60 research outputs found
An outbreak of hemodialysis catheter-related bacteremia with sepsis caused by Streptococcus agalactiae in a hemodialysis unit
AbstractBackgroundRates of invasive group B Streptococcus (GBS; Streptococcus agalactiae) disease in adults are on the rise. Invasive GBS disease can be community- or healthcare-associated. We report an outbreak of GBS catheter-related bacteremia in a hemodialysis (HD) unit.Materials and methodsTwo patients undergoing HD at the same outpatient HD unit were admitted on the same day (within a few hours of each other) with catheter-related GBS bacteremia. A retrospective study was undertaken at the HD unit to address risk factors for febrile illness on the last HD session day. A detailed questionnaire was completed by all HD patients treated on the same day as the two GBS patients and by all members of the nursing and medical staff. Medical and nursing records of the HD unit were reviewed, as well as infection control and catheter care practices. Patients and staff members submitted swabs for culture.ResultsNo rectal or vaginal culture of any HD patient or staff member was positive for GBS. The development of recent febrile disease was significantly associated with the presence of a hemodialysis catheter (p=0.028) and care for more than 30min by a specific nurse during the last two HD sessions (p=0.007).ConclusionsWe speculate that the GBS strain was transmitted from one patient to the other through the hands of medical personnel. No such outbreak has ever been reported in HD patients. The importance of strict infection control practices in HD units and the avoidance of catheters for long-term HD should be emphasized
Pneumocystis carinii pneumonia in a HIV-seronegative patient with untreated rheumatoid arthritis and CD4+ T-lymphocytopenia
Pneumocystis carinii pneumonia (PCP) usually occurs in immunocompromised
patients, and it is a life-threatening infection We report the case of a
human immunodeficiency virus (HIV)-seronegative patient with untreated
rheumatoid arthritis (RA), who developed fatal PCP related to uncommon
CD+ T-lymphocytopenia.
Although extremely rare and of uncertain aetiology, suppression of
cellular immunity and subsequent opportunistic infections should be
suspected in such patients
Detection of enterococcal surface protein gene (esp) and amplified fragment length polymorphism typing of glycopeptide-resistant Enterococcus faecium during its emergence in a Greek intensive care unit
The emergence of glycopeptide-resistant Enterococcus faecium (GREF) in a
Greek intensive care unit was studied by amplified fragment length
polymorphism analysis and esp gene detection. Three GREF clones
harboring the esp gene were recovered from 17 out of 21 patients,
indicating the dissemination of genetically homogenous and virulent
strains of GREF
Molecular investigation of an outbreak of multidrug-resistant Acinetobacter baumannii with characterisation of class 1 integrons
We investigated a multidrug-resistant Acinetobacter baumannii outbreak in the Intensive Care Unit (ICU) of a tertiary care hospital in Greece over a 3-month period. Molecular typing of the outbreak isolates from 31 patients revealed that two distinct genotypes were involved. Nine isolates, belonging to both genotypes, were resistant to carbapenems. Samples from the ICU environment and from the hands of personnel were collected to identify possible contamination. Class 1 integrons of 3.1, 2.5 and 2.2 kb were amplified from the clinical and environmental isolates. The 3.1 kb integron carrying five gene cassettes was found for the first time in A. baumannii. The outbreak ceased after implementation of hygienic measures in the ICU, including complete cleaning and disinfection
Comparative in vitro and in vivo efficacy of roxithromycin and erythromycin against a strain of methicillin-susceptible Staphylococcus epidermidis
The in vitro and in vivo efficacy of roxithromycin was compared with
that of erythromycin, against a methicillin-susceptible strain of
Staphylococcus epidermidis. We performed standard in vitro testing (MIC,
MBC, and time-kill kinetics) for roxithromycin, erythromycin, and
rifampin. Both macrolides were bacteriostatic in vitro. There was no
significant difference in microbial survival between erythromycin and
roxithromycin groups in the time-kill kinetics (p = 0.3). For the in
vivo experiments, using the rabbit experimental endocarditis model,
roxithromycin was found to be inferior to erythromycin in decreasing the
microbial burden of the endocardial vegetations (p < 0.05). Rifampin was
highly effective, both in vitro and in vivo. In conclusion, the efficacy
of roxithromycin was poor and inferior to erythromycin against a strain
of methicillin-susceptible S. epidermidis. (C) 1998 Elsevier Science
Inc
Risk factors for and influence of bloodstream infections on mortality: A 1-year prospective study in a Greek intensive-care unit
To determine the incidence, risk factors for, and the influence of bloodstream infections (BSIs) on mortality of patients in intensive-care units (ICUs), prospectively collected data from all patients with a stay in an ICU > 48 h, during a 1-year period, were analysed. Of 572 patients, 148 developed a total of 232 BSI episodes (incidence 16.3 episodes/1000 patient-days). Gram-negative organisms with high level of resistance to antibiotics were the most frequently isolated pathogens (157 strains, 67.8%). The severity of illness on admission, as estimated by APACHE II score (OR 1.07, 95% CI 1.04-1.1, P < 0.001), the presence of acute respiratory distress syndrome (OR 3.57, 95% CI 1.92-6.64, P <0.001), and a history of diabetes mellitus (OR 2.37, 95% CI 1.36-4.11, P = 0.002) were risk factors for the occurrence of BSI whereas the development of an ICU-acquired BSI was an independent risk factor for death (OR 1.76, 95% CI 1.11-2.78, P = 0.015). Finally, the severity of organ dysfunction on the day of the first BSI episode, as estimated by SOFA score, and the level of serum albumin, independently affected the outcome (OR 1.44, 95% CI 1.22-1.7, P < 0.001 and OR 0.47, 95% CI 0.23-0.97, P = 0.04 respectively). © 2008 Cambridge University Press
Fatal post-traumatic zygomycosis in an immunocompetent young patient
Zygomycosis, a relatively uncommon infection, usually occurs among
immunocompromised individuals. It has been reported only rarely in
trauma patients. A fatal case is reported of pulmonary and rapidly
progressive cutaneous zygomycosis in a young, otherwise healthy farmer,
with multiple bone fractures, wounds and soft tissue injuries after an
accident with an agricultural machine in the field. Rhizopus spp. was
isolated from both cultures of bronchial washings and wound samples. The
diagnosis was confirmed by histopathological examination of tissue
specimens from a large wound. Despite systemic antifungal therapy and
surgical debridement, the patient’s condition deteriorated and he died
from refractory septic shock
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