Increase of Non-Albicans Candida Species and Their Antifungal Susceptibility in Intensive Care Unit Patients (Mexico)

In Mexico little is known about candidemia by non-albicans Candida species and regarding their antifungal susceptibility. Besides without antifungal tests, fluconazole is one of the most used in empirical therapy. In the present study, we included patients from intensive care unit of one hospital in Mexico (2019–2020) with compatible yeast infection clinical signs, symptoms. Based on cultivable isolates, yeasts were identified by automated instrument and by molecular method (PCR), and their susceptibilities to six antifungals were characterized at different concentrations. From 105 patients, yeast cultures were recovered and identified mainly non-albicans Candida species (57.2%); and the most prevalent was C. glabrata (41.9%). Followed by C. albicans, C. krusei, C. parapsilosis, C. tropicalis and Cryptococcus neoformans. The most common infection site was urine (56%), followed by the bronchial aspirate (30%). Mostly the isolated fungi were susceptible to 5-flucytosine (98%) and to amphotericin B. Mainly C. glabrata followed by C. krusei and C. tropicalis were resistant to different concentrations of itraconazole, miconazole, and fluconazole. The present investigation contributes to the knowledge of non-albicans Candida species infections in patients and, opens the possibility for a better understanding and management in antifungal empirical therapy.in Mexico.

Antimicrobial Resistance Profile of MDR & Non-MDR Meropenem-Resistant Pseudomonas aeruginosa Isolates of Patients in Intensive Care Unit of Tertiary Hospital

Pseudomonas aeruginosa is one of the gram-negative bacteria that causes infection in the Intensive Care Unit (ICU) which is easily resistant. Patients infected with carbapenem-resistant P. aeruginosa are predicted to have a poor prognosis. This study aims to know the resistance profile of meropenem-resistant P. aeruginosa in the ICU. The results of this study can be used as a measure on the success of antimicrobial resistance control, infection control programs and become a reference for empirical therapy in the ICU. This study used a cross-sectional retrospective descriptive research method and was carried out at the Clinical Microbiology Laboratory of Sanglah Hospital Denpasar for three years, from 2018 to 2020. The results showed 38 of the 93 isolates of P. aeruginosa in the ICU were resistant to meropenem and were derived from sputum and urine. The percentage of meropenem-resistant P. aeruginosa isolates was higher in the multi-drug-resistant group and mostly came from sputum specimens. In 2018, Non-MDR meropenem-resistant P. aeruginosa isolates was that 100% sensitive to all other antibiotics used to treat P. aeruginosa infections, including; ceftazidime, cefepime, ciprofloxacin, gentamicin, amikacin, and piperacillin-tazobactam. In 2019 no meropenem-resistant P. aeruginosa isolates were found. In 2020, its sensitivity to antibiotics ceftazidime and piperacillin-tazobactam was 20.0%, ciprofloxacin 60.0% and to antibiotics gentamicin and amikacin 100%. MDR meropenem-resistant P. aeruginosa isolates in 2018 were still sensitive to ceftazidime (15.4%) and amikacin (69.2%) antibiotics, while in 2019 they were only sensitive to amikacin (37.5%). In 2020, P. aeruginosa isolates were sensitive to the antibiotics ceftazidime and cefepime (11.1%), piperacillin-tazobactam (22.2%), and amikacin (88.9%). Amikacin may be the choice of treatment for MDR meropenem-resistant P. aeruginosa.

Surgical management of septic knee arthritis with open arthrotomy and debridement-a case report

<p>Septic arthritis is an inflammatory destruction of the native joint following inoculation of pathogen. Most common organisms causing septic arthritis are <em>Staphylococcus</em> and <em>Streptococcus</em>. Large joints are commonly involved with hip and knee joint accounting for approximately 60% of the total cases. Diagnosis is usually straightforward with the patient presenting with obvious local signs and symptoms along with toxic constitutional symptoms owing to the aggressive nature of the disease. Medical management in form of intra-venous antibiotics forms the mainstay of treatment but it is often required for a prompt surgical intervention in order to provide acute relief from symptom and also to decrease the disease load so as to save the joint from irreversible damage. We have a 63-year-old male patient came presented to us with a right knee swelling and tenderness of 3 weeks duration with restricted ROM with severe toxic constitutional symptoms of 1 week duration. Patient was planned for open arthrotomy and debridement and drainage of the pus and was started on an empirical therapy of injection piperacillin and tazobactam combination for 3 weeks. Immediate relief from symptoms following arthrotomy with good range of motion at 4 weeks post-surgery. As is clear from our case, an early diagnosis of septic arthritis and starting of appropriate antibiotics along with appropriately aggressive surgical interventions in the form of open debridement is the key for treatment of septic arthritis in order to save the joint from irreversible inflammatory damage. Surgical intervention not only gives immediate symptomatic relief but also decreases the load over antibiotics and increases local blood supply subsequently helping in better healing.</p><p><strong> </strong></p>

Methicillin resistant Staphylococcus aureus - importance of appropriate empirical therapy in serious infections

India has been titled the capital of antimicrobial resistance in the world with the centre for disease dynamics, economics and policy (CDDEP) predicting two million deaths in India by 2050. As per the World Health Organisation’s global priority pathogen list of 2017, methicillin resistant Staphylococcus aureus (MRSA) has been classified as a ‘high priority’ pathogen due to its association with increased mortality rate, rising prevalence of resistance and increased burden on healthcare settings. A recent report by Indian Council of Medical Research signifies the exponential rise in the prevalence of MRSA in India, from 29% in 2009 to 39% in 2018. Serious MRSA infections are commonly associated with poor clinical outcomes coupled with increased hospitalisation stay and cost. Therefore, early identification and appropriate empiric treatment of MRSA plays a crucial role in healthcare settings. However, the constant rise in multi-drug resistance to the currently available anti-MRSA agents as well as their compromised safety profile limits its clinical use to manage severe MRSA infections. This review article explores the implications of severe MRSA infections and inappropriate empirical therapy on the clinical as well as economic outcomes. In addition, it also highlights limitations of the currently available anti-MRSA agents and the need for newer agents to manage multi drug resistant (MDR) gram positive infections.

Surveillance of hospital-acquired infections and monitoring of empiric antibiotic therapy in an internal medicine department

Introduction: Hospital-acquired infections (HAIs) are the most serious and frequent complication of healthcare systems. In 2019 the Marche Region has introduced a project to check HAIs and also the use of antibiotics in empirical therapy. The aim of this analysis was to conduct a periodic descriptive prevalence study according to the regional plan. Materials and Methods: In the quarter January-March 2020, the Internal Medicine Department of the Mazzoni Hospital of Ascoli Piceno has been considered, enrolling patients with HAIs to whom has been prescribed at least one antibiotic in empirical therapy. To assess the prevalence of multi-drug resistant organisms (MDRO), microbiological isolates were examined and laboratory response times were measured as a quality indicator. Besides, the incidence of HAIs from medical device, the clinical outcomes and the average length of stay have been analyzed. Results: The results show: high incidence of HAIs and high percentage of MDRO. The response time of the laboratory analysis is on average over 48-72 hours after sampling. The data show a widespread use of broad-spectrum antibiotics and low adherence to the new regional empiric therapy guidelines. Conclusions: The high incidence of HAIs implies the urgent need of an active surveillance of an Antimicrobial Stewardship team. This would represent a strategic solution to prevent and limit antimicrobial resistance and reduce morbidity, mortality and costs.

Empiric Treatment of Foot Infection in Patients with Severe Diabetes

Background: Despite being treated with antibiotics of broad spectrum recommended by International Consensus, severe diabetic patients with lower limb infection do not present a positive clinical evolution during empirical treatment. This study’s bacterial profile was analysed and compared with other worldwide hospital centers. Objective: To confirm the need of an individualized empirical treatment for severe diabetic patients with foot infection. Methods: Retrospective analysis of cultures and antibiograms of severe diabetic patients admitted by foot infection. Results: The results were consistent with the socioeconomic realities of developing countries. Gram-negative bacteria (52,11%) were present in most bone cultures. Results presented a high incidence of Enterococcus faecalis in both gram-positive (21,2%) and polymicrobial (34,7%) samples. Bacterial resistance with the use of ordinary antibiotics in the statistical analysis was high. Conclusion: The community infections should undergo broad spectrum empirical therapy combining amikacin (80,43%) or meropenem (72,00%) with gram-negative and vancomycin (100%) or teicoplanin (90,00%) or linezolid (74,19%) with gram-positive.

Infecção do trato urinário causada por Escherichia coli uropatogênica resistente a antibióticos: um importante problema de saúde pública

Urinary tract infection (UTI) caused by uropathogenic Escherichia coli (UPEC) is one of the most prevalent bacterial infections and is a major cause of health-related morbidity and hospital costs worldwide. The rising bacterial resistance to routinely given antibiotics for infected individuals is becoming a significant source of concern. Current research shows that UPEC is becoming more resistant to multiple antibiotic classes, including fluoroquinolones, beta-lactams, and aminoglycosides, as a result of genetic determinants of resistance and multidrug-resistant clones. Knowledge of the local etiology and the sensitivity profile of the most common uropathogens to antibiotics should guide decisions in the empirical therapy of uncomplicated UTI. Given the high prevalence of UTI and multidrug-resistant bacteria, preventative measures such as the development of an efficient vaccination are essential. The current work is an integrated literature review that synthesizes information on UTIs caused by antibiotic-resistant uropathogenic E. coli and considers the practical implications of key research results.

Molecular Confirmation of Vancomycin-Resistant Staphylococcus aureus with vanA Gene from a Hospital in Kathmandu

Staphylococcus aureus, a commensal on the skin and in the nasal cavity of humans, is one of the most serious cases of nosocomial infections. Moreover, methicillin-resistant S. aureus (MRSA) is a leading cause of morbidity and mortality worldwide. For the treatment of MRSA infections, vancomycin is considered as a drug of choice. However, the emergence of vancomycin resistance among MRSA isolates has been perceived as a formidable threat in therapeutic management. To estimate the rate of vancomycin-resistant S. aureus (VRSA) and to detect the vancomycin-resistant genes, namely, vanA and vanB, among the isolates, a hospital-based cross-sectional study was conducted from July to December 2018 in Annapurna Neurological Institute and Allied Science, Kathmandu, Nepal. S. aureus was isolated and identified from different clinical samples and processed for antibiotic susceptibility testing by the modified Kirby–Bauer disc diffusion method. The screening of MRSA was performed as per Clinical and Laboratory Standard Institute (CLSI) guidelines. VRSA was confirmed by the minimum inhibitory concentration (MIC) method by employing E-test strips. All the phenotypically confirmed VRSA were further processed to detect the vanA and vanB gene by using the conventional polymerase chain reaction (PCR) method. A total of 74 (20.3%) S. aureus were isolated, and the highest percentage of S. aureus was from the wound samples (36.5%). Of 74 S. aureus isolates, the highest number (89.2%) was resistant to penicillin, and on the other hand, linezolid was found to be an effective drug. Likewise, 45 (60.81%) were found to be MRSA, five (11.11%) were VRSA, and 93.2% of S. aureus isolates showed an MAR index greater than 0.2. Two VRSA isolates (40%) were positive for the vanA gene. The higher prevalence of MRSA and significant rate of VRSA in this study recommend routine surveillance for the MRSA and VRSA in hospital settings before empirical therapy.

CCEDRRN COVID-19 Infection Score (CCIS): development and validation in a Canadian cohort of a clinical risk score to predict SARS-CoV-2 infection in patients presenting to the emergency department with suspected COVID-19

ObjectivesTo develop and validate a clinical risk score that can accurately quantify the probability of SARS-CoV-2 infection in patients presenting to an emergency department without the need for laboratory testing.DesignCohort study of participants in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. Regression models were fitted to predict a positive SARS-CoV-2 test result using clinical and demographic predictors, as well as an indicator of local SARS-CoV-2 incidence.Setting32 emergency departments in eight Canadian provinces.Participants27 665 consecutively enrolled patients who were tested for SARS-CoV-2 in participating emergency departments between 1 March and 30 October 2020.Main outcome measuresPositive SARS-CoV-2 nucleic acid test result within 14 days of an index emergency department encounter for suspected COVID-19 disease.ResultsWe derived a 10-item CCEDRRN COVID-19 Infection Score using data from 21 743 patients. This score included variables from history and physical examination and an indicator of local disease incidence. The score had a c-statistic of 0.838 with excellent calibration. We externally validated the rule in 5295 patients. The score maintained excellent discrimination and calibration and had superior performance compared with another previously published risk score. Score cut-offs were identified that can rule-in or rule-out SARS-CoV-2 infection without the need for nucleic acid testing with 97.4% sensitivity (95% CI 96.4 to 98.3) and 95.9% specificity (95% CI 95.5 to 96.0).ConclusionsThe CCEDRRN COVID-19 Infection Score uses clinical characteristics and publicly available indicators of disease incidence to quantify a patient’s probability of SARS-CoV-2 infection. The score can identify patients at sufficiently high risk of SARS-CoV-2 infection to warrant isolation and empirical therapy prior to test confirmation while also identifying patients at sufficiently low risk of infection that they may not need testing.Trial registration numberNCT04702945.