GERMS

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Open AccessCase Report

Massive Empyema Due to Lactococcus garvieae

by Steven Tessier, Ikechukwu Emengo, Nicole Yoder, Santo Longo and Firas Ido

GERMS 2022, 12(3), 414-418; https://doi.org/10.18683/germs.2022.1347 - 30 Sep 2022

Cited by 4

Introduction: Lactococcus garvieae, a zoonotic pathogen, may rarely infect humans through the consumption of fish. Documented manifestations of L. garvieae infection in humans include infective endocarditis, prosthetic joint infections, liver abscesses, peritoneal dialysis-associated peritonitis, osteomyelitis, meningitis, infective spondylodiscitis, acalculous cholecystitis, and urinary [...] Read more.

Introduction: Lactococcus garvieae, a zoonotic pathogen, may rarely infect humans through the consumption of fish. Documented manifestations of L. garvieae infection in humans include infective endocarditis, prosthetic joint infections, liver abscesses, peritoneal dialysis-associated peritonitis, osteomyelitis, meningitis, infective spondylodiscitis, acalculous cholecystitis, and urinary tract infection. Case report: An 87-year-old female was hospitalized for coffee-ground emesis secondary to acute gastritis after eating cooked fish. One week after her discharge, she developed new-onset confusion and was returned to the hospital. Chest computed tomography revealed total consolidation of the left lung and a multiloculated left pleural effusion. The patient required intubation and direct admission to the intensive care unit. Pleural fluid and blood cultures grew L. garvieae, which was susceptible to ceftriaxone, penicillin, and vancomycin. Despite intensive antibiotic therapy and supportive care for thirteen days, the patient remained in irreversible shock, and the family opted for comfort care. Conclusions: Heretofore unreported, this case demonstrates that L. garvieae can cause bronchopneumonia and empyema. Full article

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Open AccessCase Report

Actinomyces in the Mediastinum. Surprise Is Key in All Art

by Diego Fernando Severiche-Bueno, Sandra Ximena Ramirez, María Teresa Vargas-Cuervo, David Felipe Severiche Bueno, Carmelo Jiménez Navarro, Jacqueline Mugnier and Juan Pablo Rodriguez

GERMS 2022, 12(3), 409-413; https://doi.org/10.18683/germs.2022.1346 - 30 Sep 2022

Abstract

Introduction: Actinomycosis is an unusual chronic granulomatous infectious disease. They are commensals in various sites of the human body but with little pathogenicity. Actinomyces israelii is the most prevalent species but more than 30 species have been described. Infection of the lower respiratory [...] Read more.

Introduction: Actinomycosis is an unusual chronic granulomatous infectious disease. They are commensals in various sites of the human body but with little pathogenicity. Actinomyces israelii is the most prevalent species but more than 30 species have been described. Infection of the lower respiratory tract is unusual, the involvement of mediastinum being even rarer. Case report: A 63-year-old man, previously healthy and living in a rural area, presented with a 5-month history of hemoptysis, pleuritic pain, weight loss, and night sweats. Community-acquired pneumonia with a mediastinal mass was documented, for which he received antibiotic management. Thoracoscopy was carried out for diagnosis and resection of the mediastinal mass due to inconclusive findings in the percutaneous biopsy. Pathology reported the presence of filamentous Gram-positive bacteria visible in Grocott staining. Due to the pathology findings, and the fact that no other infectious agents were identified, a diagnosis of actinomycosis was established. Treatment with oral amoxicillin 1g TID for 6 months was initiated. Conclusions: As far as we are aware, we present the sixth case of mediastinal actinomycosis. We present this case to bring attention to this rare but clinically relevant presentation to be considered as a differential diagnosis of mediastinal masses and to emphasize the need for specific anaerobic cultures to improve the diagnostic yield. Full article

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Open AccessCase Report

A Rare Case of Empyema Due to Cutibacterium acnes in the Setting of COVID-19

by Ibrahim Youssef and Dima Youssef

GERMS 2022, 12(3), 404-408; https://doi.org/10.18683/germs.2022.1345 - 30 Sep 2022

Abstract

Introduction: Cutibacterium acnes is a Gram-positive anaerobic rod that is part of the normal skin flora, as well as the oral cavity, genitourinary and gastrointestinal tracts. When detected, it is usually considered contaminant; but it is infrequently responsible for invasive infections, mainly neurosurgical [...] Read more.

Introduction: Cutibacterium acnes is a Gram-positive anaerobic rod that is part of the normal skin flora, as well as the oral cavity, genitourinary and gastrointestinal tracts. When detected, it is usually considered contaminant; but it is infrequently responsible for invasive infections, mainly neurosurgical and joint infections. It is rarely found as a pathogen responsible for lung infections or empyema. Case report: We present a unique case of C. acnes empyema following severe COVID-19, making this the first documented case of empyema due to this bacterium following COVID-19. The microorganism was identified by 16S rRNA gene sequencing. The patient was treated with a combination of antibiotics and surgical intervention. Conclusions: This case demonstrates the potential severity of C. acnes empyema. Further studies are needed to establish management guidance. Full article

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Open AccessCase Report

Transient Hypertension with Urinary Tract Infection in Congenital Hydronephrosis

by Haruka Fukayama, Hiro Nakao, Kentaro Nishi, Mitsuru Kubota and Akira Ishiguro

GERMS 2022, 12(3), 400-403; https://doi.org/10.18683/germs.2022.1344 - 30 Sep 2022

Abstract

Introduction: Hypertension is occasionally associated with congenital hydronephrosis. Case report: The authors report a four-month-old boy with severe left congenital hydronephrosis and transient hypertension triggered by his first urinary tract infection (UTI). Despite the satisfactory UTI clinical course, he suddenly developed severe hypertension [...] Read more.

Introduction: Hypertension is occasionally associated with congenital hydronephrosis. Case report: The authors report a four-month-old boy with severe left congenital hydronephrosis and transient hypertension triggered by his first urinary tract infection (UTI). Despite the satisfactory UTI clinical course, he suddenly developed severe hypertension (130/80 mmHg) on the ninth day of UTI. His aldosterone level was within the reference range and his plasma renin activity was slightly elevated. Conclusions: Although his hypertension was refractory to calcium channel blockers, an angiotensin-converting enzyme inhibitor was effective for hypertension. On day 24, he was able to discontinue the antihypertensive without organ damage. Although the precise cause of hypertension was unclear in our case, we considered it to be temporary renin-associated hypertension due to decreasing renal blood flow due to UTI in a patient with severe congenital hydronephrosis. In pediatric UTI, particularly in patients with unilateral hydronephrosis, blood pressure monitoring is very important. Full article

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Open AccessCase Report

Actinotignum schaalii Infection—A Case Series From a Tertiary Hospital in Greece

by Petros Ioannou, Stamatis Karakonstantis, Emmanuil Tavlas, Nikolaos Kontopodis, Sofia Maraki, George Chamilos and Diamantis P Kofteridis

GERMS 2022, 12(3), 394-399; https://doi.org/10.18683/germs.2022.1343 - 30 Sep 2022

Cited by 1

Abstract

Introduction: Actinotignum schaalii is a small Gram-positive facultative anaerobic coccoid rod that was reclassified in 1997 from the genus Actinomyces and is difficult to culture with usual microbiological techniques, as it is slowly growing. A. schaalii is an emerging human pathogen that is [...] Read more.

Introduction: Actinotignum schaalii is a small Gram-positive facultative anaerobic coccoid rod that was reclassified in 1997 from the genus Actinomyces and is difficult to culture with usual microbiological techniques, as it is slowly growing. A. schaalii is an emerging human pathogen that is most commonly implicated in urinary tract infections (UTIs), but has also been isolated less frequently from abscesses of various sites (such as the skin, the genitourinary tract, surgical sites or intraabdominal). Methods: All cases where A. schaalii was identified during a 6-year period (January 2016–January 2022) in the University Hospital of Heraklion were reviewed. A. schaalii was isolated in 11 cultures from 10 patients. The site of infection was skin and soft tissue in nine out of eleven cultures (81.8%) and the bone was the site of infection in two patients (18.2%). Most cultures were polymicrobial. The median age of patients was 55.5 years (interquartile range 34–63 years), and 80% (n = 8) were male. A. schaalii was susceptible to beta-lactams, quinolones and vancomycin, but resistant to clindamycin, erythromycin and metronidazole. Moreover, two cases of diabetic patients diagnosed with polymicrobial diabetic foot osteomyelitis from this organism are presented in detail. Both patients were successfully managed with targeted antimicrobial treatment and prompt surgical management. Conclusions: A. schaalii is an emerging pathogen that is likely under-reported due to difficulties in isolation and identification. Herein two cases of diabetic foot osteomyelitis are also presented in detail, successfully managed with targeted antimicrobial therapy and surgical debridement. Full article

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Open AccessArticle

Association Between Vitamin D Receptor Gene Polymorphisms and Fibrosis Susceptibility in Greek Patients with HCV Infection

by Angeliki Anna Beka, Vasileios Papadopoulos, Theodora Mylopoulou, Maria Panopoulou, Ioannis Karakasiliotis, Penelope Mavromara, Konstantinos Mimidis and Stavroula Veletza

GERMS 2022, 12(3), 384-393; https://doi.org/10.18683/germs.2022.1342 - 30 Sep 2022

Cited by 1

Abstract

Introduction: Hepatitis C virus (HCV) infection is a prime cause of chronic hepatitis worldwide, that often silently progresses to fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Notably, the majority of individuals infected with HCV develop symptoms at late stages, often associated with liver damage [...] Read more.

Introduction: Hepatitis C virus (HCV) infection is a prime cause of chronic hepatitis worldwide, that often silently progresses to fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Notably, the majority of individuals infected with HCV develop symptoms at late stages, often associated with liver damage that cannot revert after virus clearance. Thus, current antiviral therapy alone is rather insufficient to eliminate the global burden of HCV in the near future. During the past few years, vitamin D deficiency as well as certain single nucleotide polymorphisms in the vitamin D receptor (VDR) gene have been associated with liver fibrosis. Therefore, the aim of the present study was to investigate the possible correlation between VDR polymorphisms ApaI (rs7975232) and TaqI (rs731236) and the fibrosis stage of patients with HCV infection from Thrace, Greece. Methods: Eighty-one patients with HCV infection underwent transient elastography for the assessment of their fibrosis stage, and PCR-restriction fragment length polymorphism (RFLP) genotyping for VDR ApaI and TaqI polymorphisms. VDR genotypes were then statistically associated with the patients’ fibrosis stage using ordinal regression models. Results: Non-cirrhotic stages were positively correlated with TaqI TT genotype (p = 0.003) and negatively correlated with TaqI TC genotype (p = 0.007). In the presence of Hardy-Weinberg equilibrium and linkage disequilibrium between the two VDR polymorphisms, mild fibrosis stages (F0-2) were correlated with ApaI/TaqI GG/TT (p = 0.002) and TG/TT (p = 0.008) genotypes, while cirrhotic stage F4 was associated with ApaI/TaqI TG/TC genotype (p = 0.038). Conclusions: TaqI TT and ApaI/TaqI GG/TT, TG/TT and TG/TC genotypes could be explored as prognostic genetic markers for fibrosis susceptibility in HCV patients. Full article

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Open AccessArticle

Antimicrobial Resistance Pattern in Clinical Escherichia coli and Pseudomonas aeruginosa Isolates Obtained From a Secondary-Care Hospital Prior to and During the COVID-19 Pandemic in Kuwait

by Walid Q. Alali, Naglaa M. Abdo, Wadha AlFouzan and Rita Dhar

GERMS 2022, 12(3), 372-383; https://doi.org/10.18683/germs.2022.1341 - 30 Sep 2022

Cited by 4

Abstract

Introduction: The study objective was to compare the prevalence of antimicrobial resistance (AMR) in clinical Escherichia coli and Pseudomonas aeruginosa isolates obtained from a secondary-care hospital prior to and during the COVID-19 pandemic in Kuwait. Methods: A retrospective descriptive study was conducted based [...] Read more.

Introduction: The study objective was to compare the prevalence of antimicrobial resistance (AMR) in clinical Escherichia coli and Pseudomonas aeruginosa isolates obtained from a secondary-care hospital prior to and during the COVID-19 pandemic in Kuwait. Methods: A retrospective descriptive study was conducted based on AMR profiles of clinical Escherichia coli and Pseudomonas aeruginosa isolates. The AMR data represented isolates from five specimen types (body fluids; blood; respiratory; wound, bone, or other tissues; and urine) of patients admitted to four wards (surgical, medical, pediatric, and maternal-postnatal). Tested isolates between January 2019 and February 2020 represented the pre-COVID-19 pandemic period in Kuwait, whereas those from February 2020 until April 2021 represented the ‘during COVID-19’ period. Results: A total of 1303 isolates (57.2% E. coli and 42.8% P. aeruginosa) were analyzed. For ceftazidime, ertapenem and meropenem, the prevalence of AMR in E. coli was significantly (p < 0.05) lower in pre-COVID-19 wards compared to that during COVID-19, whereas for other antibiotics (i.e., cefepime, gentamicin, and trimethoprim/sulfamethoxazole), the prevalence of AMR in pre-COVID-19 was significantly higher than that during COVID-19. The prevalence of AMR to gentamicin in P. aeruginosa isolates from non-COVID-19 wards (52.8%) was significantly higher (p < 0.001) than that from COVID-19 wards (35.0%) and from the pre-COVID-19 period (32.9%). The multidrug-resistance (MDR) prevalence was 37.4% for E. coli and 32.1% for P. aeruginosa isolates. The odds of MDR in E. coli isolates from the COVID-19 medical wards were significantly lower (OR = 0.27, [95%CI: 0.09–0.80], p = 0.018) compared to the pre-COVID-19 wards. The odds of MDR E. coli and P. aeruginosa isolates by COVID-19 status stratified by specimen type were not different (p > 0.05). Conclusions: No major differences in AMR in E. coli and P. aeruginosa prevalence by specimen type and wards prior to and during the COVID-19 pandemic was observed at this hospital. The high reported MDR prevalence calls for better infection control and prevention. Full article

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Open AccessArticle

Prevalence of Clostridioides difficile Contamination in the Healthcare Environment and Instruments: A Systematic Review and Meta-Analysis

by Soroush Borji, Mosayeb Rostamian, Sepide Kadivarian, Sara Kooti, Shirin Dashtbin, Somayeh Hosseinabadi, Ramin Abiri and Amirhooshang Alvandi

GERMS 2022, 12(3), 361-371; https://doi.org/10.18683/germs.2022.1340 - 30 Sep 2022

Cited by 5

Abstract

Introduction: Worldwide, Clostridioides difficile infection is becoming one of the most common healthcare-associated infections. Management and control of this infection in healthcare facilities are associated with screening for environmental and instrumental C. difficile contamination. This systematic review and meta-analysis aimed to assess the [...] Read more.

Introduction: Worldwide, Clostridioides difficile infection is becoming one of the most common healthcare-associated infections. Management and control of this infection in healthcare facilities are associated with screening for environmental and instrumental C. difficile contamination. This systematic review and meta-analysis aimed to assess the overall prevalence of C. difficile in hospital settings, medical devices, and instruments. Methods: Four main databases, PubMed, Web of Science, Google Scholar, and Scopus, were searched using the keywords Clostridioides difficile, Clostridium difficile, C. difficile, clostridia, Clostridium spp., hospital environments, antibiotic associate colitis, intensive care unit, and ward in combination as a search strategy. The PRISMA checklist was used for selecting eligible studies. Results: A total of 11 eligible articles published between 2012 and 2021 were included. The overall pooled prevalence of C. difficile in hospital environments was 14.9%. The highest and lowest prevalence were reported for India (51.1%) and the USA (1.6%), respectively. The highest prevalence was reported for beds (46.3%). A significant heterogeneity was seen between C. difficile prevalence in hospital environments in different samples. The highest and lowest prevalence was reported for floor corners (63.2%) and privacy curtains (1.4%), respectively. Conclusions: In conclusion, hospitals' medical devices and environmental surfaces are considered a crucial source of Clostridioides difficile infection. In this regard, we strongly recommend revising and improving the cleaning and disinfection methods in hospitals and quality control of cleaning adequacy. Full article

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Open AccessArticle

Antimicrobial Resistance Trends—A Single-Center Retrospective Study of Healthcare-Associated Pathogens—Postmortem Sampling From Medico-Legal Autopsies in Bucharest

by Iuliana Diac, Cătălin Dogăroiu, Arthur-Atilla Keresztesi and Mihaela Horumbă

GERMS 2022, 12(3), 352-360; https://doi.org/10.18683/germs.2022.1339 - 30 Sep 2022

Cited by 2

Abstract

Introduction: Healthcare-associated infections are a major concern for healthcare systems around the world. Microorganisms developing resistance to potent antibiotics are an urgent threat to public health. Methods: The present study is a retrospective, single-center study performed at the Mina Minovici National Institute of [...] Read more.

Introduction: Healthcare-associated infections are a major concern for healthcare systems around the world. Microorganisms developing resistance to potent antibiotics are an urgent threat to public health. Methods: The present study is a retrospective, single-center study performed at the Mina Minovici National Institute of Legal Medicine, Bucharest, Romania, over a period of ten years (2011–2020). Autopsies for deaths occurring in the hospital setting for which postmortem bacteriological examination was solicited were screened and the recovered data consisted of demographics, hospital stay duration, autopsy data, and postmortem microbiology. Results: In the 516 autopsies recovered we found that carbapenemase-producing Enterobacteriaceae (CPE) isolates from postmortem bacteriology results increased in 2019. Positive postmortem microbiology results were associated with histological infection in over 80% of cases. Positive results for healthcare-related pathogens were associated with prolonged hospital stay. In our data vancomycin-resistant enterococci were isolated from 2015. Conclusions: Postmortem bacteriology results from medico-legal autopsies mirror antimicrobial resistance trends from hospital settings with several limitations due to the scarcity of solicitations. Full article

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Open AccessArticle

Risk Factors for Mortality in Hospitalized Patients Infected with Carbapenem-Resistant Pseudomonas aeruginosa in Iran

by Younes Khalili, Pooya Omidnia, Hamid Reza Goli, Sajjad Zamanlou, Farhad Babaie and Abed Zahedi Bialvaei

GERMS 2022, 12(3), 344-351; https://doi.org/10.18683/germs.2022.1338 - 30 Sep 2022

Cited by 1

Abstract

Introduction: Mortality due to carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection has increased worldwide in recent years. The risk factors associated with hospital settings in Iran and the role of strain resistance mechanisms in many studies are unclear. Methods: A retrospective study was conducted on [...] Read more.

Introduction: Mortality due to carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection has increased worldwide in recent years. The risk factors associated with hospital settings in Iran and the role of strain resistance mechanisms in many studies are unclear. Methods: A retrospective study was conducted on consecutive non-repetitive patients with CRPA infections isolated from seven major hospitals from northwest of Iran. We evaluated different risk factors and characteristics of bacteria for the death or survival of patients. Results: In this study, 116 CRPA isolates were obtained from patients admitted to seven hospitals. Forty-one (35.3%) patients were enrolled in the study of mortality risk factors. Significant risk factors associated with mortality included the site of infection, hospitalization in different wards, the use of invasive devices, and the type of carbapenem resistance mechanisms. Conclusions: ICU admission, the use of mechanical ventilation and chest tube and infection with pandrug-resistant strains were the most important factors in increasing mortality due to CRPA infection. These results suggested that the clinicians should emphasize the proper use of antibiotic and invasive procedures. Full article

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Open AccessArticle

Microbiological and Drug Resistance Patterns of Bronchoalveolar Lavage Samples Taken from Hospitalized Patients in Iran

by Zahra Tahmasebi, Parisa Asadollahi, Nourkhoda Sadeghifard, Sobhan Ghafourian, Behrooz Sadeghi Kalani, Esmail Ghasemi Pasha Kalaei and Iraj Pakzad

GERMS 2022, 12(3), 333-343; https://doi.org/10.18683/germs.2022.1337 - 30 Sep 2022

Cited by 1

Abstract

Introduction: Pulmonary diseases are amongst the most common causes of premature death and distressing disorders worldwide. This study aimed to detect the fastidious and routine infectious agents, and their drug resistance patterns in bronchoalveolar lavage (BAL) samples. Methods: A total of 44 BAL [...] Read more.

Introduction: Pulmonary diseases are amongst the most common causes of premature death and distressing disorders worldwide. This study aimed to detect the fastidious and routine infectious agents, and their drug resistance patterns in bronchoalveolar lavage (BAL) samples. Methods: A total of 44 BAL samples were collected by bronchoscopy from patients with respiratory disorders hospitalized at 2 teaching hospitals in Ilam, Iran. The samples were cultured on routine bacterial culture media to identify the bacterial agents and calculate the colony count. Antibiotic susceptibility was determined by disk diffusion method according to the CLSI protocol. PCR was used to detect the fastidious bacteria Mycoplasma pneumoniae and Chlamydia pneumoniae using the 16srRNA specific primers and Legionella pneumophila using the mip specific primers. Results: Overall, 100 bacterial isolates were isolated by culture from the 44 BAL samples including: Staphylococcus aureus (24, 31.2%), Streptococcus pyogenes (18, 23.4%), Enterococcus spp. (11, 14.3%), Acinetobacter baumannii (11, 14.3%), Pseudomonas aeruginosa (11, 14.3%), Enterococcus spp. (10, 13%), Micrococcus spp. (5, 6.5%), Staphylococcus epidermidis (5, 6.5%) and Klebsiella pneumoniae (5, 6.5%). PCR detected 4 positive samples (9.1%) for Chlamydia pneumoniae but no positive cases for Mycoplasma pneumoniae and Legionella pneumophila. Acinetobacter baumannii showed the highest resistance rate (81.8%) to aztreonam and ceftazidime. Seventy-five percent of the Staphylococcus aureus isolates were resistant to cefoxitin (MRSA) and 83.3% had the mecA gene. Vancomycin resistance was observed in 27.3% of the Enterococcus species (VRE). Resistance to piperacillin, cefotaxime, ciprofloxacin and imipenem was observed in 54.5%, 45.5%, and 36.4% of the Pseudomonas aeruginosa isolates, respectively. The frequency of organisms isolated from the ICU was higher (46%) than from other wards. Conclusions: The presence of MRSA, cephalosporins-resistant Enterobacteriaceae as well as Pseudomonas aeruginosa and Acinetobacter baumannii resistant against piperacillin, imipenem, cefotaxime, aztreonam and ciprofloxacin amongst different wards, especially the ICU ward of the surveyed hospitals, is a major healthcare concern and it is necessary to wisely scrutinize the preventive strategies for antibiotic resistant infections. Full article

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Open AccessEditorial

Back-to-School for University Students—Can Infectious Diseases Be Taught Online?

by Oana Săndulescu

GERMS 2022, 12(3), 332; https://doi.org/10.18683/germs.2022.1336 - 30 Sep 2022

Abstract

The COVID-19 pandemic has had an important impact on medical education. Many universities from different countries faced temporary closures at the very beginning of the pandemic, and were quick to adapt and offer an online experience for students [...] Full article

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GERMS, Volume 12, Issue 3 (09 2022) – 12 articles , Pages 332-418

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