Bacteremia in Subjects with Sickle Cell Disease: High Rate of Gram-Negative Isolates in the West African Context!

Background: Sickle cell disease is one of the most common monogenic diseases in the world, affecting approximately 70 million people, 80% in sub-Saharan Africa and 1 in 10 in Senegal. Sickle cell anemia causes functional asplenia (associated with repeated thrombosis of splenic vessels), resulting in increased susceptibility to infection. However, several studies have reported differences in the spectrum of bacterial infections in malaria-endemic areas. Therefore, we proposed to conduct a study to determine the rate of positive blood cultures and the bacteriological spectrum in sickle cell patients. Materials and Method: This is a descriptive cross-sectional study of blood culture samples from patients who received a request for hemoglobin electrophoresis as part of their treatment at the Principal’s hospital in Dakar. The study took place from January 2008 to December 2021. For each patient, we collect demographic information, including age, gender, and the service from which the analysis request originated. Data were collected in the laboratory’s computer system and entered into Microsoft Excel (2007). Statistical analyzes were performed using Epi-Info 7 software. Results: Our study included 1419 patients. The most common types of hemoglobin profiles were: normal profile (n = 1025), AS profile (n = 283), SS profile (n = 104), SC profile (n = 7). This corresponds to the proportions of 72%, 20%, 0.5% and 7.5% for the profiles Normal, AS, SC and SS. The male proportion was 61.1%, 61.5%, 57.1, respectively %, 55.8% for Normal, SA, SC, and SS profiles. A total of 19,090 individual blood culture bottles were collected from 1419 impatient patients as follows: Normal profile (n = 18,042 bottles), AS profile (n = 677 culture bottles), SS profile (n = 362 bottles). The majority of blood culture orders come from pediatric services, accounting for 70% of the total number of orders. Of 19,090 vials examined in this current study, 19.6% developed a positive blood culture. Overall, the most commonly isolated bacteria were Staphylococci (41.1%), Enterobacteriaceae (36.7%), Bacillaceae (10.2%), unfermented (6.30%), Streptococci (5.01%), and a small proportion of yeast (0.75%). There is no significant difference in bacterial spectrum between the SS profile and the normal profile of individuals (p = 0.104). Coagulase-negative staphylococci accounted for 32%, 24%, and 40% of the species isolated in the normal AS and SS profiles. respectively. Coagulase-negative staphylococci were the most commonly isolated organisms in SS. Group E and sptagged streptococci each account for less than 2% of the organisms isolated in SS. Pneumococci were not found. Bacillus accounts for 25% of isolates in SS subjects compared to 9% in normal and AS subjects, respectively. Pseudomonas aeruginosa and Burkholderia cepacia then make up 10% of the isolates in the subjects of the SS profile as non-fermenters. Conclusion: Our study shows that enterobacteria and staph are prevalent in people with sickle cell disease. There is no significant difference in bacterial spectrum between SS subjects compared to subjects with a normal profile. The rarity of Streptococcus pneumoniae in bacteremia isolates underlines the need for further studies with larger patient numbers to better understand the spectrum of bacterial infections in patients with sickle cell disease in West Africa.

Risk prediction model for distinguishing Gram-positive from Gramnegative bacteremia based on age and cytokine levels:A retrospective study

BACKGROUND Severe infection often results in bacteremia,which significantly increases mortality rate.Different therapeutic strategies are employed depending on whether the blood-borne infection is Gram-negative(G-)or Gram-positive(G+).However,there is no risk prediction model for assessing whether bacteremia patients are infected with G-or G+pathogens.AIM To establish a clinical prediction model to distinguish G-from G+infection.METHODS A total of 130 patients with positive blood culture admitted to a single intensive care unit were recruited,and Th1 and Th2 cytokine concentrations,routine blood test results,procalcitonin and C-reactive protein concentrations,liver and kidney function test results and coagulation function were compared between G+and Ggroups.Least absolute shrinkage and selection operator(LASSO)regression analysis was employed to optimize the selection of predictive variables by running cyclic coordinate descent and K-fold cross-validation(K=10).The predictive variables selected by LASSO regression analysis were then included in multivariate logistic regression analysis to establish a prediction model.A nomogram was also constructed based on the prediction model.Calibration chart,receiver operating characteristic curve and decision curve analysis were adopted for validating the prediction model.RESULTS Age,plasma interleukin 6(IL-6)concentration and plasma aspartate aminotransferase concentration were identified from 57 measured variables as potential factors distinguishing G+from G-infection by LASSO regression analysis.Inclusion of these three variables in a multivariate logistic regression model identified age and IL-6 as significant predictors.In receiver operating characteristic curve analysis,age and IL-6 yielded an area under the curve of 0.761 and distinguished G+from G-infection with specificity of 0.756 and sensitivity of 0.692.Serum IL-6 and IL-10 levels were upregulated by more than 10-fold from baseline in the G-bacteremia group but by less than ten-fold in the G+bacteremia group.The calibration curve of the model and Hosmer-Lemeshow test indicated good model fit(P>0.05).When the decision curve analysis curve indicated a risk threshold probability between 0%and 68%,a nomogram could be applied in clinical settings.CONCLUSION A simple prediction model distinguishing G-from G+bacteremia can be constructed based on reciprocal association with age and IL-6 level.

Bacteremia or pseudobacteremia?Review of pseudomonas fluorescens infections

INTRODUCTION P.fluorescens is an aerobic,Gram-negative bacillus related to Pseudomonas aeruginosa.Like other species of Pseudomonas,the organism is widespread in nature and is found in water,moist soil,and vegetation.Due to its low virulence,P.fluorescens is an infrequent cause of infections except for catheter-related bloodstream infections in cancer patients.From August 1,2003 to May 31,2016,Hyogo Emergency Medical Center and the Kobe Red Cross Hospital treated three cases of bloodstream infection

Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia

AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis(SBP) and spontaneous bacteremia(SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases(68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm3. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d periodfollowing diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci(GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli(33), Enterococcus spp(30), Streptococcus spp(25), Klebsiella pneumonia(16), S. aureus(8), Pseudomanas aeruginosa(5), other Gram-negative-bacteria(GNB)(11) and anaerobes(2). Overall, 20.8% of isolates were multidrug-resistant(MDR) and 10% extensively drugresistant(XDR). Health-care-associated(HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium(E. faecium). All but one XDR were susceptible to colistin while all GPC(including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7%(69.2% for XDR and 34.2% for the rest of the patients)(log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection(HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine(HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR(HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent lifethreatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.

Treatment of sepsis: What is the antibiotic choice in bacteremia due to carbapenem resistant Enterobacteriaceae?

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.

Appropriate empirical antibiotic use and 30-d mortality in cirrhotic patients with bacteremia

AIM: To analyze whether prompt and appropriate empirical antibiotic(AEA) use is associated with mortality in cirrhotic patients with bacteremia. METHODS: A total of 102 episodes of bacteremia in 72 patients with cirrhosis were analyzed. AEA was defined as a using or starting an antibiotic appropriate to the isolated pathogen at the time of bacteremia. The primary endpoint was 30-d mortality. RESULTS: The mortality rate at 30 d was 30.4%(31/102 episodes). Use of AEA was associated with better survival at 30 d(76.5% vs 46.9%, P = 0.05), and inappropriate empirical antibiotic(IEA) use was an independent factor associated with increased mortality(OR = 3.24; 95%CI: 1.50-7.00; P = 0.003, adjusted for age, sex, ChildPugh Class, gastrointestinal bleeding, presence of septic shock). IEA use was more frequent when the isolated pathogen was a multiresistant pathogen, and when infection was healthcare-related or hospital-acquired. CONCLUSION: AEA use was associated with increased survival of cirrhotic patients who developed bacteremia. Strategies for AEA use, tailored according to the local epidemiological patterns, are needed to improve survival of cirrhotic patients with bacteremia.

Older age, longer procedures and tandem endoscopic-ultrasound as risk factors for post-endoscopic retrograde cholangiopancreatography bacteremia

BACKGROUND Clinically significant post-endoscopic retrograde cholangiopancreatography(ERCP) bacteremia(PEB) occurs in up to 5% of cases, while antibiotic prophylaxis is recommended only when an ERCP is unlikely to achieve complete biliary drainage. However, the current recommendations may not cover all potential risk factors for PEB.AIM To identify novel risk factors for PEB and evaluate appropriateness of antibiotic prophylaxis.METHODS A retrospective study of 1082 ERCP procedures performed between January 2012-December 2013 in a single tertiary medical center. Data collection included: Demographic and clinical characteristics such as pre and post procedure antibiotic treatment and bacterial blood cultures. Exclusion criteria were:(1) Age < 18 years;(2) Positive bacterial blood culture before ERCP;(3) Scheduled antibiotic treatment prior to ERCP;(4) Hospitalization longer than 14 d before ERCP;and(5) missing critical data. Stepwise Logistic Regression analysis and Decision Tree algorithms were used for prediction modeling of PEB.RESULTS A total of 626 ERCPs performed in 434 patients were included. Mean age 66.49 ± 15.4 years and 46.5% were males. PEB prevalence was 3.7%. Antibiotic prophylaxis was administrated in 139/626(22.2%) cases but was indicated according to the guidelines only in 44/626(7%) cases. In all the PEB cases, prophylaxis was deemed not indicated. A stepwise logistic regression [receiver operating characteristic(ROC), 0.766], identified 3 variables as independent risk factors for PEB: Age at ERCP ≥ 75 years(OR, 3.780, 95%CI: 1.519-9.408, P = 0.004);Tandem EUS/ERCP with fine needle aspiration(FNA)(OR, 14.528, 95%CI: 3.571-59.095, P < 0.001);ERCP duration longer than 60 min(OR, 5.396, 95%CI: 1.86-15.656, P = 0.002). In a decision tree model(ROC, 0.778) the probability for PEB without any risk factors was 1% regardless of prophylaxis administration.CONCLUSION The prevalence of PEB in our study is similar to previous reports, despite the fact that antibiotic prophylaxis was administrated more readily than recommended. ERCP duration longer than 60 min, tandem EUS-ERCP with FNA and age above 75 years are significant risk factors for PEB. These factors should be further evaluated as indications for prophylactic antibiotic treatment before ERCP.

Hemorrhagic blisters in fulminant Aeromonas hydrophila bacteremia: Case report and literature review

The Aeromonas species, belonging to the family Aeromonadaceae, are opportunistic pathogens found in humans with an incidence rate of 76 cases per million inhabitants in Southern Taiwan.The incidence of Aeromonas septicemia is relatively low, accounting for less than 15% of cases.Patients diagnosed with Aeromonas hydrophila bacteremia who were presented with skin blisters and septic shock have been reported to have a mortality rate of 100%.Aeromonas infection must be considered in the differential diagnosis of gangrene-like tissue damage or skin lesions in patients with end-stage renal disease, due to the potential sources of infections.A 49-year-old Taiwan Residents diabetic woman with end-stage renal disease had underwent regular hemodialysis.She was referred to our hospital due to a one-day course of fever, dyspnea, hypotension, and fulminant hemorrhagic blisters covering her whole body.A physical examination uncovered multiple hemorrhagic blisters, along with a ruptured blister over the lower left leg.Laboratory tests revealed an elevation of liver enzymes, impaired renal function, lactatemia, and high anion-gap metabolic acidosis.Cultures of both blood and hemorrhagic blister fluid grew Aeromonas hydrophila.However, she experienced persistent shock despite aggressive intravenous fluid, empiric antibiotics, and inotropic agents with norepinephrine and dopamine.Early diagnosis and prompt management using intravenous fluids, antibiotics and surgical debridement is recommended in order to improve a patient's survival rate.

Bacteremia and “Endotipsitis” following transjugular intrahepatic portosystemic shunting

AIM: To identify all cases of bacteremia and suspected endotipsitis after Transjugular intrahepatic portosystemic shunting (TIPS) at our institution and to determine risk factors for their occurrence. METHODS: We retrospectively reviewed records of all patients who underwent TIPS in our institution between 1996 and 2009. Data included: indications for TIPS, underlying liver disease, demographics, positive blood cultures after TIPS, microbiological characteristics, treat- ment and outcome. RESULTS: 49 men and 47 women were included with a mean age of 55.8 years (range 15-84). Indications for TIPS included variceal bleeding, refractory ascites,hydrothorax and hepatorenal syndrome. Positive blood cultures after TIPS were found in 39/96 (40%) patients at various time intervals following the procedure. Seven patients had persistent bacteremia fitting the definition of endotipsitis. Staphylococcus species grew in 66% of the positive cultures, Candida and enterococci species in 15% each of the isolates, and 3% cultures grew other species. Multi-variate regression analysis identified 4 variables: hypothyroidism, HCV, prophylactic use of an- tibiotics and the procedure duration as independent risk factors for positive blood cultures following TIPS (P < 0.0006, 0.005, 0.001, 0.0003, respectively). Prophylactic use of antibiotics before the procedure was associated with a decreased risk for bacteremia, preventing mainly early infections, occurring within 120 d of the procedure. CONCLUSION: Bacteremia is common following TIPS. Risk factors associated with bacteremia include failure to use prophylactic antibiotics, hypothyroidism, HCV and a long procedure. Our results strongly support the use of prophylaxis as a means to decrease early post TIPS infections.

<i>Chryseobacterium indologenes</i>Bacteremia: Clinical and Microbiological Characteristics of an Emerging Infection

Purpose: Since Chryseobacterium indologenes (C. indologenes) is a rare human pathogen, its clinical significance has not yet been fully established. C. indologenes contamination of medical devices involving fluids and of surgical implants has led to an increasing number of serious infectious reported in recent years, mainly in patients in extremes ages and an immunocompromised state. In this study, we describe the clinical and microbiological characteristics of seven adult patients with C. indologenes bacteremia treated in a tertiary medical center in Israel over a six-year period. Methods: Adult patients hospitalized in Rabin Medical Center, Israel, with a blood culture positive for C. indologenes during the period 2009-2014 were identified retrospectively and their medical records were reviewed. Results: Seven episodes of C. indologenes bacteremia in seven patients were identified during the study period. Five patients were females;the mean age was 76.8 years (41 - 92). Serious underlying conditions were present in all patients. All patients but one, presented after a recent invasive healthcare related intervention. Two patients required mechanical ventilation. Two patients died. All but one isolates were susceptible to ciprofloxacin. Conclusions: Despite our limited number of cases, to the best of our knowledge, our study serves as the largest cohort of adult patients with C. indologenes bacteremia reported in recent years.

A Retrospective Quality Study of Hemodialysis Catheter-Related Bacteremia in a Danish Hospital

Background: Hemodialysis catheter-related bacteremia (HD CRB) is a major complication of long-term hemodialysis (HD) therapy and bacteremia is secondary only to cardiovascular disease as the leading cause of death in patients receiving renal replacement therapy. A large part may be preventable and surveillance is a critical aspect of infection control and prevention. Aim: To analyze incidence, causative species, and treatment of HD CRB in adult chronic HD patients at Nordsjaellands Hospital (NOH), Denmark. Methods: All episodes of bacteremia in the Department of Cardiology, Nephrology and Endocrinology (KNEA), NOH from 2010 to 2013 were analyzed. Inclusion criteria: Adult chronic HD patients with a tunneled dialysis catheter diagnosed with HD CRB. Causative microorganism and antimicrobial treatment were recorded for each episode. Findings: Ninetynine episodes of HD CRB in 72 patients were found with a mean incidence rate of 0.9/1000 catheter-days. Gram-positive bacteria were isolated in 71% of the episodes, gram-negative bacteria in 25%, both in 3%, and yeast in 1%. The most frequently isolated microorganisms were Staphylococcus aureus (33%), Coagulase-negative staphylococci (29%), enterobacteriaceae (20%) and enterococci (8%). The most commonly used empiric antimicrobials were cefuroxime and vancomycin and the overall efficacy was 77%. Conclusion: The well-functioning infection prevention strategy seems to be successful resulting in a relatively low incidence rate of HD CRB compared with that shown in international studies. The high proportion of gram-negative bacteria raises the question as to whether future antimicrobial guidelines should cover both gram-positive and gram-negative bacteria.

Two case reports of gastroendoscopy-associated Acinetobacter baumannii bacteremia

Two cases of gastroendoscopy-associated Acinetobacter baumannii (A. baumannii ) bacteremia were discovered at the study hospital. The first case was a 66-year-old woman who underwent endoscopic retrograde cholangiopancreatography and endoscopic retrograde papillotomy, and then A. baumannii bacteremia occurred. The second case was a 70-year-old female who underwent endoscopic retrograde biliary drainage due to obstruction of intra-hepatic ducts, and bacteremia occurred due to polymicrobes (Escherichia coli , viridans streptococcus , and A. baumannii ). After a literature review, we suggest that correct gastroendoscopy technique and skill in drainage procedures, as well as antibiotic prophylaxis, are of paramount importance in minimizing the risk of gastroendoscopy-associated bacteremia.

Helicobacter cinaedi bacteremia with cellulitis after ABO-incompatible living-donor liver transplantation: Case report

Helicobacter cinaedi(H. cinaedi), a Gram-negative spiral-shaped bacterium, is an enterohepatic nonHelicobacter pylori Helicobacter species. We report the first case of H. cinaedi bacteremia with cellulitis after liver transplantation. A 48-year-old male, who had been a dog breeder for 15 years, underwent ABO-incompatible living-donor liver transplantation for hepatitis C virus-induced decompensated cirrhosis using an anti-hepatitis B core antibody-positive graft. The patient was preoperatively administered rituximab and underwent plasma exchange twice to overcome blood type incompatibility. After discharge, he had been doing well with immunosuppression therapy comprising cyclosporine, mycophenolate mofetil, and steroid according to the ABO-incompatible protocol of our institution. However, 7 mo after transplantation, he was admitted to our hospital with a diagnosis of recurrent cellulitis on the left lower extremity, and H. cinaedi was detected by both blood culture and polymerase chain reaction analysis. Antibiotics improved his symptoms, and he was discharged at day 30 after admission. Clinicians should be more aware of H. cinaedi in immunocompromised patients, such as ABO-incompatible transplant recipients.

Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia

BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.

Listeria monocytogenes bacteremia in a centenarian and pathogen traceability:A case report

BACKGROUND Early diagnosis and appropriate antibiotic treatment are important to survival of Listeria monocytogenes(L.monocytogenes)bacteremia.Penicillin tends to be the most commonly used antibiotic.However,there are limited data on antibiotic use in elderly patients with serious complications.We describe the clinical presentation,antibiotic therapy,and traceability of L.monocytogenes in a centenarian with a history of eating frozen food.CASE SUMMARY A 102-year-old man suffered from high fever with chill after hematochezia.Tentative diagnoses were lower gastrointestinal hemorrhage and localized peritonitis.Meropenem and ornidazole were the empirical therapy.The patient did not respond and developed multiple system dysfunction even after teicoplanin was added to the therapy.L.monocytogenes was identified from blood cultures on day 5 of admission.The patient had a history of consuming frozen dumplings.Meropenem/ornidazole/teicoplanin were replaced with meropenem/linezolid.The patient gradually became afebrile.He received meropenem/linezolid for 10 d,and piperacillin/tazobactam was applied as step-down treatment for 2 wk with good clinical results.There was no sign of relapse during follow-up after discharge.L.monocytogenes isolates from the patient and frozen dumplings belonged to different serotypes and sequence types(STs):1/2b and ST5 from the patient and 1/2c and ST9 from the dumplings.CONCLUSION More awareness of listeriosis should be raised.Linezolid might be an option for listeriosis in elderly people with serious complications.

Daptomycin and linezolid for severe methicillin-resistant Staphylococcus aureus psoas abscess and bacteremia:A case report and review of the literature

BACKGROUND Vancomycin remains a first-line treatment drug as per the treatment guidelines for methicillin-resistant Staphylococcus aureus(MRSA)bacteremia.However,a number of gram-positive cocci have developed resistance to several drugs,including glycopeptides.Therefore,there is an urgent need for effective and innovative antibacterial drugs to treat patients with infections caused by drugresistant bacteria.CASE SUMMARY A 24-year-old male was admitted to hospital owing to lumbago,fever,and hematuria.Computed tomography(CT)results showed an abscess in the psoas major muscle of the patient.Repeated abscess drainage and blood culture suggested MRSA,and vancomycin was initiated.However,after day 10,CT scans showed abscesses in the lungs and legs of the patient.Therefore,treatment was switched to daptomycin.Linezolid was also added considering inflammation in the lungs.After 10 d of the dual-drug anti-MRSA treatment,culture of the abscess drainage turned negative for MRSA.On day 28,the patient was discharged without any complications.CONCLUSION This case indicates that daptomycin combined with linezolid is an effective remedy for bacteremia caused by MRSA with pulmonary complications.

Mycobacterium tuberculosis bacteremia in a human immunodeficiency virus-negative patient with liver cirrhosis:A case report

BACKGROUND With the increasing prevalence of human immunodeficiency virus(HIV),the incidence of Mycobacterium tuberculosis(M.tuberculosis)bacteremia has also increased.As a common affliction of acquired immunodeficiency syndrome patients,M.tuberculosis infection is associated in these patients with severe sepsis and high mortality.In contrast,M.tuberculosis bacteremia is rarely seen in HIVnegative patients,and M.tuberculosis has never been reported from the blood of patients with liver cirrhosis.CASE SUMMARY We evaluated a 55-year-old Chinese male patient who had been admitted to the hospital with abdominal distension of unknown cause of one-week duration,accompanied by diarrhea,shortness of breath,and occasional fever.Based on these indicators of abnormal inflammation and fever,we suspected the presence of an infection.Although evidence of microbial infection was not found in routine clinical tests and the patient did not show typical clinical symptoms of infection with M.tuberculosis,next-generation sequencing of blood samples nevertheless demonstrated the presence of M.tuberculosis,which was subsequently isolated from blood samples grown in conventional Bac T/ALERT FA blood culture bottles.CONCLUSION Our findings demonstrate that HIV-negative liver cirrhosis patients can also be infected with M.tuberculosis.

Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis:A case report

BACKGROUND Staphylococcus aureus bacteraemia(SAB)is among the leading causes of bacteraemia and infectious endocarditis.The frequency of infectious endocarditis(IE)among SAB patients ranges from 5%to 10%-12%.In adults,the characteristics of epidermolytic hyperkeratosis(EHK)include hyperkeratosis,erosions,and blisters.Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cellmediated immunity.CASE SUMMARY We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases.After genetic tests,the skin disease was diagnosed as EHK.CONCLUSION A breached skin barrier secondary to EHK,coupled with inadequate sanitation,likely provided the opportunity for bacterial seeding,leading to IE and deepseated abscess or organ abscess.EHK may be associated with skin infection and multiple risk factors for extracutaneous infections.Patients with EHK should be treated early to minimize their consequences.If patients with EHK present with prolonged fever of unknown origin,IE and organ abscesses should be ruled out,including metastatic spreads.

Bacteremia with Cutaneous Nodules, Due to Pseudomonas Aeruginosa

Pseudomonas aeruginosa bacteremia rarely occurs in non-immunocompromised adults and can be difficult to be treated. We report a case of 35-year-old woman who presented with respiratory distress, fever and skin lesions. There was pleural effusion in chest radiograph, and CT scan of thorax showed necrotizing pneumonia and loculated empyema. Among the cultures of blood, empyema, sputum and the skin nodules aspirates, all were positive for Pseudomonas aeruginosa. The patient was treated with ciprofloxacin, amikacin and then pleural decortications. Laboratory tests failed to reveal any immunological deficits. After a period of 21 days of antibiotic therapy, the patient was discharged from hospital with a good condition.

Multiple skin abscesses associated with bacteremia caused by Burkholderia gladioli:A case report

BACKGROUND Burkholderia gladioli(B.gladioli)is regarded as a rare opportunistic pathogen.Only a few patients with abscesses caused by B.gladioli infections have been reported,and these are usually abscesses at the incision caused by traumatic surgery.CASE SUMMARY A 74-year-old male patient with abscesses and pain throughout his body for 1 mo was admitted to our hospital.Some of the abscesses had ruptured with purulent secretions on admission.Color Doppler ultrasound examination of the body surface masses showed mixed masses 75 mm×19 mm,58 mm×17 mm,17 mm×7 mm,and 33 mm×17 mm in size in the muscle tissues of both the right and left forearms,the posterior area of the right knee and the left leg,respectively.Abscess secretions and blood cultures grew B.gladioli.The following 3 methods were used to jointly identify the bacterium:an automatic microbial identification system,matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,and full-length 16 S rDNA sequencing.After 27 d of treatment with meropenem,etimicin,trimethoprim-sulfamethoxazole and other antibiotics,most of his skin abscesses were flat and he was discharged without any symptoms.CONCLUSION This is the first reported case of multiple skin abscesses associated with bacteremia caused by B.gladioli.Our study provides important reference values for the clinical diagnosis and treatment of B.gladioli infections.