Background Candidemia is an emerging hospital-acquired bloodstream infection (BSI). It is common among severely ill and immunocompromised patients. Even following appropriate therapy in candidemia, recent studies reveal relative high mortality (40%). The global incidence of candidemia shows an incline. In Sri Lanka, candida speciation often difficult where basic facilities are less available. We have compared the risk factors, epidemiology, demography, and performance of HiChrome Candida differential agar (HiCA) characteristics with the VITEK2 YST platform for differentiation of Candida albicans (CA) and non-albicans candida (NAC) from blood culture isolate. Methods This is a laboratory-based cross-sectional study. Positive aerobic BACTEC blood cultures having yeast were identified using HiCA and VITEK2® platform. Epidemiology, risk factors, and clinical outcomes were compared between CA and NAC bloodstream isolates. Results Out of 120 positive yeast samples, VITEK2® has identified 110 (92%) as Candida sp. From that CA - 34 (31%) and NAC-76 (69%) were isolated. Candidemia following NCA in neonates ( p = 0.02), infants ( p = 0.04) and adults ( p = 0.02) in ICU and immunocompromised patients were significantly higher. Compared to CA, NAC bacteremia period prevalence (0.00041%) and incidence (0.23 per 100,000-person-years) was significantly high ( p = 0.03). NAC 48 (63%) isolates were resistance to azoles. Exposure to antifungals (odds ratio (OR); p = 0.03), prolonged intensive care stay > 14 days (OR-3.3; p = 0.04), having a central venous line for > 8 days (OR-4.3; p = 0.03) and on immunosuppressive treatment (OR-2.4; p = 0.04) was significantly poses risk for NAC candidemia. Sen day mortality was significant among non-albicans cases ( p = 0.03) while 30-day mortality was significant among albicans cases ( p = 0.04). Compared to VITEK2®, the HiCA method was 93% sensitive and 93% specific in detecting CA. Conclusion Compared to CA, candidemia following NAC was high. NAC isolates were having a high percentage of fluconazole and voriconazole resistance. VITEK2 YST® platform provides antifungal susceptibility with minimal inhibitory concentration (MIC). Impact, this would highlight the use of rapid candida identification flat form with MIC to direct appropriate antifungals for candidemia. For that implementation of novel diagnostic facilities like the VITEK2 YST platform at a tertiary care facility is demanding.
All over the globe, the incidence of vertebral infection is rising. Nowadays, compared to tuberculous variety, pyogenic spondylodiscitis incidence is high. The increase in the susceptible population and improved diagnostics summatively contributed to this. In clinical grounds, differentiation of pyogenic and tuberculous spondylodiscitis is well defined. Enterobacter agglomerans is a hospital contaminant and associated with infections in immunocompromised individuals and intravenous lines. It causes a wide array of infections. Enterobacter agglomerans spondylodiscitis is unusual and there are, around the globe, only less than 31 suspected cases that have been previously reported. Enterobacter agglomerans histology mimics tuberculous rather than pyogenic spondylodiscitis. A 65-year-old farming lady, while being in hospital, developed sudden onset spastic paraparesis with hyperreflexia. Later blood culture revealed Enterobacter agglomerans with 41-hour incubation in 99.9% probability from Ramel identification system. Her initial ESR was 120 mm/first hour. Isolate was susceptible to ciprofloxacin and intravenous followed with oral therapy shows a drastic ESR fall and improved clinical response. Differentiation of tuberculous and pyogenic spondylodiscitis is very much important in management point of view. Therefore, blood culture has a role in diagnosis of spondylodiscitis. ESR can be used as important inflammatory marker in monitoring the response to treatment. Retrospectively, ESR would aid in reaching a definitive diagnosis.
Introduction Klebsiella pneumoniae is a significant nosocomial pathogen. We aimed to assess the clinical success following high-dose ciprofloxacin for recurrent bacteremia from biofilm-forming multidrug resistant Klebsiella pneumoniae in a liver transplanted patient.Case report A 55-year-old male had undergone liver transplantation and at day 10 he developed fever and dysuria. Two blood cultures became positive and were identified by Vitek2 (BioMérieux, USA) as K. pneumoniae. From his urine K. pneumoniae was isolated. Based on antimicrobial susceptibility (AST) panel (Vitek2), i.v. meropenem 1 g 8 hourly and i.v. amikacin 15 mg/kg/ daily (5 days) were started (the isolate was ciprofloxacin-resistant). Following 14 days of meropenem he was discharged and 3 days later he was readmitted with fever and dysuria. Since the blood and urine isolate was K. pneumoniae, based on AST 21 days of meropenem were given, the patient was discharged and 3 days later he was readmitted with fever and dysuria. Since this was the 3 rd episode with K. pneumoniae bacteremia, to exclude the focus of infection contrast-enhanced computed tomography and 18 F-fluorodeoxyglucose-positron emission tomography were done but both were normal.Based on multilocus sequence typing (MLST) and microtiter plate assay, biofilm forming magA(K1)positive (+) K. pneumoniae CC23 was found. The patient was having continuous asymptomatic bacteriuria with similar (magA(K1)-positive (+) K. pneumoniae CC23) isolate; we opted for high dose oral ciprofloxacin (800 mg, 8 hourly) for 7 days.Conclusions Following a high dose of oral ciprofloxacin, we were able to achieve urinary microbial clearance and a permanent cure following (magA(K1)-positive (+) K. pneumoniae CC23) bacteremia.This could be a promising therapy to achieve microbial clearance from biofilm-forming multidrugresistant K. pneumoniae.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.