Multidrug resistant Kluyvera ascorbata septicemia in an adult patient: a case report

<p>Abstract</p> <p>Introduction</p> <p><it>Kluyvera ascorbata </it>has become increasingly significant due to its potential to cause a wide range of infections, as well as its ability to transfer gene encoding for CTX-M- type extended spectrum B-lactamases (ESBLs) to other Enterobacteriaceae.</p> <p>Case presentation</p> <p>We report the case of a 64-year-old African-American male diagnosed with severe sepsis due to a multidrug resistant <it>Kluyvera ascorbata</it>, which was isolated from his blood. He was treated with meropenem and had a favorable outcome.</p> <p>Conclusion</p> <p>To the best of our knowledge, this is the first case report of a multidrug resistant <it>Kluyvera ascorbata </it>isolated from the blood in an adult patient with sepsis.</p

Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population

Background The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced to prevent invasive pneumococcal disease (IPD) in Western Australian (WA) Aboriginal people in 2001. PCV13 replaced PCV7 in July 2011, covering six additional pneumococcal serotypes; however, IPD rates remained high in Aboriginal people in WA. Upper respiratory tract pneumococcal carriage can precede IPD, and PCVs alter serotype distribution. Methods To assess the impact of PCV13 introduction, identify emerging serotypes, and assess risk factors for carriage, nasopharyngeal swabs and information on demographic characteristics, health, medication and living conditions from Aboriginal children and adults across WA from August 2008 to November 2014 were collected. Bacteria were cultured using selective media and pneumococcal isolates were serotyped by Quellung reaction. Risk factors were analysed by multivariable logistic regression. Results One thousand five hundred swabs pre- and 1385 swabs post-PCV13 introduction were collected. Pneumococcal carriage was detected in 66.8 % of children 53.2 % of 5–14 year-olds post-PCV13, compared with pre-PCV13 prevalence of 72.2 % and 49.4 %, respectively. The prevalence of PCV13-non-PCV7 serotypes decreased in children 13.5 % pre-PCV13 to 5.8 % post-PCV13 (p \u3c 0.01), and from 8.4 % to 6.1 % in children 5–14 years old (p \u3e 0.05). The most common serotypes post-PCV13 were 11A (prevalence 4.0 %), 15B (3.5 %), 16F (3.5 %), and 19F (3.2 %). Risk of detection of pneumococcal carriage increased until age 12 months (odds ratio [OR] 4.19, 95 % confidence interval [CI] 2.39–7.33), with nasal discharge (OR 2.49 [95 % CI 2.00–3.09]), residence in a remote community (OR 2.21 [95 % CI 1.67–2.92]) and household crowding (OR 1.36 [95 % CI 1.11–1.67]). Recent antibiotic use was negatively associated with pneumococcal carriage (OR 0.48 [95 % CI 0.33–0.69]). Complete resistance to penicillin was present among isolates of serotypes 19A (6.0 %), 19F (2.3 %) and non-serotypeable isolates (1.9 %). Serotype 23F and newly emerged serotype 7B isolates showed high rates of resistance to cotrimoxazole, erythromycin and tetracycline (86.9 %, 86.9 %, 82.0 %, respectively for 23F, 100.0 %, 100.0 % and 93.3 % for 7B). Conclusion Since PCV13 replaced PCV7, carriage of PCV13-non-PCV7 serotypes decreased significantly among childrenold, those most likely to have received PCV13, and to a lesser extent in older people. Known risk factors for carriage including crowding and young age remain in the Aboriginal population

Guided Imagery Intervention does not Affect Surgical Outcome of Patients Undergoing laparoscopic Cholecystectomy : A Multi-Centre, Randomised Controlled Study

Objective:To investigate if a “non-pharmacological” intervention with guided imagery could reduce postoperative analgesic consumption, pain perception and preoperative anxiety, compared to standard care, in patients undergoing laparoscopic cholecystectomy (LC). Methods: A randomized controlled study with two parallel groups was performed at two hospital departments of anesthesiology. A total of 140 patients (≥ 18 years) that were scheduled for LC were randomized to either receive guided imagery (N=70) or standard care instructions (N=70) as a control group. Patients in the guided imagery group were provided a CD to practice guided imagery once a day, 7 days prior to surgery. Primary outcome measurement was post-operative analgesic consumption. Secondary outcomes were preoperative anxiety, post-operative self-rated pain, patient satisfaction and adverse events.Results: Of 140 patients that were randomized, 95 patients completed the study, 43 in the guided imagery group and 52 in the control group. Both groups were comparable at baseline with respect to demographic data. Compliance with intervention was fairly good as 77% of the patients had listened to the CD according to instructions. No significant differences (p=0.34) were observed for postoperative morphine use between the intervention (15.8 ± 18.5 mg) and control group (12.5 ± 13.6 mg). Secondary outcomes such as preoperative anxiety (APAIS: 15.2 ± 5.9 vs. 16.4 ± 5.9; p=0.36)), postoperative pain (VAS: 3.4 ± 1.8 vs. 3.0 ± 1.8; p=0.31) and patient satisfaction (PSQ: 4.1 ± 0.9 vs. 3.9 ± 0.8; p=0.47) also demonstrated no significant differences. No adverse events were reported in both groups.Conclusion: A short preoperative guided imagery intervention demonstrated no additional beneficial effects compared to standard care for patients undergoing LC. It therefore seems not to be as simple as to provide patients with a CD before surgery in order to effectively self-manage postoperative pain