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GERMS
Volume 9
Issue 3
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GERMS, Volume 9, Issue 3 (09 2019) – 6 articles

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Case Report
A Case Report of Eustachian Valve Endocarditis Due to Salmonella typhimurium in an Aids Patient
by Dima Youssef, Tariq S. Marroush and Farah Tanveer
GERMS 2019, 9(3), 154-157; https://doi.org/10.18683/germs.2019.1170 - 2 Sep 2019
Cited by 7
Abstract
Introduction: The eustachian valve is a normal remnant of the right valve of the sinus venosus, which directs blood in the embryo life from the inferior vena cava into the left atrium through the foramen ovale. Case report: We report a [...] Read more.
Introduction: The eustachian valve is a normal remnant of the right valve of the sinus venosus, which directs blood in the embryo life from the inferior vena cava into the left atrium through the foramen ovale. Case report: We report a case of eustachian valve endocarditis (EVE) secondary to Salmonella typhimurium in a patient with acquired immunodeficiency syndrome (AIDS). The patient also had concomitant Pneumocystis pneumonia. Discussion: Salmonella bacteremia is one of the AIDS-defining illnesses, and many patients will have recurrent episodes. Salmonella endocarditis on the other hand is rare, but when present, it has a significant morbidity and mortality. EVE rarely requires surgical intervention, and the appropriate antibiotics are the treatment of choice. Conclusions: We recommend clinicians to consider obtaining an echocardiography in AIDS patients with Salmonella bacteremia to search for possible endocarditis, as it does change the treatment plan. Full article
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Article
Virulence Determinants and Biofilm Formation of Acinetobacter baumannii Isolated from Hospitalized Patients
by Amir Aliramezani, Mohammad Soleimani, Ramin Mazaheri Nezhad Fard and Farshad Nojoomi
GERMS 2019, 9(3), 148-153; https://doi.org/10.18683/germs.2019.1171 - 2 Sep 2019
Cited by 26
Abstract
Introduction: Acinetobacter baumannii are nosocomial bacteria that are responsible for outbreaks and severe infections in hospitalized patients globally. The major target of this study was the characterization of virulence determinants and biofilm formation of A. baumannii isolates from hospitalized patients. Methods: [...] Read more.
Introduction: Acinetobacter baumannii are nosocomial bacteria that are responsible for outbreaks and severe infections in hospitalized patients globally. The major target of this study was the characterization of virulence determinants and biofilm formation of A. baumannii isolates from hospitalized patients. Methods: In total, 100 A. baumannii were collected from three hospitals in Tehran, Iran, 2017–2018. The isolates were assessed using phenotypic and genotypic methods and then screened for virulence factor encoding genes such as plcN and lasB using conventional polymerase chain reaction. Furthermore, bacterial biofilm formation, motility and hemolytic and proteolytic activities were assessed. Results: Of 100 A. baumannii isolates, 20 isolates included plcN and four isolates included lasB using PCR assay. Overall, 21 isolates were negative for biofilm formation while 45, 20 and 14 of the total isolates were reported as weak, moderate and strong biofilm producers, respectively. All isolates were positive for bap genes using PCR. Moreover, 35 isolates were motile on Luria-Bertani media, 47 isolates were α-hemolytic on Brucella blood agar media and all isolates displayed proteolytic activity. Conclusions: Healthcare-associated infections with A. baumannii are a major concern, importantly due to their potency to acquire virulence factor genes. Therefore, shedding light in the discovery of new antimicrobial and/or therapeutic agents against virulent A. baumannii strains seem to be necessary. Full article
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Article
Characteristics of Influenza in Elderly Patients with and Without Diabetes, Hospitalized for Severe Acute Respiratory Infection in a Tertiary Care Hospital from Bucharest Romania—A Three-Year Pro-spective Epidemiological Surveillance Study
by Daniela Pițigoi, Maria Nițescu, Anca Streinu-Cercel, Rodica Bacruban, Alina Elena Ivanciuc, Mihaela Lazăr, Carmen Maria Cherciu, Maria Dorina Crăciun, Victoria Aramă, Adrian Streinu-Cercel and Oana Săndulescu
GERMS 2019, 9(3), 142-147; https://doi.org/10.18683/germs.2019.1169 - 2 Sep 2019
Cited by 8
Abstract
Introduction: Patients with diabetes may be at a higher risk of developing complicated influenza. We report the characteristics of influenza in hospitalized elderly patients with and without diabetes, in three consecutive influenza seasons. Methods: The study included patients admitted for severe [...] Read more.
Introduction: Patients with diabetes may be at a higher risk of developing complicated influenza. We report the characteristics of influenza in hospitalized elderly patients with and without diabetes, in three consecutive influenza seasons. Methods: The study included patients admitted for severe acute respiratory infection (SARI) in the National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, during a three-year active epidemiological surveillance study (2015/16, 2016/17, 2017/18), in the I-MOVE+ hospital network. Results: A total of 349 patients were tested by PCR over the duration of the study. The percentage of patients with diabetes was comparable throughout the seasons: 34.7%, 28.3% and 30.4% (p = 0.587). Influenza A was the main viral type circulating in 2015/16 and 2016/17 (100% and 97.6%) in our study population, while in 2017/18, B viruses predominated (90.0%). Diabetics presented a higher median number of comorbidities (3 vs. 2) p < 0.001, and two-fold higher odds of also associating obesity (OR = 2.1, 95%CI:1.3–3.4, p = 0.003), compared to those without diabetes. Diabetics also tested positive for influenza more often (p = 0.296). Only 6 patients with diabetes (5.4%) from our study had been vaccinated against influenza, and most (n = 4) of those who had been vaccinated tested negative for influenza. Conclusions: Our study is the first to describe the circulation of influenza viral types in elderly diabetic patients hospitalized for SARI. The results reinforce the national and international recommendation to vaccinate against influenza all patients with diabetes. Full article
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Article
Dissemination of Carbapenem-Resistant Acinetobacter baumannii Strains Carrying the blaGES, blaNDM and blaOXA23 in Morocco
by Hanane El Hafa, Kawtar Nayme, Najia El Hamzaoui, Itto Maroui, Mohammed Sbiti, Khalid Zerouali, Mohammed Timinouni and Abdelhaq Belhaj
GERMS 2019, 9(3), 133-141; https://doi.org/10.18683/germs.2019.1168 - 2 Sep 2019
Cited by 17
Abstract
Background: Acinetobacter baumannii is a microorganism which has been classified by the World Health Organization in the list of the bacterial strains that pose the biggest danger to human health. This study was performed to determine the susceptibility profile to carbapenems and [...] Read more.
Background: Acinetobacter baumannii is a microorganism which has been classified by the World Health Organization in the list of the bacterial strains that pose the biggest danger to human health. This study was performed to determine the susceptibility profile to carbapenems and to detect carbapenemases production in 111 A. baumannii isolates. Among these 30 are environmental isolates and 81 are from the three major hospitals in Morocco. Methods: All strains of A. baumannii were tested against diverse antimicrobial agents (13 antibiotic drugs) by the agar diffusion test. Minimum inhibitory concentration (MIC) of imipenem on carbapenem-resistant strains (CRAB) was determined by the E-test technique. Simple phenotypic tests were used to detect carbapenemases and metallo-β-lactamases (MBLs) production including the modified Hodge test, EDTA test, and the cloxacillin test. The presence of carbapenemases-encoding resistance genes of CRAB strains was examined using polymerase chain reaction (PCR). Results: Carbapenem resistance was observed in 23 clinical Acinetobacter isolates showing dissemination of the multiresistance profile. Molecular biology techniques indicated that all these strains encoded the naturally occurring blaOXA-51-like gene and were proved as A. baumannii. The blaOXA-23 gene was detected in 16 strains (69.6%). The metallo-β-lactamase blaNDM gene was detected in five isolates (21.7%). GES-type carbapenemases were found in 15 strains, the existence of three classes of carbapenemases (blaGES, blaNDM, and blaOXA-23) was detected in three strains, while none of the CRAB isolates contained the blaOXA-58, blaOXA-24, blaVIM, blaOXA-48 or blaKPC encoding genes. Conclusions: This study established baseline proof of three classes of carbapenemases producing A. baumannii in Morocco, showing the important role of surveillance in controlling their spread. Full article
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Article
Candida glabrata Complex from Patients with Healthcare-Associated Infections in Mansoura University Hospitals, Egypt: Distribution, Antifungal Susceptibility and Effect of Fluconazole and Polymyxin B Combination
by Ghada Mashaly and Raghdaa Shrief
GERMS 2019, 9(3), 125-132; https://doi.org/10.18683/germs.2019.1167 - 2 Sep 2019
Cited by 9
Abstract
Introduction: Candida glabrata complex is composed of three cryptic species, Candida glabrata sensu stricto, C. bracarensis and C. nivariensis. Its reduced susceptibility to fluconazole is responsible for treatment failure of its infections. Combination therapy is recommended to treat these resistant strains. [...] Read more.
Introduction: Candida glabrata complex is composed of three cryptic species, Candida glabrata sensu stricto, C. bracarensis and C. nivariensis. Its reduced susceptibility to fluconazole is responsible for treatment failure of its infections. Combination therapy is recommended to treat these resistant strains. This study assessed the distribution of C. glabrata complex collected from patients in Mansoura University Hospitals and their antifungal susceptibility, with evaluation of fluconazole and polymyxin B combination against them. Methods: C. glabrata complex was collected from patients with healthcare-associated infections. The isolates were identified biochemically then the species were detected using multiplex PCR. The susceptibility of isolates to antifungals and polymyxin B was tested by the microdilution assay. The effect of fluconazole and polymyxin B combination was assessed by checkerboard microdilution and time kill assays. Results: This study included 45 isolates of Candida glabrata complex. The common isolate was Candida glabrata sensu stricto (38 isolates). There were 4 isolates of C. bracarensis and three isolates of C. nivariensis. All isolates were susceptible to amphotericin B, and 17.8% were susceptible to itraconazole. Regarding fluconazole, 48.9% of isolates were susceptible dose-dependent and 51.1% were resistant. Synergistic effect of the combination was observed in 68.9% of isolates by the checkerboard method and in 66.7% of isolates using the time kill assay. Conclusions: Candida glabrata sensu stricto is the main member of the complex. Combination of fluconazole and polymyxin B can be considered a treatment option for fluconazole resistant C. glabrata complex infections. In vivo studies are needed to validate these results. Full article
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Editorial
Antiretroviral Drug-Drug Interactions in an Era of Polypharmacy
by David Back
GERMS 2019, 9(3), 123-124; https://doi.org/10.18683/germs.2019.1166 - 2 Jun 2019
Abstract
One of the questions that I am frequently asked is ‘are drug interactions still an important issue in the management of HIV+ patients in 2019’? [...] Full article
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