Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis

Introduction: We aimed to determine the incidence, etiology, risk factors and outcome of bacterial meningitis in neonates. Methodology: Neonates who developed bacterial meningitis between 2003 and 2010 in a tertiary hospital in Turkey were included in the study. Patients born in our hospital were defined as Group 1 and patients referred from other centres were defined as Group 2. Patients with evidence of congenital infections or central nervous system malformations were excluded. Demographic features, delivery type, time of onset of meningitis, co-morbidities, clinical features, blood and cerebrospinal fluid (CSF) analysis, cranial sonographic findings, and outcome of patients were recorded. Results: The study comprised 325 meningitis cases identified from 38,023 hospitalised patients in the neonatology unit among 11,8091 live births. Mean gestational age, birth weight, and hospital stay were 36.8±3.7 weeks, 2.480±924 g, and 26±12.4 days, respectively. Almost half (48%) of the patients were diagnosed in the first seven postnatal days and 52% at 8-30 days after birth. CSF culture findings were positive in 59 (18%) patients (28 in Group 1 and 31 in Group 2). Gram-positive bacteria were the responsible agents in 30 (51%) patients, whereas 26 (44%) patients had Gram-negative bacterial meningitis and 3 (5%) had Candida meningitis. Gram-negative bacteria were predominant in Group 1 whereas Gram positive bacteria were predominant in Group 2. Transfontanel ultrasonography revealed pathologic findings in 17.5% of patients. The total mortality rate was 2.5%. Conclusion: This large-scale study provides essential information about the etiology, characteristics, and outcome of neonatal bacterial meningitis in Turkey.

Download Full-text

Lactate production by aerobic bacteria grown in cerebrospinal fluid.

Clinical Chemistry ◽

10.1093/clinchem/30.11.1875 ◽

1984 ◽

Vol 30 (11) ◽

pp. 1875-1876 ◽

Cited By ~ 10

Author(s):

F L Kiechle ◽

M A Kamela ◽

R W Starnes

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Lactate Concentration ◽

Lactate Production ◽

Aerobic Bacteria ◽

Gram Negative Bacteria ◽

High Concentration ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria

Abstract The source of the abnormally high concentration of lactate in the cerebrospinal fluid in patients with bacterial meningitis is not known. It may represent a bacterial metabolite. To determine whether cerebrospinal fluid possesses appropriate substrates to support the growth of pathogenic aerobic bacteria, three Gram-positive and nine Gram-negative bacteria were separately inoculated in pooled normal cerebrospinal fluid. After incubation for 24 h, all Gram-positive bacteria increased lactate, eight Gram-negative bacteria decreased lactate, and one Gram-negative bacteria failed to significantly change the lactate concentration. We conclude that lactate produced in cerebrospinal fluid in patients with aerobic bacterial meningitis is not necessarily a bacterial metabolite.

Download Full-text

Epidemiology, Pathogens Distribution, Antibiotic Susceptibility and the Risk Factors for Mortality of Patients With Central Nervous System Infections: a Retrospective Study From 2012 to 2019 in a Teaching Hospital in China

10.21203/rs.3.rs-153262/v1 ◽

2021 ◽

Author(s):

Zheng Zhang ◽

Yan Song ◽

Jianbang Kang ◽

Surong Duan ◽

Qi Li ◽

...

Keyword(s):

Risk Factors ◽

Central Nervous System ◽

Nervous System ◽

Retrospective Study ◽

Pulmonary Infection ◽

Gram Negative Bacteria ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Cns Infections

Abstract Background: Central nervous system (CNS) infections are relatively rare but associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the prognosis of patients with CNS infections, which should be based on the knowledge of pathogens distribution and antibiotic sensitivities. China is a vast country, and the pathogens distribution varies nationwide. The aim of this study is to investigate the features of pathogens in patients with CNS infections in north China and we tried to evaluate the risk factors for mortality.Methods: We retrospectively analyzed the patients with positive cerebrospinal fluid (CSF) culture in a teaching hospital between January 2012 and December 2019. The following information were collected: demographic characteristics, laboratory data, causative organisms and antimicrobial susceptibility results. Univariate analysis and binary logistic regression analysis were performed to identify the risk factors for mortality.Results: In this eight-year retrospective study, a total of 72 patients were diagnosed with CNS infections and 86 isolates were identified. Among all the microorganisms detected, Gram-positive strains consisted of 59.3%, Gram-negative bacteria of 30.2% and fungi of 10.5%. The predominant Gram-positive isolate was coagulase-negative staphylococci. Acinetobacter baumannii, Escherichia coli and Klebsiella were the common Gram-negative strains. Compared to 2012-2015 years, the proportion of Gram-negative bacteria increased markedly during 2016-2019 years. Vancomycin, teicoplanin and linezolid were still 100% sensitive to Gram-positive bacteria. For the multidrug-resistant Gram-negative bacteria, only tigecycline was the 100% sensitive antibiotics. The mortality of the 72 patients was 30.6%. In the multivariate analysis, age >50 years, combined pulmonary infection and CSF glucose < normal value were associated with poor prognosis. Conclusions: CNS infections cause high mortality worldwide. Although Gram-positive bacteria are still the primary pathogen of CNS infections, Gram-negative bacteria had increased in recent years and should be considered in the choice of empirical antibiotic treatment. Special attention should be given to older patients and those combined pulmonary infection and with low CSF glucose level.

Download Full-text

Effect of Duration of Chronic Peritoneal Dialysis Therapy on the Development of Peritonitis

Peritoneal Dialysis International ◽

10.1177/089686089901900416 ◽

1999 ◽

Vol 19 (4) ◽

pp. 376-379 ◽

Cited By ~ 9

Author(s):

Laura Troidle ◽

Nancy Gorban–Brennan ◽

Alan S. Kliger ◽

Fredric O. Finkelstein

Keyword(s):

Peritoneal Dialysis ◽

Morphological Changes ◽

Chronic Peritoneal Dialysis ◽

Gram Positive ◽

Gram Negative ◽

Group 3 ◽

Time Periods ◽

Group 2 ◽

Artery Disease ◽

Group 1

Objective Long-term chronic peritoneal dialysis (CPD) therapy has been associated with alterations in peritoneal membrane structure and peritoneal macrophage function. We thus reviewed our experience with the development of peritonitis among patients maintained on CPD therapy for various time periods to determine if the spectrum of organisms, rates of peritonitis, and outcome changed with the duration of CPD therapy. Setting and Patients Patients maintained on CPD therapy in our out-patient unit in New Haven, Connecticut. Design Retrospective review of the charts of patients maintained on CPD therapy (HomeChoice Cycler or Ultrabag, Baxter, McGaw Park, IL, U.S.A.) between 1 January 1997 and 31 March 1998. These patients were divided into three groups: group 1, patients maintained on CPD therapy < 12 months; group 2, patients maintained on CPD therapy for 13 - 36 months; and group 3, patients maintained on CPD therapy for ≥ 37 months. Results The study included 256 patients: 101 patients in group 1, 110 patients in group 2, and 45 patients in group 3. All groups of patients were similar in age. There were significantly fewer Caucasians and fewer males in group 3 in comparison to groups 1 and 2. The incidence of diabetes mellitus, coronary artery disease, and peripheral vascular disease was significantly lower among patients in group 3 in comparison to groups 1 and 2. There were 155 episodes of peritonitis during the study period for an overall rate of 1 episode in 18.7 patient-months. The overall, gram-positive, and gram-negative rates of peritonitis were not significantly different among the patients in groups 1, 2, and 3. There were more episodes of Staphylococcus aureus peritonitis among patients in group 3 in comparison to group 2 (1 episode in 59.6 vs 1 episode in 280.2 patient-months, respectively). Two weeks after the development of peritonitis, 94.6% of the patients in group 3 continued CPD therapy, while 79.4% of the patients in group 1 continued CPD therapy ( p < 0.05). No patient in group 3 transferred to hemodialysis, while 10.3% and 8.2% of the patients in groups 1 and 2 transferred to hemodialysis ( p < 0.05). The death rate 2 weeks after the onset of peritonitis was 10.3%, 9.8%, and 5.4% in groups 1, 2, and 3, respectively ( p = NS). Conclusions Despite the immunological and morphological changes that occur in the peritoneal cavity with increased time on CPD therapy, there was no difference in the overall, gram-positive, or gram-negative rates of peritonitis for patients maintained on CPD therapy for various time periods. Patients in group 3 continued CPD therapy more often than did patients in group 1. Patients in group 3 transferred to hemodialysis less often than did the remaining patients in the study period. The incidence of death was not significantly different for the three groups of patients.

Download Full-text

Parallels of infections of diabetic foot syndrome at inpatient and outpatient stages of treatment

Medical Council ◽

10.21518/2079-701x-2021-7-68-76 ◽

2021 ◽

pp. 68-76

Author(s):

A. B. Zemlianoi ◽

T. A. Zelenina ◽

V. V. Salukhov

Keyword(s):

Diabetic Foot ◽

Acute Infection ◽

Multidrug Resistant ◽

Diabetic Foot Syndrome ◽

Gram Positive ◽

Gram Negative ◽

Diabetic Foot Infection ◽

Infectious Process ◽

Group 2 ◽

Group 1

Introduction. Long-lasting ulcerative defects in patients with diabetic foot syndrome (DFS) are prone to reinfection, persistence of primary and hospital-acquired infection, and the infectious process is often caused by multidrug-resistant organisms (MDRO).Aim of the study: to compare the prevalence and specific characteristics of the severe diabetic foot infection pathogens during the inpatient and outpatient stages of treatment.Materials and methods. We included 62 type 2 diabetic inpatients (group 1) with severe foot infection and 102 diabetic foot outpatients (group 2) with postoperative wounds, who had been operated on and discharged from the hospital, in to the study.Cultures were obtained after surgery interventions immediately and on 14 days of hospitalization in group 1 of patients and in group 2 of patients with clinical signs of infection. Microbe species and resistant of pathogens to antibiotic were assessed.Results and discussion. Severe infection connected with polymicrobe pathogens in both groups of patients. However, the prevalence of Gram-positive and Gram-negative bacilli was different. The most frequently isolated pathogens were Gram-positive bacteria in the wound samples of group 1 of patients with acute infection obtained after surgery interventions immediately. In the wound cultures of group 1 on 14 day of hospitalization and group 2 the prevalence of Gram-positive and Gram-negative bacilli was the same. It should be noted that there is still a high total frequency of isolation of non-fermenting Gram-negative bacilli among Gram-negative pathogens in complicated diabetic foot infection both at the inpatient and outpatient stages of treatment.Conclusion. The great finding of the study is the identification of a parallel of the same prevalence of Gram-positive and Gramnegative pathogens in a prolonged infection at the inpatient and outpatient stages of treatment. The role of Enterobacterales increased with duration of infection. The prevalence of multidrug resistant Enterobacterales makes this group of microorganisms as important as Staphylococcaceae in the complicated course of the infectious process. Polyvalent microbial spectrum of pathogens significantly reduces the effectiveness of treatment.

Download Full-text

ANTIMICROBIAL RESISTANCE OF GRAM POSITIVE BACTERIA ISOLATED LNPATLENTS WLTHCHRONLCKLDNEYDLSEASSTAGE5D: PREVALENCE AND OUTCOMES

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.2(46).2015.02 ◽

2015 ◽

pp. 13-21

Author(s):

І.М. Shifris ◽

I.O. Dudar ◽

V.F. Krot ◽

V.T. Kruglikov ◽

N.G. Aleksieva ◽

...

Keyword(s):

Pathogenic Bacteria ◽

Adult Patients ◽

Disease Stage ◽

Dialysis Access ◽

Gram Positive ◽

Clinical Prognosis ◽

Gram Positive Bacteria ◽

Group 2 ◽

Opportunistic Pathogenic ◽

Group 1

Bacterial infections in chronic kidney disease stage VD (CKD VD st.)patients are associated with increased risk of hospitalization and death. The aim was to study of opportunistic pathogenic bacteria spectrum, their antibacterial resistance and the correlation between carriage and hospitalization and mortality rate in adult patients with CKD V D st. Materials and methods. This prospective cohort, open-label, randomized, two-phase study included 146 patients with CKD V D st., 118 of whom were treated by hemodialysis (HD) and 28 by peritoneal dialysis (PD). The microbiological screening was conducted in the first stage. The examined material was throat/nose swabs and wet smears from skin of dialysis access site. On the second stage all patients were randomized on two groups: the group 1 (n=61) included patients with identified MRSA / VRE colonization and group 2 (n=85) included patients with colonization of other strains of opportunistic pathogenic bacteria. The groups were representative according to gender, age, type of kidney affections and renal replacement therapy (RRT) modality. The microbiological examination consisted of inoculation of hard medium by examined material. The end points were total amount of hospitalization and death events evaluated for 24 months after randomization. Results. The colonization of some biotype of opportunistic pathogenic bacteria was established in 100% ofpatients. In total were isolated 347 strains of gram-positive bacteria: 284 and 63 in HD and PD patients, respectively. Without statistical significance approximately 20% of microorganism strains were resistant to 10 and more antibiotics according to dialysis modality. The MRSA colonization was identified in 49 (33.6%) patients (37/31.4% and 12/42.9% of HD u PD patients, respectively; p=0,246). The VRE colonization was established in 12 patients (10/8.5% and 2/7.1% of HD and PD patients, respectively; p=0.81). The 70 hospitalization episodes were recorded during monitoring period. The significant majority was established in group 1 of patients (39/64% vs. 31/36.5 %; %2 =10.733, p=0,001) irrespective ofRRTmodality. The specific share ofdead persons in group 1 was in three times more than such share in group 2 (9/14.8% vs. 4/4.7 %; %2=4.42, p= 0.0355). The relative risks of hospitalization and death in the presence of MRSA/VRE colonization increased in 1.75 (95% CI: 1.252.5) and 3.14(95% CI: 1.01-9.7) times. Conclusion. In this study was demonstrated that MRSA/VRE colonization in adult patients with CKD V D st. is a risk marker and a predictor of negative clinical prognosis. The RRT modality hadn’t significant effect on rate of negative consequences, particularly on rate of hospitalization and death in population of CKD V D st. patients.

Download Full-text

Impact of Antibiotics Associated with the Development of Toxic Epidermal Necrolysis on Early and Late-Onset Infectious Complications

Microorganisms ◽

10.3390/microorganisms9010202 ◽

2021 ◽

Vol 9 (1) ◽

pp. 202

Author(s):

Bretislav Lipovy ◽

Jakub Holoubek ◽

Marketa Hanslianova ◽

Michaela Cvanova ◽

Leo Klein ◽

...

Keyword(s):

Toxic Epidermal Necrolysis ◽

Late Onset ◽

Infectious Complications ◽

Hypersensitive Reaction ◽

Gram Positive ◽

Antibiotic Development ◽

Gram Positive Bacteria ◽

Significant Difference ◽

Group 2 ◽

Group 1

Toxic epidermal necrolysis (TEN) is a rare disease, which predominantly manifests as damage to the skin and mucosa. Antibiotics count among the most common triggers of this hypersensitive reaction. Patients with TEN are highly susceptible to infectious complications due to the loss of protective barriers and immunosuppressant therapy. The aim of this study was to investigate the potential relationship between antibiotics used before the development of TEN and early and late-onset infectious complications in TEN patients. In this European multicentric retrospective study (Central European Lyell syndrome: therapeutic evaluation (CELESTE)), records showed that 18 patients with TEN used antibiotics (mostly aminopenicillins) before the disease development (group 1), while in 21 patients, TEN was triggered by another factor (group 2). The incidence of late-onset infectious complications (5 or more days after the transfer to the hospital) caused by Gram-positive bacteria (especially by Enterococcus faecalis/faecium) was significantly higher in group 1 than in group 2 (82.4% vs. 35.0%, p = 0.007/pcorr = 0.014) while no statistically significant difference was observed between groups of patients with infection caused by Gram-negative bacteria, yeasts, and filamentous fungi (p > 0.05). Patients with post-antibiotic development of TEN are critically predisposed to late-onset infectious complications caused by Gram-positive bacteria, which may result from the dissemination of these bacteria from the primary focus.

Download Full-text

Analysis of risk factors and clinical indicators in bloodstream infections among patients with hematological malignancy : a retrospective study

10.21203/rs.3.rs-85374/v1 ◽

2020 ◽

Author(s):

Yating Ma ◽

Ming Yang ◽

Jinfeng Bao ◽

Chengbin Wang

Keyword(s):

Risk Factors ◽

Blood Culture ◽

Hematological Malignancy ◽

Gram Negative Bacteria ◽

Negative Group ◽

Infection Group ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Culture Positive

Abstract Background: The incidence of bloodstream infection caused by bacteremia is more common in patients with hematological malignancy. It is important to distinguish infectious episodes from non-infectious episodes. The present study was aimed to describe epidemiology and clinical indexes for in-hospital infection of hematological malignancy patients.Methods: Single-center retrospective research was performed on hematological malignancy patients admitted to our hospital from July 2015 to March 2018. Laboratory and clinical information from 322 febrile patients were acquired. These episodes were divided by blood culture results into two groups: (1) blood culture positive group, (2) blood culture negative group.Results: In the 322 febrile cases, 81 (25.2%) patients were blood culture positive, and among them, Gram-negative bacteria (51.9%) were more isolated than Gram-positive bacteria (32.1%) and fungi (7.4%). Gram-negative bacteria were more likely to have a drug resistance than Gram-positive bacteria. Independent risk factors revealed that patients with complications, high levels of procalcitonin (PCT), glucose, interleukin-6 (IL-6) and d-dimer (D-D), and low concentration of albumin were correlated with occurrence of infection. PCT, IL-6 and D-D performed well in differentiating not only the infection group from the non-infection group, but also in the Gram-negative group from the Gram-positive group with the areas under the curve all above 0.75.Conclusions: We analyzed the risk factors for bloodstream infection in patients with hematological malignancy, the distribution of bacteria, antibiotics resistance and the changes of clinical parameters. This single-center retrospective study may provide clinicians insight to the diagnosis and treatment of infection.

Download Full-text

Epidemiology and mortality in bacterial bloodstream infections in patients with hematologic malignancies

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11457 ◽

2019 ◽

Vol 13 (08) ◽

pp. 727-735

Author(s):

Duygu Mert ◽

Sabahat Ceken ◽

Gulsen Iskender ◽

Dicle Iskender ◽

Alparslan Merdin ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Mortality Rate ◽

Hematological Malignancies ◽

Methicillin Resistance ◽

Bloodstream Infections ◽

Hematologic Malignancies ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria

Introduction: Patients with hematological malignancies, who are in the high risk group for infectious complications and bacterial bloodstream infections. The aim of the study evaluated epidemiology and mortality in bacterial bloodstream infections in patients with hematologic malignancies. In addition to determine the risk factors, changes in the distribution and frequency of isolated bacterias. Methodology: In this retrospective study. There were investigated data from 266 patients with hematological malignancies and bacterial bloodstream infections who were hospitalized between the dates 01/01/2012 and 12/31/2017. Results: There were 305 blood and catheter cultures in febrile neutropenia attacks in total. In these total attacks, primary bloodstream infections were 166 and catheter-related bloodstream infections were 139. In blood cultures; Escherichia coli and Klebsiella pneumoniae bacteria were detected in 58,0% and 22,9% of the samples, respectively. 52,4% of the cultured Gram-negative bacterias were extended spectrum beta-lactamase (ESBL). Carbapenemase positive culture rate was 17,2% in Gram-negative bacteria cultures. Staphylococcus epidermidis was found in 38,4% of the Gram-positive bacteria cultures. In Gram-positive bacteria; methicillin resistance were detected in 82,2% of the samples. There was a statistically significant relationship between bloodstream infection and disease status. 60 patients with primary bloodstream infections were newly diagnosed. Conclusions: In patients with hematological malignancies, certain factors in the bloodstream infections increase the mortality rate. With the correction of these factors, the mortality rate in these patients can be reduced. The classification of such risk factors may be an important strategy to improve clinical decision making in high-risk patients, such as patients with hematological malignancies.

Download Full-text

Epidemiology, pathogens distribution, antibiotic susceptibility and the risk factors for mortality of patients with central nervous system infections: a retrospective study from 2012 to 2019 in a teaching hospital in China

10.21203/rs.3.rs-153262/v2 ◽

2021 ◽

Author(s):

Zheng Zhang ◽

Yan Song ◽

Jianbang Kang ◽

Surong Duan ◽

Qi Li ◽

...

Keyword(s):

Risk Factors ◽

Central Nervous System ◽

Nervous System ◽

Retrospective Study ◽

Pulmonary Infection ◽

Gram Negative Bacteria ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Cns Infections

Download Full-text

Microanatomy of the Periplasm of Bacillus Licheniformis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100065365 ◽

1971 ◽

Vol 29 ◽

pp. 262-263

Author(s):

B.K. Ghosh

Keyword(s):

Cell Wall ◽

Plasma Membrane ◽

Bacillus Licheniformis ◽

External Environment ◽

Permeability Barrier ◽

Periplasmic Space ◽

Modified Technique ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria

Periplasm of bacteria is the space outside the permeability barrier of plasma membrane but enclosed by the cell wall. The contents of this special milieu exterior could be regulated by the plasma membrane from the internal, and by the cell wall from the external environment of the cell. Unlike the gram-negative organism, the presence of this space in gram-positive bacteria is still controversial because it cannot be clearly demonstrated. We have shown the importance of some periplasmic bodies in the secretion of penicillinase from Bacillus licheniformis.In negatively stained specimens prepared by a modified technique (Figs. 1 and 2), periplasmic space (PS) contained two kinds of structures: (i) fibrils (F, 100 Å) running perpendicular to the cell wall from the protoplast and (ii) an array of vesicles of various sizes (V), which seem to have evaginated from the protoplast.

Download Full-text