European Journal of Clinical Microbiology & Infectious Diseases

Hübner, N.-O.; Assadian, O.; Grohmann, S.; Diab-Elschahawi, M.; Kramer, A.

doi: 10.1007/s10096-010-1085-xpmid: 21604206

Alcohol-based skin antiseptics are recommended with a minimum application time of 10 min on skin containing high numbers of sebaceous glands. In clinical practice, a 10-min application time is often too long. Therefore, we determined the efficacy of skin antiseptics on the forehead and lower back using shorter application times. Five alcoholic solutions were tested in a double-blind trial for their colony-forming units (cfu) reduction after 3, 4, 5 and 10 min on the forehead of 20 healthy volunteers and the lower back of 10 healthy volunteers and 10 patients against the reference alcohol 70% propan-2-ol, 10 min. After an application time of 3 min, 3/5 (forehead) and 5/5 (lower back) preparations were at least equally as effective compared to the reference alcohol and an application time of 10 min. Alcohol-based skin antiseptics do not require a 10-min application time. For all of the tested antiseptics, a minimum application time of 3 min on sebaceous skin can be recommended.

Limper, M.; Kruif, M.; Ajubi, N.; Zanten, A.; Brandjes, D.; Duits, A.; Gorp, E.

doi: 10.1007/s10096-010-1150-5pmid: 21594556

Procalcitonin (PCT) has been shown to be of additional value in the work-up of a febrile patient. This study is the first to investigate the additional value of PCT in an Afro-Caribbean febrile population at the emergency department (ED) of a general hospital. Febrile patients were included at the ED. Prospective, blinded PCT measurements were performed in patients with a microbiologically or serologically confirmed diagnosis or a strongly suspected diagnosis on clinical grounds. PCT analysis was performed in 93 patients. PCT levels differentiated well between confirmed bacterial and confirmed viral infection (area under the curve [AUC] of 0.82, sensitivity 85%, specificity 69%, cut-off 0.24 ng/mL), between confirmed bacterial infection and non-infectious fever (AUC of 0.84, sensitivity 90%, specificity 71%, cut-off 0.21 ng/mL) and between all bacterial infections (confirmed and suspected) and non-infectious fever (AUC of 0.80, sensitivity 85%, specificity 71%, cut-off 0.21 ng/mL). C-reactive protein (CRP) levels were shown to be less accurate when comparing the same groups. This is the first study showing that, in a non-Caucasian febrile population at the ED, PCT is a more valuable marker of bacterial infection than CRP. These results may improve diagnostics and eventually decrease antibiotic prescriptions in resource-limited settings.

Dunais, B.; Bruno-Bazureault, P.; Carsenti-Dellamonica, H.; Touboul, P.; Pradier, C.

doi: 10.1007/s10096-011-1154-9pmid: 21611871

The antimicrobial resistance and serotype distribution of Streptococcus pneumoniae (SP) among children attending day-care centres in south-eastern France were monitored from 1999 to 2008, before and after interventions promoting prudent antibiotic use initiated in 2000 and the availability of pneumococcal conjugate vaccine in 2003. Antibiotic susceptibility and serotypes of SP isolates were determined on nasopharyngeal samples of children aged 3-40 months attending day-care centres, from January to March 1999, 2002, 2004, 2006 and 2008. SP carriage fell from 54% to 45%, and SP with diminished susceptibility to penicillin (PDSP) fell from 34% to 19%. Antibiotic prescriptions dropped from 63% to 38% of children, but third-generation cephalosporins were increasingly prescribed. The overall antibiotic susceptibility increased. Over 90% of the children had received at least one vaccine dose in 2008. Vaccine serotypes 6B, 9V, 19F and 23F (76%) in 1999 were replaced by non-vaccine types (95%) in 2008, among which were 15 (20%), 19A (15%), 23A/B (10%) and 6A (9%). Serotypes 6A, 19A and 15 accounted for over 50% of PDSP strains in 2008 versus 6% in 1999. Children now mostly harbour non-vaccine types; however, PDSP isolates are mainly recruited among these. Vaccine-related benefits may be threatened by combined vaccine- and antibiotic-driven selective pressure.

Cid, J.; García-Pardo, G.; Aguinaco, R.; Sánchez, R.; Llorente, A.

doi: 10.1007/s10096-011-1164-7pmid: 21249409

The purpose of this study was to evaluate the diagnostic accuracy and prognostic value of neutrophil CD64 expression for bacterial infection in febrile adult patients presenting to our hospital emergency department. We prospectively included 132 patients with fever ≥38ºC (≥100.4ºF) during the last 24 hours and we measured CD64 expression on neutrophils the day after admission at the emergency department. We followed the patients until full recovery or death. There were 115 (87%) patients with bacterial infection and 108 (94%) of them survived. There were 17 (13%) patients without bacterial infection and 12 (71%) of them survived. Patients with bacterial infection and patients who survived showed a CD64 index higher when compared with patients without bacterial infection and patients who died, respectively (3.7 ± 3.2 vs. 2.5 ± 2.3; p = 0.03; and 3.7 ± 3.1 vs. 1.7 ± 0.6; p =  0.002; Mann-Whitney U test). The receiver operating characteristic (ROC) curve analysis for detecting bacterial infection and predicting survival with the CD64 index showed an area under curve (AUC) of 0.66 (95% CI, 0.52–0.8; p = 0.03) and 0.71 (95% CI, 0.57–0.85; p = 0.01), respectively. Diagnostic accuracy and prognostic value of CD64 expression was good in adult patients with fever.

Liew, Y.; Chlebicki, M.; Lee, W.; Hsu, L.; Kwa, A.

doi: 10.1007/s10096-011-1165-6pmid: 21279532

Clinicians have used procalcitonin (PCT) (biomarker to differentiate bacterial from non-bacterial sepsis) to guide use of antibiotics in patients. As the data for utility of PCT to discontinue antibiotics in an antimicrobial stewardship program (ASP) are lacking, we aim to describe the outcomes of patients in whom PCT was used to discontinue antibiotics under our ASP. An antimicrobial stewardship (AS) team intervened to discontinue antibiotics in patients with persistent fever or leucocytosis, source of sepsis unknown or negative bacteriological cultures, who had completed an adequate course of antibiotic therapy and had a PCT of <0.5 μg/L. Main outcomes evaluated were 14-day re-infection, 30-day mortality and readmission. Antibiotic therapy was discontinued in 42 patients in 1 year. Unknown source of sepsis was found in 38% of the patients (including possible malignant fever) and culture-negative pneumonia was found in 21%. Two patients died of advanced cancer. One patient decided for comfort care and died one week later. One patient died due to a second episode of pneumonia 37 days after first PCT test. Six patients were readmitted within 30 days due to non-infectious causes. Three patients were readmitted due to culture-negative pneumonia. None had a 14-day re-infection. PCT used to discontinue antibiotics under our ASP did not compromise patients’ outcome.

Saiz de la Hoya, P.; Marco, A.; García-Guerrero, J.; Rivera, A.

doi: 10.1007/s10096-011-1166-5pmid: 21274586

Purpose The Prevalhep study seeks to determine the prevalence of factors associated with the hepatitis C (HCV) and B (HBV) virus in Spanish prisoners. Methods This was an observational, cross-sectional study which randomly selected 18 Spanish prisons to participate, with 21 prisoners per centre. Results There were 378 prisoners selected, 370 of whom had serological HCV and 342 had HBV data. The HCV population was predominantly male (91.6%), middle age (66.7% ≤ 40 years of age), of Spanish origin (60.5%), with a history of injection drug use (IDU; 23.2%), in prison <5 years (71.2%) and having entered prison after 2006 (51.9%). The prevalence of HCV was 22.7% (n = 84; 95% CI, 18.3–27.1) and HBV was 2.6% (n = 9; 95% CI, 0.2–4.9%). Of the patients with HCV, 40.5% were co-infected with HIV, 0.3% co-infected with HBV, and 1.5% with triple virus co-infection (HBV + HCV + HIV). The three markers of HB had been measured in 99 inmates: 32.1% had post-vaccination immunity (antiHBS+) and 30.4% contact status with HBV (HBcAb + and/or HBsAg+), while 37.5% were susceptible to HB. Conclusions The prevalence of HBV and HCV has decreased in the Spanish prison population, probably as a result of decrease in IDU transmission, and an increase in immigrant prisoner population that does not have this risk behaviour.

Fox, L.; Kramer, M.; Haim, I.; Priess, R.; Metvachuk, A.; Shitrit, D.

doi: 10.1007/s10096-011-1167-4pmid: 21431989

Limited data exist about the clinical characteristics of Mycobacterium tuberculosis (TB) isolates with resistance to isoniazid (IZN). We describe the demographic and clinical characteristics and risk factor information for persons with IZN monoresistant (resistant to isoniazid) TB compared with drug-susceptible TB and multidrug-resistant (MDR) TB. From 2002 to 2009, 590 cases of TB were diagnosed. Of these, 44 (7.5%) developed MDR-TB and 38 (6.4%) had IZN monoresistant TB. Among the IZN monoresistant TB patients, more common demographic characteristics were former resident of the Soviet Union immigrant, smoker, and previous history of TB (p = 0.005, 0.025, and 0.005, respectively), while HIV, weight loss, and hemoptysis were less common (p = 0.005 for all parameters). The mean length of treatment was 24 ± 4 months for MDR-TB, 10 ± 3 months for IZN monoresistant TB cases, and 8 ± 2 months for all other TB cases. The directly observed therapy (DOT) rate was similar in all three groups. However, treatment failure, completion of TB treatment, and mortality were all similar in drug-susceptible TB and higher in MDR-TB. In multivariate analysis, only a history of previous TB (odds ratio [OR] 1.4; 95% confidence interval [CI]: 1.2–1.6) was significantly associated with IZN monoresistant TB. IZN monoresistant TB has distinct characteristics. However, the length of treatment and outcome are similar to drug-susceptible TB cases.

Valenza, G.; Müller, S.; Schmitt, C.; Turnwald, D.; Lam, T-T.; Frosch, M.; Abele-Horn, M.; Pfeifer, Y.

doi: 10.1007/s10096-011-1169-2pmid: 21271268

The VITEK 2 AST-N111 card was evaluated for detection of extended-spectrum beta-lactamases (ESBLs) by testing 51 ESBL positive and 50 ESBL negative isolates of E. coli, K. pneumoniae, and K. oxytoca. The occurrence of beta-lactamase genes was confirmed by PCR and sequencing. The advanced expert system (AES) of the VITEK 2 system achieved sensitivity and specificity values of 100% and 96.0%, respectively. The ESBL test of the VITEK 2 AST-N111 card showed a sensitivity of 92.1% and a specificity of 90.0%. Contradictory results obtained with the two VITEK 2 tools could be clarified by combination disk tests in nine of 11 isolates. The combined use of AES and ESBL tests of the AST-N111 card in association with combination disk tests in case of contradictory results seems to be a reliable method for ESBL detection.

Pinelli, E.; Herremans, T.; Harms, M.; Hoek, D.; Kortbeek, L.

doi: 10.1007/s10096-011-1170-9pmid: 21365288

Toxocara canis, Toxocara cati and Ascaris suum are roundworms of dogs, cats and pigs, respectively, that can also infect humans. These zoonotic helminths have a worldwide distribution and are also endemic in the Netherlands. Infection with Toxocara sp. may result in visceral larva migrans (VLM) or ocular larva migrans (OLM) caused by the migrating larvae. Although A. suum has been reported to occasionally mature to the adult stage in humans, clinical cases of VLM suspected to be caused by A. suum have been described. Diagnosis of these helminth infections relies mainly on serology. Here we analyse the results from the Toxocara and Ascaris IgG-ELISA from a total of 2,838 serum samples from VLM and OLM suspected patients that were sent to our institution from 1998 to 2009. Results indicate that for each year the Ascaris seropositivity is significantly higher compared to the Toxocara seropositivity. Furthermore, while Toxocara seropositivity has decreased over time, the Ascaris seropositivity has not significantly changed for the past 12 years. The Ascaris and Toxocara seropositivity was also shown to increases with age and, while gender has no influence on the Ascaris seropositivity, males showed higher Toxocara seropositivity.

Bader, M.; Abouchehade, K.; Yi, Y.; Haroon, B.; Bishop, L.; Hawboldt, J.

doi: 10.1007/s10096-011-1171-8pmid: 21286928

Studies have established that diabetic patients with community-acquired pneumonia (CAP) may have increased mortality. The primary objective of this study was to investigate if time to first appropriate antibiotic in the emergency department (ED) was associated with in-hospital mortality of CAP in patients with diabetes mellitus (DM). This was a retrospective cohort study of adult diabetic patients who were admitted with CAP. Patients were stratified into two groups: those who received first dose of appropriate antibiotic within 8 hours of triage and those who received it later than 8 hours. A multiple logistic regression analysis was performed. Two hundred six patients were included in the study. Fifty-nine patients (28.6%) had complications of CAP on admission and 31 patients (16%) died. In-hospital mortality was higher in patients who received their initial appropriate antibiotic after 8 hours of triage than those who received it within 8 hours [18 (35.3%), 15 (9.7%), p < 0.0001]. Time to first appropriate antibiotic later than 8 hours of triage was associated with increased in-hospital mortality (OR 4, 95% CI 1.2–13.1, p = 0.02). Antibiotic administration later than 8 hours of triage in the ED was associated with increased in-hospital mortality of CAP among patients with DM.