Lack of effect of shorter turnaround time of microbiological procedures on clinical outcomes: a randomised controlled trial among hospitalised patients in the NetherlandsBruins, M.; Oord, H.; Bloembergen, P.; Wolfhagen, M.; Casparie, A.; Degener, J.; Ruijs, G.
doi: 10.1007/s10096-005-1309-7pmid: 15834750
Shortening the turnaround time of microbiological procedures was associated with an improved clinical outcome in two studies performed in the USA. To study the clinical impact of a shortened turnaround time in a northwest European setting in which an automated system was used for bacterial identification and susceptibility testing, a single-blind, prospective, randomised controlled trial was conducted in a hospital in the Netherlands. All hospitalised patients with a bacterial infection confirmed by culture were randomly assigned to a control (conventional) group or an intervention (rapid) group. Overnight methods were used for identification and susceptibility testing in the control group, while the Vitek 2 system (bioMérieux, Marcy l’Etoile, France) was used in the rapid group. In each of three consecutive study periods, accelerating factors were added progressively to the laboratory workflow of the rapid group to increase same-day reporting, whereas methods remained identical in the conventional group. The turnaround time of the microbiological cycle using the Vitek 2 system as compared to conventional methods was studied and the clinical impact of a shortened turnaround time assessed in terms of mortality, morbidity, and cost. For the rapid groups, the turnaround time was significantly shorter for oral reporting of final susceptibility results in all three study periods and for reporting on paper in the third study period. There was no significant difference between groups in any of the clinical impact variables. Vitek 2 results were available for reporting significantly earlier as compared to conventional testing. For the overall patient group in our hospital setting, however, this had no clinical impact.
Involvement of adenovirus in clinical mononucleosis-like syndromes in young childrenMelón, S.; Méndez, S.; Iglesias, B.; Boga, J.; Rodríguez, M.; Fanjul, J.; Méndez, F.; Oña, M.
doi: 10.1007/s10096-005-1333-7pmid: 15891915
Although Epstein-Barr virus (EBV) commonly causes infectious mononucleosis (IM) or IM-like syndromes, other agents can be implicated. In this study, viral and parasitic screening was performed to determine the etiological agent of pediatric IM-like syndromes in 38 children. Adenovirus was the agent most frequently detected (47.3%), followed by EBV (31.5%) and cytomegalovirus (2.6%). Although the statistically significant difference between viral detection rates observed in patients who fulfilled clinical and hematological criteria and detection rates in those who presented clinical symptoms only (91.6% vs. 64.3%) indicates that hematological abnormalities are common in viral IM-like syndromes, the existence of syndromes of viral etiology without hematological criteria cannot be discarded. A further analysis showed an absence of lymphocytosis in adenovirus infections as well as a low number (14.3%) of EBV infections associated with increased neutrophils. These data suggest the usefulness of appropriate virological techniques for the detection of adenovirus in pediatric IM-like syndromes.
Clostridium clostridioforme: a mixture of three clinically important speciesFinegold, S.; Song, Y.; Liu, C.; Hecht, D.; Summanen, P.; Könönen, E.; Allen, S.
doi: 10.1007/s10096-005-1334-6pmid: 15891914
Clostridium clostridioforme shows much variability in phenotypic and antimicrobial susceptibility tests, suggesting it may be more than a single species even though all strains share unique morphology. This study was designed to determine if there are multiple species and, if so, to demonstrate the differences that exist between them. A total of 107 strains of C. clostridioforme were investigated by sequencing of the 16S rRNA gene, phenotypic studies, and antimicrobial susceptibility testing. In addition, clinical data from patients whose infections yielded an organism identified as C. clostridioforme was reviewed. Data from the above studies revealed three principal species in what has been called C. clostridioforme: Clostridium bolteae, C. clostridioforme, and Clostridium hathewayi. Each species may be distinguished by certain phenotypic tests. All three species were involved in infections, including bacteremia. C. clostridioforme appears to be associated with more serious or invasive human infections than the other two species in the group. Resistance to penicillin G is common and is due to β-lactamase production. Resistance to clindamycin and moxifloxacin is also seen. The three species differ in terms of virulence and antimicrobial resistance. “C. clostridioforme” actually represents three distinct species that are different in terms of 16S rRNA sequences, phenotypic characteristics, and antimicrobial susceptibility. It is important for microbiology laboratories to distinguish between these species and for clinicians to be aware of the differences between them.
Candida species distribution in bloodstream cultures in Lyon, France, 1998–2001Martin, D.; Persat, F.; Piens, M.-A.; Picot, S.
doi: 10.1007/s10096-005-1321-ypmid: 15856138
In order to determine the types of Candida spp. isolated from bloodstream cultures in Lyon, France, a retrospective study of isolates collected at five different bacteriology laboratories from 1998 to 2001 was conducted. During this period Candida spp. were isolated from 190 patients hospitalized in the internal medicine (32%), hematology (23%) and surgery (23%) wards, and in intensive care units (22%). C. albicans was the leading cause of Candida infection (49.5%), followed by C. glabrata (12.6%) and C. parapsilosis (12.1%). Among the onco-hematology patients, the major cause of candidemia was C. krusei (34%), followed by C. albicans (19%), while these two species were identified in 4% and 59% of patients in the other wards, respectively. In the single onco-hematology ward that was specialized in treating acute myeloid leukemia, 14 C. krusei isolates were identified in this study, which contrasts with the single C. krusei isolate recorded between 1992 and 1996. Since C. krusei has inherent resistance to the antifungal agent fluconazole, prophylactic use of fluconazole in these patients was investigated, but no relationship between these two parameters was found.
Isolation of Mycoplasma hominis from extragenital culturesMiranda, C.; Camacho, E.; Reina, G.; Turiño, J.; Rodríguez-Granger, J.; Yeste, R.; Bautista, M.; García, M.; Alados, J.; Rosa, M.
doi: 10.1007/s10096-005-1326-6pmid: 15868155
In order to document the characteristics of extragenital Mycoplasma hominis infections, the clinical features of 36 cases in which M. hominis was isolated from extragenital sites of adult patients were reviewed. In most cases, the organism was detected in conventional bacterial cultures (from specimens obtained from surgical and immunosuppressed patients) that had been incubated for at least 72 h. The results indicate that in cases in which M. hominis involvement is suspected, prolonged incubation or specialized microbiological techniques for detecting Mycoplasma spp. should be employed.
An outbreak of Q fever in an urban area in IsraelOren, I.; Kraoz, Z.; Hadani, Y.; Kassis, I.; Zaltzman-Bershadsky, N.; Finkelstein, R.
doi: 10.1007/s10096-005-1324-8pmid: 15868156
Reported here is an outbreak of 21 cases of Q fever that were diagnosed during 5 months in the spring and summer of 2001 at Rambam Medical Center, Haifa, Israel. An epidemiological investigation and a case-control study were conducted to identify risk factors associated with acquisition of the disease in this outbreak. Patients were more likely than controls to live in Krayot (a large suburb of Haifa) (76.2% vs. 41.5%; p=0.005), to have more contact with animals (usually pets) (66.7% vs. 26.9%; p=0.007), and to consume more unpasteurized dairy products (23.8% vs. 0%; p=0.01). The Krayot suburb is an entirely urban area, but several livestock facilities are located in its close vicinity, and some of them have been reported to harbor Q fever. Although the patients did not recall having had direct contact with farm animals, the results suggest the presence of livestock facilities in such close proximity to a residential area may cause urban outbreaks of Q fever.
Bibliometric analysis of global trends for research productivity in microbiologyVergidis, P.; Karavasiou, A.; Paraschakis, K.; Bliziotis, I.; Falagas, M.
doi: 10.1007/s10096-005-1306-xpmid: 15834594
In order to expand upon the limited literature estimating the quantity and quality of worldwide research production in the field of microbiology, a bibliometric analysis was conducted for the period 1995–2003 using the PubMed and Journal Citation Reports databases. By searching the “microbiology” category of the Journal Citation Reports database, a total of 74 journals were identified that were also included in PubMed. From these journals, a total of 89,527 articles were identified for analysis, and data on the country in which the research originated was available for 88,456 (98.8%) of them. The individual countries were separated into nine world regions. In terms of research production for the period studied, Western Europe exceeded all other world regions, with the USA ranking second. The mean impact factor was highest for the USA at 3.4, while it was 2.8 for Western Europe and 2.4 for the rest of the world combined. The research productivity per unit of expenditure for research and development was higher for Canada and Western Europe than for the USA. The three regions in which research productivity increased the most were Asia, Latin America, and Eastern Europe.
A case of Aspergillus mediastinitis after heart transplantation successfully treated with liposomal amphotericin B, caspofungin and voriconazoleForestier, E.; Remy, V.; Lesens, O.; Martinot, M.; Hansman, Y.; Eisenmann, B.; Christmann, D.
doi: 10.1007/s10096-005-1327-5pmid: 15889298
Reported here is a case of mediastinitis caused by Aspergillus fumigatus and Staphylococcus epidermidis following a heart transplantation that was successfully treated with amphotericin B in combination with new antifungal drugs (caspofungin and voriconazole), antibiotics and superficial wound drainage. A review of the literature revealed that Aspergillus as a cause of mediastinitis has been rarely described. In the few existing reports, evolution was generally fatal, especially in immunocompromised patients, despite treatment with antifungal drugs and surgery.