A 72-year-old woman was hospitalized for Streptococcus equi subsp. zooepidemicus meningitis. The same organism was cultured from her two horses. She denied contact with horses, but had a practice of consuming unpasteurized milk from a cow. The cow was in the same stable as the horses, and the ill woman's son milked the cow.
Introduction: We aimed to report the distribution and resistance patterns of eight invasive clinically relevant bacteria surveyed in the Clinical Center of Serbia (CCS) in Belgrade. Methodology: A total of 477 clinical blood stream isolates of Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. were collected in the period from January to December 2013. Antimicrobial susceptibility testing was performed using standard methods and interpreted using the Clinical and Laboratory Standards Institute (CLSI) breakpoint criteria. Results: Acinetobacter spp. was the most prevalent bacteria encountered (37%), followed by K. pneumoniae (25.7%). Multidrug resistance was observed in 92.5% of all isolates. Out of 177 strains of Acinetobacter spp., 97.7% were resistant to fluoroquinolones and carbapenems. Resistance to aminoglycosides, fluoroquinolones, and third-generation cephalosporins was 97.1%, 95.4%, and 95.8% among K. pneumoniae and 21.4%, 21.7%, and 31% among E. coli isolates, respectively. In total, 65.1% of K. pneumoniae and 12.1% of E. coli isolates were determined to be extended-spectrum beta-lactamase (ESBL) positive. High-level aminoglycoside resistance of E. faecalis was 71.4%, and glycopeptide resistance of E. faecium was 95%. Out of 66 strains of S. aureus, 63.4% were methicillin resistant. Conclusions: The majority of bloodstream isolates of clinically relevant bacteria in CCS were multidrug resistant. The biggest concerns are carbapenem-resistant Acinetobacter spp., K. pneumoniae, and P. aeruginosa; third-generation cephalosporin-resistant E. coli; vancomycinresistant E. faecium; and methicillin-resistant S. aureus. Stricter measures of infection control and antibiotic use are needed.
A case of native valve endocarditis caused by Enterococcus durans in a patient with transposition of the great vessels is reported. The patient was treated initially with gentamicin and ceftriaxone; after isolation of enterococci, ceftriaxone was switched to ampicillin. The only virulence factors established in the strain were haemolytic activity and biofilm formation.
The purpose of this study was to evaluate the molecular relatedness of clinical isolates of vancomycin-resistant enterococci (VRE) collected from patients of the Clinic for Infectious and Tropical Diseases in Belgrade. Among 40 isolates available for the investigation, 36 were identified as Enterococcus faecium, whereas 2 were Enterococcus faecalis and Enterococcus raffinosus, respectively. Pulsed-field gel electrophoresis (PFGE) typing revealed 21 strain types, comprising 7 clusters which contained at least two isolates and 14 unique PFGE patterns. Although we searched for pathogenicity factor genes (gelE, cylB, asa1, efaAfs, esp, cpd, cob) in representatives of all macro-restriction patterns, they have been confirmed in only one clone of E. faecalis. Genes esp and hyl, commonly found in E. faecium, were yilded in 10 macro-restriction patterns of this species, and their presence could not be ascribed to clonally related strains (p = 0.05). All VRE isolates were multiresistant and positive for vanA gene. Twenty strains of VRE and 6 clusters obtained from Intensive care unit (ICU) are proof of intensive transmission of these microorganisms at this department. The results of this study suggest wide genotypic variability among the clinical VRE isolates, but also intrahospital dissemination of some of them.
Background: Knowledge of seasonal trends in incidence of pneumococcal meningitis may improve the understanding of factors which contribute to onset and development of the diseases.Methods: Clinic for Infectious and Tropical Diseases in Belgrade is the biggest institution in the country where infections of central nervous system are treated. A database containing results of cerebro spinal fluid (CSF) cultures (January 1981-December 2010) from this Clinic was assembled. The database included monthly counts of inpatient CSF cultures positive for Streptococcus pneumoniae. Results of monthly measuring mean atmospheric parameters for the same period in Belgrade were obtained from national meteorological database.Results: A total of 1068 inpatient CSF yielding bacterial pathogens, deemed to be causes of meningitis, were reported. Summer season (April-September) was associated with 19.64% fewer pneumococci (137) relative to winter (October-March, 204 isolates). Correlation analysis has been used to compare the total number of pneumococci in CSF and mean atmospheric parameters for each one of 12 months in 30 year period. Positive correlation has been proved with atmospheric pressure (R=0.724, p<0.01) and negative correlation with temperature (R= -0.751, p<0.01) and insolation (R= -0.759, p<0.01), while the correlation with monthly precipitation hasn't reached the level of statistical significance (R=0.417, p>0.05). Regression model of the occurrence of pneumococci in CSF revealed linear trend of growth, R square=0.319, p<0.01. Conclusion:Winter season, higher mean atmospheric pressure and lower monthly outdoor temperature and insolation are associated with substantially increased frequency of pneumococcal meningitis.
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