We report a case of a haemodialysis patient that presented a catheter-related bacteraemia caused by a Coagulase negative Staphylococcus. With the utilization of molecular biology techniques the bacterial isolate recov...We report a case of a haemodialysis patient that presented a catheter-related bacteraemia caused by a Coagulase negative Staphylococcus. With the utilization of molecular biology techniques the bacterial isolate recovered from catheter was surprisingly identified as S. hominis by sequencing of the 16S ribosomal gene. The S. hominis isolate, which is not often associated with infections in dialysis patients, was resistant to methicillin, being mecA positive, and to daptomycin. The patient was successfully treated with vancomycin together with the catheter retirement.展开更多
目的比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症的疗效和安全性。方法计算机检索Cochrane图书馆(2009年第1期)、Cochrane图书馆临床对照试验资料库(2009年第1期)、MEDLINE、EMbase、Current Controlled Trials、The National Research...目的比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症的疗效和安全性。方法计算机检索Cochrane图书馆(2009年第1期)、Cochrane图书馆临床对照试验资料库(2009年第1期)、MEDLINE、EMbase、Current Controlled Trials、The National Research Register、中国生物医学文献数据库、中文科技期刊全文数据库和中文学术期刊全文数据库,手工检索相关会议的中英文论文集。纳入比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症疗效和安全性的随机对照试验(RCT),评价纳入研究的内部真实性。检索时间均从建库至2009年3月10日,并采用RevMan5.0进行Meta分析。结果共纳入8个RCT,共670例患者。Meta分析结果显示,利奈唑胺在治疗革兰氏阳性菌血症方面与万古霉素疗效相当[RR=1.07,95%CI(0.98,1.17),P=0.15]。对于耐甲氧西林金葡菌引起的菌血症,尽管利奈唑胺临床治愈率略高于万古霉素,但差异并无统计学意义[RR=1.22,95%CI(0.97,1.53),P=0.10]。在治疗导管相关性菌血症中,利奈唑胺与万古霉素疗效相当[RR=1.01,95%CI(0.86,1.19),P=0.90]。利奈唑胺和万古霉素不良反应发生率无明显差异(P=0.64),两种药物引起贫血的发生率也无明显差异(P=0.48)。万古霉素组发生肾功能不全的几率为2.51%,明显高于利奈唑胺组的0.47%(P=0.0003),而利奈唑胺引起血小板减少症的几率为4.39%,明显高于万古霉素组的1.35%(P=0.01)。结论目前的研究提示,利奈唑胺在治疗革兰氏阳性菌血症方面的疗效与万古霉素相当。考虑到利奈唑胺较好的耐受性和较小的肾毒性,在治疗万古霉素耐药患者、重症患者,尤其合并肾功能不全时,可以考虑选用利奈唑胺替代万古霉素进行治疗。展开更多
Sepsis is one of the major challenges of today. Although gram-positive bacteria related infections are more prevalent in hospital setting, the highest mortality rate is associated with gram-negative microorganisms esp...Sepsis is one of the major challenges of today. Although gram-positive bacteria related infections are more prevalent in hospital setting, the highest mortality rate is associated with gram-negative microorganisms especially Enterobacteriaceae. Enterobacteriaceae, including Escherichia coli, Klebsiella spp., Proteus spp., Enterobacter spp. and Serratia spp. Resistance to β-lactams in Enterobacteriaceae is primarily attributed to the production of B-lactamase enzymes with subsequent antibiotic hydrolysis and to a lesser extent by alteration of efflux pump or porins expression. Carbapenem resistant Enterobacteriaceae(CRE) and Acinetobacter baumannii are the most notorious pathogens due to the high incidence of morbidity and mortality especially in the immunocompromised patients in the intensive care unit. The most appropriate antimicrobial therapy to treat CRE is still controversial. Combination therapy is preferred over monotherapy due to its broad-spectrum coverage of micro-organisms, due to its synergetic effect and to prevent development of further resistance. Current suggested therapies for CRE resistance as well as promising antibiotics that are currently under investigation for winning the war against the emerging CRE resistance are reviewed and discussed.展开更多
Peripheral venous catheters (PVC) are widely used in the hospital and seem to be innocent. However, complications can be devastating. We present a case of a fatal septic shock due to vertebral osteomyelitis after PVC-...Peripheral venous catheters (PVC) are widely used in the hospital and seem to be innocent. However, complications can be devastating. We present a case of a fatal septic shock due to vertebral osteomyelitis after PVC-related Staphylococcus aureus bacteremia (SAB). Staphylococcus aureus is a leading cause of bacteraemia in both the community and the hospital with a significantly increased incidence over the last several decades. Intravascular catheters are the most common cause of SAB. Morbidity and mortality are high, even with appropriate therapy. Although complications are known and common, they may be difficult to recognize. Vertebral osteomyelitis is one of these known severe complications.展开更多
Objective:To determine the risk factors and outcomes of imipenem-resistant Acinetobacter baumannii(IRAB) bloodstream infection(BSI) cases,since there is very little publication on Aeinetobacter baumannii infections fr...Objective:To determine the risk factors and outcomes of imipenem-resistant Acinetobacter baumannii(IRAB) bloodstream infection(BSI) cases,since there is very little publication on Aeinetobacter baumannii infections from Malaysia.Methods:A cross sectional study of 41 cases(73.2%) of imipenem-sensitive Acinetobacter baumanii(ISAB) and 15 cases(26.8%) of IRAB was conducted in a teaching hospital which was located at North-Eastern state of Malaysia.Results:There was no independent risk factor for IRAB BSI identified but IRAB BSI was significantly associated with longer bacteraemic days[OR 1.23(95%CI 1.01,1.50)].Although prior use of carbepenems and cephalosporin were higher among IRAB than ISAB group,statistically they were not significant.There was no significant difference in term of outcomes between the two groups.Conclusions:Although statistically not significant,this analysis compliments previous publication highlighting the importance of appropriate empiric antibiotic usage in hospital especially carbepenems and need further evaluation with bigger subjects.展开更多
Background Bloodstream infections (BSIs) cause significant morbidity and mortality of children worldwide.The aim of this study was to investigate BSI in children and determine the identity of causative organism and th...Background Bloodstream infections (BSIs) cause significant morbidity and mortality of children worldwide.The aim of this study was to investigate BSI in children and determine the identity of causative organism and their susceptibility patterns in a metropolitan public hospital in Australia.Methods We retrospectively reviewed children aged 0-16 years admitted to a public hospital from January 1,2010 to August 31,2014 inclusive,and whose blood cultures revealed bacteraemia.Data were collected regarding patient demographics,species of bacteria isolated,antimicrobial susceptibility of these isolates,and clinical outcomes.Results Out of 96 patients with BSI,55 (57.3%) were males.The median age was 3.35 years (IQR 0.44-7.46),and there were 2 mortalities.Common sites of infection were the respiratory tract (16.6%,n =16),bone and joints (l 5.6%,n =15)and the urinary tract (11.5%,n =1 1).The most frequent isolates were Staphylococcus aureus (27.0%),Escherichia coli (14.0%) and Streptococcus pneumoniae (12.0%).Whilst most bacterial isolates displayed susceptibility (> 90%) to common antimicrobial agents,only 57.1% (8/14) of Escherichia coli isolates were susceptible to ampicillin and 58.3% (7/12) were susceptible to co-trimoxazole.Conclusions Gram-positive bacteria accounted for the majority of pediatric BSIs,of which invasive pneumococcal disease remains a noteworthy cause.The majority of isolates,except Escherichia coli,were susceptible to commonly used antimicrobials.This study confirms the knowledge of high rates of resistance of Escherichia coli to ampicillin.Therefore,empirical treatment should still include gentamicin.Monitoring of resistance patterns is warranted to ensure that antibiotic therapy remains appropriate.展开更多
基金partially supported by grant FIS10/00125 from INSTITUTO DE SALUD CARLOSIII(Spanish Health Ministry)to S.M.-A.
文摘We report a case of a haemodialysis patient that presented a catheter-related bacteraemia caused by a Coagulase negative Staphylococcus. With the utilization of molecular biology techniques the bacterial isolate recovered from catheter was surprisingly identified as S. hominis by sequencing of the 16S ribosomal gene. The S. hominis isolate, which is not often associated with infections in dialysis patients, was resistant to methicillin, being mecA positive, and to daptomycin. The patient was successfully treated with vancomycin together with the catheter retirement.
文摘目的比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症的疗效和安全性。方法计算机检索Cochrane图书馆(2009年第1期)、Cochrane图书馆临床对照试验资料库(2009年第1期)、MEDLINE、EMbase、Current Controlled Trials、The National Research Register、中国生物医学文献数据库、中文科技期刊全文数据库和中文学术期刊全文数据库,手工检索相关会议的中英文论文集。纳入比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症疗效和安全性的随机对照试验(RCT),评价纳入研究的内部真实性。检索时间均从建库至2009年3月10日,并采用RevMan5.0进行Meta分析。结果共纳入8个RCT,共670例患者。Meta分析结果显示,利奈唑胺在治疗革兰氏阳性菌血症方面与万古霉素疗效相当[RR=1.07,95%CI(0.98,1.17),P=0.15]。对于耐甲氧西林金葡菌引起的菌血症,尽管利奈唑胺临床治愈率略高于万古霉素,但差异并无统计学意义[RR=1.22,95%CI(0.97,1.53),P=0.10]。在治疗导管相关性菌血症中,利奈唑胺与万古霉素疗效相当[RR=1.01,95%CI(0.86,1.19),P=0.90]。利奈唑胺和万古霉素不良反应发生率无明显差异(P=0.64),两种药物引起贫血的发生率也无明显差异(P=0.48)。万古霉素组发生肾功能不全的几率为2.51%,明显高于利奈唑胺组的0.47%(P=0.0003),而利奈唑胺引起血小板减少症的几率为4.39%,明显高于万古霉素组的1.35%(P=0.01)。结论目前的研究提示,利奈唑胺在治疗革兰氏阳性菌血症方面的疗效与万古霉素相当。考虑到利奈唑胺较好的耐受性和较小的肾毒性,在治疗万古霉素耐药患者、重症患者,尤其合并肾功能不全时,可以考虑选用利奈唑胺替代万古霉素进行治疗。
文摘Sepsis is one of the major challenges of today. Although gram-positive bacteria related infections are more prevalent in hospital setting, the highest mortality rate is associated with gram-negative microorganisms especially Enterobacteriaceae. Enterobacteriaceae, including Escherichia coli, Klebsiella spp., Proteus spp., Enterobacter spp. and Serratia spp. Resistance to β-lactams in Enterobacteriaceae is primarily attributed to the production of B-lactamase enzymes with subsequent antibiotic hydrolysis and to a lesser extent by alteration of efflux pump or porins expression. Carbapenem resistant Enterobacteriaceae(CRE) and Acinetobacter baumannii are the most notorious pathogens due to the high incidence of morbidity and mortality especially in the immunocompromised patients in the intensive care unit. The most appropriate antimicrobial therapy to treat CRE is still controversial. Combination therapy is preferred over monotherapy due to its broad-spectrum coverage of micro-organisms, due to its synergetic effect and to prevent development of further resistance. Current suggested therapies for CRE resistance as well as promising antibiotics that are currently under investigation for winning the war against the emerging CRE resistance are reviewed and discussed.
文摘Peripheral venous catheters (PVC) are widely used in the hospital and seem to be innocent. However, complications can be devastating. We present a case of a fatal septic shock due to vertebral osteomyelitis after PVC-related Staphylococcus aureus bacteremia (SAB). Staphylococcus aureus is a leading cause of bacteraemia in both the community and the hospital with a significantly increased incidence over the last several decades. Intravascular catheters are the most common cause of SAB. Morbidity and mortality are high, even with appropriate therapy. Although complications are known and common, they may be difficult to recognize. Vertebral osteomyelitis is one of these known severe complications.
基金Supported by Universiti Sains Malaysia(No:304/PPSP/6131378)
文摘Objective:To determine the risk factors and outcomes of imipenem-resistant Acinetobacter baumannii(IRAB) bloodstream infection(BSI) cases,since there is very little publication on Aeinetobacter baumannii infections from Malaysia.Methods:A cross sectional study of 41 cases(73.2%) of imipenem-sensitive Acinetobacter baumanii(ISAB) and 15 cases(26.8%) of IRAB was conducted in a teaching hospital which was located at North-Eastern state of Malaysia.Results:There was no independent risk factor for IRAB BSI identified but IRAB BSI was significantly associated with longer bacteraemic days[OR 1.23(95%CI 1.01,1.50)].Although prior use of carbepenems and cephalosporin were higher among IRAB than ISAB group,statistically they were not significant.There was no significant difference in term of outcomes between the two groups.Conclusions:Although statistically not significant,this analysis compliments previous publication highlighting the importance of appropriate empiric antibiotic usage in hospital especially carbepenems and need further evaluation with bigger subjects.
文摘Background Bloodstream infections (BSIs) cause significant morbidity and mortality of children worldwide.The aim of this study was to investigate BSI in children and determine the identity of causative organism and their susceptibility patterns in a metropolitan public hospital in Australia.Methods We retrospectively reviewed children aged 0-16 years admitted to a public hospital from January 1,2010 to August 31,2014 inclusive,and whose blood cultures revealed bacteraemia.Data were collected regarding patient demographics,species of bacteria isolated,antimicrobial susceptibility of these isolates,and clinical outcomes.Results Out of 96 patients with BSI,55 (57.3%) were males.The median age was 3.35 years (IQR 0.44-7.46),and there were 2 mortalities.Common sites of infection were the respiratory tract (16.6%,n =16),bone and joints (l 5.6%,n =15)and the urinary tract (11.5%,n =1 1).The most frequent isolates were Staphylococcus aureus (27.0%),Escherichia coli (14.0%) and Streptococcus pneumoniae (12.0%).Whilst most bacterial isolates displayed susceptibility (> 90%) to common antimicrobial agents,only 57.1% (8/14) of Escherichia coli isolates were susceptible to ampicillin and 58.3% (7/12) were susceptible to co-trimoxazole.Conclusions Gram-positive bacteria accounted for the majority of pediatric BSIs,of which invasive pneumococcal disease remains a noteworthy cause.The majority of isolates,except Escherichia coli,were susceptible to commonly used antimicrobials.This study confirms the knowledge of high rates of resistance of Escherichia coli to ampicillin.Therefore,empirical treatment should still include gentamicin.Monitoring of resistance patterns is warranted to ensure that antibiotic therapy remains appropriate.
