Hematogenous dissemination of Candida dubliniensis causing spondylodiscitis and spinal abscess in a HIV-1 and HCV-coinfected patient

We report a case of spondylodiscitis and spinal abscess following haematogenous dissemination of the emerging yeast Candida dubliniensis in a human immunodeficiency virus-1 (HIV-1) and hepatitis C virus (HCV)-coinfected patient. Although C. dubliniensis is considered less virulent compared to its closest known relative Candida albicans, reports of severe fungal infections are increasing. This case indicates that the pathogenicity of C. dubliniensis may be higher than previously believed. Therefore fungal infections caused by this dimorph fungus should be kept in mind in immunocompromised patients with spondylodiscitis and spinal abscess

Severe Community-Acquired Bloodstream Infection with Acinetobacter ursingii in Person who Injects Drugs

We report a community-acquired bloodstream infection with Acinteobacter ursingii in an HIV-negative woman who injected drugs. The infection was successfully treated with meropenem. Species identification was performed by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Improved identification of Acinetobacter spp. by using this method will help identify clinical effects of this underdiagnosed pathogen

Carbapenem-resistant Gram-negative pathogens in a German university medical center: Prevalence, clinical implications and the role of novel β-lactam/β-lactamase inhibitor combinations.

To determine the spectrum of infections with multidrug-resistant Gram-negative bacteria (MDR-GNB) and the clinical impact of the newly available betalactam/betalactamase inhibitor combinations ceftolozane/tazobactam and ceftazidime/avibactam in a German academic tertiary care center.Retrospective analysis.Between September 1, 2015 and August 31, 2016, 119 individual patients (0.22% of all hospital admissions) were colonized or infected with carbapenem-resistant MDR-GNB. The species distribution was Pseudomonas aeruginosa, n = 66; Enterobacteriaceae spp., n = 44; and Acinetobacter baumannii, n = 18. In 9 patients, carbapenem-resistant isolates belonging to more than one species were detected. Infection was diagnosed in 50 patients (total: 42.0%; nosocomial pneumonia: n = 23, 19.3%; bloodstream infection: n = 11, 9.2%). Antimicrobial treatment with broad-spectrum antibiotics prior to detection of a carbapenem-resistant isolate was documented in 105 patients (88.2%, prior administration of carbapenems: 62.2%). Nosocomial transmission was documented in 29 patients (24.4%). In 26 patients (21.8%), at least one carbapenem-susceptible, third-generation cephalosporin non-susceptible isolate was documented prior to detection of a carbapenem-resistant isolate belonging to the same species (median 38 days, IQR 23-78). 12 patients (10.1%) had documented previous contact to the healthcare system in a country with high burden of carbapenemase-producing strains. Genes encoding carbapenemases were detected in 60/102 patient isolates (58.8%; VIM-2, n = 25; OXA-48, n = 21; OXA-23-like, n = 10). Susceptibility to colistin was 94.3%. Ceftolozane/tazobactam and ceftazidime/avibactam were administered to 3 and 5 patients, respectively (in-hospital mortality: 66% and 100%). Development of drug-resistance under therapy was observed for both antimicrobials.i) The major predisposing factors for acquisition of carbapenem-resistant MDR-GNB were selective pressure due to preceding antimicrobial therapy and nosocomial transmission. ii) Colistin remains the backbone of antimicrobial chemotherapy for infections caused by carbapenem-resistant MDR-GNB. iii) Novel β-lactam/β-lactamase inhibitor combinations are of limited usefulness in our setting because of the high prevalence of Ambler class B carbapenemases and the emergence of nonsusceptibility under therapy

Intestinal Colonization with Tropheryma whipplei—Clinical and Immunological Implications for HIV Positive Adults in Ghana

BACKGROUND: Recent studies demonstrated higher prevalence rates of Tropheryma whipplei (T. whipplei) in HIV positive than in HIV negative subjects. However, associations with the immune status in HIV positive participants were conflicting. Methods: For this cross-sectional study, stool samples of 906 HIV positive and 98 HIV negative individuals in Ghana were tested for T. whipplei. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and laboratory parameters were assessed. Results: The prevalence of T. whipplei was 5.85% in HIV positive and 2.04% in HIV negative participants. Within the group of HIV positive participants, the prevalence reached 7.18% in patients without co-trimoxazole prophylaxis, 10.26% in subjects with ART intake, and 12.31% in obese participants. Frequencies of clinical symptoms were not found to be higher in HIV positive T. whipplei carriers compared to T. whipplei negative participants. Markers of immune activation were lower in patients colonized with T. whipplei. Multivariate regression models demonstrated an independent relationship of a high CD4+ T cell count, a low HIV-1 viral load, and an obese body weight with the presence of T. whipplei. Conclusions: Among HIV positive individuals, T. whipplei colonization was associated with a better immune status but not with clinical consequences. Our data suggest that the withdrawal of co-trimoxazole chemoprophylaxis among people living with HIV on stable cART regimen may inadvertently increase the propensity towards colonization with T. whipplei

Examples of strain typing results using pulse-field gel electrophoresis.

<p>Panels A and B: Identical PFGE patterns generated from carbapenem-resistant MDR <i>Acinetobacter baumannii</i> (five individual patients A₁-A₅, panel A) and <i>Klebsiella pneumoniae</i> (five individual patients K₁-K₅, panel B) highly suggestive of nosocomial transmission. Panel C: Identical PFGE patterns of carbapenem-susceptible (P₁) and carbapenem-resistant (P₂) MDR <i>Pseudomonas aeruginosa</i> isolates from the same patient (blood culture and bronchioalveolar lavage, respectively) exemplifying acquisition of carbapenem-resistance under therapy. The time span between detection of the carbapenem-susceptible and carbapenem-resistant isolate was 21 days. Abbreviations: M, DNA Marker; C, unrelated clinical control isolate (same species, obtained outside the study period).</p

Distribution, initiation of treatment and in-hospital mortality of patients colonized or infected with carbapenem-resistant MDR-GNB.

<p>Distribution, initiation of treatment and in-hospital mortality of patients colonized or infected with carbapenem-resistant MDR-GNB.</p

Clinical characteristics, microbiology data and outcome of patients treated with ceftolozane/tazobactam or ceftazidime/avibactam during the study period.

<p>Clinical characteristics, microbiology data and outcome of patients treated with ceftolozane/tazobactam or ceftazidime/avibactam during the study period.</p

Carbapenem-resistant Gram-negative pathogens in a German university medical center: Prevalence, clinical implications and the role of novel β-lactam/β-lactamase inhibitor combinations - Fig 3

<p><b>Colistin minimal inhibitory concentrations (MICs) for a) <i>Klebsiella pneumoniae</i>, b) <i>Pseudomonas aeruginosa</i>, and c) <i>Acinetobacter baumannii</i> isolates.</b> Shown are non-duplicate isolates from individual patients. Dashed line: Clinical breakpoint according to EUCAST Breakpoint Table v.7.0 (MIC ≤ 2 mg/L, susceptible; MIC > 2 mg/L resistant).</p

Detection of carbapenemase alleles in clinical MDR-GNB isolates.

<p>Detection of carbapenemase alleles in clinical MDR-GNB isolates.</p