Malassezia furfur as emerging pathogen in immunocompromised patients: Unique genotype associated with bloodstream infections in Italian neonates and pediatric patients.

E. meningoseptica is widely distributed in fresh and salt waters, in the soil, and in some animals but is not considered a normal human microflora. It is a gram negative non-fermentative bacillus which is found in the hospital environment and associated with nosocomial infections. It causes various disease like endocarditis, peritonitis, bacteremia, pneumonia, pediatric meningitis. It is mostly associated with infections in the immunocompromised patients. Recognition of E. meningoseptica is of paramount importance for clinicians since multi-drug resistance is common for this organism and secondly it is resistant to antibiotics which are normally used in the treatment of gram negative infections and is sensitive to vancomyin. So knowledge about this organism and its sensitivity will help clinicans to start the antibiotic of choice promptly. We here reported 2 cases of Elizabethkingia meningoseptica in blood and pleural fluid from immunocompromised pediatric patients. JMS 2014;17(2):61-63

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#49: Results of 10 Years of Peripherally Inserted Central Catheter Use and the Association with Infections in Pediatric Patients at a Tertiary Care Oncology Hospital

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.051 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S16-S16

Author(s):

Jennia J Acebo ◽

María Costta ◽

Gisella Sánchez ◽

Erika Villanueva ◽

Erika Montalvo E ◽

...

Keyword(s):

Cancer Patients ◽

Complication Rate ◽

Best Practice ◽

Infectious Complication ◽

Pediatric Patients ◽

Tertiary Care ◽

Bloodstream Infections ◽

Complication Rates ◽

Peripheral Venous Access ◽

Pediatric Cancer Patients

Abstract Introduction Pediatric cancer patients merit the placement of central lines for the treatments they receive. Subcutaneous central ports (SCs) and peripherally inserted central catheters (PICCs) are the most frequently used lines. PICCs have gained popularity due to the ease of insertion, which can be invaluable in the pediatric oncology setting for administration of intravenous therapy, parenteral nutrition, and/or blood products. Since central-line-associated bloodstream infections increase the morbidity and mortality of cancer patients, as well as increase the cost generated by their treatment, active surveillance of these healthcare-associated infections is warranted. Methods This is a retrospective descriptive study of pediatric patients treated via PICCs at the Hospital SOLCA Núcleo Quito between 2009 and 2019. Results During the study period, 70 PICC lines were placed in 66 patients, totaling 1862 catheter-days. The majority of patients (75.7%) were diagnosed with leukemia or lymphoma. As of 2011, all PICCs were placed in the operating room by a surgeon. Ultrasound was used 39 times for the insertion of PICCs. Inadequate peripheral venous access was the most common indication (64.2%) for placement. Twenty-nine PICCs had complications, of which 13 were infectious complications and 16 were noninfectious. The most common infectious complication was PICC-related bloodstream infection (13), and the most frequent noninfectious complication was occlusion (10). The overall complication rate was 15.5 complications per 1000 catheter-days, and the overall infectious complication rate was 6.9 complications per 1000 catheter days. Annual complication rates fluctuated over the study period. The PICC line-associated infection rate per 1000 catheter-days was 13.1‰ in 2009, 12.4‰ in 2010, 5.0‰ in 2011, 7.9‰ in 2012, 0 in 2013, 13.4‰ in 2014, 4.8‰ in 2015, 16.2‰ in 2016, 8.2‰ in 2017, and 4.3‰ in 2018. Conclusion In general, complications related to PICC in pediatric patients at a tertiary care oncology hospital have fluctuated over the years. Our findings indicate the need for further efforts in staff education and training in the insertion, care, and maintenance of PICC lines. Best practice guidelines are also critical to reducing complications, especially occlusion and infection rates, to thereby improve patient outcomes.

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Raoultella ornithinolytica in MALT-type non-Hodgkin Lymphoma

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_003023 ◽

2021 ◽

Author(s):

Rui Seixas ◽

Adelaide Alves ◽

Aurelia Selaru ◽

Manuela Vanzeller ◽

Teresa Shiang ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Hodgkin Lymphoma ◽

Immunocompromised Patient ◽

Bloodstream Infections ◽

Immunocompromised Patients ◽

Non Hodgkin Lymphoma ◽

First Case ◽

Tract Infections

Raoultella ornithinolytica is a bacterium that belongs to the Enterobacteriaceae family. The most frequently reported infections are gastrointestinal and hepatobiliary. Urinary tract infections are very rarely reported and bloodstream infections are usually reported without an identified source. This bacterium is responsible for an increasing number of infections, especially in immunocompromised patients. The authors describe the first case ever reported of an immunocompromised patient due to non-Hodgkin lymphoma MALT type and corticotherapy, who developed urinary tract infection and subsequently bacteriemia due to this pathogen.

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#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.048 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S15-S16

Author(s):

Miguel A Minero ◽

Asia Castro ◽

Martha Avilés-Robles

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Febrile Neutropenia ◽

Pediatric Oncology ◽

Pediatric Patients ◽

Bloodstream Infections ◽

Oncology Patients ◽

Factors Associated ◽

Patients With Cancer ◽

The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

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Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

PEDIATRICS ◽

10.1542/peds.2020-042069 ◽

2021 ◽

Author(s):

William J.H. Ford ◽

David G. Bundy ◽

Suzette Oyeku ◽

Moonseong Heo ◽

Lisa Saiman ◽

...

Keyword(s):

Risk Factors ◽

Pediatric Patients ◽

Secondary Analysis ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Type Number ◽

Central Venous ◽

Medical Centers ◽

Associated Risk Factors

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

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In Vitro Azole and Amphotericin B Susceptibilities of Malassezia furfur from Bloodstream Infections Using E-Test and CLSI Broth Microdilution Methods

Antibiotics ◽

10.3390/antibiotics9060361 ◽

2020 ◽

Vol 9 (6) ◽

pp. 361 ◽

Cited By ~ 2

Author(s):

Wafa Rhimi ◽

Chioma Inyang Aneke ◽

Adriana Mosca ◽

Domenico Otranto ◽

Claudia Cafarchia

Keyword(s):

Amphotericin B ◽

Reading Time ◽

Antifungal Susceptibility ◽

Bloodstream Infections ◽

Hospitalized Patients ◽

Malassezia Furfur ◽

Broth Microdilution ◽

Test Procedures ◽

The Media

The number of reports of Malassezia furfur bloodstream infections is constantly increasing and there is a need for more simple antifungal susceptibility methods for their management. In this study, a total of 39 M. furfur isolates collected from hospitalized patients with fungemia were screened for antifungal susceptibility to azole and amphotericin B (AmB) using Clinical and Laboratory Standards Institute broth microdilution (CLSI BMD) and E-test in Sabouraud dextrose agar + 1% Tween80 (SDAt) and mDixon agar (DIX). Essential agreement (EA) and discrepancies between the two methods were evaluated after 48 h and 72 h reading times. Itraconazole (ITZ) and posaconazole (POS) displayed the lowest MIC values whereas fluconazole (FLZ) and AmB the highest, regardless of the methods and the reading time. The EA between BMD was >95% for FLZ and voriconazole (VOR) regardless of the media in the E-tests and reading time. The EA between BMD with E-test for AmB was >97% only when E-test in SDAt was used. The EA between BMD and E-test for ITZ and POS varied according to the media in E-test procedures and the reading time and was higher than 66.6% (POS) or 72% (ITZ) only when SABt was used. Substantial discrepancies for ITZ and POS were >5.1% regardless of the media and the reading time. This study suggests that the E-test in SABt represents an alternative method to CLSI BMD to evaluate the susceptibility of M. furfur to FLZ, VOR and AmB and not for ITZ and POS.

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The Addition of Anaerobic Blood Cultures for Pediatric Patients with Concerns for Bloodstream Infections: Prevalence and Time to Positive Cultures

Journal of Clinical Microbiology ◽

10.1128/jcm.01844-19 ◽

2020 ◽

Vol 58 (9) ◽

Author(s):

Jennifer Dien Bard ◽

Todd P. Chang ◽

Rebecca Yee ◽

Keya Manshadi ◽

Nhan Lichtenfeld ◽

...

Keyword(s):

Blood Culture ◽

Pediatric Patients ◽

Bloodstream Infections ◽

Pediatric Emergency ◽

Blood Cultures ◽

Secondary Outcome ◽

Culture Positivity ◽

Blood Culture Positivity ◽

Anaerobic Bottle ◽

Clinically Significant

ABSTRACT Anaerobes are an important but uncommon cause of bloodstream infections (BSIs). For pediatric patients, routine inclusion of an anaerobic blood culture alongside the aerobic remains controversial. We implemented automatic anaerobic blood culture alongside aerobic blood cultures in a pediatric emergency department (ED) and sought to determine changes in recovery of obligate and facultative anaerobes. This was a cohort study in a pediatric ED (August 2015 to July 2018) that began in February 2017. Blood culture positivity results for true pathogens and contaminants were assessed, along with a secondary outcome of time to positivity (TTP) of blood culture. A total of 14,180 blood cultures (5,202 preimplementation and 8,978 postimplementation) were collected, with 8.8% (456) and 7.1% (635) positive cultures in the pre- and postimplementation phases, respectively. Of 635 positive cultures in the postimplementation phase, aerobic blood cultures recovered 7.6% (349/4,615), whereas anaerobic blood cultures recovered 6.6% (286/4,363). In 211/421 (50.0%) paired blood cultures, an organism was recovered in both cultures. The number of cases where organisms were only recovered from an aerobic or an anaerobic bottle in the paired cultures were 126 (30.0%) and 84 (20.0%), respectively. The TTP was comparable regardless of bottle type. Recovery of true pathogens from blood cultures was approximately 7 h faster than recovery of contaminants. Although inclusion of anaerobic blood cultures only recovered 2 (0.69%) obligate anaerobes, it did allow for recovery of clinically significant pathogens that were negative in aerobic blood cultures and supports the routine collection of both bottles in pediatric patients with a concern of bloodstream infections.

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Minocycline-EDTA-Ethanol Antimicrobial Catheter Lock Solution Is Highly Effective In Vitro for Eradication of Candida auris Biofilms

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02146-19 ◽

2020 ◽

Vol 64 (4) ◽

Author(s):

Ruth A. Reitzel ◽

Joel Rosenblatt ◽

Bahgat Z. Gerges ◽

Nylev Vargas-Cruz ◽

Issam I. Raad

Keyword(s):

Therapeutic Option ◽

Bloodstream Infections ◽

Central Line ◽

Emerging Pathogen ◽

Candida Auris ◽

Content Type ◽

Lock Solution ◽

Highly Effective ◽

Catheter Lock

ABSTRACT Candida auris is an emerging pathogen that can cause virulent central-line-associated bloodstream infections. Catheter salvage through the eradication of biofilms is a desirable therapeutic option. We compared taurolidine and minocycline-EDTA-ethanol (MEE) catheter lock solutions in vitro for the eradication of biofilms of 10 C. auris strains. MEE fully eradicated all C. auris biofilms, while taurolidine lock partially eradicated all of the C. auris biofilms. The superiority was significant for all C. auris strains tested (P = 0.002).

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Galactomannan and PCR in the Central Nervous System to Detect Invasive Mold Disease - A Retrospective Analysis in Immunocompromised Children

Scientific Reports ◽

10.1038/s41598-019-49426-0 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Thomas Lehrnbecher ◽

Peter Michael Rath ◽

Andishe Attarbaschi ◽

Gunnar Cario ◽

Michaela Döring ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Infectious Complication ◽

Pediatric Patients ◽

Immunocompromised Patients ◽

Chain Reaction ◽

The Central Nervous System ◽

Polymerase Chain ◽

Pcr Assays ◽

Work Up

Abstract Invasive mold disease (IMD) of the central nervous system (CNS) is a severe infectious complication in immunocompromised patients, but early microbiological diagnosis is difficult. As data on the value of biomarkers in the CNS are scarce, in particular in children, we retrospectively analyzed the performance of galactomannan (GM) and PCR assays in CNS samples of 15 children with proven and probable CNS IMD and of 32 immunocompromised children without fungal infection. Galactomannan in the cerebrospinal fluid (CSF) was assessed in nine of the 15 pediatric patients and was positive in five of them. Polymerase chain reaction (PCR) was performed in eight of the 15 patients and detected nucleic acids from molds in six patients. Galactomannan and PCR in CNS samples were the only positive microbiologic parameter in the CNS in three and two patients, respectively. In four patients, PCR specified the pathogen detected in microscopy. Galactomannan and PCR results remained negative in the CSF of all immunocompromised children without evidence for CNS IMD. Our data suggest that GM and PCR in CNS specimens are valuable additional tools in diagnosing CNS IMD and should be included in the work up of all pediatric patients with suspected mold disease of the CNS.

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