Although there have been a few reported cases of Enterococcal endophthalmitis, this is an unusual case of endophthalmitis complicated with corneal ulcer caused by Enterococcus faecalis. A 67-year-old male patient with diabetes mellitus underwent secondary intraocular lens implantation. Post-operative recovery was uneventful until a wound rupture was noted 3 weeks after the operation. On day 12 after the repair of the wound, endophthalmitis accompanied by wound necrosis and a fullthickness corneal ulcer was detected. His vision was light perception, and Enterococcus faecalis was identified by culture in samples of conjunctival sac, anterior chamber and vitreous humor. After 3 rounds of intravitreal antibiotics injection, the vitreous opacity disappeared on ultrasonographic finding but corneal opacity and corneal neovascularization still remained.
Aged ; Anti-Bacterial Agents/administration & dosage ; Corneal Ulcer/diagnosis/drug therapy/*microbiology ; Endophthalmitis/diagnosis/drug therapy/*microbiology ; Enterococcus faecalis/drug effects/*isolation & purification ; *Eye Infections, Bacterial/diagnosis/drug therapy/microbiology ; Gram-Positive Bacterial Infections/diagnosis/drug therapy/*microbiology ; Humans ; Lens Implantation, Intraocular ; Male ; Microbial Sensitivity Tests ; Surgical Wound Infection/diagnosis/drug therapy/*microbiology ; Treatment Outcome

Selective intestinal decontamination (SID) with norfloxacin has been widely used for the prophylaxis of spontaneous bacterial peritonitis (SBP) because of a high recurrence rate and preventive effect of SID for SBP. However, it does select resistant gut flora and may lead to SBP caused by unusual pathogens such as quinolone-resistant gram-negative bacilli or gram-positive cocci. Enterococcus hirae is known to cause infections mainly in animals, but is rarely encountered in humans. We report the first case of SBP by E. hirae in a cirrhotic patient who have previously received an oral administration of norfloxacin against SBP caused by Klebsiella pneumoniae and presented in septic shock.
Administration, Oral ; Ampicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Ascitic Fluid/microbiology ; Enterococcus/*isolation & purification ; Gram-Positive Bacterial Infections/complications/drug therapy/*microbiology ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Peritonitis/*diagnosis/drug therapy/microbiology ; Sepsis/*etiology

We report a case of necrotizing fasciitis involving Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a 36-yr-old female diabetic patient, which started after a minor dog bite to the toe of the patient. This case suggested that a trivial infection after a minor dog bite in an immunocompromised patient such as diabetes patient could result in a significant complication such as necrotizing fasciitis. The life-threatening infection was cured by timely above-the-knee amputation, as well as penicillin G and clindamycin therapy.
Actinomycetales Infections/diagnosis/microbiology ; Adult ; Animals ; Anti-Bacterial Agents/therapeutic use ; Arcanobacterium ; Bites and Stings/*complications ; Clindamycin/therapeutic use ; Diabetes Mellitus/diagnosis/therapy ; *Dogs ; Fasciitis, Necrotizing/diagnosis/drug therapy/*microbiology ; Female ; Gram-Positive Bacterial Infections/diagnosis/microbiology ; Humans ; Penicillin G/therapeutic use ; Peptostreptococcus ; Streptococcal Infections/diagnosis/microbiology ; Streptococcus agalactiae

OBJECTIVETo study the clinical characteristics, pathogenic bacteria, and antibiotics resistance of neonatal purulent meningitis in order to provide the guide for early diagnosis and appropriate treatment.

METHODA retrospective review was performed and a total of 112 cases of neonatal purulent meningitis (male 64, female 58) were identified in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical University seen from January 1, 2004 to December 31, 2013. The clinical information including pathogenic bacterial distribution, drug sensitivity, head imageology and therapeutic outcome were analyzed. Numeration data were shown in ratio and chi square test was applied for group comparison.

RESULTAmong 112 cases, 46 were admitted from 2004 to 2008 and 66 from 2009 to 2013, 23 patients were preterm and 89 were term, 20 were early onset (occurring within 3 days of life) and 92 were late onset meningitis (occurring after 3 days of life). In 62 (55.4%) cases the pathogens were Gram-positive bacteria and in 50 (44.6%) were Gram-negative bacteria. The five most frequently isolated pathogens were Escherichia coli (32 cases, 28.6%), coagulase-negative staphylococcus (CNS, 20 cases, 17.9%), Streptococcus (18 cases, 16.1%, Streptococcus agalactiae 15 cases), Enterococci (13 cases, 11.6%), Staphylococcus aureus (9 cases, 8.0%). Comparison of pathogenic bacterial distribution between 2004-2008 and 2009-2013 showed that Gram-positive bacteria accounted for more than 50% in both period. Escherichia coli was the most common bacterium, followed by Streptococcus in last five years which was higher than the first five years (22.7% (15/66) vs. 6.5% (3/46), χ(2) = 5.278, P < 0.05). Klebsiella pneumoniae was more common isolate in preterm infants than in term infants (13.0% (3/23) vs. 1.1% (1/89), χ(2) = 7.540, P < 0.05). Streptococcus (most were Streptococcus agalactiae) was the most common bacteria in early onset meningitis and higher than those in late onset meningitis (35.0% (7/20) vs. 12.0% (11/92), χ(2) = 4.872, P < 0.05). Drug sensitivity tests showed that all the Gram-positive bacterial isolates were sensitive to linezolid. Staphylococci were resistant to penicillin, and most of them were resistant to erythromycin, oxacillin and cefazolin; 77.8%of CNS isolates were methicillin-resistant staphylococcus. No Streptococcus and Enterococcus faecalis was resistant to penicillin. None of enterococci was resistant to vancomycin. Among the Gram-negative bacterial isolates, more than 40% of Escherichia coli were resistant to commonly used cephalosporins such as cefuroxime, cefotaxime and ceftazidime, and all of them were sensitive to amikacin, cefoperazone sulbactam and imipenem. Isolates of Klebsiella pneumoniae were all resistant to ampicillin, cefuroxime, cefotaxime and ceftazidime, but none of them was resistant to piperacillin tazobactam and imipenem. Of the 112 patients, 69 were cured, 23 improved, 9 uncured and 11 died. There were 47 cases (42.0%) with poor prognosis, they had abnormal head imageology, severe complications and some cases died, 13 of 18 (72.2%) patients with meningitis caused by Streptococcus died.

CONCLUSIONEscherichia coli, CNS and Streptococcus are the predominant pathogens responsible for neonatal purulent meningitis over the past ten years. There were increasing numbers of cases with Streptococcus meningitis which are more common in early onset meningitis with adverse outcome, therefore careful attention should be paid in clinic. Linezolid should be used as a new choice in intractable neonatal purulent meningitis cases caused by gram positive bacteria.

Anti-Bacterial Agents ; pharmacology ; Cefotaxime ; Child ; Drug Resistance, Bacterial ; Female ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases ; Intensive Care Units, Neonatal ; Male ; Meningitis, Bacterial ; diagnosis ; drug therapy ; microbiology ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Penicillins ; Retrospective Studies ; Staphylococcus ; Staphylococcus aureus ; Streptococcal Infections ; Streptococcus ; Streptococcus agalactiae

Lactococcus lactis cremoris infections are very rare in humans. We experienced liver abscess and empyema due to L. lactis cremoris in an immunocompetent adult. A 42-yr-old man was admitted with fever and abdominal pain. Abdominal computed tomography (CT) revealed a liver abscess and chest CT showed loculated pleural effusion consistent with empyema. L. lactis cremoris was isolated from culture of the abscess material and blood. The patient was treated with pus drainage from liver abscess, video-assisted thoracoscopic decortications for empyema, and antibiotics including cefotaxime and levofloxacin. The patient was completely recovered with the treatment. To our knowledge, this is the first report of a L. lactis cremoris infection in Korea.
Adult ; Anti-Bacterial Agents/therapeutic use ; Cefotaxime/therapeutic use ; Drainage ; Empyema/*diagnosis/*microbiology/surgery ; Gram-Positive Bacterial Infections/complications/*diagnosis/drug therapy ; Humans ; *Lactococcus lactis/drug effects/isolation & purification ; Liver Abscess/*diagnosis/*microbiology ; Male ; Microbial Sensitivity Tests ; Ofloxacin/therapeutic use ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed