Bacteremia ; microbiology ; Clostridium Infections ; complications ; Clostridium perfringens ; pathogenicity ; Female ; Hemolysis ; physiology ; Humans ; Sepsis ; microbiology

Laribacter hongkongensis is an emerging pathogen in patients with community-acquired gastroenteritis and traveler's diarrhea. We herein report a case of L. hongkongensis infection in a 24-yr-old male with liver cirrhosis complicated by Wilson's disease. He was admitted to a hospital with only abdominal distension. On day 6 following admission, he complained of abdominal pain and his body temperature reached 38.6degrees C. The results of peritoneal fluid evaluation revealed a leukocyte count of 1,180/microL (polymorphonuclear leukocyte 74%). Growth on blood culture was identified as a gram-negative bacillus. The isolate was initially identified as Acinetobacter lwoffii by conventional identification methods in the clinical microbiology laboratory, but was later identified as L. hongkongensis on the basis of molecular identification. The patient was successfully treated with cefotaxime. To the best of our knowledge, this case is the first report of hospital-acquired L. hongkongensis bacteremia with neutrophilic ascites.
Acinetobacter/isolation & purification ; Acinetobacter Infections/complications/diagnosis/microbiology ; Bacteremia/complications/*microbiology ; Cefotaxime/therapeutic use ; Diagnosis, Differential ; Gastroenteritis/complications/*diagnosis/*microbiology ; Hepatolenticular Degeneration/complications/microbiology ; Humans ; Liver Cirrhosis/complications/microbiology ; Male ; Neisseriaceae/*isolation & purification ; Phylogeny ; Republic of Korea ; Young Adult

BACKGROUND: This study was conducted to evaluate the risk factors for infection and clinical outcomes of bacteremic spontaneous bacterial peritonitis (SBP) due to ESBL-producing E. coli and K. pneumoniae, in patients with advanced liver cirrhosis. METHODS: The ESBL production was determined by NCCLS guidelines and/or double-disk synergy tests, on stored E. coli and K. pneumoniae blood isolates collected between 1998 and 2002. Of the patients with advanced liver cirrhosis, 15 case patients, with SBP due to ESBL-producers, were compared with 30 matched controls, with SBP due to non-ESBL-producers. RESULTS: There were no significant differences in age, sex, Child-Pugh scores, or APACHE II scores between the two groups. Significant factors associated with infection by ESBL-producing organisms, according to univariate analysis, were: ICU care, indwelling urinary catheter, central venous catheterization, an invasive procedure within the previous 72 hours, and prior use of antibiotics within the previous 30 days. When assessing the clinical response at 72 hours after the initial antimicrobial therapy, the treatment failure rate was significantly higher in the ESBL group (73.3% vs. 16.7%, p< 0.001). Also, overall 30-day mortality rates were 60% (9/15) in the ESBL groups and 23.3% (7/30) in the control group (p=0.015). CONCLUSION: Among patients with advanced liver cirrhosis, bacteremic SBP due to ESBL-producing E. coli and K. pneumoniae was associated with adverse outcomes, and significantly higher mortality.
Bacteremia/*complications/microbiology ; Case-Control Studies ; Escherichia coli Infections/*complications ; Female ; Humans ; Klebsiella Infections/*complications ; Korea ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Peritonitis/*microbiology

Acute Disease ; Aged ; Anti-Bacterial Agents/therapeutic use* ; Bacteremia/microbiology* ; Female ; Hepatitis B, Chronic/complications* ; Hepatitis C, Chronic/complications* ; Humans ; Hypersplenism/complications* ; Liver Cirrhosis/complications* ; Meningococcal Infections/microbiology* ; Neisseria meningitidis/isolation & purification* ; Peritonitis/microbiology*

Adult ; Bacteremia ; pathology ; Humans ; Male ; Otorhinolaryngologic Surgical Procedures ; adverse effects ; Palate ; surgery ; Pharynx ; surgery ; Postoperative Complications ; microbiology

Aerococcus viridans, a catalase-negative gram-positive coccus rarely causing bacteremia, was isolated from blood cultures of a 52-yr-old man under the gran-ulocytopenic condition. The isolate showed the typical characteristics of A. viridans, i.e., tetrad arrangements in gram stain, positive pyrrolidonyl aminopeptidase (PYR) and negative leucine aminopeptidase (LAP) reactions, and no growth at 45 degrees C.The isolate was revealed to be highly resistant to penicillin, erythromycin, clindamycin, and ceftriaxone, although most strains of A. viridans isolated from the previously reported patients were susceptible to penicillin and other commonly used antibiotics. Even though A. viridans is rarely associated with human infections, it could be a potential causative agent of bacteremia, especially in immunocompromised patients.
Agranulocytosis/*complications/microbiology/physiopathology ; Bacteremia/*complications/microbiology/physiopathology ; Ceftriaxone/pharmacology ; Clindamycin/pharmacology ; *Drug Resistance, Multiple, Bacterial ; Erythromycin/pharmacology ; Gram-Positive Bacterial Infections/*complications/microbiology/physiopathology ; Humans ; Male ; Middle Aged ; Penicillins/*pharmacology ; Streptococcaceae/*drug effects/isolation & purification

INTRODUCTIONThis is a prospective, observational study. The aims of the study were to determine the rate of bacteraemia in febrile children in Turkey, and to evaluate the usefulness of white blood cell (WBC) count and manual differential counts of peripheral blood smears and a RISK score in predicting bacteraemia among these children.

MATERIALS AND METHODSA total of 377 febrile children aged 3 to 36 months were included in the study. Complete blood cell (CBC) count, manual differential counts and blood cultures were performed in all patients. The main outcome measures used to evaluate the usefulness of the RISK score were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), odds ratio (OR), posterior probability, areas under receiver operator characteristic curves (AUC) and miss-to-diagnosis ratio (MDR).

RESULTSAmong the patients, 4.4% had bacteraemia and the predominant pathogen was Streptococcus pneumoniae. The Yale Observation Scale scores, percentages of neutrophil and bands, band-neutrophil ratio, absolute neutrophil count and absolute band count were found to be statistically significant predictors of bacteraemia. When the RISK score was 2 or higher, sensitivity was 93.8%, false positive ratio 35.8%, PPV 10.6%, NPV 99.5%, OR 26.2 (95% CI, 3.4 to 200.8), MDR 0.066 and posterior probability value 10%.

CONCLUSIONSWe conclude that determination of the RISK score will significantly decrease unnecessary blood culture sampling, antibiotherapy and hospitalisation among febrile patients aged 3 to 36 months without an identifiable focus of infection.

Bacteremia ; complications ; diagnosis ; drug therapy ; microbiology ; Bacteria ; isolation & purification ; Child ; Child, Preschool ; Fever ; complications ; Humans ; Infant ; Leukocyte Count ; Neutrophils ; Predictive Value of Tests ; ROC Curve ; Risk Assessment ; Sensitivity and Specificity

BACKGROUND/AIMS: We examined the prevalence of extended-spectrum beta-lactamase (ESBL) production and the impact of ESBL on clinical outcomes in cancer patients with Enterobacter spp. bacteremia. METHODS: Using prospective cohort data on Enterobacter bacteremia obtained between January 2005 and November 2008 from a tertiary care center, the prevalence and clinical impact of ESBL production were evaluated. RESULTS: Two-hundred and three episodes of Enterobacter spp. bacteremia were identified. Thirty-one blood isolates (15.3%, 31/203) scored positive by the double-disk synergy test. Among 17 isolates in which ESBL genes were detected by polymerase chain reaction and sequencing, CTX-M (n = 12), SHV-12 (n = 11), and TEM (n = 4) were the most prevalent ESBL types. Prior usage of antimicrobial agents (77.4% vs. 54.0%, p = 0.02) and inappropriate empirical antimicrobial therapy (22.6% vs. 3.0%, p < 0.001) were more commonly encountered in the ESBL-positive group than in the extended-spectrum cephalosporin-susceptible ESBL-negative group, respectively. Clinical outcomes did not differ significantly between the two groups (30-day mortality rate, 19.4% vs. 17.0%, p = 0.76; median length of hospital stay, 24.0 days vs. 30.5 days, p = 0.97). Initial presentation of severe sepsis/septic shock, pneumonia, and intra-abdominal infection were independently associated with 30-day mortality. CONCLUSIONS: The prevalence of ESBL-producing isolates was 15.3% in cancer patients with Enterobacter bacteremia. Although inappropriate empirical therapy was more common in the ESBL-positive group, ESBL production was not associated with poorer outcomes.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Bacteremia/*complications/drug therapy/microbiology ; Child ; Cohort Studies ; Enterobacter/*enzymology/genetics ; Enterobacteriaceae Infections/*complications/drug therapy/microbiology ; Female ; Humans ; Infant ; Male ; Middle Aged ; Neoplasms/*complications ; Prospective Studies ; Treatment Outcome ; beta-Lactamases/*biosynthesis/genetics

A 42-yr-old man with hepatitis B virus associated liver cirrhosis was admitted to the emergency room because of multiple seizures, a history of chills and myalgia over the previous 2 weeks, and 3 days of melena. He was febrile with a temperature of 38.0degrees C. There were no symptoms and signs related to the genitourinary system, skin, or joints. Three sets of blood cultures were obtained and oxidase-positive, gram-negative diplococci were detected after 25.9-26.9 hr of incubation in all aerobic vials. The organism was positive for catalase and oxidase, and was identified as Neisseria gonorrhoeae, using a Vitek Neisseria-Haemophilus Identification card (bioMerieux Vitek, Inc., USA). Further, 16S rRNA sequencing of this isolate revealed a 99.9% homology with the published sequence of N. gonorrhoeae strain NCTC 83785 (GenBank Accession No. NR_026079.1). Acute bleeding by variceal rupture seems to be a likely route of introduction of N. gonorrhoeae from the mucosa into the blood. To the best of our knowledge, this is the first case of gonococcal bacteremia in Korea.
Adult ; Bacteremia/complications/*diagnosis/microbiology ; Catalase/metabolism ; Esophageal and Gastric Varices/complications/*diagnosis ; Gastrointestinal Hemorrhage/*etiology ; Gonorrhea/complications/*diagnosis/microbiology ; Humans ; Ligation ; Liver Cirrhosis/diagnosis ; Male ; Neisseria gonorrhoeae/genetics/*isolation & purification ; Oxidoreductases/metabolism ; RNA, Ribosomal, 16S/chemistry/genetics ; Sequence Analysis, DNA

This study aimed to compare the clinical presentations of Aeromonas hydrophila, A. veronii biovar sobria and A. caviae monomicrobial bacteremia by a retrospective method at three hospitals in Taiwan during an 8-yr period. There were 87 patients with A. hydrophila bacteremia, 45 with A. veronii biovar sobria bacteremia and 22 with A. caviae bacteremia. Compared with A. hydrophila and A. veronii biovar sobria bacteremia, A. caviae bacteremia was more healthcare-associated (45 vs 30 and 16%; P = 0.031). The patients with A. caviae bacteremias were less likely to have liver cirrhosis (27 vs 62 and 64%; P = 0.007) and severe complications such as shock (9 vs 40 and 47%; P = 0.009) and thrombocytopenia (45 vs 67 and 87%; P = 0.002). The APACHE II score was the most important risk factor of Aeromonas bacteremia-associated mortalities. The APACHE II scores of A. caviae bacteremias were lower than A. hydrophila bacteremia and A. veronii biovar sobria bacteremia (7 vs 14 and 16 points; P = 0.002). In conclusion, the clinical presentation of A. caviae bacteremia was much different from A. hydrophila and A. veronii biovar sobria bacteremia. The severity and mortality of A. caviae bacteremia were lower than A. hydrophila or A. veronii biovar sobria bacteremia.
APACHE ; Adult ; Aeromonas caviae/drug effects/*pathogenicity ; Aeromonas hydrophila/drug effects/*pathogenicity ; Aged ; Aged, 80 and over ; Bacteremia/complications/drug therapy/*microbiology/mortality ; Cross Infection/microbiology ; Female ; Gram-Negative Bacterial Infections/complications/drug therapy/*microbiology/mortality ; Humans ; Liver Cirrhosis/microbiology ; Male ; Middle Aged ; Retrospective Studies ; Shock, Septic/microbiology ; Taiwan ; Thrombocytopenia/complications ; Young Adult