Campylobacter jejuni fatal sepsis in a patient with non-Hodgkin’s lymphoma: Case report and literature review of a difficult diagnosis

Campylobacter jejuni (C. jejuni) bacteremia is difficult to diagnose in individuals with hematological disorders undergoing chemotherapy. The cause can be attributed to the rarity of this infection, to the variable clinical presentation, and to the partial overlapping symptoms underlying the disease. Here, we report a case of a fatal sepsis caused by C. jejuni in a 76-year-old Caucasian man with non-Hodgkin's lymphoma. After chemotherapeutic treatment, the patient experienced fever associated with severe neutropenia and thrombocytopenia without hemodynamic instability, abdominal pain, and diarrhea. The slow growth of C. jejuni in the blood culture systems and the difficulty in identifying it with conventional biochemical phenotyping methods contributed to the delay of administering a targeted antimicrobial treatment, leading to a fatal outcome. Early recognition and timely intervention are critical for the successful management of C. jejuni infection. Symptoms may be difficult to recognize in immunocompromised patients undergoing chemotherapy. Thus, it is important to increase physician awareness regarding the clinical manifestations of C. jejuni to improve therapeutic efficacy. Moreover, the use of more aggressive empirical antimicrobial treatments with aminoglycosides and/or carbapenems should be considered in immunosuppressed patients, in comparison to those currently indicated in the guidelines for cancer-related infections supporting the use of cephalosporins as monotherapy

The Emerging Role of Microbial Biofilm in Lyme Neuroborreliosis

Lyme borreliosis (LB) is the most common tick-borne disease caused by the spirochete Borrelia burgdorferi in North America and Borrelia afzelii or Borrelia garinii in Europe and Asia, respectively. The infection affects multiple organ systems, including the skin, joints, and the nervous system. Lyme neuroborreliosis (LNB) is the most dangerous manifestation of Lyme disease, occurring in 10-15% of infected individuals. During the course of the infection, bacteria migrate through the host tissues altering the coagulation and fibrinolysis pathways and the immune response, reaching the central nervous system (CNS) within 2 weeks after the bite of an infected tick. The early treatment with oral antimicrobials is effective in the majority of patients with LNB. Nevertheless, persistent forms of LNB are relatively common, despite targeted antibiotic therapy. It has been observed that the antibiotic resistance and the reoccurrence of Lyme disease are associated with biofilm-like aggregates in B. burgdorferi, B. afzelii, and B. garinii, both in vitro and in vivo, allowing Borrelia spp. to resist to adverse environmental conditions. Indeed, the increased tolerance to antibiotics described in the persisting forms of Borrelia spp., is strongly reminiscent of biofilm growing bacteria, suggesting a possible role of biofilm aggregates in the development of the different manifestations of Lyme disease including LNB

Comment on “Intravitreal Ampicillin Sodium for Antibiotic-Resistant Endophthalmitis: Streptococcus uberis

In the paper by Velez-Montoya et al. [1], the authors reported the first description of a case of intraocular infection in humans caused by an antibiotic-resistant strain of Streptococcus uberis. We would like to point out that the absence of any description of the method used for bacteria identification in this paper raises some concerns related to the possibility of a misidentification of this bacterium as a pathogen affecting the human eye

Risk factors for hepatitis C virus infection among nonintravenous-drug-using heterosexuals attending a clinic for sexually transmitted disease in Italy

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Misidentification of Streptococcus uberis as a human pathogen: a case report and literature review.

Summary Streptococcus uberis is an environmental bacterium responsible for bovine mastitis. It is occasionally described as a human pathogen, though in most cases the identification was based on biochemical phenotyping techniques. This report shows that the biochemical phenotyping may incorrectly identify Enterococcus faecium as S. uberis

Biofilm is a major virulence determinant in bacterial colonization of chronic skin ulcers independently from the multidrug resistant phenotype

Bacterial biofilm is a major factor in delayed wound healing and high levels of biofilm production have been repeatedly described in multidrug resistant organisms (MDROs). Nevertheless, a quantitative correlation between biofilm production and the profile of antimicrobial drug resistance in delayed wound healing remains to be determined. Microbial identification, antibiotic susceptibility and biofilm production were assessed in 135 clinical isolates from 87 patients. Gram-negative bacteria were the most represented microorganisms (60.8%) with MDROs accounting for 31.8% of the total isolates. Assessment of biofilm production revealed that 80% of the strains were able to form biofilm. A comparable level of biofilm production was found with both MDRO and not-MDRO with no significant differences between groups. All the methicillin-resistant Staphylococcus aureus (MRSA) and 80% of Pseudomonas aeruginosa MDR strains were found as moderate/high biofilm producers. Conversely, less than 17% of Klebsiella pneumoniae extended-spectrum beta-lactamase (ESBL), Escherichia coli-ESBL and Acinetobacter baumannii were moderate/high biofilm producers. Notably, those strains classified as non-biofilm producers, were always associated with biofilm producer bacteria in polymicrobial colonization. This study shows that biofilm producers were present in all chronic skin ulcers, suggesting that biofilm represents a key virulence determinant in promoting bacterial persistence and chronicity of ulcerative lesions independently from the MDRO phenotype

Clostridium difficile infection in Italian urban hospitals: data from 2006 through 2011

BACKGROUND: In developed countries, Clostridium difficile infection (CDI) represents an emerging threat in terms of morbidity and mortality rates. In our country limited CDI epidemiological data can be found. We have conducted a 6-year retrospective study to evaluate the incidence of CDI in Italian urban hospitals. METHODS: Stool samples tested for C. difficile toxins from January 2006 to December 2011 in 5 large hospitals in Rome, Italy, were considered in the analysis. Repeated samples taken ≤ 2 months after a positive result were excluded. RESULTS: A total of 402 CDI episodes were identified. The incidence of CDI episodes progressively increased from 0.3 in 2006 to 2.3 per 10,000 patient-days in 2011. CDI episodes mostly occurred in patients > 60 years of age (77%). The >80 year-old age class reported the highest percentage of CDI episodes on tested samples (16%). Eighty percent (80%) of CDI episodes occurred in medical wards followed by surgery (10.2%) and intensive care units (9.8%). CONCLUSIONS: A significant increasing incidence of CDI episodes over the study period was observed during the years (p<.001), particularly in the older age groups. Medical wards experienced the highest number of CDI episodes as compared to intensive care and surgical wards. The increasing rate of CDI episodes over the last six years in our country, is alarming; urgent improvements in the surveillance systems and control programs are advisable

Analisi delle antibiotico-resistenze di Gram-negativi isolati da pazienti con infezioni del tratto urinario afferenti al Polo Oncologico e Dermatologico I.F.O.

Introduction. Urinary tract infections represent a worlwide problem due to their prevalence among nosocomial infections and to the increasing frequency of antibiotic resistance among the Gram-negative pathogens. Knowledge of the antimicrobial resistance patterns according to local epidemiology is essential for providing clinically appropriate therapy for urinary tract infection. In the present study we analysed the drug resistence pattern of Gram negative bacteria isolated from urine samples of patients with urinary tract infections at the Microbiological Laboratory of I.F.O., Rome. Materials and Methods. A total 3650 isolates have been collected during three years (2000-2003). Isolates were subcultured to Agar blood-Mac-Conckey and analysed in the Vitek 1 for identification and drug susceptibility. Results. As expected, Escherichia coli was found to be the main cause of urinary tract infection (73%). Proteus mirabilis, Klebsiella pneumoniae, and Pseudomonas aeruginosa, were less frequently isolated (9.,6%, 8.9% and 4.5%, respectively). The E. coli had the highest resistance rate to ampicillin (38%), followed by trimethoprim-sulphamethoxazole (22%) and ciprofloxacine (16%), while nitrofurantoin susceptibility of the E. coli isolates was still at acceptable levels (98%). The P. mirabilis isolates were found to be resistant to amoxycillin (35%), to trimethoprimsulphamethoxazole (34%).The P. aeruginosa isolates were found to be resistant to ciprofloxacina and imipenem (48% and 28% respectively). Conclusions.The increased drug resistance developed by bacteria consistently due to previous treatments with several antimicrobial drugs makes it essential the culture and susceptibility testing in genitourinary tract infection before instituting antimicrobial therapy. Empirical antimicrobial therapy should be avoided or reassessed by 48 to 72 hours after initation based on preterapy culture results

Molecular and Immunological Characterization of Staphylococcus aureus in Pediatric Atopic Dermatitis: Implications for Prophylaxis and Clinical Management

S. aureus represents a critical cofactor in atopic dermatitis (AD). In this paper, the prevalence of S. aureus infection/colonization was evaluated in 117 children as well as in their cohabitants, in order to assess the value of S. aureus characterization in predicting disease onset and severity and in providing indications for prophylaxis. Results showed that children with AD as well as their cohabitants had a significantly greater incidence of S. aureus infection/colonization as compared to controls. The genetic characterization showed a virtual identity of the bacteria strains collected at different sites of the patients with those found in the cohabitants, suggesting both a direct transmission between the nasal reservoir and the lesions in the same atopic subject and a risk for reinfection within family cohabitants. These data stress the need of preliminary laboratory assessment and posttherapy control in both AD patients and their close contacts for effective S. aureus eradication

Evaluation of the Abbott RealTime HBV DNA Assay and Comparison to the Cobas AmpliPrep/Cobas TaqMan 48 Assay in Monitoring Patients with Chronic Cases of Hepatitis B▿

The new Abbott RealTime hepatitis B virus (HBV) assay was compared to the Cobas AmpliPrep/Cobas TaqMan assay with 128 serum samples from patients with chronic hepatitis B. There was an excellent correlation (r = 0.961) between the two assays, with the Abbott RealTime test showing at least equivalent sensitivity and a slightly wider dynamic range than the Cobas TaqMan assay. By coupling high sensitivity with a large dynamic range, the Abbott RealTime HBV assay is useful in monitoring the response to antiviral therapy