Volume 24, Issue 1, 2016
Review
Intrathecal or intraventricular colistin: a review
Bargiacchi Olivia,
De Rosa Francesco Giuseppe
Central Nervous System (CNS) infections related to external ventricular derivation are a major complication of patients undergoing neurosurgical procedures. Antimicrobial treatment of CNS infections should be based not only on the susceptibility of the isolated microorganism, but also on the treatment’s pharmacokinetic properties demonstrating the passage of the molecule through the blood-brain barrier. When CNS infections are caused by multi-drug resistant Gram-negative bacteria, intrathecal colistin is considered an effective and safe option. We review the literature of intrathecal/intraventricular use of colistin, comprehensive of both pharmacokinetic data and clinical experiences.
Original article
Detection of HPV and co-infecting pathogens in healthy Italian women by multiplex real-time PCR
Camporiondo Maria Pia ,
Farchi Francesca,
Ciccozzi Massimo,
Denaro Aurelia,
Gallone Domenica,
Maracchioni Fabio,
Favalli Cartesio,
Ciotti Marco
Several pathogens can be transmitted sexually and are an important cause of morbidity among sexually active women. The aim of the study was to detect the presence of human papillomavirus (HPV), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), Ureaplasma urealyticum (UU), and Ureaplasma parvum (UP) in a group of 309 healthy women enrolled at the San Camillo – Forlanini hospital of Rome by using two multiplex real-time PCR assays based on TOCE™ technology. The women's ages ranged from 34 to 60 years, median 49 [IQR 45-54]. Of the 309 women tested, HPV DNA was detected in 77/309 (24.9%) patients. Of these, 44 (14.2%) harboured a single infection while 33 (10.7%) were infected by multiple genotypes. Prevalence of HPV infection was highest among females aged 40-50 years (15.2%). Of the other pathogens sought, CT, MG and NG were not detected while positive results were found for MH (12/309, 3.9%), TV (4/309, 1.3%), UP (89/309, 28.8%) and UU (14/309, 4.5%). Co-infections were as follows: 5 MH/HPV, 4 TV/HPV, 34 UP/HPV and 9 UU/HPV. In HPV-positive women, the probability of being infected by UP and UU was 2.5- (p=0.00045) and 6-fold higher (p=0.0016) than in HPV-negative women. The study supports the use of multiplex real-time PCR assays in a routine diagnostic setting. The high sensitivity and specificity of these assays along with the simultaneous detection of the most common sexually transmitted pathogens confers an advantage with respect to more obsolete methods reducing costs and time to diagnosis.
Anti-infectives for systemic use prescribed in a Spanish hospital between 2009 2013
March Rosselló Gabriel Alberto,
Artero Mora Arturo,
Pérez Rubio Alberto,
Eiros Bouza José María
The overuse and misuse of antimicrobials contribute to the emergence of antibiotic-resistant bacteria. The aim of this work was to analyse all the anti-infectives for systemic use (J ATC group) prescribed at the University Clinic Hospital of Valladolid (Spain) for the years 2009-2013. Amounts of anti-infectives (antibacterials, antifungals and antivirals) used in the period 2009-2013 were expressed as defined daily doses (DDDs) and as total expenditure, and the significance of the difference in consumption of anti-infectives and the relevant expenditure between years was evaluated from the overlapping of the corresponding confidence intervals at 95% confidence level of DDDs and expenditure. The results obtained showed that DDDs and expenditure of antibacterials decreased in the period 2009-2013. Antimycotics showed an upward trend in expenditure and DDDs in the five-year study period, but with major oscillations. The consumption of antivirals was practically constant in the period 2009-2011; in 2012, a significant reduction was observed and this reduction was conserved in 2013, although their expenditure increased year by year. In conclusion, in the period 2009-2013, expenditure on anti-infectives increased year to year. However, this increase in expenditure resulted in a downward trend of DDDs.
Characterisation of drug resistance of nosocomial ESBL-producing E. coli isolates obtained from a Turkish university hospital between 2009 and 2012 by pulsed field gel electrophoresis and antibiotic resistance tests
Karagöz Alper,
Sunnetcioglu Mahmut,
Ceylan M. Resat,
Bayram Yasemin,
Yalcin Gozde,
Kocak Nadir,
Suvak Burak,
Andac Cenk A.
In this study, drug resistance of 28 ESBL-producing Escherichia coli isolates obtained from 144 patients hospitalized at the Yüzüncüyil University Hospital at Van (YUH), Turkey, between 2009 and 2012 were characterized by pulsed field gel electrophoresis and antibiotic susceptibility tests. Antibiotic resistance profile was determined by a Phoenix automated system (BD, USA). The ratio of ESBL-producing E. coli strains was determined to be 19.4% (28 out of 144 E. coli isolates). It was determined that the anaesthesiology, paediatrics and thoracic medicine intensive care units in YUH were cross-contaminated between 2009 and 2012 by ESBL-producing E. coli strains, which is a sign of nosocomial infection in YUH. Analysis of PFGE results gave rise to two main PFGE profiles, profile-A with four subprofiles and profile-B with three subprofiles, where profile-A predominates over profile-B (14%). Comparison of the antibiotic resistance profile with the PFGE profile yielded similarities while some differences also exist due to either identical restriction enzyme cutting sites with slightly different genetic sequences in between the cutting sites or newly formed restriction enzyme cutting sites that do not affect antibiotic resistance genes. Enterobacteriaceae, particularly E. coli, have developed resistance in YUH by producing ESBLs against oxyimino and non-oxyimino cephalosporins, and penicillin-type antibiotics. Therefore, more effective antibiotics such as cefoxitin or cefoperazone-sulbactam should be used for the treatment of future nosocomial infections in YUH while hospital staff should take care with hygiene, such as hand washing.
Hypertransaminasaemia in children with viral gastroenteritis
Kucuk Oznur,
Ugras Meltem,
Bicer Suat,
Col Defne,
Giray Tuba,
Ciler Erdag Gulay,
Yalvaç Zerrin,
Kaspar Cigdem,
Vitrinel Ayca
We investigated the rates of increase in serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of patients with rotavirus, norovirus and enteric adenovirus gastroenteritis. Two hundred children with viral gastroenteritis were evaluated for hypertransaminasaemia retrospectively. The patients were between 0 - 17 years (mean ± SD: 5.10 ± 3.01) of age. ALT was elevated up to 67 IU/L in 7 (8.5%) patients in the rotavirus group (n=82), whereas it was elevated in 3 (4.0%) and 1 (2.3%) patients in the norovirus (n=74) and adenovirus (n=44) groups, respectively. AST was elevated up to 89 IU/L in 20 (24.4%) patients in the rotavirus group, whereas it was elevated in 6 (8.1%) and 1 (2.3%) patients in the norovirus and adenovirus groups, respectively. Both transaminases were elevated in 7.3%, 1.4%, and 2.3% of patients in the rotavirus, norovirus, and adenovirus groups, respectively. The increases in ALT and AST levels were found to be significantly higher in the rotavirus group (n=27) than in the norovirus (n=9), and adenovirus group (n=2) (p<0.05). Mean serum ALT and AST levels in the rotavirus group were significantly higher than those in the norovirus and adenovirus group (p<0.05). Our study investigated the correlation between viral gastroenteritis and hypertransaminasaemia. When evaluating a patient with hypertransaminasaemia physicians should remember to consider acute gastroenteritis due to some viruses as a cause of elevated AST and ALT.
The role of overweight and obesity in urinary tract infection in children
Mahyar Abolfazl,
Ayazi Parviz,
Gholmohammadi Parisa,
Alireza Moshiri Seyed,
Oveisi Sonia,
Esmaeily Shiva
This study was conducted to determine the relationship between overweight/obesity and UTI in children. A comparison was made, in terms of overweight and obesity, between 135 children with UTI (case group) and 135 healthy children (control group). UTI was diagnosed through urine culture. Dimercaptosuccinic acid renal scanning (DMSA) was also used to distinguish between lower UTI and acute pyelonephritis. Overweight and obesity were determined based on standard body mass index (BMI) curves. There were 12 (8.8%) overweight and 26 (19.2%) obese children in the case group. Four (3.0%) overweight and five (3.7%) obese children were found in the control group. There was a significant difference between the two groups regarding overweight and obesity frequencies. However, no such difference existed between children with cystitis and acute pyelonephritis. This study showed a significant relationship between overweight/obesity and UTI. Therefore, overweight and obesity may play a role in the pathogenesis of UTI in children.
Serological survey of Echinococcus granulosus in nomads of southwest Iran using the ELISA method during 2014-15
Kasaei Razieh,
Tavalla Mehdi,
Etebar Hosein
Echinococcosis is one of the diseases common to humans and animals worldwide and its metacestode form Echinococcus granulosus is the cause of disease. Diagnosis based on clinical symptoms is a problem. However, using serological methods such as ELISA, specific antibodies can be determined. Based on the medical and economic importance of the disease, this study aimed to undertake a serological survey of human echinococcosis in Behbahan nomads using the ELISA method during 2014-15. In a descriptive study, 180 blood samples were collected and analysed from the tribes in the four geographic regions of Behbahan city. The obtained sera were assessed for the presence of IgG antibodies against hydatid cyst. Demographic data were collected using a questionnaire and the results were analysed by SPSS software. In all, 175 persons (97.2%) tested negative while five (2.8%) were positive. The most frequent was in people over 50 years with three persons (1.7%). In the 40-50 years age group, two subjects (1.1%) tested positive. 62 (34.4%) of the subjects were female and 118 (65.6%) were male, among which four men (2.2%) and one woman (0.6%) were infected. Overall, the most infected were men. Of the infected persons, three lived in the East, one in the South and one in the West of the city. All subjects had a history of contact with dogs. According to the results of this study, the prevalence was high in the area and therefore disease control programmes are recommended.
The investigation of oxacillinase/metallo-beta-lactamase genes and clonal analysis in carbapenem-resistant Klebsiella pneumoniae
Çetinkol Yeliz,
Altunçekiç Yldirim Arzu,
Telli Murat,
Kerem Çalgin Mustafa
Infections due to carbapenem-resistant Klebsiella pneumoniae represent a growing problem nationally. In our study, we aimed to examine carbapenem-resistant K. pneumoniae with multiple resistance isolated in the intensive care unit of our hospital. Isolates were investigated for the presence of oxacillinase and metallo-beta lactamase genes with a view to determining the clonal relationship between the strains intensely over a short period. Strain identification was completed with conventional methods and automated identification kit. OXA-58, OXA-23, OXA-51, OXA-24 and OXA-48 and metallo-beta lactamase genes IPM, VIM, SPM, SIM, GIM and NDM-1 were investigated with PCR. For clonal relationships of carbapenem-resistant strains, the PFGE experiment was performed. While all of these carbapenem-resistant strains were positive for OXA-48, the resistant genes NDM-1, VIM, KPC, IPM, SPM, GIM, SIM, OXA-23, OXA-24, OXA-58 and OXA-51 were not observed. When molecular typing results were investigated, PFGE determined clonal distribution of three pulsotypes. However, it was observed that the strains intensified in a single clone and this was assessed as the outbreak isolate. The results of this study showed the primary enzyme responsible for carbapenem resistance in K. pneumoniae strains in our hospital is still OXA-48. To prevent the spread of carbapenem-resistant K. pneumoniae isolates, with epidemic potential, national-level monitoring and effective infection control precautions should be enforced.
Case report
Metastatic muscle abscesses complicating infected total hip arthroplasty
Balato Giovanni,
Ascione Tiziana,
Mariconda Massimo,
Pagliano Pasquale
A 73-year-old woman with rheumatoid arthritis presented to our institution with infection of her right total hip arthroplasty. On admission, a draining sinus tract over the hip and a palpable mass in the left lower posterior region of the neck were detected. The contrast CT scan showed a large abscess in the trapezius muscle and multiple abscesses involving muscle of the neck and right shoulder. Intraoperative specimens from the muscle abscess were positive for presumably the same methicillin-resistant Staphylococcus aureus that sustained the prosthetic joint infection. Prolonged intravenous daptomycin led to remission of the muscle abscess and control of the prosthetic joint infection. The patient refused revision total hip arthroplasty and oral cotrimoxazole was prescribed for chronic suppression of the infection. Three years after the primary surgery there was stable remission of the prosthetic joint infection. This rare case demonstrates the severity of prosthetic joint infections sustained by multiresistant bacteria in immunocompromised hosts, which may result in their bacteraemic spread.
Bloodstream infection with Oligella ureolytica: a case report and review of the literature
Pagotto Alberto,
Merluzzi Sonia,
Pillinini Paolo,
Valeri Marica
Oligella ureolytica is an emerging bacteria rarely implicated as a human pathogen. It is mostly recovered from urinary and respiratory tract specimens as a commensal organism, but very seldom from bloodstream infections. It is rarely reported in the literature, probably due to misidentification of the organism or uncertainty of its pathogenicity.
A life-threatening brainstem compression by cerebral Echinococcus granulosus
Çağla Karakoç Zehra,
Ömür Kasımcan Mustafa,
Pipia Anna Paola,
Tore Gessica,
Alberti Alberto,
Varcasia Antonio,
Sav Aydın,
Oruçkaptan Hakan
Cystic echinococcosis (CE) is a zoonotic disease caused by Echinococcus granulosus. It is of worldwide importance, and is widespread in the Mediterranean region and Middle East. This tapeworm shows great intraspecific variation in relation to host specificity, epidemiology and morphology. This variability led in previous years to the identification of ten (G1–G10) different genotypes of the parasite. Cerebral localization of E. granulosus is not common: it especially affects children and is more frequently located in the supratentorial region. It can be life-threatening due to its localization in eloquent areas especially in the posterior fossa. Despite the benign nature of hydatid cyst, invasion of critical areas may cause significant mortality and morbidity in some patients. Urgent surgical decompression and adjuvant medical treatment must be employed as soon as possible in these patients. We present a clinical case of life-threatening brainstem compression in a child due to a rare form of CE which was confirmed with biomolecular techniques. She presented with respiratory distress and progressive quadriparesis. All cysts were removed by microsurgical technique and albendazole was given postoperatively for one year with regular follow-ups.
An unnoticed origin of fever: periapical tooth abscess. Three case reports and literature review
Arslan Ferhat,
Karagöz Ergenekon,
Yigit Arslan Birsen,
Mert Ali
Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Hospital, Istanbul; Department of Infectious Diseases and Clinical Microbiology, Van Military Hospital, Van; Department of Anesthesiology and Reanimation, Esenyurt State Hospital, Istanbul, Turkey
Report of an immunocompetent case with disseminated infection due to Nocardia otitidiscaviarum: Identification by 16S rRNA gene sequencing
Eren Esma,
Ulu-Kilic Aysegul,
Atalay Altay,
Demiraslan Hayati,
Parkan Omur,
Koc Nedret
Nocardia otitidiscaviarum belongs to the agents of opportunistic infections seen in immunocompromised patients, but may occur rarely in immunocompetent patients. In this report we described a case of a previously healthy 69-year-old woman with cerebral and retroperitoneal abscess due to Nocardia otitidiscaviarum. The patient was admitted to hospital because of loss of strength in her right arm and leg. Nocardia spp. was isolated from the abscess material. The intracranial lesions were drained by stereotactic craniotomy. The large abscess located around the left kidney was drained and microscopic examination of aspirated material showed Nocardia spp. For species identification, 16S rRNA gene sequencing was carried out and was 100% concordant with Nocardia otitidiscaviarum. Use of 16S rDNA gene sequencing for identification permits detection of rare aetiologic agents that cause brain abscesses.
The Infections in the History of Medicine
Historical perspective of brucellosis: a microbiological and epidemiological overview
Akpinar Orhan
The historical process of brucellosis extends back to humankind’s first contact with animals. Although brucellosis is a sporadic disease observed in animals in certain regions of the world, it is an important disease in humans that can affect many organs and systems due to the consumption of contaminated milk or milk products. Studies have shown that the presence of Brucella dates back to 60 million years ago. In 450 BC, Hippocrates described a disease similar to brucellosis. Since Hippocrates’ time, brucellosis has been characterized by fever. Our aim is to investigate selfless work undertaken by scientists on the epidemiology, diagnosis and clinical findings of brucellosis until today, and to gain a historical perspective about the disease that is as old as human history, still has importance today, causes economic losses in treated animals and harms human health
Letters to the editor
Discrepancy between immunosuppressive status and extensiveness of fungal infections?
Modesto dos Santos Vitorino,
Modesto dos Santos Lister Arruda
Not available
Erratum
A probable drug-to-drug interaction between voriconazole and haloperidol in a slow metabolizer of CYP2C19 patient
Motta Ilaria,
Calcagno Andrea,
Baietto Lorena,
D’Avolio Antonio,
De Rosa Francesco Giuseppe,
Bonora Stefano
Erratum
Following publication of the original article (Infez Med. volume 23, issue 4, pages 367-369, year 2015) we became aware of the following errors which we wish to correct. These corrections have no impact over the study results, their interpretation or conclusions.
Title
The correct title is the following:
A probable drug-to-drug interaction between voriconazole and haloperidol in a CYP2C19 poor metabolizing patient
Summary
The correct summary is the following:
SUMMARY
We present a case of Aspergillus fumigatus renal abscess treated with voriconazole. Following haloperidol treatment we observed an unexpected increase in voriconazole - trough concentrations and liver function tests. CYP2C19*2 loss of function allele was stated and the introduction of haloperidol, a weak CYP3A4 inhibitor, probably explains this interaction.. Therapeutic drug monitoring and CYP2C19 genotyping may be suggested when administering voriconazole to complex patients.
Evaluation of CHROMagar Candida, VITEK2 YST and VITEK® MS for identification of Candida strains isolated from blood cultures
Mutlu Sariguzel Fatma,
Berk Elife,
Nedret Koc Ayse,
Sav Hafize,
Aydemir Gonca
Erratum
Following publication of the original article (Infez Med. volume 23, issue 4, pages 318-322, year 2015) we became aware of the following errors which we wish to correct. These corrections have no impact over the study results, their interpretation or conclusions.
Title
The correct title is the following:
Evaluation of chromagenic agar, VITEK2 YST and VITEK® MS for identification of Candida strains isolated from blood cultures
Text
In the whole text CHROMOMagar Candida shoul be read as chromogenic agar
