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Bacterial co-infections in mucormycosis in severely ill populations: an overlooked and complex challenge. 重症患者中粘液瘤病的细菌合并感染:被忽视的复杂挑战。
Pub Date : 2024-11-12 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000850.v4
D E Corzo Leon, V H Ahumada-Topete, L Ostrosky-Zeichner

Mucormycosis is found in co-infection with bacteria in >50% of the cases. Most of these cases were reported among people with haematological diseases. The two most frequent bacteria found were Pseudomonas aeruginosa and Klebsiella pneumoniae. Almost 40% of the identified bacteria were reported as multidrug resistant.

在超过 50% 的病例中,粘孢子菌病与细菌同时感染。这些病例大多发生在患有血液病的人群中。最常见的两种细菌是铜绿假单胞菌和肺炎克雷伯菌。据报告,近 40% 的已确认细菌具有多重耐药性。
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引用次数: 0
Molecular characteristics of CTX-M β-lactamase-producing and quinolone-resistant Escherichia coli among deer in a popular tourist spot in Japan. 日本著名旅游景点鹿群中产CTX-M β-内酰胺酶和耐喹诺酮大肠埃希菌的分子特征。
Pub Date : 2024-11-12 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000882.v3
Shiori Ikushima, Michiyo Sugiyama, Tetsuo Asai

Introduction. Antimicrobial resistance (AMR) is a growing global concern. Clonal lineages of CTX-M β-lactamase-producing Escherichia coli (CTXE) and quinolone-resistant E. coli (QREC) were disseminated among the deer population in a famous tourist destination (Nara Park; NP) in Japan. Hypothesis/gap statement. The molecular characteristics of CTXE or QREC isolates, which could pose a threat to public health, have not been elucidated. Aim. This study aimed to characterize the genetic traits of CTXE and QREC isolates derived from NP deer and compare them with lineages prevalent worldwide. Methodology. Sixteen CTXE and three QREC isolates recovered from NP deer faeces between 2018 and 2020 were analysed using whole-genome sequencing (WGS). For endemic lineages, phylogenetic trees were constructed against the isolates registered in the EnteroBase database using the core genome SNP scheme. Results. The most prevalent lineage in NP deer was ST3580. Several pandemic lineages, such as sequence type (ST) 38, ST58 and ST117, were included. The QREC lineages prevalent among deer were designated as extra-intestinal pathogenic E. coli or uropathogenic E. coli (UPEC). Thirteen of the 24 antimicrobial resistance genes (ARGs) were considered high-risk ARG families. Chromosomal integration of bla CTX-M-15 was observed in all plasmid-negative isolates. Phylogenetic analysis suggested relationships between NP isolates and isolates sourced from the environment or poultry. Conclusion. ST3580 has a high potential for clonal dissemination. Furthermore, multiple clinically relevant lineages of CTXE and QREC are endemic in NP deer; however, they could be less virulent than isolates belonging to the same lineages, which could cause severe infectious diseases. Further studies are required to investigate the relationship between chromosomal integration of plasmid-encoded genes and the stable propagation of AMR bacteria in wildlife and the environment.

导言。抗菌药耐药性(AMR)是一个日益受到全球关注的问题。在日本著名的旅游胜地(奈良公园),产CTX-M β-内酰胺酶大肠杆菌(CTXE)和耐喹诺酮大肠杆菌(QREC)的克隆菌系在鹿群中传播。假设/差距说明。CTXE 或 QREC 分离物的分子特征尚未阐明,它们可能对公共卫生构成威胁。研究目的本研究旨在确定来自 NP 鹿的 CTXE 和 QREC 分离物的遗传特征,并将其与全球流行的品系进行比较。研究方法。使用全基因组测序(WGS)分析了 2018 年至 2020 年期间从南太平洋鹿粪便中分离的 16 株 CTXE 和 3 株 QREC。对于地方性种系,使用核心基因组 SNP 方案,根据 EnteroBase 数据库中登记的分离株构建系统发生树。结果。在南太平洋鹿中最流行的系谱是 ST3580。其中包括几个大流行系,如序列类型(ST)38、ST58 和 ST117。鹿中流行的 QREC 菌系被定为肠道外致病性大肠杆菌或尿路致病性大肠杆菌(UPEC)。24 个抗菌药耐药性基因(ARG)中有 13 个被认为是高风险 ARG 家族。在所有质粒阴性的分离物中都观察到了 bla CTX-M-15 的染色体整合。系统发育分析表明,NP 分离物与来自环境或家禽的分离物之间存在关系。结论:ST3580ST3580 有很高的克隆传播潜力。此外,CTXE 和 QREC 的多个临床相关品系在 NP 鹿中流行,但它们的毒性可能低于属于同一品系的分离物,而后者可能导致严重的传染病。需要进一步研究质粒编码基因的染色体整合与 AMR 细菌在野生动物和环境中稳定繁殖之间的关系。
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引用次数: 0
Epidemiological and virological characteristics of people living with HIV on antiretroviral treatment for more than 6 months in virological failure in Brazzaville, Republic of Congo. 刚果共和国布拉柴维尔病毒学失败且接受抗逆转录病毒治疗6个月以上的艾滋病毒感染者的流行病学和病毒学特征
Pub Date : 2024-11-11 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000805.v3
Ferdinand Emaniel Brel Got, Gervillien Arnold Malonga, Juthèce Privat Malanda-Kiminou, Maryse Akolbout, Ghislain Loubano-Mvoumbi, Dagene Ebourombi, Merlin Diafouka, Gontran Ondzotto

Introduction. Virological failure is one of the main causes of failing to treat, and better management of HIV infection requires understanding and controlling the factors that contribute to this phenomenon. The main objective was to characterize the patients of the active file of the Brazzaville Outpatient Treatment Center in virological failure to identify predictive factors leading to virological failure. Methods. Conducted between June and December 2020, this was a cross-sectional study. Patients enrolled were HIV-1-infected patients from the Brazzaville Outpatient Treatment Center receiving a potent combination therapy for at least 6 months but experiencing virological failure. Viral load was measured using the automated Abbott Real-time HIV-1 m2000rt System. Sociodemographic and clinical data were collected from a computerized patient record software called Santia. For the identification of the independent predictors of virological failure, statistical analysis was performed. Results. A total of 109 patients with virological failure were recruited. The median age of the patients was 45 years (interquartile range: 37-52 years) and women were more represented (74%). More than half of the patients had World Health Organization stage IV HIV and the median duration of antiretroviral treatment was 96 months. The most followed treatment regimen was AZT+3TC+EFV (or nevirapine) with 48%, while the median viral load was 12985 copies ml-1. Conclusion. In our study, we did not identify any sociodemographic or clinical variables predictive of virological failure. However, we felt that it would be desirable to carry out a study with temporal follow-up and the possibility of sequencing in order to identify the different circulating genotypes and resistance mutations.

介绍。病毒学失败是治疗失败的主要原因之一,更好地管理艾滋病毒感染需要了解和控制导致这一现象的因素。主要目的是表征布拉柴维尔门诊治疗中心病毒学失败的活跃档案患者的特征,以确定导致病毒学失败的预测因素。方法。这是一项在2020年6月至12月期间进行的横断面研究。纳入的患者是来自布拉柴维尔门诊治疗中心的hiv -1感染患者,他们接受了至少6个月的有效联合治疗,但出现病毒学失败。使用自动雅培实时HIV-1 m2000rt系统测量病毒载量。社会人口统计和临床数据是从一个名为Santia的计算机化患者记录软件中收集的。为了确定病毒学失败的独立预测因子,进行了统计分析。结果。共招募了109例病毒学失败的患者。患者的中位年龄为45岁(四分位数范围:37-52岁),女性占比更高(74%)。超过一半的患者感染了世界卫生组织的第四阶段艾滋病毒,抗逆转录病毒治疗的中位持续时间为96个月。最常见的治疗方案是AZT+3TC+EFV(或奈韦拉平),占48%,中位病毒载量为12985拷贝ml-1。结论。在我们的研究中,我们没有发现任何预测病毒学失败的社会人口学或临床变量。然而,我们认为,为了确定不同的循环基因型和耐药突变,开展一项有时间随访和测序可能性的研究是可取的。
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引用次数: 0
Genome sequence data for 61 isolates of Xanthomonas campestris pv. campestris from Brassica crops in Serbia. 61株油菜黄单胞菌基因组序列数据。来自塞尔维亚芸苔属作物的campestris。
Pub Date : 2024-11-08 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000870.v3
Tatjana Popović Milovanović, Shannon Greer, Renata Iličić, Aleksandra Jelušić, Daisy Bown, Mikaeel Hussain, Jamie Harrison, Murray Grant, Joana G Vicente, David J Studholme

This Technical Resource describes genome sequencing data for 61 isolates of the bacterial pathogen Xanthomonas campestris pv. campestris collected from Brassica and Raphanus crops between 2010 and 2021 in Serbia. We present the raw sequencing reads and annotated contig-level genome assemblies and determine the races of ten isolates. The data can be used to test hypotheses and phylogeographic analyses and inform the design of informative molecular markers for population genetics studies. When combined with phenotypic data, they could be used to dissect relationships between genotypes and phenotypes such as host range and virulence. Finally, these genome sequences expand our inventory of plasmids known to reside in this pathogen.

本技术资源描述61株细菌病原菌油菜黄单胞菌pv的基因组测序数据。2010年至2021年期间在塞尔维亚从芸苔属和莴苣属作物中收集的campestris。我们提出了原始测序读数和注释的contig水平基因组组装,并确定了10个分离株的种族。这些数据可用于检验假设和系统地理分析,并为群体遗传学研究提供信息分子标记的设计。当与表型数据相结合时,它们可用于剖析基因型和表型之间的关系,如宿主范围和毒力。最后,这些基因组序列扩大了我们已知存在于这种病原体中的质粒的库存。
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引用次数: 0
Diversity of HBV genotypes and their association with precore/basal core mutations among HBsAg-positive patients in Ibadan, Nigeria. 尼日利亚伊巴丹 HBsAg 阳性患者中 HBV 基因型的多样性及其与前核心/基本核心突变的关系。
Pub Date : 2024-11-07 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000821.v3
Adedayo Omotayo Faneye, Babatunde Olanrewaju Motayo, Aisha Mustafa, Georgina Odiabo

Background. Hepatitis B virus (HBV) is the most implicated cause of severe liver disease and hepatocellular carcinoma worldwide. Studies have shown that the basal core protein (BCP) and precore protein (PC) of HBV play a significant role in HBV-related carcinogenesis. There is a paucity of data on the type and effect of BCP and PC mutations in Nigeria. This study aims to genotype HBV and investigate any mutations within the BCP and PC among HBV patients in Ibadan, Nigeria. Methods. Forty HBV-DNA-positive patients were recruited into this study, and the viral load assay and genotyping by nested multiplex PCR were done. The partial X gene region was amplified and Sanger sequenced. The BPC and PC genomic regions were then analysed using bioinformatics. Results. Twenty-three participants recorded HBV DNA viral load of >20 000 IU, while 17 had <20 000 IU and 28 samples were genotyped. Five genotypes (A, B, C, D and E) and four mixed genotypes (AC, AD ACD and ABCD) were detected. Genotype AC was the most frequently encountered, while genotypes E and B were the least encountered. Mutation was highest in ages 34-45 years. Double mutation A1762T and G1764A within the BCP region was the most encountered mutation. Conclusions. We report a diverse HBV genetic landscape, with mixed infections between genotypes with BCP double-mutation A1762T/G1764A, signalling the likelihood of poor HBV-related liver disease prognosis. Our findings contribute to our understanding of the molecular characteristics of HBV and its potential implications for disease progression and management among HBV-infected Nigerians.

背景。乙型肝炎病毒(HBV)是导致全球严重肝病和肝细胞癌的最主要原因。研究表明,乙型肝炎病毒的基础核心蛋白(BCP)和前核心蛋白(PC)在乙型肝炎病毒相关致癌过程中发挥着重要作用。有关尼日利亚 BCP 和 PC 突变的类型和影响的数据很少。本研究旨在对尼日利亚伊巴丹的 HBV 患者进行基因分型,并调查 BCP 和 PC 是否存在突变。研究方法本研究招募了 40 名 HBV DNA 阳性患者,通过巢式多重 PCR 进行病毒载量检测和基因分型。对部分 X 基因区进行了扩增和 Sanger 测序。然后利用生物信息学对 BPC 和 PC 基因组区域进行分析。结果23 名参与者的 HBV DNA 病毒载量大于 20 000 IU,17 名有结论。我们报告了一个多样化的 HBV 遗传景观,BCP 双突变 A1762T/G1764A 基因型之间存在混合感染,这预示着 HBV 相关肝病预后不良的可能性。我们的研究结果有助于我们了解 HBV 的分子特征及其对尼日利亚 HBV 感染者疾病进展和管理的潜在影响。
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引用次数: 0
Erysipelothrix rhusiopathiae-associated bloodstream infection in a patient with systemic lupus erythematosus: a case report and literature review. 一名系统性红斑狼疮患者的红斑狼疮相关血流感染:病例报告和文献综述。
Pub Date : 2024-11-06 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000881.v3
Calvin Ka-Fung Lo, Cole Schonhofer, Neil Mina, Shazia Masud, Patrick Ho Pun Wong, Michael G Chapman

Introduction. Systemic human infections caused by Erysipelothrix rhusiopathiae have been increasingly reported especially within immunocompromised hosts and those with significant occupational exposure to livestock and aquatic animals. We report a case of E. rhusiopathiae bacteraemia in a patient with systemic lupus erythematosus (SLE) and present a literature review on clinical outcomes and microbiologic diagnosis for this organism. Casepresentation. A 43-year-old female patient was reporting a 1-month history of intermittent fevers. She recently increased her immunosuppression medication for her underlying SLE on the advice of her rheumatologist. The patient sustained a finger laceration from butchering cattle meat 2 weeks after the onset of her initial symptoms, with worsening index finger swelling and increased febrile episodes. Two weeks post-injury, multiple blood cultures were drawn, and each isolated Gram-positive bacilli. Given her recurrent intermittent fevers, there was a concern for ongoing infection, and therefore, intravenous vancomycin was started with prompt referral to an outpatient parenteral antibiotic therapy clinic. The Gram-positive bacillus was confirmed as E. rhusiopathiae via matrix-assisted laser desorption/ionization-time of flight analysis. Given intrinsic resistance to vancomycin, vancomycin was switched to intravenous ceftriaxone as targeted antimicrobial therapy for 2 weeks. Reassuringly, there was no echocardiographic evidence of infective endocarditis, warranting the prolonged treatment course. Post-treatment, she remained symptom-free with the resolution of joint symptoms and fevers. Conclusion. Our report illustrates a case of E. rhusiopathiae bacteraemia from an immunodeficient host, with prompt microbiologic diagnosis and intervention with appropriate antimicrobial coverage. Literature reflects the rarity of this infection, predilections to specific susceptible hosts and the importance of raising awareness of zoonotic infections.

导言。由红斑狼疮埃希氏菌(Erysipelothrix rhusiopathiae)引起的人类系统性感染的报道越来越多,尤其是在免疫力低下的宿主和大量接触家畜和水生动物的职业人群中。我们报告了一例系统性红斑狼疮(SLE)患者的红斑狼疮菌血症病例,并对该病菌的临床结果和微生物学诊断进行了文献综述。病例介绍。一名 43 岁的女性患者报告有 1 个月的间歇性发热病史。在风湿免疫科医生的建议下,她最近增加了治疗系统性红斑狼疮的免疫抑制药物。最初症状出现两周后,患者在屠宰牛肉时手指被撕裂,食指肿胀加重,发热次数增多。受伤两周后,她进行了多次血液培养,每次都分离出革兰氏阳性杆菌。鉴于她反复出现间歇性发烧,人们担心她会受到持续感染,因此开始静脉注射万古霉素,并迅速转诊到门诊肠外抗生素治疗诊所。通过基质辅助激光解吸/电离飞行时间分析,确认该革兰氏阳性杆菌为红细胞埃希氏菌。考虑到万古霉素的内在耐药性,患者改用静脉注射头孢曲松作为靶向抗菌治疗,疗程为两周。令人欣慰的是,没有出现感染性心内膜炎的超声心动图证据,因此延长了治疗疗程。治疗后,她仍无症状,关节症状和发热均已缓解。结论我们的报告展示了一例免疫缺陷宿主的红腹水杆菌菌血症病例,该病例得到了及时的微生物学诊断和适当的抗菌药物干预。文献反映了这种感染的罕见性、对特定易感宿主的偏好以及提高对人畜共通感染认识的重要性。
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引用次数: 0
Genome sequencing and analysis of Salmonella enterica subsp. enterica serotype Enteritidis PT4 578: insights into pathogenicity and virulence. 肠炎沙门氏菌亚种血清型肠炎PT4 578的基因组测序和分析:致病性和毒力研究。
Pub Date : 2024-11-04 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000828.v3
Deisy G Carneiro, Pedro Marcus P Vidigal, Túlio Morgan, Maria Cristina D Vanetti

Salmonella enterica serotype Enteritidis is a generalist serotype that adapts to different hosts and transmission niches. It has significant epidemiological relevance and is among the most prevalent serotypes distributed in several countries. Salmonella Enteritidis causes self-limited gastroenteritis in humans, which can progress to systemic infection in immunocompromised individuals. The Salmonella pathogenicity mechanism is multifactorial and complex, including the presence of virulence factors that are encoded by virulence genes. Poultry products are considered significant reservoirs of many Salmonella serotypes, and Salmonella Enteritidis infections are often related to the consumption of chicken meat and eggs. This study reports the whole-genome sequence of Salmonella Enteritidis PT4 strain 578. A total of 165 genes (3.66%) of the 4506 coding sequences (CDS) predicted in its genome are virulence factors associated with cell invasion, intestinal colonization, and intracellular survival. The genome harbours twelve Salmonella pathogenicity islands (SPIs), with the SPI-1 and SPI-2 genes encoding type III secretion systems (T3SS) showing high conservation. Six prophage-related sequences were found, with regions of intact prophages corresponding to Salmon_118970_sal3 and Gifsy-2. The genome also contains two CRISPR systems. Comparative genome analysis with Salmonella Enteritidis ATCC 13076, Salmonella Typhimurium ATCC 13311, and Salmonella Typhimurium ATCC 14028 demonstrates that most unshared genes are related to metabolism, membrane, and hypothetical proteins. Finally, the phenotypic characterization evidenced differences among Salmonella Enteritidis PT4 578 and the other three serotypes regarding the expression of the red, dry, and rough (rdar) morphotype and biofilm formation. Overall, the genomic characterization and phenotypic properties expand knowledge of the mechanisms of pathogenicity in Salmonella Enteritidis PT4 578.

肠炎沙门氏菌血清型 Enteritidis 是一种适应不同宿主和传播环境的通用血清型。它具有重要的流行病学意义,是分布在多个国家最普遍的血清型之一。肠炎沙门氏菌会引起人类自限性胃肠炎,免疫力低下的人可能会发展为全身感染。沙门氏菌的致病机制是多因素和复杂的,包括存在由致病基因编码的致病因子。禽类产品被认为是多种沙门氏菌血清型的重要储库,肠炎沙门氏菌感染通常与食用鸡肉和鸡蛋有关。本研究报告了肠炎沙门氏菌 PT4 578 株的全基因组序列。在其基因组预测的 4506 个编码序列(CDS)中,共有 165 个基因(3.66%)是与细胞入侵、肠道定植和细胞内存活相关的毒力因子。基因组中包含 12 个沙门氏菌致病性岛(SPI),其中 SPI-1 和 SPI-2 基因编码 III 型分泌系统(T3SS),显示出高度的保守性。发现了 6 个噬菌体相关序列,其中完整的噬菌体区域与 Salmon_118970_sal3 和 Gifsy-2 相对应。该基因组还包含两个 CRISPR 系统。与肠炎沙门氏菌 ATCC 13076、伤寒沙门氏菌 ATCC 13311 和伤寒沙门氏菌 ATCC 14028 的基因组比较分析表明,大多数未共享基因与代谢、膜和假定蛋白有关。最后,表型特征显示,肠炎沙门氏菌 PT4 578 和其他三个血清型在红色、干燥和粗糙(rdar)形态表达和生物膜形成方面存在差异。总之,基因组特征和表型特性扩展了对肠炎沙门氏菌 PT4 578 致病机制的认识。
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引用次数: 0
Salmonella Weltevreden lung abscess and empyema without preceding gastrointestinal symptoms: an emerging pathogen in Australia? Weltevreden 沙门氏菌引起的肺脓肿和肺水肿,之前无胃肠道症状:澳大利亚新出现的病原体?
Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000635.v3
Victoria Grey, Ernest Tee, Lauren Phillips, Gino Micalizzi, Mark Armstrong

Non-typhoidal Salmonella lung infections are rare and are usually confined to immunocompromised hosts. Previous case reports have found that usually patients have either gastroenteritis or bacteraemia in addition to pulmonary involvement. We present the first known reported case of a Salmonella Weltevreden lung abscess and empyema in an immunocompetent patient without gastroenteritis. Despite the use of antimicrobials active against the pathogen, the patient needed surgical intervention to achieve adequate source control. While S. Weltevreden has previously been associated with returned travellers, especially from Southeast Asia, its incidence in Queensland is now increasing. Therefore, it is important for clinicians to be aware of its potential severity as well as the range of presentations.

非伤寒沙门氏菌肺部感染非常罕见,通常仅限于免疫力低下的宿主。以往的病例报告发现,患者除肺部受累外,通常还伴有胃肠炎或菌血症。我们报告的这例病例是首例免疫功能正常、无肠胃炎的韦尔特弗雷登沙门氏菌肺脓肿和肺水肿病例。尽管使用了对该病原体有效的抗菌药物,但患者仍需要进行外科手术才能实现充分的病源控制。韦尔泰夫雷登氏杆菌以前一直与回国旅行者有关,尤其是来自东南亚的旅行者,但现在它在昆士兰州的发病率正在上升。因此,临床医生必须意识到其潜在的严重性和表现范围。
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引用次数: 0
Corynebacterium amycolatum peritonitis in a patient undergoing peritoneal dialysis: case report and literature review. 一名腹膜透析患者的淀粉样棒状杆菌腹膜炎:病例报告和文献综述。
Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000880.v3
Fatima Zahra Adil, Imane Aragon, Elmostafa Benaissa, Yassine Ben Lahlou, Fatna Bssaibis, Adil Maleb, Mariama Chadli, Mostafa Elouennass

Peritoneal dialysis is a blood purification technique used in cases of end-stage chronic kidney failure, based on the filtering capabilities of the peritoneum. Infections, often caused by poor asepsis during catheter manipulation, are generally attributed to Staphylococcus epidermidis and Staphylococcus aureus. Corynebacterium, usually considered non-pathogenic, is rarely involved in these infections. We present a case of peritonitis due to Corynebacterium amycolatum in a patient undergoing peritoneal dialysis. The diagnosis was made based on cytobacteriological examination of the dialysate fluid, which on two occasions showed high levels of white blood cells with a predominance of neutrophilic polymorphonuclear and a monomorphic appearance of colonies on agar medium, whose identification by biochemical tests and antibiotic sensitivity study confirmed the presence of C. amycolatum. The patient was successfully treated with vancomycin, resulting in symptom resolution and sterilization of the dialysate fluid. Although rare, the involvement of Corynebacterium species underscores the importance of confirming its pathogenicity. Further studies are needed to better understand the epidemiology of these infections and guide future treatments. This case also highlights the need for a rigorous approach to confirming the pathogenicity of Corynebacterium despite its traditional classification as a contaminant.

腹膜透析是一种基于腹膜过滤功能的血液净化技术,用于治疗终末期慢性肾衰竭。感染通常是由于导管操作过程中无菌操作不当引起的,一般由表皮葡萄球菌和金黄色葡萄球菌引起。通常被认为不具致病性的棒状杆菌很少参与这些感染。我们报告了一例正在接受腹膜透析的患者因淀粉样棒状杆菌引起的腹膜炎。诊断是根据透析液的细胞细菌学检查做出的,透析液中两次出现高浓度白细胞,其中以中性多形核为主,琼脂培养基上的菌落呈单形。患者成功接受了万古霉素治疗,症状得到缓解,透析液也得到消毒。虽然罕见,但棒状杆菌的参与强调了确认其致病性的重要性。要更好地了解这些感染的流行病学并指导未来的治疗,还需要进一步的研究。本病例还突出表明,尽管传统上把棒状杆菌归类为污染物,但仍需要采用严格的方法来确认其致病性。
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引用次数: 0
Bloodstream infections in cancer patients in central India: pathogens and trends of antimicrobial resistance over a 5-year period. 印度中部癌症患者的血流感染:5 年间的病原体和抗菌药耐药性趋势。
Pub Date : 2024-10-29 eCollection Date: 2024-01-01 DOI: 10.1099/acmi.0.000673.v5
Sonali Choudhari, Ruchita Gawande, Jerestin Watchmaker, Pooja Bamnote, Pradeep Mishra, Pankaj Dwivedi
<p><p><b>Introduction.</b> Bloodstream infection (BSI) is a common complication with a high fatality rate in cancer patients. There are notable variations in the epidemiology of BSI over time and among different countries. Infections due to multidrug-resistant organisms (MDROs) such as extended-spectrum beta-lactamases (ESBLs) and carbapenem-resistant <i>Enterobacteriaceae</i> (CRE) are increasing. This may lead to inadequate empirical antibiotic therapy, increasing the antimicrobial resistance (AMR) problem and unfavourable outcomes in these immunocompromised patients. There is paucity of data pertaining to AMR in such vulnerable patients from developing countries such as India. The aim of this study was to investigate the distribution of the bacterial pathogens causing BSI and the AMR trend in cancer patients in central India. <b>Methodology.</b> This single-centre retrospective observational study was conducted in a tertiary care cancer hospital. Patients with solid organ and haematological malignancies, both adults and paediatric, who had blood cultures sent to the microbiology laboratory from January 2018 to December 2022 were included. Blood cultures were processed using the BacT/ALERT 3D system (bioMérieux, France), and the identification of the bacteria and their antimicrobial susceptibility (AST) was performed using the Vitek 2 compact system (bioMérieux, France). Electronic medical records and microbiology lab records were used to retrieve the demographic and microbiological data. Microsoft Excel (RRID:SCR_016137) was used to enter and tabulate the data. Statistical analysis was performed using SPSS version 29 (RRID:SCR_002865). <b>Results.</b> A total of 687 isolates from 524 patients were studied. Gram-negative bacteria (64%) were the commonest cause of BSI in the studied patients, followed by Gram-positive cocci (25%) and fungal isolates (9%). Ten cases were polymicrobial. <i>Escherichia coli</i> (<i>n</i>=140) was the most common among the isolated pathogens, followed by <i>Klebsiella</i> species (<i>n</i>=103), <i>Pseudomonas</i> species (<i>n</i>=102), and coagulase-negative staphylococci (CONS) (<i>n</i>=92). Among the 140 isolates of <i>E. coli</i>, 66% were extended-spectrum β-lactamase (ESBL) producers and 26% were resistant to carbapenem. Among the 103 isolated <i>Klebsiella</i> species, 50% were carbapenem resistant and 36% were ESBL producers. Among enterobacterales, the CRE rate was 34%. Carbapenem resistance was seen in 25% of <i>Pseudomonas</i> species and 53% of <i>Acinetobacter</i> species isolates. <i>Klebsiella</i> species were the most resistant pathogens isolated. CONS comprised 56% of all Gram-positive isolates, followed by <i>Staphylococcus aureus</i> (36%), enterococci species (11%), and streptococci species (3%). Methicillin resistance was 60% in CONS and 64% in <i>S. aureus</i>. One vancomycin-resistant enterococcus was isolated. Non-<i>albicans Candida</i> was the most common fungal pathogen. The sensitivity
简介血流感染(BSI)是癌症患者常见的并发症,致死率很高。不同时期和不同国家的 BSI 流行病学存在明显差异。耐多药生物(MDRO),如广谱β-内酰胺酶(ESBL)和耐碳青霉烯类肠杆菌科细菌(CRE)引起的感染正在增加。这可能会导致经验性抗生素治疗不足,增加抗菌药耐药性(AMR)问题,对这些免疫力低下的患者造成不利影响。在印度等发展中国家,有关此类易感患者的抗菌药物耐药性的数据十分匮乏。本研究旨在调查印度中部地区癌症患者中引起 BSI 的细菌病原体的分布情况和 AMR 趋势。研究方法。这项单中心回顾性观察研究在一家三级癌症医院进行。研究纳入了2018年1月至2022年12月期间将血液培养物送至微生物实验室的实体器官和血液恶性肿瘤患者,包括成人和儿童。使用 BacT/ALERT 3D 系统(法国生物梅里埃公司)处理血液培养物,并使用 Vitek 2 紧凑型系统(法国生物梅里埃公司)鉴定细菌及其抗菌药物敏感性(AST)。电子病历和微生物实验室记录用于检索人口统计学和微生物学数据。使用 Microsoft Excel (RRID:SCR_016137) 输入数据并制成表格。统计分析使用 SPSS 29 版 (RRID:SCR_002865) 进行。结果共研究了来自 524 名患者的 687 个分离菌株。革兰氏阴性菌(64%)是导致 BSI 的最常见原因,其次是革兰氏阳性球菌(25%)和真菌分离物(9%)。其中有 10 例为多微生物感染。在分离出的病原体中,最常见的是大肠埃希菌(n=140),其次是克雷伯菌(n=103)、假单胞菌(n=102)和凝固酶阴性葡萄球菌(CONS)(n=92)。在分离出的 140 株大肠埃希菌中,66% 产生广谱 β-内酰胺酶(ESBL),26% 对碳青霉烯类耐药。在 103 个分离出的克雷伯氏菌中,50%对碳青霉烯类耐药,36%产生 ESBL。在肠杆菌中,CRE 的比率为 34%。25%的假单胞菌和53%的醋氨梭菌分离菌株对碳青霉烯类耐药。克雷伯菌是分离出的耐药性最强的病原体。在所有革兰氏阳性分离菌中,CONS 占 56%,其次是金黄色葡萄球菌(36%)、肠球菌(11%)和链球菌(3%)。甲氧西林耐药性在 CONS 中占 60%,在金黄色葡萄球菌中占 64%。分离出一种耐万古霉素肠球菌。非大肠念珠菌是最常见的真菌病原体。非阿氏念珠菌对氟康唑的敏感率为 84%,只有一例白念珠菌对氟康唑产生耐药性。5 年间,病原体的变化趋势并不明显,最常见的是革兰氏阴性菌。此外,5 年来 ESBL 和 CRE 耐药模式的趋势也没有明显变化。结论革兰氏阴性菌是 BSI 中最常见的病原体,癌症患者的抗菌药耐药率较高。34%的CRE耐药率令人担忧,限制了经验性抗生素治疗的选择。
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