A Nocardia cyriacigeorgica strain causing severe bovine mastitis

Nocardia cyriacigeorgica је узрочник који се све чешће изолује у случајевима нокардиозе људи, међутим његова идентификација до нивоа врсте представља изазов за већину микробиолошких лабораторија. Инфекције изазване овом актиномицетом се релативно ретко сусрећу у ветеринарској клиничкој пракси при чему доступни литературни подаци обухватају мали број описаних случајева пиогрануломатозних лезија код животиња. Приказана студија описује случај тешког маститиса говеда на малом газдинству у Босни и Херцеговини изазваног узрочником N. cyriacigeorgica који је безуспешно третиран применом стандардне антибиотске терапије. С обзиром да изолат није идентификован применом конвенционалних микробиолошких техника, извршена је MALDI-ToF MS анализа чији су резултати били недовољно поуздани. У циљу утврђивања врсте анализирана је секвенца гена 16S субјединице рибозомалне рибонуклеинске киселине (16S rRNK). Наведени налаз је додатно потврђен применом технике секвенцирања више генских локуса (MLST) при чему су коришћене секвенце gyrB, 16S rRNK, secA1 и hsp65. Метода диск дифузије за испитивање осетљивости изолата N. cyriacigeorgica на антибиотике је примењена у складу са препорученим публикованим упутствима. Колико је ауторима познато, ово представља први случај маститиса говеда изазван узрочником N. cyriacigeorgica у Европи, али и први изолат Nocardia spp. пореклом од животиња за чију је идентификацију примењен MLST.Although Nocardia cyriacigeorgica is recognized as a cause of human nocardiosis and is regarded as an emerging pathogen, many clinical laboratories find it difficult to identify this organism at the species level. The infections caused by this actinomycete are relatively uncommon in veterinary clinical practice, and the limited information currently available mostly relates to several cases of pyogranulomatous lesions in animals. We describe a case of severe bovine mastitis in a small holding in Bosnia and Herzegovina caused by N. cyriacigeorgica that did not improve after standard antibiotic therapy. The causative agent could not be identified using standard microbiological techniques and MALDI-ToF MS analysis was performed, yielding unclear results. Subsequently, the species N. cyriacigeorgica was confirmed by 16S rRNA sequence analysis, which was further validated by multilocus sequence analysis (MLSA) using the gyrB, 16S rRNA, secA1, and hsp65 sequences. The disc diffusion method was used to test for antibiotic susceptibility in accordance with published guidelines. To the best of our knowledge, this is the first report of N. cyriacigeorgica isolation from a clinical case of bovine mastitis in Europe, as well as the first time a strain of Nocardia spp. isolated from animals has been distinguished using the MLSA method.Zbornik kratkih sadržaj

Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards.

In order to provide guidance data for clinically rational use of an antibiotics consuption, prescribing and prevalence of multidrug resistant (MDR) Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were monitored on the surgical (S) and medical (M) wards of the University Hospital Center "Dr. Dragisa Misovic-Dedinje" (Belgrade, Serbia), in the study period from 2012 to 2015. Appropriateness of antimicrobial use was evaluated using the Global-Prevalence Survey method designed by the University of Antwerp. The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae and P. aeruginosa were higher on the S (86.2% and 49.1%) than on the M (63.2% and 36.9%) wards. The percentage of MDR A. baumannii was not different between S (93.7%) and M (79.5%) wards. An overall antibiotics consumption (defined daily doses/100 bed-days) during study was 369.7 and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials were evaluated in138 adults admitted to wards on the day of the survey. The percentage of antimicrobials prescribed for prophylaxis on the M and S wards were 0% and 25%, respectively. Therapies were more frequently empiric (S, 86.8% and M, 80%). The percentages of medical errors on the S and M wards were 74.6% and 27.3%, respectively. The quality indicators for antibiotic prescribing on the S and M wards were as follows: the incorrect choice of antimicrobials (35.6% vs. 20.0%), inappropriate dose interval (70.6% vs. 16.9%) or duration of therapy (72.5% vs. 23.1%), a non-documented stop/review data (73.6% vs. 16.9%) and divergence from guidelines (71.9% vs. 23.1%). Treatment based on biomarkers was more common on the M wards as compared to the S wards. The increasing prevalence of MDR pathogens, a very high consumption and incorrect prescribing of antimicrobials need special attention, particularly on the S wards

Quality of antimicrobial prescribing obtained by Global-Point Prevalence Survey method.

<p>Quality of antimicrobial prescribing obtained by Global-Point Prevalence Survey method.</p

Reasons for antibiotics prescribing obtained by Global-Point Prevalence Survey method.

<p>Reasons for antibiotics prescribing obtained by Global-Point Prevalence Survey method.</p

Association between antimicrobial consumption and isolation rate of multi drugs resistant <i>K</i>. <i>pneumoniae</i>, <i>P</i>. <i>aeruginosa</i> and <i>A</i>. <i>baumannii</i> at surgical (A) and medical (B) wards.

<p>Association between antimicrobial consumption and isolation rate of multi drugs resistant <i>K</i>. <i>pneumoniae</i>, <i>P</i>. <i>aeruginosa</i> and <i>A</i>. <i>baumannii</i> at surgical (A) and medical (B) wards.</p

Resistance rate (%) of <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i> and <i>Acinetobacter baumannii</i> strains isolated from 2012–2015.

<p>Resistance rate (%) of <i>Klebsiella pneumoniae</i>, <i>Pseudomonas aeruginosa</i> and <i>Acinetobacter baumannii</i> strains isolated from 2012–2015.</p

Annual distribution of isolation rates and patients on surgical and medical wards.

<p>Annual distribution of isolation rates and patients on surgical and medical wards.</p

Types and frequency of appearance of bacterial strains from 2012 to 2015.

<p>Types and frequency of appearance of bacterial strains from 2012 to 2015.</p

Main indications for antimicrobial therapy from 2012 to 2015.

<p>Main indications for antimicrobial therapy from 2012 to 2015.</p

Trends of antibiotic consumption by individual drugs on surgical (A) and medical (B) wards from 2012 to 2015.

<p>A. *There was a statistically significant decrease in the use of amoxicillin/clavulanate (b = -2.881; p = 0.014). B. *There was a statistically significant decrease in the use of ceftriaxone (b = -2.925; p = 0.047). **There was a statistically significant increase in the use of levofloxacin (b = 2.745; p = 0.014). ***There was a statistically significant increase in the use of metronidazole (b = 1.385; p = 0.029).</p