Comparative analisys in cultural test of biological fluids: routine Vs a new strumentation (Alifax HB&L Uroquattro)

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Colistin resistance in KPC-producing Klebsiella pneumoniae strains from a high specialization rehabilitation facility

The worldwide rapid spread of KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) represents an increasing problem in clinical settings. Reports on KPC-Kp epidemic spread in Italian hospitals began to appear since 2010; colistin (COL) represents one of the few remaining therapeutic options available for the treatment of such multi drug-resistant (MDR) pathogens. Here we report the presence and diffusion of COL resistant KPC-Kp isolates from a High Specialization Rehabilitation Facility located in Northern Italy. Species identification and antimicrobial susceptibilities were obtained by NBC46/NM40 Microscan panels (Siemens); imipenem, meropenem and ertapenem MICs were also evaluated by Etest and broth microdilution method; blaKPC-like genes PCR were performed. PFGE (XbaI) was used to investigate clonal relatedness; epidemiological data were collected from the hospital database. Seventy-five carbapenem-resistant K. pneumoniae isolates were collected from the Fondazione S. Maugeri hospital during the period January-June 2011. Seven out of 75 MDR KPC-Kp isolates by Microscan System showed COL resistance (MIC >2 mg/L). Among them, 5/7 were collected from coma and 2/7 from cardiology and rehabilitation cardiology wards. Most of these strains were from urine (5/7); the remaining 2/7 were from blood and bronco-alveolar lavage. The 85.7% of the strains showed susceptibility to tigecycline and fosfomycin; 71.4% only to gentamicina, 28.5% to trimethoprim/sulfamethoxazole and 14.2% to amikacin. The PFGE profiles obtained analyzing 5/7 isolates from patients hospitalized from almost 10 days, showed clonal relatedness between 4/5 isolates, thus confirming the high epidemic potential of almost one KPC-Kp clinical strain collected from 4 different wards.The emergence of COL resistance in KPC-Kp, dramatically reduces the available therapeutic options. These results underline the ability of a COL resistant KPC-producing clone to rapidly spread within this Rehabilitation Facility

<it>Absidia Corymbifera </it>in an immune competent accident victim with multiple abdominal injuries: case report

Abstract Background We report a case of mucormycosis in a healthy 17-year-old accident victim with multiple abdominal injuries which was caused by infection with Absidia Corymbifera, a ubiquitous saphrophyte in the ground. Case presentation The patient was admitted to hospital with massive abdominal trauma. During an 8-hour emergency operation he received transfusions of compacted red blood cells, plasma, platelets and hemagel. He developed a crush syndrome with acute renal failure, resolved with extra-corporeal dialysis and had to undergo splenectomy because of spleen hematoma. As wound secretion and central venous catheter (CVC) blood cultures and drainage fluid were positive for Enterococcus Faecium, Providentia Rettgeri, Hafnia Alvei and Candida Albicans, tecoplanin, metronidazole, imipenem, and flucanozole were administered. Although the CVC was changed high fever persisted and discharge continued from the large abdominal wound. Repeated tampons in different sections and wound secretion smears were positive for A. corymbifera. Flucanozole was stopped and liposomal amphotericin (Ambisome; 5 mg/Kg i.v.) given for over 3 months. The patient improved; fever gradually disappeared. After 8 days, tampons and wound secretion smears were negative for A. corymbifera. No other fungal infections developed. Drainage fluid was later positive for tecoplanin-resistant E. faecium and Pseudomonas Aeroginosa responding only to meropenem and ciprofloxacin. Abdominal computerized tomography visualized fluid accumulation around the iliac-femoral bypass. Abcess was ruled out when scintigraphy showed no tracer uptake. The lesion was drained. Drainage fluid cultures were negative for bacteria and fungi. Fluid accumulation gradually disappeared with prolonged antibiotic and antifungal therapy. One year after the accident the patient is in good health, with normal quality of life. Conclusion Successful outcome was due to early, specific antifungal therapy, at sufficiently high dosage which was prolonged for an adequate period of time. Early diagnosis of mucormycosis is essential for efficacious anti-fungal treatment and prevention of irreversible spread of mucormycosis to vital organs. It presupposes awareness that A. corymbifera infection can develop in healthy individuals who are stressed and traumatized through skin-ground contact in accidents.</p

Comparative analisys in cultural test of biological fluids: routine Vs a new strumentation (Alifax HB&L Uroquattro)

The accuracy and rapidity of a microbiological diagnosis is crucial for the proper management of critical or neutropenic patients.To reduce the time of analysis, we compared the performances of an automated system with those of the conventional method (direct coltural analysis in agar medium BD and a enrichement for aerobic and anaerobic bacteria and fungi in BD bactec bottles). For this study, we evaluated the kind of specimens, the time of analysis and the positivity for several bacterial strains. Finally we compared the specificity and sensitivity of the automated system with those of the traditional coltures. A total of 50 specimens were analysed.All the specimens were from patiens hospitalized in the wards of Perugia’s hospital.We found that the results obtained with the Alìfax system differed from those of conventional/coltural method.We propose to utilize the Alìfax system for coltural analysis of urine where the cut off of signifìcativity is 50 cfu/mL and the infectious agent involved is often monomicrobic and aerobic.We will continue to use the arrichment of fluid in BD bottles which is very accurate

Colistin resistance in KPC-producing Klebsiella pneumoniae strains from a high specialization rehabilitation facility

The worldwide rapid spread of KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) represents an increasing problem in clinical settings. Reports on KPC-Kp epidemic spread in Italian hospitals began to appear since 2010; colistin (COL) represents one of the few remaining therapeutic options available for the treatment of such multi drug-resistant (MDR) pathogens. Here we report the presence and diffusion of COL resistant KPC-Kp isolates from a High Specialization Rehabilitation Facility located in Northern Italy. Species identification and antimicrobial susceptibilities were obtained by NBC46/NM40 Microscan panels (Siemens); imipenem, meropenem and ertapenem MICs were also evaluated by Etest and broth microdilution method; blaKPC-like genes PCR were performed. PFGE (XbaI) was used to investigate clonal relatedness; epidemiological data were collected from the hospital database. Seventy-five carbapenem-resistant K. pneumoniae isolates were collected from the Fondazione S. Maugeri hospital during the period January-June 2011. Seven out of 75 MDR KPC-Kp isolates by Microscan System showed COL resistance (MIC &gt;2 mg/L). Among them, 5/7 were collected from coma and 2/7 from cardiology and rehabilitation cardiology wards. Most of these strains were from urine (5/7); the remaining 2/7 were from blood and bronco-alveolar lavage. The 85.7% of the strains showed susceptibility to tigecycline and fosfomycin; 71.4% only to gentamicina, 28.5% to trimethoprim/sulfamethoxazole and 14.2% to amikacin. The PFGE profiles obtained analyzing 5/7 isolates from patients hospitalized from almost 10 days, showed clonal relatedness between 4/5 isolates, thus confirming the high epidemic potential of almost one KPC-Kp clinical strain collected from 4 different wards.The emergence of COL resistance in KPC-Kp, dramatically reduces the available therapeutic options. These results underline the ability of a COL resistant KPC-producing clone to rapidly spread within this Rehabilitation Facility

How circulating tumor cells escape from multidrug resistance: translating molecular mechanisms in metastatic breast cancer treatment.

Resistance to anthracyclines is responsible for treatment failure in most patients with metastatic breast cancer. According to recent studies, the expression of specific drug transporters (MRPs) on circulating tumor cells is predictive of prognosis in different cancer types. We observed that patients whose circulating tumor cells expressed MRP1 and MRP2, two drug-export pumps responsible for anthracyclines efflux, who received conventional anthracyclines had a significantly shorter time to progression compared with patients sharing same characteristics who received non pegylated liposomal doxorubicin (P < 0.005). These results may highlight a new appealing role of the liposomal doxorubicin formulation, not only because of its reduced cardiac toxicity but especially referring to its theoretical efficacy in anthracycline-resistant breast cancer patients

CHANGING PATTERNS IN MACROLIDE RESISTANCE AND emm-TYPES IN Streptococcus pyogenes ISOLATED IN ITALY DURING 2012

Objectives. Surveillance of antimicrobial resistance and global dissemination of clones with specific emm-types is an important issue in GAS epidemiology also in relation to the design of a vaccine against the M protein. Methods. We have collected 218 GAS isolates, mainly from pharyngotonsillitis, in the Centre of Italy during winter-spring 2012 and determined their emm-type by sequencing. Antimicrobial susceptibility was tested by disc diffusion towards benzylpenicillin, erythromycin, telithromycin, clindamycin, tetracycline, linezolid, and rifampicin following the EUCAST guidelines. All resistant isolates were screened by PCR for the presence of the main corresponding genetic determinants of resistance. Results. The most frequent emm-types were emm-4, -1, -12, -89, -6, -44, -18, -29, -5, and -28 accounting for 80% of the isolates. Resistance towards erythromycin and telithromycin was observed in 10% of the isolates, clindamycin in 6%, and tetracycline in 4.6%. The 9 macrolide-ketolide resistant isolates were positive to mef(A), while the 12 macrolide-lincosamide-ketolide resistant isolates were positive to erm(B). In the latter group, one tetracycline susceptible and 9 resistant isolates were positive to tetM, which was present in another isolate resistant to tetracycline only. Macrolide resistance was mainly associated with emm-types 4, 11, and 12. Conclusion. The distribution and frequencies of the emm-types in contemporary Italian GAS have changed to the point that the vaccine coverage of the 26-valent formulation under development, which would have been about 77% ten years ago, would be 65% today (p<0.05). Against the slight decrease in macrolide consumption registered since the last ten years, the prevalence of macrolide resistance lowered consistently from 25-30% to 10%. This phenomenon may correlate to the disappearance or lower prevalence of some emm-types, such as emm2, emm77, and emm89