A fatal case of persistent bacteremia and acute cholecystitis caused by Staphylococcus aureus: A case report

Biliary tract infections caused by Staphylococcus aureus are rare. Here, we describe a case of fatal acute cholecystitis and persistent bacteremia caused by S. aureus in a patient with newly diagnosed diabetes mellitus. Staphylococcus aureus can cause bacteremic biliary tract infections, which are associated with higher mortality rates compared to biliary Klebsiella pneumoniae bacteremia. Early aggressive treatment and consultations with infectious disease specialists are recommended when biliary S. aureus bacteremia is clinically suspected

Infectious disease consultations in a Japanese tertiary care teaching hospital: a retrospective review of 508 cases

Abstract Objective Limited epidemiological data are available at tertiary care teaching hospitals in Japan. We reviewed infectious disease (ID) consultations in a tertiary acute care teaching hospital in Japan. Methods This is a retrospective review of the ID consultations from October 2016 to December 2017. The demographic data, such as requesting department, consultation wards, and final diagnosis, were analyzed. Results There were 508 ID consultations during the 15-month study period. Among the 508 consultations, 201 cases (39.6%) were requested from the internal medicine department and 307 cases (60.4%) were requested from departments other than internal medicine. The most frequent requesting departments were Surgery (n = 102, 20.1%), Pulmonary Medicine (n = 41, 8.1%), and Plastic Surgery (n = 35, 6.7%). The most common diagnoses were intra-abdominal (n = 81, 16.0%), respiratory (n = 62, 12.2%), and skin and soft tissue infections (n = 59, 11.6%). ID consultations for disease diagnosis and management were more frequent in the internal medicine group than in the non-internal medicine group (37 cases, 20.8% vs. 40 cases, 13.7%, p = 0.046), and the number of requests for consultations for noninfectious diseases at the time of final diagnosis was higher in the internal medicine group than in the non-internal medicine group (21 cases, 11.8% vs. 16 cases, 5.5%, p = 0.0153). Conclusion Some physicians prefer ID specialists to identify and solve various medical problems. Internists had a greater tendency to request consultations for diagnostic problems, and noninfectious disease specialists have more requests for consultation at the point of final diagnosis. The role of ID specialists is expanding, from individual patient management to antibiotic stewardship, antibiotic prophylaxis, and development of and adherence to antibiotic protocol implementation based on the hospital’s microbial susceptibility and infection control. Although the number of specialists is limited in Japan, ID services now play an important role for achieving a good outcome in patient management

Validation of blood culture gram staining for the detection of Staphylococcus aureus by the ‘oozing sign’ surrounding clustered gram-positive cocci: a prospective observational study

Abstract Background Staphylococcus aureus bacteraemia is a common and significant infection, associated with high rates of mortality. Therefore, early identification is important for the initiation of appropriate treatment. The objective of this study was to evaluate the accuracy of blood culture Gram staining along with the finding of an ‘oozing sign’ to diagnose either Staphylococcus aureus or coagulase-negative staphylococci. Methods This single-centre, prospective observational study was performed from May 2017 to November 2017. We used routine blood culture bottles (BacT/ALERT FA and BacT/ALERT SN; bioMérieux, Inc., Durham, NC). Bacterial species were identified and the minimum inhibitory concentration was determined by using the MicroScan WalkAway 96 SI system (Beckman Coulter, Tokyo, Japan). Bottles showing growth were removed, and Gram staining was performed. Results A total of 118 samples, including 55 aerobic and 63 anaerobic bottle samples, were analysed. The overall sensitivity of Gram staining was 78.7% (95% CI: 65.8–94.3%), and the specificity was 95.0% (95% CI: 84.7–98.4%). Conclusion The ‘oozing sign’ observed in Gram staining may be useful for the rapid prediction of S. aureus in BacT/ALERT blood culture bottles

Gemella haemolysans bacteremia in a patient with secondary peritonitis due to a duodenal ulcer perforation: A case report

We describe a case of Gemella haemolysans septic shock in a 75-year old Japanese male with a duodenal perforation and secondary peritonitis. Blood cultures on admission were positive for Gram-positive and Gram-variable cocci, and G. haemolysans was identified using whole cell matrix-assisted laser desorpition/ionization mass spectrometry (MALDI-TOF MS), with a score value of 2.12. The 16S rRNA sequencing was difficult to use as a diagnostic test because there was more than 99% sequence homology with related bacterial strains. Based on both the biochemical profiles and whole groEL sequence, we concluded that the strain in our patient was G. haemolysans. The patient was successfully treated with a 16-day course of antimicrobials. His clinical condition improved, and no evidence of a relapse of the infection was noted. Although MALDI-TOF MS and 16S rRNA sequencing are useful for identification of the species, the basic biochemical profile is also important to identify a rare species. Keywords: Gemella haemolysans, Bacteremia, Secondary peritonitis, MADLI-TOF MS, 16S rRN

Intravenous to oral switch therapy in cancer patients with catheter-related bloodstream infection due to methicillin-sensitive Staphylococcus aureus: A single-center retrospective observational study.

The most common complication in cancer patients is catheter-related bloodstream infection (CRBSI), of which Staphylococcus aureus is a common pathogen. Although S. aureus CRBSI patients are recommended for prolonged intravenous therapy, this is often not feasible. We assessed the effectiveness of switching from intravenous to oral antimicrobial therapy in cancer patients with CRBSI due to methicillin-sensitive S. aureus (MSSA). We conducted a retrospective observational study of 60 patients at one tertiary-care cancer center between April 2005 and March 2016. Patients who received effective intravenous (IV) antibiotics for at least 10 days (IV group) were compared to the IV group of patients who had switched to effective oral (PO) antibiotics after IV treatment for at least 10 days (IV + PO group). The primary endpoint was all-cause mortality within 90 days. Univariate and propensity score-adjusted multivariate logistic regression analyses using variables likely to influence the outcomes were performed. Of the 60 patients, 32 (53.3%) and 28 (46.7%) were in the IV and IV + PO groups, respectively. The median antibiotic treatment durations in the IV and IV + PO groups were 17 (13-31) and 33 (26-52) days, respectively (p<0.001). The 90-day mortality in the IV and IV + PO groups were 53.1% (17/32) and 10.7% (3/28), respectively (p = 0.001). Univariate logistic regression model showed that the odds ratios of oral switch therapy for 90-day mortality was 0.106 (95% confidence interval [CI]: 0.027-0.423; p = 0.001). The propensity score-adjusted multivariate logistic regression model estimated the odds ratios of oral switched therapy for 90-day mortality as 0.377 (95% CI: 0.037-3.884; p = 0.413). Our results suggest that oral switch therapy was not associated with mortality in cancer patients with CRBSI due to MSSA compared with no oral switch therapy. Oral switch therapy may be a reasonable option for patients with CRBSI due to MSSA

Mapping out the diagnosis

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83185/1/875_ftp.pd

Kluyvera intermedia bacteremia with septic shock: A case report

Background: Kluyvera intermedia is a bacterium indigenous to humans. But Kluyvera intermedia bacteremia has been not reported thus far. We report a case of Kluyvera intermedia bacteremia with septic shock due to left obstructive pyelonephritis as a result of urolithiasis. Case presentation: A 66-year-old woman with septic shock due to left obstructive pyelonephritis was transferred to our hospital. Tazobactam/Piperacillin 4.5 g was administered every 8 h for 5 days. The patient's condition improved, and she was transferred back to the previous hospital. Kluyvera intermedia was obtained by blood cultures. The patient was successfully treated with a two-week course of antibiotics. Conclusions: We describe the first case of bacteremia with septic shock caused by Kluyvera intermedia. Kluyvera intermedia can be a causative pathogen of septic shock. Since this bacterium has not been reported in the past, we expect further reports and the accumulation of cases in the future