like bronchoscopy for microscopy and quantitative cultures of lower respiratory tract samples is useful but not always possible for potential risk of the procedure and the associated cost. The non-bronchoscopic sampling of the lower airways and quantitative cultures of tracheal aspirate may offer simple and readily available alternative to bronchoscopy with promising results. This study was done to evaluate the efficacy of blind tracheal aspirate in the microbiological diagnosis of nosocomial pneumonia occurring in intubated patients on mechanical ventilator. Materials & Methods: This cross-sectional study was carried out in the Intensive Care Unit in the Department of Critical Care Medicine, BIRDEM Hospital, Dhaka over a period 16 months starting from January 2010 to April 2011. A total of 54 clinically diagnosed cases of nosocomial (hospital acquired) pneumonia who were on ventilator were consecutively included in the study based on predefined enrolment criteria. All the 54 cases were subjected to blind endotracheal aspirate (BTA) followed by bronchoalveolar lavage (BAL) for quantitative cultures of specimens and isolation of causative microorganisms from them. Result: The present study showed that the mean age of the patients was 61 years (range: 24-86 years). Males were predominant in the series with male to female ratio being 7:3. Majority of the patients was haemodynamically stable as indicated by mean blood pressures, heart rate, temperature and respiratory rate. Most (83.3%) of the cases showed significant growth of microbes on culture of blind tracheal aspirates at cut-off value of 105 colony forming unit/ml (cfu/ml), while 87% of the cases exhibited positive growth on culture of bronchoalveolar lavage at cut-off value of 104 cfu/ml. Acinetobacter baumannii was the predominant organism isolated from BTA (73.3%) followed by Pseudomonas aeruginosa (33.3%). An almost similar pattern of growth was evident in BAL with more than 70% being Acinetobacter baumannii and about 30% Pseudomonas aeruginosa. C. albicans. Kiebsiella sp., E. coli, and Flavobacter were less commonly observed in either group. The Kappa test revealed a good agreement (70.7%) between the two procedures suggesting that the two diagnostic modalities are almost comparable in diagnosing pneumonia in patients admitted in ICU (p < 0.001). Conclusion: The study concluded that the accuracy of blind tracheal aspirate and bronchalveolar lavage in the diagnosis of nosocomial pneumonia was fairly comparable. The strength of agreement between the two diagnostic modalities is also good encouraging its use instead of more invasive procedures like BAL in the diagnosis of hospital-acquired pneumonia who are on mechanical ventilator. Ibrahim Cardiac Med J 2014; 4(2): 49-55

scholarly journals Comparison of the In Vitro Susceptibility of Ceftolozane-Tazobactam With the Cumulative Susceptibility Rates of Standard Antibiotic Combinations When Tested Against Pseudomonas aeruginosa From ICU Patients With Bloodstream Infections or Pneumonia

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Dee Shortridge ◽  
Michael A Pfaller ◽  
S J Ryan Arends ◽  
Janet Raddatz ◽  
Daryl D DePestel ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bloodstream Infections ◽  
The United States ◽  
Multidrug Resistant ◽  
In Vitro Susceptibility ◽  
Patients At Risk ◽  
Seriously Ill Patients ◽  
Tract Infections ◽  
Hospital Acquired

Abstract Background Pseudomonas aeruginosa remains an important cause of hospital-acquired infections in the United States and is frequently multidrug-resistant (MDR). The Infectious Diseases Society of America guidelines recommend empiric combination therapy that includes an antipseudomonal β-lactam with an aminoglycoside or fluoroquinolone likely to cover ≥95% of P. aeruginosa infections in seriously ill patients at risk of having an MDR pathogen. Ceftolozane is an antipseudomonal cephalosporin, combined with the β-lactamase inhibitor tazobactam. Ceftolozane-tazobactam is approved for treatment of complicated urinary tract infections and complicated intra-abdominal infections. A phase 3 clinical trial for the treatment of hospital-acquired pneumonia including ventilator-associated pneumoniae was recently completed. We compared the in vitro susceptibility rate of ceftolozane-tazobactam with the cumulative susceptibility rates of antibiotic combinations commonly used against P. aeruginosa. Methods Isolates were collected from intensive care unit patients hospitalized in 32 US hospitals from 2011 to 2017. The susceptibilities of 1543 P. aeruginosa isolates from bloodstream infections (198 isolates, 12.8%) or pneumonia (1345 isolates, 87.2%) were determined for ceftolozane-tazobactam and comparators. Results The most active antimicrobials were colistin (99.4% susceptible), amikacin (98.1% susceptible), and ceftolozane-tazobactam (96.5% susceptible). The susceptibilities to other antipseudomonal β-lactams and fluoroquinolones were &lt;84%. A cumulative susceptibility of ≥95% was reached for cefepime, ceftazidime, meropenem, and piperacillin-tazobactam only in combination with amikacin due to the lower susceptibilities of gentamicin, ciprofloxacin, and levofloxacin. Monotherapies that exceeded 95% were ceftolozane-tazobactam, amikacin, and colistin. Conclusions Ceftolozane-tazobactam monotherapy is likely to be active against more isolates than a combination of another β-lactam and a fluoroquinolone or gentamicin for serious P. aeruginosa infections.

scholarly journals Neonatal Pneumonia in NICU of a Tertiary Care Center

2018 ◽  
Vol 42 (3) ◽  
pp. 112-117
Author(s):  
MA Mannan ◽  
Nazmun Nahar ◽  
Firoz Ahmed ◽  
Ismat Jahan ◽  
Taskina Mosleh ◽  
...  
Keyword(s):  
Blood Culture ◽  
Neonatal Intensive Care ◽  
Care Center ◽  
Tertiary Care ◽  
Neonatal Infection ◽  
Community Acquired Pneumonia ◽  
Sick Newborn ◽  
Hospital Acquired Pneumonia ◽  
Medical University ◽  
Hospital Acquired

Background: Pneumonia is one of the causes of neonatal infection and responsible for significant morbidity and mortality, especially in developing countries. The study was aimed to reveal frequency and outcome of pneumonia among hospitalized sick newborn of neonatal intensive care unit. Methodology: This observational study was carried out in the NICU of Bangabandhu Sheikh Mujib Medical University (BSMMU) on 94 neonates with the diagnosis of pneumonia admitted from July 2012 to June 2014. All studied neonates were subjected to history taking, clinical examination, routine investigations, chest radiography and blood culture and sensitivity. Results: Incidence of neonatal pneumonia was 43% among admitted neonates with respiratory distress. Mean birth weight and gestational age were 2392±854 and 33±3.9 weeks respectively. Of enrolled infants with pneumonia, 38 (40.4%) were early onset, 24 (25%) were hospital acquired pneumonia and community acquired pneumonia was documented in 14 (14.8 %) and the rest 18 (19%) were ventilator associated pneumonia. Blood culture was positive in 18 (19%) of cases with neonatal pneumonia; most common pathogen isolated was acinetobacter. Mean duration of hospital stay was 19±8 days. Most of the neonatal pneumonia were cured 72 (76%) with therapy, whereas 17 (18%) died during their hospital course. Conclusion: Overall incidence among admitted sick neonates was 8.4% which constituted 34% of distressed neonate. Bangladesh J Child Health 2018; VOL 42 (3) :112-117

scholarly journals Approach to Pneumonia in Immunocompetent Patients

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Spandana Veeravalli ◽  
Safiya Soullane
Keyword(s):  
Decision Making ◽  
Lung Inflammation ◽  
Infectious Agent ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
Outpatient Management ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Infectious Etiology ◽  
Immunocompetent Patients

Pneumonia is a leading cause of morbidity. Pneumonia is defined as a lung inflammation of infectious etiology. It can be subcategorized into Community Acquired Pneumonia, Hospital Acquired Pneumonia and Ventilator Acquired Pneumonia. Validated scores including the CRB-65, CURB-65 and PSI can guide decision-making between inpatient and outpatient management of pneumonia. While mild presentations can be managed through empiric treatment alone, more acute cases require identification of the infectious agent, initiation of empiric therapy, and subsequent de-escalation of treatment to the identified pathogen. This article aims to provide a framework for junior trainees to diagnose and manage pneumonia.

scholarly journals Activity of Meropenem-Vaborbactam against Bacterial Isolates Causing Pneumonia in Patients in U.S. Hospitals during 2014 to 2018

2020 ◽  
Vol 64 (3) ◽  
Author(s):  
Cecilia G. Carvalhaes ◽  
Dee Shortridge ◽  
Helio S. Sader ◽  
Mariana Castanheira
Keyword(s):  
Susceptibility Testing ◽  
The United States ◽  
Ventilator Associated Pneumonia ◽  
Bacterial Isolates ◽  
Content Type ◽  
Microdilution Method ◽  
Carbapenem Resistant ◽  
Broth Microdilution Method ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

ABSTRACT Meropenem-vaborbactam is approved to treat hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP), in Europe. Meropenem-vaborbactam activity was evaluated against 3,193 Pseudomonas aeruginosa and 4,790 Enterobacterales isolates causing pneumonia, including VAP, in hospitalized patients in the United States. Susceptibility testing was performed by using the broth microdilution method, and all carbapenem-resistant isolates were submitted for whole-genome sequencing. Meropenem-vaborbactam exhibited almost complete activity against Enterobacterales (>99.9% susceptible), including carbapenem-resistant Enterobacterales (CRE), and was also very active against P. aeruginosa isolates (89.5% susceptible).

scholarly journals Cryptococcus gattiiin an Immunocompetent Patient in the Southeastern United States

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
John W. Amburgy ◽  
Joseph H. Miller ◽  
Benjamin J. Ditty ◽  
Patrick Vande Lune ◽  
Shaaf Muhammad ◽  
...  
Keyword(s):  
United States ◽  
Southeastern United States ◽  
The United States ◽  
Immunocompetent Patient ◽  
Northwestern Region ◽  
Intracranial Lesions ◽  
Inpatient Therapy ◽  
One Year ◽  
Neurosurgical Intervention ◽  
Immunocompetent Patients

Cryptococcal infections are seen throughout the United States in both immunocompromised and immunocompetent patients. The most common form isC. neoformans. In the Northwestern United States,C. gattiihas received considerable attention secondary to increased virulence resulting in significant morbidity and mortality. There are no cases in the extant literature describing a patient withC. gattiirequiring neurosurgical intervention in Alabama. A middle-aged immunocompetent male with no recent travel or identifiable exposure presented with meningitis secondary toC. gattii. The patient underwent 12 lumbar punctures and a ventriculoperitoneal shunt and required 83 days of inpatient therapy with 5-flucytosine and amphotericin B. The patient was found to have multiple intracranial lesions and a large intramedullary spinal cryptococcoma within his conus. Following an almost 3-month hospitalization the patient required treatment with oral voriconazole for one year. In the United States meningitis caused byC. gattiiinfection is not isolated to the Northwestern region.

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