Fatal acute melioidosis in a tourist returning from Martinique Island, November 2010

We report the fatal case of acute melioidosis in a patient returning from Martinique with fever in November 2010. Gram-negative rods were isolated from a blood culture and Burkholderia pseudomallei identified within 24 hours after first medical contact. The patient died two days after admission to hospital despite intravenous therapy with high doses of imipenem/cilastatin and intensive care. Clinicians seeing travellers returning from the subtropics or tropics with severe pneumonia or septicaemia should consider the possibility of acute melioidosis.

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Bacterial profile and their antibiotic resistance patterns from blood culture in Intensive Care Unit patients at the University Of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

10.21203/rs.2.9515/v1 ◽

2019 ◽

Cited By ~ 1

Author(s):

Segen Tekle Gebre-egziabher ◽

Feleke Moges Yehuala ◽

Zemene Tigabu Kebede ◽

Alem Getaneh Mehari

Keyword(s):

Intensive Care Unit ◽

Antibiotic Resistance ◽

Intensive Care ◽

Blood Culture ◽

Bacterial Pathogens ◽

Gram Negative ◽

Specialized Hospital ◽

Resistance Patterns ◽

The University ◽

Antibiotic Resistance Patterns

Abstract Abstract Background: The burden of bloodstream infection and antibiotic resistance in intensive care unit (ICU) is high when compared with other settings. The data on the changing antibiotic resistance trends are important for infection control activities. There is no sufficient data in the intensive care units of this hospital. Objective: The aims of this study were to assess the magnitude and risk factors of bacterial pathogens and their antibiotic resistance patterns of blood culture isolates from ICU patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia. Materials and Methods: A cross-sectional study was conducted from February to May 2018.Blood specimen were collected from 384 patients and inoculated on appropriate culture media. Identification of bacterial pathogens and antibiotic susceptibility tests were performed using bacteriological standard methods. Presence of Extended Spectrum Beta Lactamase (ESBL) enzymes was confirmed by combined disk diffusion method. Data were analyzed using SPSS version 20. Result: Of the total 384 study participants, 96(25%) were culture positive. Majority of bacteria isolates 67(69.8%) were Gram negative. The commonly isolated bacterial species were K.pneumoniae 18(18.8%), Coagulase negative Staphylococcus 13(13.5%), K.ozanae 10(10.4%), K.rhinose 8(8.3%) and E.coli, E.cloacae, Citrobacter species, S.aureus each accounts 7(7.3%). Gram negative isolates were found to be resistant to ampicillin 66(98%), amoxicillin/clavulanate 64(95%) and ceftriaxone 52(77.6%). However, amikacin 64(95.5%), meropenem 58(87%) and Ciprofloxacin 56(83.6%) were relatively effective drugs. Gram positive isolates were found to be resistant to Penicillin 28(96.5%), amoxicillin/clavulanate27 (93.1%) and erythromycin 26(90%). They were sensitive to ciprofloxacin 22(79%) and clindamycin 24(83%). Methicillin resistant S.aureus accounted 4(57.1%) and ESBL enzyme producing Gram negative isolates accounted 41(78.8%). Conclusion: Klebsiella species were the predominant bacterial isolates in ICU settings. Antibiotic resistance due to ESBL enzyme production is alarmingly high. This result might be a reflection of inappropriate use of antibiotics and poor infection prevention control practice in these settings. Key words: Antibiotic resistance, ICU, ESBL, Gondar Ethiopia.

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Proteus mirabilis – a rare cause of non-HACEK Gram-negative infective endocarditis

Acute Medicine Journal ◽

10.52964/amja.0819 ◽

2020 ◽

Vol 19 (3) ◽

pp. 149-153

Author(s):

Angus De Wilton ◽

◽

Marios Margaritis ◽

Henrietta Mills ◽

Sarah Logan ◽

...

Keyword(s):

Infective Endocarditis ◽

Blood Culture ◽

Literature Review ◽

Proteus Mirabilis ◽

Final Diagnosis ◽

Clinical Findings ◽

Intravenous Therapy ◽

Gram Negative ◽

Oral Ciprofloxacin

Infective endocarditis caused by Proteus mirabilis is strikingly rare. Here, we describe the case of an 86-year old man with five recurrent septic episodes over a period of three months associated with Proteus mirabilis bacteraemia secondary to underlying Proteus endocarditis. The final diagnosis was made based on clinical findings, blood culture results and transoesophageal echocardiogram. The patient was treated medically with 6 weeks of ceftriaxone and long-term oral ciprofloxacin. On completion of intravenous therapy the patient remained well. We performed a literature review and found this to be only the fourth confirmed case of Proteus mirabilis endocarditis successfully treated with antibiotic therapy alone. This case highlights an important but rare cause of endocarditis, reinforcing the need to consider this diagnosis in recurrent Gram-negative bacteraemia even if by an atypical organism.

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Nosocomial Bloodstream Infections in Children in Intensive Care Unit: Organisms, Sources, Their Sensitivity Pattern and Outcome of Treatment

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v35i3.34341 ◽

2017 ◽

Vol 35 (3) ◽

pp. 115-122

Author(s):

Syed Ahsan Tauhid ◽

MAK Azad Chowdhury ◽

Md Mahbubul Hoque ◽

MA Kamal ◽

Emdadul Haque

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Nosocomial Infections ◽

Negative Impact ◽

Bloodstream Infections ◽

Suction Catheter ◽

Third Generation ◽

Gram Negative ◽

Sensitivity Pattern

Background: Nosocomial bloodstream infection in paediatric ICU is a leading, preventable infectious complication in critically ill patients and has a negative impact on patients outcome. This study was done to determine the type of pathogens responsible for nosocomial infections and its sensitivity pattern, to evaluate the probable sources (fomites) of nosocomial infections and also to compare the outcome of treatment between children with and without nosocomial bloodstream infections in terms of length of ICU stay and mortalityMaterial and methods: This study was conducted in the intensive care unit of Dhaka Shishu(children) hospital. Children between 0-5 years of age were included in the study. Blood culture positive case at the time of admission and Children discharged or died within 48 hours of admission were excluded. When children clinically suspected to have nosocomial infections, their blood culture and swab culture of probable sources were done.Results: Out 110 patients, 23(20.9%) patients developed nosocomial BSI. Neonates were found to be more susceptible to develop nosocomial BSI. Most of the organisms (86%) were Gram negative bacilli. Klebsiella was the most common pathogens (30.78%) followed by acinatobacter (21.73%), E-coli (13.04%), Pseudomonas (8.7%). Type of micro-organisms and their sensitivity pattern obtained from blood culture and sources culture of corresponding patient were almost similar which indicate the clue for probable source of nosocomial infection. Microorganisms were almost sensitive to Imipenem but there were high resistance to commonly used antibiotics including third generation cephalosporins. ICU acquired infections increase hospital mortality and duration of hospital stay.Conclusion: Nosocomial bloodstream infections in children in ICU are associated with high mortality rate and prolong hospital stay. Neonates are more susceptible to develop nosocomial BSI than children aged above 28 days. Gram negative organisms are predominant isolates and are developing resistance to commonly used antibiotics including third generation cephalosporin. Imipenem is the most effective and reliable antibiotic option. Fomites especially health care device including IV canula, suction catheter, endotracheal tubes, oxygen mask are the important probable sources of nosocomial infections.J Bangladesh Coll Phys Surg 2017; 35(3): 115-122

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2170. Xpert Carba-R Assay on Flagged Blood Culture Samples: Clinical Utility in Intensive Care Unit Patients with Gram-Negative Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1850 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S736-S737

Author(s):

Surendran Rajendran ◽

Ram Gopalakrishnan ◽

Anil Tarigopula ◽

Sureshkumar Dorairajan ◽

Senthur Nambi Panchatcharam ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Likelihood Ratio ◽

Predictive Value ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Sensitivity Testing ◽

Gram Negative ◽

Gram Negative Bacteremia

Abstract Background Rapid molecular diagnostics that predict carbapenem resistance (CR) well before the availability of routine drug sensitivity testing (DST) can serve as an antimicrobial stewardship tool in the context of high rates of carbapenem-resistant enterobacteriaceae (CRE). Methods A retrospective observational study of patients more than 18 years of age on whom Xpert Carba-R (FDA approved for rectal swab specimen) was done on Gram-negative bacteria (GNB) flagged blood culture samples, in a tertiary care Indian intensive care unit between January 2015 and November 2018. Results The study included 160 patients who had a median (Sequential Organ Failure Assessment) SOFA score of 16. A total of 164 GNB were isolated with 4 patients having polymicrobial bacteremia. Klebsiella pneumoniae and Escherichia coli were the predominant isolates (Figure 1). Carba-R was positive in 58/164 (35.36%) samples (Figure 2) and 73/161 isolates (45.34%) were CR (after excluding intrinsic CR organisms) on routine DST. The distribution of CR genes overall was: OXA-48 like (29/58–50%), followed by NDM (19/58–32.7%), followed by OXA-48 and NDM co-expression (9/58–15.51%) and in individual groups as in Figure 3. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value (PPV) and negative predictive value (NPV) of Carba-R vs. routine DST were 90.74%, 93.15%, 13.25, 0.10, 83.58% and 96.31% for enterobacteriaceae (Figure 4). The median time to obtaining the Carba-R report was 30 hours 34 minutes vs. 74 hours and 20 minutes for carbapenem resistance on routine DST. Based on the Carba-R report, 9.72% of patients had escalation of antibiotics (e.g., colistin) to cover CR organisms and 27.08% had de-escalation from CR cover that had already been started. Conclusion Xpert Carba-R serves as a rapid diagnostic tool for CR Gram-negative bacteremia, particularly hospital-acquired enterobacteriaceae in intensive care units with a high CRE prevalence. It assists in initiating early appropriate therapy and early institution of infection control measures in these patients, as well as in de-escalation of colistin in patients without carbapenem resistance. We recommend that clinicians consider routinely utilizing this test in this setting. Disclosures All authors: No reported disclosures.

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Hospital Acquired Bloodstream Infection by Multi Drug Resistant Organisms-Alarming and Challenging Issue in the Intensive Care Units at Present Era

Journal of Pure and Applied Microbiology ◽

10.22207/jpam.14.4.35 ◽

2020 ◽

Vol 14 (4) ◽

pp. 2595-2601

Author(s):

Barnini Banerjee ◽

Soumayan Mondal ◽

Vandana Kalwaje Eshwara ◽

Chiranjay Mukhopadhyay ◽

Muralidhar Varma

Keyword(s):

Intensive Care ◽

Blood Culture ◽

Bloodstream Infection ◽

Intensive Care Units ◽

Multidrug Resistant ◽

Drug Resistant ◽

Prolonged Stay ◽

Gram Negative ◽

Tertiary Teaching ◽

Hospital Acquired

Hospital-acquired bloodstream infections (BSIs) cause high mortality in the intensive care units (ICUs) compared to wards. Furthermore, the isolation of multidrug resistant (MDR) organisms in ICUs add to the gravity of the condition making the treatment a bigger challenge. The present study was aimed to evaluate the prevalence, spread, and the possible MDR organisms contributing to ICU-acquired BSI & the source of the secondary BSI in the ICUs. A prospective study was conducted in four ICU of tertiary teaching hospital over a period of six months. Patient that developed features of BSI within 48 hours after hospital admission were included in the present study Blood culture was performed by an automated BacT/ALERT®3D system. The source of secondary BSI was identified by analysing culture results for the samples other than blood. These samples were taken within 48 hours of the patient’s blood culture test being positive. A total of 50 patients (25%) had an ICU acquired bloodstream infection. Out of 50 patients, 74% of them had bacterial etiology. Thirty one patients (62%) among them developed multidrug resistant bacteraemia. Fifty six percent of Gram negative bacilli were multi drug resistant. The resistance to carbapenem was 42%. The most common MDR Gram negative isolate was identified as Klebsiella pneumoniae (n=12; 38.7%,) and the most common source was pulmonary infection (26.7% (n=12). 42% of isolates in our study were carbapenem resistant suggesting the need for a proper antibiotic policy in the ICUs. Prolonged stay in the ICU with mechanical ventilation was the critical risk factor and ICU mortality was high (38%).

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Bloodstream infections and antibiotic sensitivity pattern in intensive care unit

Tropical Doctor ◽

10.1177/0049475520977043 ◽

2020 ◽

pp. 004947552097704

Author(s):

Parul Chaturvedi ◽

Mamta Lamba ◽

Deepak Sharma ◽

Ved P Mamoria

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Microbial Growth ◽

Antibiotic Sensitivity ◽

Bloodstream Infections ◽

Gram Negative ◽

Extended Spectrum Beta Lactamase ◽

Sensitivity Pattern ◽

Esbl Producers

Bloodstream infection remains one of the most important causes of morbidity and mortality globally, specifically among intensive care unit patients. This prospective observational study included 887 blood culture samples collected cases admitted to intensive care unit suspected of having sepsis. Samples were cultured and evaluated for antimicrobial susceptibility patterns: 202 (22.78%) blood cultures were positive and yielded microbial growth with 132 (14.88%) having mono-microbial growth. Gram-negative bacteria accounted for 45.2% cases, with Escherichia coli being the most common; Gram positives accounted for 43.9% with Staphylococci haemolyticus being most common and 10.9% were fungal isolates. Gram-negative isolates were sensitive to colistin and tigecycline and 77.3% of isolates were extended spectrum beta-lactamase (ESBL) producers. Gram-positive isolates were sensitive to tigecycline, linezolid, vancomycin and teicoplanin with 97.5% being methicillin-resistant Staphylococci (MRSA). Most of the blood culture isolates from critically ill patients in intensive care unit were multidrug-resistant, ESBL producers and MRSA which raises a serious concern about the development of serious antibiotic resistance.

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Cervical melioidosis: an infrequent cause of neck abscess

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200157 ◽

2020 ◽

Vol 6 (2) ◽

pp. 388

Author(s):

Nurul Alya Binti Azwan ◽

Ram Kumar Sharma Shanmugam ◽

Kong Yin Teng

Keyword(s):

Infectious Disease ◽

Blood Culture ◽

Burkholderia Pseudomallei ◽

Case Series ◽

Morbidity Rate ◽

Gram Negative ◽

Mortality And Morbidity ◽

Neck Abscess ◽

Culture And Sensitivity ◽

Soil And Water

Melioidosis remains as one of the rare infectious disease with high mortality and morbidity rate. It is caused by the gram-negative bacilli Burkholderia pseudomallei found in soil and water. We would like to share our experience of four case series that had been collected in Bintulu Hospital, Sarawak over a period of eight months starting from June 2018- January 2019. A total of four patients presented with neck abscess where the pus culture and sensitivity show B. pseudomallei but the blood culture and sensitivity show no culture or growth.

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Rapid Identification of Burkholderia pseudomallei in Blood Cultures by a Monoclonal Antibody Assay

Journal of Clinical Microbiology ◽

10.1128/jcm.37.11.3662-3667.1999 ◽

1999 ◽

Vol 37 (11) ◽

pp. 3662-3667 ◽

Cited By ~ 16

Author(s):

Supinya Pongsunk ◽

Nittaya Thirawattanasuk ◽

Nuanchan Piyasangthong ◽

Pattama Ekpo

Keyword(s):

Monoclonal Antibody ◽

Blood Culture ◽

Culture System ◽

Burkholderia Pseudomallei ◽

Bacterial Culture ◽

Brain Heart Infusion ◽

Culture Method ◽

Blood Culture System ◽

Gram Negative

Burkholderia pseudomallei is the causative agent of melioidosis. In northeast Thailand, this gram-negative bacterium is a major cause of mortality from septicemia. The definitive diagnosis of this disease is made by bacterial culture. In this study, we produced a monoclonal antibody (MAb) specific to the 30-kDa protein of B. pseudomallei by in vivo and in vitro immunization of BALB/c mice with a crude culture filtrate antigen. The MAb could directly agglutinate with all 243 clinical isolates of B. pseudomallei but not with other gram-negative bacteria, except for one strain of Burkholderia mallei. However, the MAb cross-reacted with the gram-positive Bacillus sp. andStreptococcus pyogenes. B. pseudomallei in brain heart infusion broth (BHIB) subcultured from a BacT/Alert automated blood culture system could be identified by simple agglutination with this MAb assay. The sensitivity and specificity of direct agglutination compared to the “gold standard,” the culture method, were 94.12 and 98.25%, respectively. However, the MAb adsorbed to polystyrene beads or latex particles directly identified the bacterium in blood culture specimens and in BHIB subcultured from a BacT/Alert automated blood culture system. The sensitivity of the latex agglutination test was 100% for both blood culture and BHIB specimens. The specificity was 85.96 and 96.49% for the blood culture and BHIB specimens, respectively. The specificity could be increased if the nonspecific materials in the blood culture broths were eradicated by centrifugation at low speeds. Thus, a combination of blood culture and the agglutination method could be used for the rapid diagnosis of melioidosis in the routine bacteriological laboratory. This method could speed up detection of the bacterium in blood culture by at least 2 days, compared to the conventional bacterial culture method. In addition, the MAb is stable at room temperature for 2 weeks and at 4, −20, and −70°C for at least 1 year. The latex reagent was stable for at least 6 months at 4°C.

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