Disseminated Saprochaete capitata in a patient with Diabetes mellitus and HCV Hepatitis; A Case Report

Saprochaete capitata yeast rarely causes human infections; nonetheless the vast majority of infections were reported in patients with hematological malignancy. Here, we report one of the unusually rare presentations of disseminated Saprochaete capitata in a patient without hematological malignancy, but the patient had a prolonged history of chronic active hepatitis C, diabetes mellitus, prolonged ICU stay on mechanical ventilation, and exposure to several antimicrobials. The currently isolated Saprochaete capitata showed resistance to Amphotericin B, triazoles and ecchinocandins, but susceptible to 5-fluocytocine with MIC ≤1 mg/dl

Colistin in Critically Ill Patients: A Critical Review

Colistin emerged in the last decade as a savior for the treatment of critically septic patients who suffer MDR-GNB infections. This develop- ment came in time with the drying new antibacterial pipelines. MDR- GNB became problematic in ICU’s including MDR Acinetobacter spp., Pseudomonas aeruginosa, and carbapenemase-producing Enterobac- teriaecae (CPE).With the resurgence of wide colistin prescription espe- cially in ICU’s, awareness on when to switch to this reintroduced drug is required. Recently, it is observed that there are differences between the past dosages and the currently proposed dosages. Nephrotoxicity and neurotoxicity are observed to be less than what was published in the past.This may be due to more pure preparations and attention to other drug therapies that are employed in the critically ill patients residing the ICU’s. However,randomized control studies are still lack- ing to shed light on its efficacy and safety. Agreement is still looming on dosages, and monotherapy of colistin versus its combination with other agents

A Patient with autoimmune hepatitis and transverse myelitis presented with persistent Staphylococcus aureus bacteremia, the discrepancies in assessing susceptibility; VISA versus Non-VISA

Vancomycin-Intermediate Staphylococcus aureus (VISA) is still uncommon among MRSA isolates. In our region, we rarely encountera case of VISA and/or GISA bacteremia. Here, we report a man who suffered from autoimmune hepatitis on immunosuppressive therapy and thoracic transverse myelitis suspected to be due to polyomavirus infection; he developed persistent MRSA blood stream infection, PVL-positive and MLST clonal complex 88 which is reported most commonly from Africa. A strain with Vancomycin susceptibility of 4 – 6 µg/ml (VISA) was initially identifid, retested again elsewhere and showed MIC of 2µg/ml and Teicoplanin susceptibility of 4µg/ml. Treatment failure occurred while attaining higher serum vancomycin levels than recommended and died

Relevance of vancomycin suceptibility on patients outcome infected with Staphylococcus aureus

Background: Staphylococcus aureus is a serious pathogen with high rates of complications. We aim to study the susceptibility and outcome of S. aureus infection. Methods: A retrospective multicentre study conducted in three hospitals, Amman - Jordan. Between June 2013 and March 2014 laboratory records were reviewed for culture-positive samples growing S. aureus, also, medical records for the patients were reviewed for the demographic data, predisposing conditions, vancomycin MIC level and outcome. Inpatients and outpatients were included, a case was classified as either hospital-associated (HA), community-associated (CA), or healthcare-associated (HCA). Data were entered as excel sheets and were statistically analysed using SPSS version 22. Results: A total of 127 patient (46% MRSA) were culture-positive for S. aureus from different sources were collected. Eighty (63%) were inpatients. High resistance rates to non β-lactam antimicrobials were recorded. Glycopeptides agents were the antibiotics of choice for the treatment of infections caused by MRSA strains. Complications rates were higher for patients with MRSA infections including mortality, but hospital stay was longer for MSSA.   Conclusion MRSA rates were high though it lately appeared plateauing in Jordan. There is a value for knowing vancomycin MICs for S. aureus as it has its own implications for outcomes, though most outcomes evaluated were significantly worse with MRSA infection

Comamonas testosteroni Blood Stream Infection in A Patient with End-stage Renal Failure on Hemodialysis

We report for the first time from Jordan and probably Arab countries a very rare case of Comamonas testosteroni causing blood stream infection in a Sudanese patient with renal failure on hemodialysis whom was waiting for a living-related renal transplant. He was successfully treated with cefepime and had his transplant ten days into his treatment. Post-transplant he did well and was discharged home

A Patient Presented with High Fever and Bloody Pericardial Effusion (Hemorrhagic Pericarditis)

We report a case of hemorrhagic pericarditis caused by Mycobacterium tuberculosis infection of the pericardium which is an extremely rare diagnosis. The literature review showed that there were rare cases of tuberculosis-causing hemorrhagic pericarditis, but the diagnosis was made either postmortem or not firmly diagnosed. Our patient was diagnosed as hemorrhagic pericarditis due to M. tuberculosis, he was treated and was discharged

Usefulness of routine pairing of anaerobic with aerobic blood culture bottles and decision making on antimicrobial therapy

ObjectivesTo evaluate the growth concordance in paired aerobic/anaerobic sets, and the impact of the anaerobic growth on patients' antimicrobial management.MethodThis is a prospective multicenter study which was conducted in three hospitals, with total beds of 750 beds and 52 ICU beds. Prospectively, laboratory blood cultures logbooks were daily reviewed and patients from whom blood cultures were ordered were followed, their chart were reviewed. Entries on antimicrobial therapeutic changes were noted for all paired sets. Clinicians were blinded to the study, though they were informed about culture results via the usual work protocol in each hospital.ResultsCollected Blood culture sets totaled 2492; 172 single sets were excluded, and 1160 paired sets were analyzed. 1046 were concordant; 79 sets had bacterial growth and 967 sets had no bacterial growth. 114 sets were discordant; 97 in aerobic bottles, 13 in anaerobic, and 4 in both.The proportion of agreement for the concordant paired growth sets was 90.2%.  The composite proportion of agreement for sets with any growth (N = 193, composite proportion of agreement = 56%, 95% C.I., 34% - 48%). Cohen kappa composite agreement, measured for the total analyzed paired-sets (N = 1160, K = .52, SE = .038. 95% C.I., .447 - .595). The odds of modifying antimicrobial regimen were for total and subgroups intent to treat odds, based on paired sets showed that one modification took place in one anaerobic growth set (N = 1160, Odds = 0.0008), the odds for all sets with any growth (N = 193, odds = .005), and based on any anaerobic sets (79 concordant, 13 anaerobic, and 4 discordant) with bacterial growth (N = 96: odds = 0.010).ConclusionThe study demonstrates that the proportion of agreement among paired sets were high, and needless to include anaerobic sets in routine blood culture collection. Also the decision-making of anti-infective treatment on patients based on anaerobic blood culture growth was not evident

Compliance with antimicrobials de-escalation in septic patients and mortality rates: an old subject revisited

Background To compare the recent de-escalations rates with a six-year earlier study, and mortality associated with de-escalation. Methods Settings A prospective multicenter study including septic patients, all were on broad-spectrum antimicrobials (BSA). Excluded from the study patients on antimicrobial prophylaxis, and patients without a microbiological diagnosis, or bacteria were solely BSA-susceptible. The study team made recommendations for antimicrobials de-escalation to the treating physician(s) must an opportunity loomed. Results 182 patients were available for analysis. De-escalation was achieved in 43 (24%) patients. The clinical diagnoses, comorbidities, commonly used antimicrobials, the microbiological diagnoses were not different between the two groups (patients with and without de-escalation). Logistic regression analysis showed no correlation between bacterial species and de-escalation (Nagelkerke R2 = 0.076). Relapsing sepsis and reinfection were not different (P > 0.05). The in-hospital mortality rates for the de-escalated patients were lower (P = 0.015), not on day 30 (P = 0.354). The length of the ICU stay and ward stay were not different (P >0.05), but more de-escalated patients were discharged home from the ICU (P = 0.034), however, patients without de-escalation were discharged more from the ward (P = 0.002). Conclusion De-escalation rates increased within six years from 6.7% - 24% (P = 0.000), with added benefits of shorter ICU stay and less in-hospital mortalit

The Effect of Vitamin D treatment on COVID 19- Patients, an Inverted Propensity Score Weighting (IPSW), and Inverted Probability of Treatment Weighting (IPTW) Analyzed Study

Background Vitamin D3 (1,25(OH)2 cholecalciferol) as a treatment for COVID 19 patients is being disputed, and a clear clinical benefit is not being confirmed. Methods A retrospective evaluation for COVID-19 patients who were treated with various cumulative doses of vitamin D. Data was extracted from the COVID-19 database, it included patients admitted to three hospitals in Amman, Jordan. Characteristics of patients were tabulated and compared for all-cohort, and propensity score index (PSI) adjustment, The comparison was based on two vitamin D strata ((≤ 149,000 i.u. and > 150,000 i.u.). Logistic regression analysis was utilized to predict recovery, the need for oxygen, and all-cause mortality for all-cohort, IPSW, and IPTW patients, based on vitamin D cumulative doses during their hospital stay. Results             1131 all-cohort and 768 PSI-adjusted patients were recruited. Except for antibiotics and antivirals, all other characteristics were balanced (P = NS). There were 1017 patients on vitamin D, 847 received cumulative ≤ 149,000 i.u., and 170 patients received cumulative dose ≥ 150,000 i.u. (Range 1000 – 385000). It was demonstrated that escalating cumulative doses of vitamin D did not contribute to the assessed outcomes; all-cohort patients (OR = 1.000, 95% C.I. 1.000 to 1.000), IPSW (OR = 1.000, 95% C.I. 1.000 to 1.000), and the IPTW (OR = 1.000, 95% C.I. 1.000 to 1.000). Conclusion             In our patients’ cohorts, we could not demonstrate a beneficial effect for vitamin D therapy in COVID-19 patients for recovery, the need for home oxygen, and all-cause mortality, by hospital discharge

A Ten Years Study of The Rates and Resistance Trends of the ESKAPE Bacteria Isolated from Sterile Body Sites (2010 – 2019) at a Single Hospital

Background To assess the rates and trends of resistance among ESKAPE pathogens during 2010 – 2019. Methods A retrospective, single-center study between 2010 –2019, non-duplicate isolates from six sterile sources were studied. Pathogens were processed through the  automated VITEK-2. The Clinical Laboratory Standards Institute (CLSI) breakpoints were referenced. The aim was to detect the rates and resistance trends of the ESKAPE pathogens, the rates of  ESBL-producing K. pneumoniae, and the carbapenem-resistant (CR)-K. pneumoniae, CRAb, CRPa, VRE, and MRSA for the inpatients. Trends for the prevalence and resistance rates were analyzed by linear regression. Missing values were averaged based on the neighboring values. Data analysis was by SPSS version 25, and statistical significance is considered for one-tailed P < 0.05. Results The ESKAPE bacteria (4286 isolate) comprised (45.57%) of the inpatients' isolates, the sterile sources consisted of 1421 (33.15%): K. pneumonia 272 isolates, the ESBL-producing K. pneumoniae significantly declined (Pearson R - 0.877, P = 0.001), CR-K. pneumoniae showed no significant trends (P = 0.475). P. aeruginosa 202 isolates; resistance to carbapenem (CRPa) averaged 42%. S. aureus 198 isolates; MRSA rates averaged 45%. A. baumannii 165 isolates; carbapenem-resistance (CRAb) average 93%. Vancomycin-resistant (VR)E. Faecium = 33%, and VRE. faecalis = 15% with a weighted average 17%. Enterobacter spp. resistance rates were: Amikacin 3.6%, Third and fourth generation cephalosporines 28% and 20% respectively, Quinolones 27% ± 3%, Piperacillin/tazobactam resistance 29%, Imipenem 15%, and Meropenem 27. Conclusion The ESKAPE pathogens were highly resistant, making treatment more complicated, and compromise the initial empiric treatment. &nbsp