eThe prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has been increasing worldwide. bla IMP has been reported to be the predominant carbapenemase-encoding gene within Enterobacteriaceae in Australia. However, there are limited data currently available on CPE from Queensland, Australia. A total of 58 CPE isolates were isolated between July 2009 and March 2014 from Queensland hospitals. The clonality of isolates was determined by Diversilab repetitive sequence-based PCR. The isolates were investigated for the resistance mechanisms carbapenemase, extended-spectrum ␤-lactamase, and AmpC ␤-lactamase and for aminoglycoside resistance and plasmid-mediated quinolone resistance genes by PCR. The plasmid types associated with carbapenemase-encoding genes were characterized. The majority of the CPE were Enterobacter cloacae (n ‫؍‬ 29). The majority of Queensland CPE isolates were IMP producers and comprised 11 species (n ‫؍‬ 48). Nine NDM-producing Enterobacteriaceae were identified. One NDM-producing Klebsiella pneumoniae isolate coproduced OXA-48. One K. pneumoniae isolate was an OXA-181 producer. The incidence of IMP producers increased significantly in 2013. bla IMP-4 was found in all IMP-producing isolates. bla TEM , qnrB, and aacA4 were common among IMP-4 producers. The HI2 (67%) and L/M (21%) replicons were associated with bla IMP-4 . All HI2 plasmids were of sequence type 1 (ST1). All but one of the NDM producers possessed bla CTX-M-15 . The 16S rRNA methylase genes found among NDM producers were armA, rmtB, rmtC, and rmtF. The substantial increase in the prevalence of CPE in Queensland has been associated mainly with the emergence E. cloacae strains possessing HI2 plasmids carrying bla IMP-4 over the past 2 years. The importation of NDM producers and/or OXA-48-like producers in patients also contributed to the increased emergence of CPE.

No abstract

Objective: To determine the prevalence of community‐acquired methicillin‐resistant Staphylococcus aureus (CA‐MRSA) carriage and infection among children living in an Indigenous community in Queensland. Design, setting and participants: Swabs for culture of S. aureus were collected from the nose, throat and skin wounds of primary school children. Main outcome measures: MRSA carriage, antibiotic sensitivity, genotype, and presence of the virulence factor Panton–Valentine leukocidin (PVL); and epidemiological risk factors for MRSA carriage. Results: 92 (59%) of 157 eligible children were included in the study. Twenty‐seven (29%) carried S. aureus; 14 of these (15% of total) carried MRSA. MRSA was isolated from 29% of wound swabs, 8% of nose swabs, and 1% of throat swabs. Fourteen of 15 MRSA isolates were sensitive to all non‐β‐lactam antibiotics tested. Eight children (9%) carried CA‐MRSA clonal types: six carried the Queensland clone (ST93), and two carried the South West Pacific clone (ST30). All these isolates carried the virulence factor PVL. The remaining six children carried a hospital‐associated MRSA strain (ST5), negative for PVL. Conclusions: We have identified a high prevalence of CA‐MRSA carriage in school children from a Queensland Indigenous community. In this setting, antibiotics with activity against CA‐MRSA should be considered for empiric therapy of suspected staphylococcal infection. Larger community‐based studies are needed to improve our understanding of the epidemiology of CA‐MRSA, and to assist in the development of therapeutic guidelines for this important infection.

A 54-year-old ranch hand presented to the emergency room with an alleged spider bite and multiple abscesses. Both wound and blood cultures grew Photorhabdus asymbiotica, an enteric gram-negative rod that was initially misidentified by the hospital's rapid identification system. Clinical laboratories should be aware of the limitations of their rapid identification systems and always use them as an adjunct to analysis of morphological and phenotypic traits.A 54-year-old male presented to the emergency department of a local Houston hospital during July 2003. He was a ranch hand who believed that he was bitten by a spider on his left breast. He presented with multiple carbuncles on his left chest wall and multiple pustular nodular lesions over his extremities. The patient, who has a family history of diabetes, had a blood sugar level of 400 on admission. His temperature was 101°F, his blood pressure was 135/70, his respiratory rate was 20, and his pulse was 60. Culture of the left-breast abscess showed moderate numbers of methicillin-resistant Staphylococcus aureus and an unremarkable gram-negative rod identified by a MicroScan Neg Urine Combo Panel Type 34 on the MicroScan WalkAway (Dade Behring, Inc