Are New beta-Lactam/beta-Lactamase Inhibitors Viable Carbapenem Sparing Options for Treating Serious Infections Caused by Extended-Spectrum beta-Lactamase-Producing Microorganisms?
Infectious Diseases; Immunology; escherichia-coli; susceptibility; cephalosporins
Kallstrom G
Infectious Diseases in Clinical Practice
2019
2019-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ipc.0000000000000729" target="_blank" rel="noreferrer noopener">10.1097/ipc.0000000000000729</a>
Streptococcus bovis Group Bacteremia in the 21st Century Review of 42 Episodes Over a 12-Year Period (2006-2017) at a Large Community Teaching Hospital
association; bacteremia; colonic neoplasia; consultation; endocarditis; identification; Immunology; Infectious Diseases; liver-disease; lutetiensis; mortality; Streptococcus; Streptococcus bovis group; Streptococcus gallolyticus; Streptococcus infantarius; Streptococcus pasteurianus; update
Introduction Advanced phenotypic, genomic, and proteomic laboratory techniques have recently modified Streptococcus bovis group (SBG) nomenclature. We wished to determine if physicians continue to recognize the importance of SBG and its association with gastrointestinal (GI) tract abnormalities and infective endocarditis amid the changes in microbiologic identification and nomenclature of these organisms. Methods We reviewed the medical records of adult patients (>= 18 years of age) with positive blood cultures for SBG organisms admitted to our 510-bed teaching hospital from January 1, 2006, to December 31, 2017. We report the epidemiology, sources of bacteremia, comorbid conditions, courses of treatment, and the mortality for these patients. We also assess the hospital treatment team's (HTT's) knowledge of SBG nomenclature and of the associations of SBG bacteremia and underlying GI disease and infective endocarditis amid the changes in nomenclature of these organisms. Results There were 42 cases of SBG bacteremia during the 12-year study period: 22 in women (52.4%) and 20 in men (47.6%). Patient ages ranged from 51 to 96 years (mean age, 74.3 years; median age, 72.0 years). All but 2 patients had multiple comorbid conditions. Diabetes mellitus was the most common comorbidity. Colonoscopy was performed during hospitalization in 22 (52.5%) of 42 patients. The identifiable sources of bacteremia were as follows: lower GI tract in 19 patients (45.2%), upper GI tract in 5 patients (11.9%), Laennec cirrhosis in 3 patients (7.1%), and pancreatic disorders in 2 patients (4.6%). Eleven patients (26.2%) had primary bacteremia. Two patients with primary bacteremia had prior splenectomy. The historic association between SBG bacteremia and underlying GI tract disease was recognized by 37 (88.1%) of 42 HTTs, but all available provider progress notes mention only "colon carcinoma" as the possibly associated GI tract pathology. The historic association of SBG bacteremia with infective endocarditis was recognized in writing by 32 (76.2%) of 42 HTTs. Endocarditis was diagnosed in 12 patients (28.6%): 9 definite endocarditis and 3 possible endocarditis. The mitral valve was the most commonly involved valve. Four SBG isolates were intermediately susceptible to penicillin G with minimum inhibitory concentrations of 0.125 mu g/mL or greater. Twenty-three (54.8%) of 42 SBG strains were resistant or intermediately susceptible to clindamycin. Twenty-four (57.1%) of 42 strains were resistant or intermediately susceptible to erythromycin. All strains were tested for susceptibility to ceftriaxone and vancomycin and retained susceptibility to both antimicrobial agents throughout the study period. Six of 42 patients died, for a mortality rate of 11.9%. Infectious disease consultation was obtained in 35 (80.0%) of 42 patients. Infectious disease consultation was positively associated with survival (P = 0.0041, Fisher exact test). The new nomenclature schemes for prior members of the SBG were recognized by all HTTs because our microbiology laboratory reported each member of the group, regardless of new name, with "bovis group" added to the identification on all positive culture reports. Conclusions Streptococcus bovis group bacteremia is a disease of older adults with all but 3 patients 60 years or older and a mean age at onset of 73.4 years. Most HTTs considered colon carcinoma as a possible source for and infective endocarditis as a potential complication of SBG bacteremia. However, most HTTs were not aware that SBG bacteremia could be associated with nonmalignant colonic lesions especially polyps, Laennec cirrhosis, or with pancreatic, biliary, and upper GI tract anatomic abnormalities. Of our SBG isolates, 54.8% were not sensitive to clindamycin. Clindamycin should not be used for empiric treatment of SBG bacteremia. The ID service should be consulted on all patients with SBG bacteremia because such consultation had a positive correlation with patient survival (P = 0.0041).
Sidda A; Kallstrom G; Myers J P
Infectious Diseases in Clinical Practice
2019
2019-01
Journal Article
<a href="http://doi.org/10.1097/ipc.0000000000000690" target="_blank" rel="noreferrer noopener">10.1097/ipc.0000000000000690</a>
Streptococcus Pyogenes Bacteremia In Adults In The 21st Century: Review Of 68 Episodes Over 10-year Period In A Large Community Teaching Hospital
bacteremia; children; epidemic; group A Streptococcus; Immunology; Infectious Diseases; medical-center; Streptococcus pyogenes; vaginal carrier; wound infections
BackgroundStreptococcus pyogenes causes pharyngitis, tonsillitis, cellulitis, and less frequently other clinical syndromes. It is infrequently included in the differential diagnosis of other infectious illnesses. Methods We reviewed the medical records of all adult patients (16 years of age and older) with S. pyogenes bacteremia admitted to our institution during the 10 years from January 1, 2007, to December 31, 2016. We report the epidemiology, source of infection, comorbid conditions, treatment, and mortality for these patients. Results There were 68 cases of S. pyogenes bacteremia during the study period. There were 27 episodes in men (39.7%) and 41 episodes in women (60.3%). The patients' ages ranged from 17 to 91 years with a mean of 58.1 years and a median of 59.5 years. Skin and soft tissue infections with or without necrotizing fasciitis were the most common presentation followed by primary bacteremia, pneumonia, septic bursitis/arthritis, obstetric/gynecologic, and head/neck infections. All strains of S. pyogenes tested during the study period maintained sensitivity to penicillin G. Diabetes mellitus was the most common comorbid condition. Seven of 68 patients died for a mortality rate of 10.3%. Conclusions Bacteremic S. pyogenes infections continue to be a significant clinical problem years into the 21st century. Resident physicians, hospitalists, intensivists, and surgeons should be keenly aware of this information and understand the potential consequences of unrecognized, rapidly progressive group A streptococcal infection. Emergent surgical intervention remains essential to the survival of many of these patients.
Hupp J A; Kallstrom G; Myers J P
Infectious Diseases in Clinical Practice
2018
2018-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/ipc.0000000000000560" target="_blank" rel="noreferrer noopener">10.1097/ipc.0000000000000560</a>