PEERA HEMARAJATA, M.D., PH.D., D(ABMM)

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Lit review January #2

January 29, 2018

Disclaimer: this compilation of synopses have been collected from multiple sources, including Mark Crislip's Puscast, Journal Watch Infectious Diseases, Medscape Infectious Diseases, CDC MMWR, AMA Morning Rounds, ProMED Mail, Journal of Clinical Microbiology, Antimicrobial Agents and Chemotherapy, Clinical Infectious Diseases, and more. I chose these articles based on their relevance to clinical microbiology and would be of interest to my fellows, and some other pieces that I found amusing to read. All credit goes to these original contributors. I'm just a messenger :).

QuickStats: Percentage* of Emergency Department Visits for Acute Viral Upper Respiratory Tract Infection† That Had an Antimicrobial Ordered or Prescribed,§ by Metropolitan Statistical Area¶ — United States, 2008–2015**

https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a7.htm?s_cid=mm6703a7_e

 

  • This needs no explanation. Sigh.

Antibody detection by agglutination–PCR (ADAP) enables early diagnosis of HIV infection by oral fluid analysis

http://www.pnas.org/content/early/2018/01/12/1711004115

  • Anti-HIV antibodies are found at far lower concentrations in OF compared with blood, leading to poor sensitivity and a longer period of time from infection to detection threshold

  • HIV oral-fluid test based on Antibody detection by agglutination-PCR (ADAP) using DNA conjugates of the HIV proteins p24, gp41, and gp120

  • Analytical sensitivity 1,000- to 10,000-fold higher than EIAs

  • 100% sensitivity and specificity in 22 patients and 22 controls

  • Able to resolve EIA and WB indeterminate

 

Oral Human Papillomavirus Infection: Differences in Prevalence Between Sexes and Concordance With Genital Human Papillomavirus Infection

http://annals.org/aim/fullarticle/2657698/oral-human-papillomavirus-infection-differences-prevalence-between-sexes-concordance-genital

  • About 10,000 adults 18-69 years who participated in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014

  • Oral HPV: 11.5% of men and 3.2% women

    • Translates to 11 million men and 3.2 million women nationally

  • Oral HPV 16: 1.7 million men and 270,000 women in the United States

Underdiagnosis of influenza virus infection in hospitalized older adults

http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15298/abstract

  • A study in Tennessee: adults 65 years and older hospitalized with fever or respiratory symptoms during influenza season are less likely to have a provider-ordered influenza test than younger adults. Some, but not all, of this disparity is due to a lower likelihood of ILI presentation.

Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger

http://pediatrics.aappublications.org/content/early/2018/01/12/peds.2017-3068

  • Looked at febrile infants ≤60 days old

  • UTI criteria: ≥50 000 or ≥10 000 colony-forming units (CFUs) per mL of a uropathogen

  • For ≥50 000 CFU/mL: positive UA

    • Sensitivity was 0.94 regardless of bacteremia; 1.00 with bacteremia; and 0.94 without bacteremia

    • Specificity was 0.91 (95% CI: 0.90–0.91) in all groups

  • Sens and spec a little lower when threshold lowered to ≥10,000

Association Between Sporadic Legionellosis and River Systems in Connecticut

https://academic.oup.com/jid/article-pdf/217/2/179/23258019/jix531.pdf

  • Background: typically associated with aquatic systems in buildings or water tanks/towers

  • This study in CT found that proximity to several rivers and residence in the corresponding watersheds were associated with increased incidence of the disease

  • Elevated rainfall and stream flow rate were associated with increases in incidence 2 weeks later

  • Natural water is also reservoir for disease! Another bug to worry about for those who enjoy “raw water”!

Reduced Chlorhexidine and Daptomycin Susceptibility in Vancomycin-Resistant Enterococcus faecium after Serial Chlorhexidine Exposure

http://aac.asm.org/content/62/1/e01235-17.short?rss=1

  • VREfm are likely frequently exposed to CHX (commonly used antiseptics); however, the long-term effects of CHX exposure have not been studied in enterococci

  • VREfm exposed to CHX for 21 days

  • Reduced CHX susceptibility emerged (4-fold shift in CHX MIC)

  • There were also subpopulations with reduced daptomycin (DAP) susceptibility with significant alterations in membrane phospholipids associated with reduced DAP susceptibility

Tradeoff Between Cell Viability and Lysis in Antibiotic-Mediated Biofilms

https://www.jwatch.org/na45897/2018/01/22/tradeoff-between-cell-viability-and-lysis-antibiotic

  • Generally, biofilms play an important role in bacteria colonization in endocarditis, osteomyelitis, joint infections, etc.

  • Subinhibitory concentrations of antibiotic may enhance biofilm formation

  • Sub-MIC levels of wall agents (FOS, AMP, OXA, CRO) increased biofilm formation in vitro for Enterococcus faecalis

  • Protein, nucleic acid, folate targets: no effect

Texas Ellis County reports 6 cases of measles

http://www.wfaa.com/news/health/ellis-county-reports-6-cases-of-measles/510971477

  • 6 measles cases in Ellis County, Texas

  • Also recently found customer sick with measles attended a movie

  • People who went to the theater on that day should continue to monitor themselves for measles symptoms through [Tue 30 Jan 2018]

Dissemination of Multidrug-Resistant Proteus mirabilis Clones Carrying a Novel Integron-Borne blaIMP-1 in a Tertiary Hospital

http://aac.asm.org/content/62/2/e01321-17.full

  • First report of IMP-1 (metallo BL) in P. mirabilis worldwide: IPM>64, MEM>64, ETP 32-64

  • Gene in a pretty mobile plasmid

In Vitro Activity of the Siderophore Cephalosporin, Cefiderocol, against Carbapenem-Nonsusceptible and Multidrug-Resistant Isolates of Gram-Negative Bacilli Collected Worldwide in 2014 to 2016

http://aac.asm.org/content/62/2/e01968-17.full

  • Cefiderocol is a parenteral siderophore cephalosporin under investigation

  • Unique mechanism of bacterial cell entry with addition of catechol moiety (siderophore) at the three-position side chain of cefiderocol to allow chelation with ferric iron, and facilitates its transport across the outer membrane of Gram-negative bacilli using bacterial iron transport systems

  • The cephalosporin moiety of cefiderocol binds primarily to PBP3

  • In vitro activity against carbapenem-nonsusceptible Enterobacteriaceae, MDR A. baumannii, MDR P. aeruginosa, S. maltophilia, and B. cepacia.

 

 

The Utility of Multiplex Molecular Tests for Enteric Pathogens: a Micro-Comic Strip

http://jcm.asm.org/content/56/2/e01916-17.full

 

 

The Brief Case: Staphylococcus intermedius Group—Look What the Dog Dragged In

http://jcm.asm.org/content/56/2/e00839-17.full

  • 46-year-old man with a history of DM type I)HTN, CHF, CAD presented to his primary care physician with a 3-week history of ulceration on his left, great toe

  • Abundant white beta-hemolytic colonies resembling Staphylococcus spp.

  • Catalase, coagulase, pyrrolidonyl arylamidase (PYR) positive

  • MALDI: Staphylococcus intermedius

  • Staphylococcus intermedius group (SIG): S. intermedius, S. pseudintermedius, and S. delphini, MALDI may have a problem ID species

  • SIG members are common colonizers of animal mucosal surfaces, especially those of dogs

That's all for now. Bug Hunters, may the odds be ever in your favor.