6 research outputs found
A Prospective Randomized Clinical Trial to Assess Antibiotic Pocket Irrigation on Tissue Expander Breast Reconstruction
Bacterial infection is the most common complication following staged post-mastectomy breast reconstruction initiated with a tissue expander (TE). to limit bacterial infection, antibiotic irrigation of the surgical site is commonly performed despite little high-quality data to support this practice. We performed a prospective randomized control trial to compare the impact of saline irrigation alone to a triple antibiotic irrigation regimen (1 g cefazolin, 80 mg gentamicin, and 50,000 units of bacitracin in 500 mL of saline) for breast implant surgery. The microbiome in breasts with cancer
Liax Is a Surrogate Marker For Cell Envelope Stress and Daptomycin Non-Susceptibility in Enterococcus Faecium
Daptomycin (DAP) is often used as a first-line therapy to treat vancomycin-resistan
Recommended from our members
242. Evaluation of PBP4 promoter variation and clinical outcomes in patients with Enterococcus faecalis bacteremia
Abstract Background Penicillin-binding protein 4 (PBP4) is a low affinity PBP that has been associated with decreased susceptibility to penicillins in Enterococcus faecalis (Efs). Changes in the promoter region leading to increased expression of the pbp4 gene contribute to this phenotype. There is limited data on the clinical outcome of patients infected with these strains in the U.S. We investigated the clinical outcomes of patients with Efs bacteremia stratified by PBP4 promoter type and piperacillin MIC. Methods Index Efs bloodstream isolates from 167 patients were selected from the VENOUS cohort (2016-2021). Whole genome sequencing was performed on all isolates and changes in the promoter region (200 bp upstream of the start codon) were identified, using Efs JH2-2 as reference. β-lactam susceptibility (ampicillin, penicillin, and piperacillin [PIP]) was performed on all isolates by broth microdilution. Clinical outcomes (in-hospital mortality, microbiologic failure, and recurrence) were collected on all patients. Results The median age for the cohort was 65 years (IQR: 56-72), and 63.5% were male. The median length of hospitalization was 13 days (IQR: 8-22). The duration of bacteremia was 3 days (IQR: 2-4) and 8.98% of patients had prolonged bacteremia (≥ 7 days). Among 167 isolates, 4 major primary promoter variants were identified: reference JH2-2 (n=66), ΔA88 (n=43), A175C (n=35), and insA192 (n=20). All strains were susceptible to ampicillin and penicillin. A PIP MIC ≥ 16 mg/L (non-susceptible) was found in 74.4% of strains with the ΔA88 promoter, as compared to 22.7% of reference, 17.1% of A175C, and 10% of insA192 (p < 0.001). Clinical outcomes of the 167 patients are shown in Table 1. PIP non-susceptibility was associated with immunocompromise state (49.09% vs 23.85%, p=0.001), history of hematological cancer (40% vs 16.51%, p=0.002), and recurrence (7.27% vs 0.92%, p=0.044). There was no statistical difference in mortality or microbiologic failure. Conclusion Isolates with ΔA88 PBP4 promoter variants were associated with PIP non-susceptibility. While in-hospital mortality and microbiologic failure were similar between all patients, those who were infected with a PIP non-susceptible strain were more likely to experience a recurrence. Disclosures Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support Lilian M. Abbo, MD, MBA, Ferring: Advisor/Consultant|Pfizer: Advisor/Consultant|Regeneron: Grant/Research Support|Shionogi: Advisor/Consultant William R. Miller, M.D, Merck: Grant/Research Support|UpToDate: Honorari
Recommended from our members
Multisite Detection of Tn1549-Mediated vanB Vancomycin Resistance in Multidrug-Resistant Enterococcus faecalis ST6 in Texas and Florida
In the United States, vanB-mediated resistance in enterococci is rare. We characterized three sequence type (ST) 6, vancomycin-resistant Enterococcus faecalis isolates causing bacteremia in unique patients in spatiotemporally distinct settings.
In the United States, vanB-mediated resistance in enterococci is rare. We characterized three sequence type (ST) 6, vancomycin-resistant Enterococcus faecalis isolates causing bacteremia in unique patients in spatiotemporally distinct settings. Isolates were recovered between 2018 and 2020 in two cities in the United States (Houston, TX; Miami, FL). The isolates harbored the vanB operon on a chromosomally located Tn1549 transposon, and epidemiological data suggested multiple introductions of the vanB gene cluster into ST6 E. faecalis