Disseminated nocardiosis with thyroid involvement: A case report

Nocardiosis is a life-threatening infection that affects the lungs, skin, and central nervous system, particularly in immune-compromised patients. We report a case of disseminated nocardiosis with pneumonia, brain abscesses, meningitis, and thyroiditis, for an individual with recent steroid therapy. Recovery was uneventful with a 4-month course of sulfamethoxazole–trimethoprim

In situ reconstruction of septic aortic pseudoaneurysm due to Salmonella or Streptococcus microbial aortitis: long-term follow-up

AbstractObjectiveThis study was undertaken to illustrate the safety of in situ reconstruction of septic aortic pseudoaneurysm (SAP) secondary to microbial aortitis, with or without long-term antibiotic treatment.MethodsData for patients with SAP (11 abdominal, 4 thoracic) operated on between 1993 and 1999 were reviewed. Computed tomography and aortography showed septic pseudoaneurysm in all patients before surgery. After diagnosis of SAP, all patients underwent aneurysm resection and extensive debridement, with in situ prosthetic grafting or patch repair angioplasty. The graft in 10 of the 11 patients with abdominal SAP was also wrapped with an omental pedicle. In vitro active parenteral antibiotic therapy was prescribed for all patients for at least 2 to 8 weeks after surgery.ResultsAll 15 patients had positive preoperative blood cultures or intraoperative tissue cultures for Salmonella spp (n = 12), viridans Streptococcus (n = 1), group G Streptococcus (n = 1), or Streptococcus pneumoniae (n = 1). There were two perioperative deaths (13.3%), one 6 days after surgery and the other 19 days after surgery, and two late deaths, at 8 and 10 months after surgery, neither of which was related to aortic repair. One patient was unavailable for follow-up. The other 10 patients have been regularly followed up with abdominal ultrasound or computed tomography (mean, 84 months; range, 47-118 months). To date, there has been no graft infection, thrombosis, false aneurysm, or subsequent aortic surgery in these 10 patients.ConclusionSAP due to Salmonella and streptococcal microbial arortitis can be successfully treated with resection of the aneurysm and extensive debridement, followed by in situ prosthetic graft interposition or patch repair aortoplasty. This is a safe and effective treatment that may result in complete remission of SAP. Postoperative parenteral antibiotic therapy should be continued for 2 to 8 weeks. Although usually recommended, lifelong suppressive antibiotic therapy appears to be nonessential with this approach

Community-onset bacteremia in kidney transplant recipients: The recipients fare well in terms of mortality and kidney injury

BackgroundBloodstream infection is not uncommon in kidney transplant recipients (KTRs) and is associated with mortality, graft loss, and increased medical expenses. Whether these septic patients are more vulnerable to serious complications, resistant strains, or worse clinical outcomes than other patient groups in the community-onset settings remains undetermined.MethodsA retrospective study was conducted at a medical center in southern Taiwan. Community-onset bacteremia in the KTRs and a control population at the emergency department were identified. Demographic data, clinical characteristics, bacteremic pathogens, antimicrobial resistance, and clinical outcomes were recorded.ResultsForty-one bacteremic episodes in the KTRs and 82 episodes in control patients were studied. The KTR group had younger age, fewer malignancies, more urosepsis (61% vs. 22%, p = 0.004), and fewer biliary tract infections (0% vs. 13.4%, p = 0.018). Escherichia coli was the most commonly isolated pathogen in both the groups (51.2% and 41.5%, respectively). No Klebsiella pneumoniae bacteremia was noted in the KTRs, compared with 14 (17.1%) episodes in the control group (p = 0.010). Antimicrobial resistance profiles of bacteremic pathogens were similar (all p > 0.6). The KTRs with community-onset bacteremia did not have a worse outcome (in-hospital mortality rate: 2.4% vs. 10%, p = 0.172) nor more incomplete resolution of kidney injury after acute kidney injury events (21.1% vs. 25%, p > 0.99) than the control group.ConclusionKTRs with community-onset bacteremia did not fare worse in terms of clinical outcome and kidney injury

Emergence of Ceftriaxone-Resistant Salmonella Isolates and Rapid Spread of Plasmid-Encoded CMY-2–Like Cephalosporinase, Taiwan

Of 384 Salmonella isolates collected from 1997 to 2000 in a university hospital in Taiwan, six ceftriaxone-resistant isolates of Salmonella enterica serovar Typhimurium were found in two patients in 2000. The resistance determinants were on conjugative plasmids that encoded a CMY-2–like cephalosporinase. During the study period, the proportion of CMY-2–like enzyme producers among Escherichia coli increased rapidly from 0.2% in early 1999 to >4.0% in late 2000. Klebsiella pneumoniae isolates producing a CMY-2–like β-lactamase did not emerge until 2000. The presence of blaCMY-containing plasmids with an identical restriction pattern from Salmonella, E. coli, and K. pneumoniae isolates was found, which suggests interspecies spread and horizontal transfer of the resistance determinant. Various nosocomial and community-acquired infections were associated with the CMY-2–like enzyme producers. Our study suggests that the spread of plasmid-mediated CMY-2–like β-lactamases is an emerging threat to hospitalized patients and the public in Taiwan

Fluoroquinolone therapy for bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae

AbstractBackground/PurposeFor extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infections, carbapenems are recommended as first line therapy, and clinical data on the therapeutic efficacy of fluoroquinolones (FQs) is limited. This study compares the efficacy of FQs and carbapenems for bloodstream infections caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae.MethodsBetween 2008 and 2010, adults with ESBL-producing E. coli or K. pneumoniae bacteremia at two medical centers were reviewed. Adults receiving definitive FQ or carbapenem therapy were compared in a propensity score-matched analysis, and 30-day mortality was the primary endpoint.ResultsA total of 299 patients were eligible. Patients receiving a FQ (n = 24), either ciprofloxacin or levofloxacin, had a lower 30-day mortality rate than those with carbapenem therapy (8.3%, 2/24 vs. 23.3%, 64/275; p = 0.12). Multivariate regression analysis revealed that a critical illness [Pitt bacteremia score ≥ 4 points; odds ratio (OR), 7.09; p < 0.001], rapidly fatal underlying disease (OR, 5.73; p < 0.001), and hospital-associated infection (OR, 2.57; p = 0.01) were independently associated with 30-day mortality. By contrast, FQ definitive therapy was a protective factor compared with carbapenems (OR, 0.18; p = 0.04). There were 72 matched cases with carbapenem therapy in a propensity score-matched analysis, and a difference in the 30-day mortality rate of two groups was noted (8.3% vs. 29.2%; p = 0.05).ConslusionFor ESBL-producing E. coli or K. pneumoniae bacteremia, ciprofloxacin or levofloxacin, if active in vitro, can be considered as a carbapenem-sparing alternative

Bacteremic pneumonia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: Appropriateness of empirical treatment matters

BackgroundClinical information about bacteremic pneumonia caused by extended-spectrum beta-lactamase (ESBL)-producing organism is limited.MethodsA retrospective study was conducted at two medical centers in Taiwan. From May 2002 to August 2010, clinical information and outcome of adults with bacteremic pneumonia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae were analyzed. The primary outcome is the 30-day mortality.ResultsA total of 111 patients with bacteremic pneumonia caused by E. coli (37 patients, 33.3%) and K. pneumoniae (74, 66.7%) were identified. Their mean age was 69.2 years and 51.4% were male patients. Fifty-seven (51.3%) episodes were classified as hospital-acquired infections, 19 (17.1%) as health-care-associated infections, and four (3.6%) as community-acquired infections. Fifty-one (45.9%) patients received appropriate empiric antimicrobial therapy. The 30-day mortality rate was 40.5% (45 patients). In the multivariate analysis, several independent risk factors, including rapidly fatal underlying disease [odds ratio (OR), 5.75; 95% confidence interval (CI), 1.54–21.48; p = 0.009], severe sepsis (OR, 4.84; 95% CI, 1.55–15.14; p = 0.007), critical illness (OR, 4.28; 95% CI, 1.35–13.57; p = 0.013), and receipt of appropriate empirical therapy (OR, 0.19; 95% CI, 0.07–0.55; p = 0.002), were associated with 30-day mortality. The survival analysis consistently found that individuals with appropriate empiric therapy had a higher survival rate (log-rank test, p < 0.001).ConclusionESBL-producing bacteremic pneumonia, especially health-care-associated infections, often occurred in adults with comorbidities. Appropriate empirical therapy was associated with a favorable outcome

Physicochemical properties of rainbow trout (Oncorhynchus mykiss) filet treated with high-voltage electrostatic field under different storage temperatures

The post-mortem rigid of farmed rainbow trout (Oncorhynchus mykiss) affects the texture of the meat and might even be risky for microorganisms, undermining the popularity of frozen filets among consumers. This study investigated the importance of different conditions (0°C, 4°C, and 25°C for 0–4 days) and physicochemical characteristics of rainbow trout filet storage on fish’s characteristics, freshness, quality, and shelf-life. Results showed that the fish easily underwent rigor mortis and resolution of rigor mortis when stored at 25°C. However, rigor mortis was more likely to occur under storage at 0°C than at 4°C [with 100 kV/m high voltage electrostatic fields (HVEF)] due to low-temperature stimulation, but resolution of rigor mortis began to appear after 24 h of storage at either temperature. The protein solubility and gel strength of fish stored at 25°C continued to decrease due to thermal denaturation, and those of fish stored at 4°C and 0°C also showed a decrease owing to rigor mortis and then an increase when rigor mortis disappeared. The K values increased rapidly at 25°C and reached 61% at 14 h. Under storage at 4°C and 0°C, the K values only slightly increased before resolution of rigor mortis. However, the K-values did not exceed 40% for 4 days post-resolution of rigor mortis. Differential Scanning Calorimetry analysis and tissue sectioning showed that protein denaturation and separation between muscle fibers persisted during storage at various temperatures, most notably at 25°C. It is important to note that storing at 0°C for 96 h did not result in any significant changes in the molecular protein composition. Moreover, the muscle tissue remained in excellent condition compared to storage at 25°C and 4°C. Additionally, there was no significant difference in the total viable count (TVC) and psychrophilic bacteria between storage at 0°C and 4°C, considered safe for food consumption. These promising findings are conveyed in a circular economy based on the food industry, particularly adequate raw materials, stable prices, measures to reduce food loss and waste, and contributing to developing efficient, diverse, and sustainable food processing systems

Melioidosis Outbreak after Typhoon, Southern Taiwan

From July through September 2005, shortly after a typhoon, 40 cases of Burkholderia pseudomallei infection (melioidosis) were identified in southern Taiwan. Two genotypes that had been present in 2000 were identified by pulsed-field gel electrophoresis. Such a case cluster confirms that melioidosis is endemic to Taiwan