The septicemia caused by the Arizona group organism is rare and usually observed in adults with underlying diseases. In Korea, Salmonella infection is common, but a report of Arizona infection is unknown. We isolated S. entercia subsp. diarizonae from blood of a 6-month-old infant. The serovar was determined as 28:z10:-, a rare one in America. The isolate was susceptible to ampicillin, chloramphenicol, cotrimoxazole and others. The patient rapidly recovered with ampicillin and gentamicin therapy. Clinical laboratories should consider that the infection exists in Korea and should attempt to isolate and identify Arizona organism in certain patients.
Bacteremia/*microbiology ; Case Report ; Enteritis/*microbiology ; Human ; Infant ; Korea/epidemiology ; Male ; *Salmonella Infections ; *Salmonella arizonae

OBJECTIVEIn mid-July 2005, five patients presented with septic shock to a hospital in Ziyang city in Sichuan, China, to identify the etiology of the unknown reason disease, an epidemiological, clinical, and laboratory study were conducted.

METHODSAn enhanced surveillance program were established in Sichuan, the following activities were introduced: active case finding in Sichuan of (a) laboratory diagnosed Streptococcus suis infection and (b) clinically diagnosed probable cases with exposure history; supplemented by (c) monitoring reports on meningococcal meningitis. Streptococcus suis serotype 2 infection was confirmed by culture and biochemical reactions, followed by sequencing for specific genes for serotype and virulence factors.

RESULTSFrom June 10 to August 21, 2005, 68 laboratory confirmed cases of human Streptococcus suis infections were reported. All were villagers who gave a history of direct exposure to deceased or sick pigs in their backyards where slaughtering was performed. Twenty six (38%) presented with toxic shock syndrome of which 15 (58%) died. Other presentations were septicaemia or meningitis. All isolates were tested positive for genes for tuf, species-specific 16S rRNA, cps2J, mrp, ef and sly. There were 136 clinically diagnosed probable cases with similar exposure history but incomplete laboratory investigations.

CONCLUSIONAn outbreak of human Streptococcus suis serotype 2 infections occurred in villagers after direct exposure to deceased or sick pigs in Sichuan. Prohibition of slaughtering in backyards brought the outbreak to a halt. A virulent strain of the bacteria is speculated to be in circulation, and is responsible for the unusual presentation of toxic shock syndrome with high case fatality.

Animals ; Bacteremia ; epidemiology ; microbiology ; China ; epidemiology ; Disease Outbreaks ; Humans ; Meningitis, Bacterial ; epidemiology ; microbiology ; Shock, Septic ; epidemiology ; microbiology ; Streptococcal Infections ; epidemiology ; microbiology ; veterinary ; Streptococcus suis ; isolation & purification ; Swine ; Swine Diseases ; microbiology

To study the pathogens incidences in cord blood and the efficiency of different detective methods, 60 samples were drawn and reserved from collected and processed cord blood, respectively. The BACTEC 9050 system, improved Martin/thioglycollate broth (22 degrees C) and thioglycollate broth (35 degrees C) were employed to detected bacteria (including fungus) at the same time. Two hundred and six cord blood serum samples were used to detect the HBV DNA and HCV RNA by molecular biology technique, HBsAg, Anti-HBC, Anti-HCV, Anti-HCMV-IgM, HTLV-1, HTLV-2, HIV-1 and HIV-2 by ELISA and RBC agglutination test were used to detect the TPHA. Results showed that using BACTEC 9050 system, the incidence of bacteria and fungus was 3.33% and 0% respectively in collected cord blood; in processed cord blood, the rates increased to 6.67% and 1.67%, respectively. The sensitivity of BACTEC 9050 was higher than that of Martin/thioglycollate broth (22 degrees C/35 degrees C) culture. In 206 serum samples, the positive rate of HBV DNA was 5.8%, HCV RNA was 2.4%, HBsAg was 2.4%, HCMV-IgM was 1.89%, HCV was 2.4% and Anti-HBC was 29.4%. In those samples that Anti-HBC was positive, the positive rate of HBV DNA was 6.7%. It was concluded that the incidences of microbiological contamination in cord blood were high. The routine culture system would lead to false negative results of obligate anaerobes. It was necessary to replace the current culture system with improved system, such as BACTEC 9050 system. The molecular biology technique would make up for the default of ELISA.
Bacteremia ; epidemiology ; Blood Specimen Collection ; Fetal Blood ; microbiology ; virology ; Fungemia ; epidemiology ; Humans ; Polymerase Chain Reaction ; Probability ; Viremia ; epidemiology

INTRODUCTIONStenotrophomonas maltophilia is an aerobic gram-negative bacillus that is a frequent coloniser of fluids used in the hospital setting. It causes infection in immunosuppressed hosts, especially those who are neutropaenic, on chemotherapy and broad spectrum antibiotics. Skin and soft tissue manifestations of Stenotrophomonas maltophilia infection are becoming an increasingly recognised entity; the clinical spectrum ranges from mucocutaneous, skin to soft tissue infections.

MATERIALS AND METHODSWe present a case of an 8-year-old girl with acute myeloid leukaemia who developed metastatic skin lesions secondary to Stenotrophomonas maltophilia bacteraemia. The authors reviewed a total of 24 reported cases of mucocutaneous, skin and soft tissue infections by Stenotrophomonas maltophilia. The presentations include metastatic cellulitis, primary cellulitis and infected mucocutaneous ulcers.

RESULTSThis is the first locally reported case of metastatic nodular skin lesions caused by Stenotrophomonas maltophilia bacteraemia. This is also the first reported paediatric case of embolic skin lesions caused by Stenotrophomonas maltophilia. Of the 6 cases of Stenotrophomonas maltophilia bacteraemia seen in the paediatric oncology patients from year 2000 to 2004 at our hospital, only 1 case developed metastatic skin lesions.

CONCLUSIONStenotrophomonas maltophilia skin infection should be included into the list of differential diagnoses for metastatic skin lesions in neutropaenic patients, especially with an underlying haematologic malignancy who has received recent chemotherapy and broad spectrum antibiotics. Haematologic malignancy, transplantation, neutropaenic, immunosuppressive therapy and a high severity of illness score were important prognostic factors.

Acute Disease ; Anti-Infective Agents ; therapeutic use ; Bacteremia ; epidemiology ; microbiology ; Cellulitis ; epidemiology ; microbiology ; Child ; Comorbidity ; Female ; Gram-Negative Bacterial Infections ; complications ; Humans ; Leukemia, Myeloid ; epidemiology ; Neutropenia ; epidemiology ; Prognosis ; Skin Diseases, Bacterial ; epidemiology ; Stenotrophomonas maltophilia ; Trimethoprim, Sulfamethoxazole Drug Combination ; therapeutic use

BACKGROUND/AIMS: Bacterial infection of biliary tract may cause severe inflammatory response or sepsis. An immediate bile culture and appropriate antibiotic administration are important to control the biliary tract infection. The objective of the study was to identify organisms in bile and the features of antibiotic susceptibility in patients with biliary tract infection. METHODS: We retrospectively reviewed the clinical records of 212 patients whose bile had been cultured for variable biliary tract diseases at Inje University Ilsan Paik Hospital from Jan. 2000 to Feb. 2007. Bile samples were obtained from percutaneous transhepatic biliary drainage (PTBD, n=89), percutaneous transhepatic gallbladder drainage (PTGBD, n=14) or endoscopic naso-biliary drainage (ENBD, n=49). RESULTS: The overall positive rate of bile culture was 71.7% (152 cases). The organisms cultured were Escherichia coli (25.0%), Enterococcus spp. (13.4%), Klebsiella spp. (11.1%), Pseudomonas spp. (11.1%), and coagulase-negative Staphylococcus (9.7%) in decreasing order. Effective antibiotics for Gram-negative organisms were amoxicillin/clavulanic acid, amikacin, imipenem, and piperacillin/tazobactam in order of effectiveness. Of the cultured blood samples from 160 patients, fifty (31.2%) showed positive bacterial growth. The organisms isolated from blood were similar to those found in the bile. CONCLUSIONS: A broad spectrum penicillin/beta-lactamase inhibitor is a recommendable antimicrobial for empirical treatment for biliary tract infection. However, Gram-positive bacteria such as Enterococcus spp. or methicillin-resistant Staphylococcus aureus are emerging as causative microorganisms. If these organisms are isolated, antimicrobial drugs should be replaced by narrower-spectrum antimicrobials.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*pharmacology ; Bacteremia/epidemiology/microbiology ; Bacterial Infections/*microbiology ; Bile/*microbiology ; Bile Duct Diseases/*microbiology ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Retrospective Studies

Bacteremia ; diagnosis ; epidemiology ; microbiology ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Pseudomonas Infections ; diagnosis ; epidemiology ; Pseudomonas aeruginosa ; Retrospective Studies ; Rural Population ; Urban Population

BACKGROUNDBloodstream infections (BSIs) remain a major cause of morbidity and mortality in patients undergoing surgery. This study aimed at elucidating the clinical characteristics of community-acquired BSIs (CABs) and nosocomial BSIs (nBSIs) in patients admitted to the surgical wards of a teaching hospital in Beijing, China.

METHODSThis cross-sectional study compared 191 episodes of BSIs in 4074 patients admitted to the surgical wards between January 2008 and December 2011. Cases of BSIs were classified as CABs or nBSIs, and the characteristics, relevant treatments, and outcomes of CABs and nBSIs were compared.

RESULTSOf the 191 BSIs, 52 (27.2%) and 139 (72.8%) were CABs and nBSIs, respectively. Escherichia coli, coagulasenegative staphylococci, and Klebsiella spp, were the most frequently isolated microorganisms. There were significant differences between CABs and nBSIs with respect to the use of hormonal drugs, ventilation, acute physiology and chronic health evaluation (APACHE) II and American Society of Anesthesiologists scores, and prevalence of cancer (P < 0.05). Empirical antibacterial therapy did not decrease the crude mortality, but multivariate analysis showed that high APACHE II was independently associated with a risk of mortality (odds ratio = 0.97, 95% confidence interval: 0.93-1.02 for APACHE II).

CONCLUSIONSWe found significant differences in the clinical characteristics of surgical patients with CABs and nBSIs. The outcome of patients seems to be related to high APACHE II scores.

Anti-Bacterial Agents ; Bacteremia ; epidemiology ; China ; Community-Acquired Infections ; epidemiology ; microbiology ; Cross Infection ; epidemiology ; microbiology ; Cross-Sectional Studies ; Escherichia coli ; pathogenicity ; Female ; General Surgery ; statistics & numerical data ; Hospitals ; Humans ; Male ; Staphylococcus ; pathogenicity

OBJECTIVE: To investigate the phylogenetics and prevalence of bloodstream infections with ST131, the antimicrobial resistance profiles of the pathogens, and the clinical features. METHODS: Non-duplicate isolates were collected from 144 patients with bloodstream infections in our hospital between January and December, 2016.The phylogenetic groups of the isolates were analyzed using multiplex PCR, and O serotyping of ST131 strains was performed by allele-specific PCR.The clinical characteristics of the 144 patients were analyzed to define the differences in the clinical features between patients with ST131 infection and those with non-ST131 infection.Antibiotic susceptibility of the isolates was determined using the Vitek 2 compact system. RESULTS: The phylogenetic group analysis showed a domination by group B2 (41.0%[59/144]), followed by group F, group B1 and group E, which accounted for 16.7%(24/144), 13.9%(20/144), and 13.2% (19/144), respectively.Nine strains (6.3%) of were identified to be ST131 strains, among which 8 were O25b-B2-ST131 strains and 1 was O16-B2-ST131 strain.Of the 9 cases of ST131 infection, 7(77.8%) were found to occur in a nosocomial setting.The demographic characteristics and clinical features of the ST131-infected patients were similar to those of non-ST131-infected patients.ST131 strains were sensitive to piperacillin/tazobactam, imipenem, ertapenem, and amikacin, but showed high resistance rates to cefazolin, ceftriaxone, ciprofloxacin, levofloxacin, gentamicin, and trimethoprim/ sulfamethoxazole (all over 50%).The positivity rate of ESBLs in the ST131 strains was 77.8%, and the multidrug resistance rate reached 88.9%, which was higher than that of non-ST131 isolates, but the difference was not statistically significant. CONCLUSIONS The most common phylogenetic groups of isolates from patients with bloodstream infections are group B2 and F, and the positivity rate of ST131 is low.We for the first time detected O16-ST131 in patients with blood-borne infections in China.The clinical features of ST131-infected patients are similar to those of non-ST131-infected patients.The positivity rate of ESBLs and the multidrug resistance rate are high in ST131 strains, which may raise concerns in the future.
Anti-Bacterial Agents ; therapeutic use ; Bacteremia ; drug therapy ; epidemiology ; microbiology ; China ; Drug Resistance, Bacterial ; Escherichia coli ; classification ; drug effects ; genetics ; Escherichia coli Infections ; drug therapy ; epidemiology ; microbiology ; Genotype ; Humans ; Microbial Sensitivity Tests ; Molecular Epidemiology ; Phylogeny ; Species Specificity

Although extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) has emerged as a significant community-acquired pathogen, there is little epidemiological information regarding community-onset bacteremia due to ESBL-EC. A retrospective observational study from 2006 through 2011 was performed to evaluate the epidemiology of community-onset bacteremia caused by ESBL-EC. In a six-year period, the proportion of ESBL-EC responsible for causing community-onset bacteremia had increased significantly, from 3.6% in 2006 to 14.3%, in 2011. Of the 97 clinically evaluable cases with ESBL-EC bacteremia, 32 (33.0%) were further classified as healthcare-associated infections. The most common site of infection was urinary tract infection (n=35, 36.1%), followed by biliary tract infections (n=29, 29.9%). Of the 103 ESBL-EC isolates, 43 (41.7%) produced CTX-M-14 and 36 (35.0%) produced CTX-M-15. In the multilocus sequence typing (MLST) analysis of 76 isolates with CTX-M-14 or -15 type ESBLs, the most prevalent sequence type (ST) was ST131 (n=15, 19.7%), followed by ST405 (n=12, 15.8%) and ST648 (n=8, 10.5%). No significant differences in clinical features were found in the ST131 group versus the other group. These findings suggest that epidemic ESBL-EC clones such as CTX-M-14 or -15 type ESBLs and ST131 have disseminated in community-onset infections, even in bloodstream infections, which are the most serious type of infection.
Aging ; Bacteremia/drug therapy/*epidemiology ; Biliary Tract Diseases/epidemiology/microbiology ; Cephalosporin Resistance/genetics ; Cephalosporins/therapeutic use ; Community-Acquired Infections/*epidemiology/microbiology ; Escherichia coli/isolation & purification/metabolism ; Escherichia coli Infections/drug therapy/*epidemiology ; Female ; Humans ; Male ; Microbial Sensitivity Tests ; Molecular Epidemiology ; Multilocus Sequence Typing ; Prevalence ; Retrospective Studies ; Urinary Tract Infections/epidemiology/microbiology ; beta-Lactamases/*metabolism

A prospective multicenter observational study was performed to investigate the epidemiology and outcomes of community-acquired severe sepsis and septic shock. Subjects included 1,192 adult patients admitted to the 22 participating intensive care units (ICUs) of 12 university hospitals in the Korean Sepsis Registry System from April, 2005 through February, 2009. Male accounted for 656 (55%) patients. Mean age was 65.0 +/- 14.2 yr. Septic shock developed in 740 (62.1%) patients. Bacteremia was present in 422 (35.4%) patients. The 28-day and in-hospital mortality rates were 23.0% and 28.0%, respectively. Men were more likely to have comorbid illnesses and acute organ dysfunctions, and had higher mortality and clinical severity compared to women. While respiratory sources of sepsis were common in men, urinary sources were predominant in women. In the multivariate logistic regression analysis, cancer (odds ratio 1.89; 95% confidence interval 1.13-3.17), urinary tract infection (0.25; 0.13-0.46), APACHE II score (1.05; 1.02-1.09), SOFA score on day 1 (1.13; 1.06-1.21) and metabolic dysfunction (2.24, 1.45-3.45) were independent clinical factors for gender-related in-hospital mortality. This study provided epidemiological and clinical characteristics of community-acquired severe sepsis and septic shock in ICUs in Korea, and demonstrated the impact of clinical factors on gender difference in mortality.
APACHE ; Adult ; Aged ; Aged, 80 and over ; Bacteremia/epidemiology/microbiology ; Community-Acquired Infections/epidemiology/microbiology/virology ; Comorbidity ; Female ; Hospital Mortality ; Hospitals, University ; Humans ; Intensive Care Units ; Logistic Models ; Lung Diseases/epidemiology ; Male ; Metabolic Diseases/epidemiology ; Middle Aged ; Neoplasms/epidemiology ; Odds Ratio ; Prospective Studies ; Republic of Korea ; Risk Factors ; Sepsis/diagnosis/*epidemiology/mortality ; Severity of Illness Index ; Sex Factors ; Shock, Septic/diagnosis/*epidemiology/mortality ; Urinary Tract Infections/epidemiology