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

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Lit Review April #1

April 6, 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 :).

 

Leading Photo by CDC (https://www.cdc.gov/salmonella/index.html)

Distinct fermentation and antibiotic sensitivity profiles exist in salmonellae of canine and human origin

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828451/

 

  • S. enterica is pathogenic in both humans and dogs, but no evidence showing possibility of transfer between dog and owner

  • Looked at 88 human and 86 dog isolates (clinical)

  • Carbon utilization profiles between two groups was different (determined using a phenotypic array ala API

  • Canine isolates seemed to have higher AMP, AMX, CHL MICs compared to human isolates

  • Suggested separated reservoirs for disease

  • WGS would have given a better resolution

Salmonella enterica Serotype 4,[5],12:i:- in Swine in the United States Midwest: An Emerging Multidrug-Resistant Clade

 

https://www.ncbi.nlm.nih.gov/pubmed/29069323

  • Examples of Kauffmann-White-Le Minor scheme (from WHO document)

  • "4,[5],12" = somatic O antigen

  • ":i:-" = H antigen phase 1 is "i"

  • "-" = no phase 2 H antigen

 

  • Emerging globally, including in pork in the US, lacks the second-phase flagellar antigen

  • Compared WGS data from hundreds of 4,[5],12:i:- and Typhimurium from US and Europe, with a focus on isolates from pork in the US Midwest

  • 4,[5],12:i:- regardless of source could be divided into two clades – B I and B II

    • 85% of US isolates from 2014-15 in clade B II, which is emerging globally

  • R to AMP, STR, sulfonamides, TET

  • Subset of isolates R to enrofloxacin or ceftiofur associated with presence of plasmid-mediated resistance genes (qnrB19/qnrB2/qnrS1 for FQ and blaCMY-2/blaSHV-12 for ceph), with FQ resistance probably acquired in the US

 

Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

 

https://academic.oup.com/ofid/article/5/3/ofy037/4925997

 

  • PVO: difficult to treat, sometimes culture-negative, pt on broad-spectrum treatment for a long time with little benefit compared to a shorter course, besides reduction of relapse in some studies

  • A study from Australia looking at 129 patients over 10 years

    • Most patients had blood culture, 44% had vertebral samples (open Bx better yield than core or FNA)

    • 78% organism identified, MSSA or gram positive most prevalent, these patients were more likely to be febrile and had elevated CRP on admission – makes sense

    • 22% - only 5 patients had histology results, with varying evidence of inflammation, 16s PCR in these patients was not conclusive

  • Overall clinical outcomes poor regardless of organism ID (only 15% complete recovery upon D/C)

  • However, not having org ID associated with more risk of adverse outcomes (mortality during index admission or attributable readmission within 2 years due to stuff like pain, disability, or need for more investigation)

  • It may be reasonable to go above and beyond to get a microbiological diagnosis to guide treatment instead of empirical

 

Systemic Antibiotics for the Treatment of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis

 

http://www.annemergmed.com/article/S0196-0644(18)30142-2/fulltext

 

  • To use or not to use antibiotics after I&D? Classical way of thinking is that antibiotics wouldn’t add much

  • Meta-analysis looking at 2400 patients

    • About half had MRSA

    • Treated with SXT or CLI

    • Treatment failure in antibiotic group (7.7%) less than placebo (16.1%)

    • Antibiotic also reduced risk of developing more lesions, while increase in adverse effects was minimal and mild (GI, rash, etc)

  • Mark Crislip on his podcast: DOX and LZD result in less chance of developing C. diff

 

Management of an Outbreak of Exophiala dermatitidis Bloodstream Infections at an Outpatient Oncology Clinic

 

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