Bifidobacterium breve Sepsis in Child with High-Risk Acute Lymphoblastic Leukemia

To the Editor: Patients with cancer often consume probiotics as part of their diet, although therapeutic use of probiotics is not recommended because of their potential invasiveness. In a recent review, 5 cases of probiotic treat-ment–related bacteremia were identified in oncology pa-tients, although no cases of invasive Bifidobacterium spp. infection were included (1). We describe a case of B. breve sepsis in a child with Philadelphia chromosome–positive acute B-cell lymphoblastic leukemia. The patient was a previously healthy 2-year-old boy who had no history of immunodeficiency and whose leuko-cyte counts had been within reference ranges during check-up visits before his diagnosis. After leukemia was diag-nosed, chemotherapy was started (prednisone, vincristine, doxorubicin, and L-asparaginase). During the second week of treatment, the boy experienced abdominal discomfort and constipation. Two weeks later, his condition worsened; he refused food, his abdomen was distended, and he had colicky pain. Thickened intestinal wall and fecal masses were seen ultrasonographically. Twelve hours later he be-came hypotensive. Laboratory test results showed severe neutropenia and increased inflammatory markers (Figure). Two aerobic and anaerobic blood culture samples were collected from a central venous line (implantable venous access system) in a 30-minute span, and treatment with piperacillin/tazobactam, vancomycin, and gentamicin was empirically initiated according to local recommendations for pediatric febrile neutropenia with shock. Both anaerobic blood cultures were positive. Gram-positive, irregular rods with bifid and branching forms without spores grew anaer-obically on blood agar with hemin and vitamin K after 48 hours of incubation and were identified as B. breve by ma-trix-assisted laser desorption/ionization time-of-flight mas

Invasive neonatal Streptococcus agalactiae infection in Slovenia, 2003–2013

Background: Streptococcus agalactiae (group B streptococcus, GBS) is the leading cause of invasive neonatal infections in the developed world. We present epidemiological and clinical characteristics of invasive GBS disease among Slovenian neonates between 2003 and 2013. Methods: A retrospective cohort study was performed. Children aged 0–90 days with invasive GBS disease, born in Slovenia and hospitalized in the University Medical Centre Ljubljana were included. Cases were identified concurrently from (i) hospital and (ii) microbiological databases. Medical records from mothers and children were reviewed and relevant data extracted. The incidence rate was calculated based on the national vital statistics data and expressed per 1000 live births. Results: Altogether, 144 children were included in the analysis, 72.9 % (n = 105) based on hospital database and 27.1 % (n = 39) based on microbiological database. Among them, 47.9 % (n = 69) were girls and 52.1 % (n = 75) boys. Among the cases with available data, 54.5 % (n = 73) were born at term and 45.5 % (n = 61) were preterm. Early-onset disease (0–6 days) was present in 74.3 % (n = 107) of patients; 95.3 % (n = 102) of them became ill during the first 3 days of life. Late-onset disease (7–90 days) was present in 25.7 % (n = 37) of patients. Outcome data was available for 134 children. Neonatal mortality rate was 4.5 % (n = 6). Periventricular leukomalacia (PVL) or intraventricular haemorrhages Grade III/IV (IVH 3/4) were detected in 17.9 % (n = 24). Severe outcomes (death or PVL or IVH 3/4) were detected in 22.4 % (n = 30) children. Cumulative incidence rate was 0.72/1000 live births; 0.53/1000 for early-onset and 0.18/1000 for late-onset disease. Risk factors for early-onset disease were present in 47.9 % (n = 68) mothers in labour. Intrapartum antibiotic prophylaxis was delivered to 16.9 % (n = 24) of mothers. Conclusions: High incidence of invasive neonatal GBS disease was detected in Slovenia. Although low mortality was observed, brain pathology concordant with long-term adverse outcome was confirmed in a high proportion of patients. The application of intrapartum antibiotic prophylaxis in cases of known risk factors was suboptimal, especially among preterm deliveries. Approximately half of the patients were born to mothers without any risk factors. A comprehensive national strategy for the prevention of invasive GBS disease is warranted in Slovenia

Clinical MRSA isolates from skin and soft tissue infections show increased in vitro production of phenol soluble modulins

BACKGROUND: Phenol-soluble modulins (PSMs) are amphipathic, pro-inflammatory proteins secreted by most Staphylococcus aureus isolates. This study tested the hypothesis that in vitro PSM production levels are associated with specific clinical phenotypes. METHODS: 177 methicillin-resistant S. aureus (MRSA) isolates from infective endocarditis (IE), skin and soft tissue infection (SSTI), and hospital-acquired/ventilator-associated pneumonia (HAP) were matched by geographic origin, then genotyped using spa-typing. In vitro PSM production was measured by high performance liquid chromatography/mass spectrometry. Statistical analysis was performed using Chi-squared or Kruskal-Wallis tests as appropriate. RESULTS: Spa type 1 was significantly more common in SSTI isolates (62.7% SSTI; 1.7% IE; 16.9% HAP; p < 0.0001) while HAP and IE isolates were more commonly spa type 2 (0% SSTI; 37.3% IE; 40.7% HAP; p < 0.0001). USA300 isolates produced the highest levels of PSMs in vitro. SSTI isolates produced significantly higher quantities of PSMα1-4, PSMβ1, and δ-toxin than other isolates (p < 0.001). These findings persisted when USA300 isolates were excluded from analysis. CONCLUSIONS: Increased in vitro production of PSMs is associated with an SSTI clinical source. This significant association persisted after exclusion of USA300 genotype isolates from analysis, suggesting that PSMs play a particularly important role in the pathogenesis of SSTI as compared to other infection types

Microbiological diagnostics of bloodstream infections in Europe-an ESGBIES survey

On behalf of theESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES).[Objectives] High-quality diagnosis of bloodstream infections (BSI) is important for successful patient management. As knowledge on current practices of microbiological BSI diagnostics is limited, this project aimed to assess its current state in European microbiological laboratories. [Methods] We performed an online questionnaire-based cross-sectional survey comprising 34 questions on practices of microbiological BSI diagnostics. The ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES) was the primary platform to engage national coordinators who recruited laboratories within their countries. [Results] Responses were received from 209 laboratories in 25 European countries. Although 32.5% (68/209) of laboratories only used the classical processing of positive blood cultures (BC), two-thirds applied rapid technologies. Of laboratories that provided data, 42.2% (78/185) were able to start incubating BC in automated BC incubators around-the-clock, and only 13% (25/192) had established a 24-h service to start immediate processing of positive BC. Only 4.7% (9/190) of laboratories validated and transmitted the results of identification and antimicrobial susceptibility testing (AST) of BC pathogens to clinicians 24 h/day. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry from briefly incubated sub-cultures on solid media was the most commonly used approach to rapid pathogen identification from positive BC, and direct disc diffusion was the most common rapid AST method from positive BC. [Conclusions] Laboratories have started to implement novel technologies for rapid identification and AST for positive BC. However, progress is severely compromised by limited operating hours such that current practice of BC diagnostics in Europe complies only partly with the requirements for optimal BSI management

Livestock-associated methicillin-resistant Staphylococcus aureus in humans, Europe

To estimate the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates from humans that were sequence type (ST) 398, we surveyed 24 laboratories in 17 countries in Europe in 2007. Livestock-associated MRSA ST398 accounted for only a small proportion of MRSA isolates from humans; most were from the Netherlands, Belgium, Denmark, and Austria

Livestock-associated methicillin-resistant Staphylococcus aureus in humans, Europe

To estimate the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates from humans that were sequence type (ST) 398, we surveyed 24 laboratories in 17 countries in Europe in 2007. Livestock-associated MRSA ST398 accounted for only a small proportion of MRSA isolates from humans; most were from the Netherlands, Belgium, Denmark, and Austria

Risk factors for mortality among patients with Pseudomonas aeruginosa bacteraemia: a retrospective multicentre study

This study aimed to evaluate risk factors for 30-day mortality among hospitalised patients with Pseudomonas aeruginosa bacteraemia, a highly fatal condition. A retrospective study was conducted between 1 January 2009 and 31 October 2015 in 25 centres (9 countries) including 2396 patients. Univariable and multivariable analyses of risk factors were conducted for the entire cohort and for patients surviving ≥48 h. A propensity score for predictors of appropriate empirical therapy was introduced into the analysis. Of the 2396 patients, 636 (26.5%) died within 30 days. Significant predictors (odds ratio and 95% confidence interval) of mortality in the multivariable analysis included patient-related factors: age (1.02, 1.01–1.03); female sex (1.34, 1.03–1.77); bedridden functional capacity (1.99, 1.24–3.21); recent hospitalisation (1.43, 1.07–1.92); concomitant corticosteroids (1.33, 1.02–1.73); and Charlson comorbidity index (1.05, 1.01–1.93). Infection-related factors were multidrug-resistant Pseudomonas (1.52, 1.15–2.1), non-urinary source (2.44, 1.54–3.85) and Sequential Organ Failure Assessment (SOFA) score (1.27, 1.18–1.36). Inappropriate empirical therapy was not associated with increased mortality (0.81, 0.49–1.33). Among 2135 patients surviving ≥48 h, hospital-acquired infection (1.59, 1.21–2.09), baseline endotracheal tube (1.63, 1.13–2.36) and ICU admission (1.53, 1.02–2.28) were additional risk factors. Risk factors for mortality among patients with P. aeruginosa were mostly irreversible. Early appropriate empirical therapy was not associated with reduced mortality. Further research should be conducted to explore subgroups that may not benefit from broad-spectrum antipseudomonal empirical therapy. Efforts should focus on prevention of infection, mainly hospital-acquired infection and multidrug-resistant pseudomonal infection