Canadian Journal of Infectious Diseases & Medical Microbiology

TABLE OF CONTENTS Autumn  2013Volume 24Issue 3  

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CJID&MM – Bold leadership in an emerging publishing model
RB Kalina

Antimicrobial resistance in community-acquired Escherichia coli isolated from urinary infection: Good news or bad?
LE Nicolle

The changing culture of the microbiology laboratory
KB Laupland, L Valiquette

Duration of antibiotic therapy for critically ill patients with bloodstream infections: A retrospective cohort study
TC Havey, RA Fowler, R Pinto, M Elligsen, N Daneman

Bacterial bloodstream infections (BSIs) are associated with high mortality rates and incidence may be on the rise. The optimal duration of antibiotic therapy for BSIs should successfully eradicate the infection and prevent relapse while being short enough to reduce side effects and cost, and not select for antibiotic-resistant bacteria. This retrospective cohort study assessed the typical length of antibiotic treatment as well as outcomes for BSI among 100 critically ill patients.

Burden of rotavirus disease: A population-based study in Eastern Townships, Quebec
S Bernard, L Valiquette, P De Wals, V Nault, C Babakissa, C Cyr, T Côté Boileau, A Gagneur

Rotaviruses cause acute gastroenteritis and are the leading cause of infectious diarrhea among children younger than five years of age. A vaccine has been developed that has been shown to be effective in reducing hospitalizations for rotavirus infections, and is now recommended to be administered to all healthy infants. This article describes a study that aimed to determine the baseline (prevaccine) disease burden of rotavirus-associated acute gastroenteritis among children younger than five years of age residing in Eastern Townships, Quebec.

Antibiotic-resistant Escherichia coli in women with acute cystitis in Canada
WJ McIsaac, R Moineddin, C Meaney, T Mazzulli

Acure bacterial cystitis is common in women and, in the majority of cases, is caused by Escherichia coli. In the past, trimethoprim-sulfamethoxazole (TMP/SMX) has been the first-line treatment. Resistance to TMP-SMX is on the rise, however, and it is not indicated for first-line treatment in regions where resistance exceeds 20%. The authors of this study aimed to determine the prevalence of resistance to TMP-SMX and other antibiotics in patients with acute uncomplicated cystitis across Canada. Implications for the empirical treatment of cystitis are discussed.

Emergency department surveillance as a proxy for the prediction of circulating respiratory viral disease in Eastern Ontario
G Hall, T Krahn, A Majury, A Van Dijk, G Evans, K Moore, A Maier

It is very important to track and document outbreaks of respiratory diseases. The authors of this article examined whether visits to the emergency department may be used as a proxy to monitor the incidence of seasonal influenza. Emergency department complaints for respiratory illnesses were compared with the incidence of laboratory-confirmed influenza infection to assess correlation.

Aerococcus viridans native valve endocarditis
W Zhou, V Nanci, A Jean, AH Salehi, F Altuwaijri, R Cecere, J Genest

Aerococcus species are ubiquitous in the air of living environments. They are rarely pathogenic in humans; however, Aerococcus viridans can, infrequently, cause infections including bacteremia and endocarditis. This article describes a case of mitral valve endocarditis caused by A viridans infection in a 69-year-old man. The authors also conducted a review of the literature regarding A viridans infection, highlighting the aggressive nature of A viridans endocarditis.

Potential consequences of essential drug shortages in Canada: Brain abscess due to Nocardia farcinica associated with dapsone prophylaxis for Pneumocystis jirovecii pneumonia.
TC Wuerz, EJ Bow, MD Seftel

Trimethoprim-sulfamethoxazole (TMP-SMX) is often prescribed as a prophylactic agent against Pneumocystis jirovecii in immune-compromised individuals. A shortage of TMP-SMX tablets occurred in Canada in 2012. This article describes a case involving a 54-year-old immunosuppressed man who was treated with dapsone rather than TMP-SMX as a result of this shortage. The consequences of this switch in treatment are described, and issues related to drug shortages in Canada are discussed.

A review of pertussis cases admitted to a Canadian pediatric centre – the need for strategies to protect young infants
M Wengiel, S Fanella

Assessment of linezolid efficacy, safety and tolerability in the treatment of tuberculosis: A retrospective case review
A Tse-Chang, D Kunimoto, E Der, R Ahmed

With the emergence of drug-resistant strains of Mycobacterium tuberculosis, it is becoming more important to identify alternative drugs to treat the disease. The authors of this article assessed treatment outcomes, safety and tolerability of one such alternative drug, the oxazolidinone antibiotic linezolid, among individuals with drug-resistant tuberculosis in Edmonton, Alberta, and northern regions of Alberta.

Clinical characteristics of pediatric patients hospitalized with methicillin-resistant Staphylococcus aureus in Canadian hospitals from 2008 to 2010
KR Leifso, D Gravel, A Mounchili, S Kaldas, N Le Saux

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a growing threat over the past few years. The Canadian Paediatric Surveillance Program undertook surveillance of MRSA infections in hospitalized children younger than 18 years of age. The authors of this article provide a summary of these data to describe the spectrum of infections in this population over a two-year period.

Methicillin-resistant Staphylococcus aureus colonization among health care workers in a downtown emergency department in Toronto, Ontario
G Saito, J Thom, Y Wei, P Gnanasuntharam, P Gnanasuntharam, N Kreiswirth, B Willey, M Loftus, C Varner, V Porter, A McGeer, B Borgundvaag

Methicillin-resistant Staphylococcus aureus (MRSA) has previously been associated mainly with nosocomial infections, although community-acquired MRSA has become more common in recent years. Health care workers may be vectors for the transmission of MRSA; the assessment of MRSA colonization among health care workers is, therefore, an important step toward reducing transmission of the bacteria in the hospital setting.

Population-based surveillance for hypermucoviscosity Klebsiella pneumoniae causing community-acquired bacteremia in Calgary, Alberta
G Peirano, JDD Pitout, KB Laupland, B Meatherall, DB Gregson

Klebsiella pneumoniae is a common cause of bacterial infections, including liver abscess, meningitis, pneumonia and endophthalmitis. Rates of infection caused by a hypermucoviscous phenotype of the bacterium that can cause more severe disease are increasing. This study assessed the prevalence of the hypermucoviscous phenotype among samples isolated from patients with bacteremia caused by K pneumoniae in Calgary, Alberta, between 2001 and 2007.

Ten-year review of candidemia in a Canadian tertiary care centre: Predominance of non-albicans Candida species
GN Al-Rawahi, DL Roscoe

Bloodstream infections due to Candida species are associated with significant morbidity and mortality. Over the past decade, several reports have suggested that the epidemiology of the Candida species responsible for bloodstream infections may be evolving. Accordingly, the authors of this article performed a retrospective chart review to document the species of Candida responsible for bloodstream infections between January 2000 and December 2009.

Peripheral blood leukocytes and serum nested polymerase chain reaction are complementary methods for monitoring active cytomegalovirus infection in transplant patients
PD Andrade, MT Fioravanti, EBV Anjos, C De Oliveira, DM Albuquerque, SCB Costa

Human cytomegalovirus (CMV) infection is common and can cause serious disease in immunocompromised individuals. Typically, CMV infection is diagnosed using polymerase chain reaction (PCR) performed using DNA isolated from peripheral blood leukocytes. The authors of this article developed a nested PCR assay for use on serum samples, and compared the new test with the use of leukocyte PCR as a diagnostic marker for active CMV infection.

The impact of serum vancomycin levels and minimum inhibitory concentrations of methicillin-resistant Staphylococcus aureus on mortality in patients with nosocomial pneumonia
DP Machado, LZ Goldani, RM Paiva, VR Aquino, F de-Paris, T Lisboa, B Jung, RP dos Santos

Vancomycin is a first-line option to treat methicillin-resistant Staphylococcus aureus infections; however, treatment failure can still occur, even when the minimum inhibitory concentration is within the susceptible range. This study examined the relationships among 30-day mortality, serum vancomycin levels and vancomycin minimum inhibitory concentrations, as well as relevant molecular markers, in a group of patients with hospital-acquired methicillin-resistant Staphylococcus aureus pneumonia.

Determination of susceptibility to fosfomycin and tigecycline of Enterobacteriaceae, particularly Escherichia coli isolates, producing extended-spectrum ß-lactamases from multiple regional Canadian hospitals
C Beuk, C Hill, S Whitehead, E Blondel-Hill, K Wagner, N Cheeptham

Bacterial strains producing extended-spectrum ß-lactamases are becoming more common worldwide, and treatment options are limited. Fosfomycin and tigecycline are valid options to treat individuals infected with these strains; however, resistance to these antibiotics is also a potential issue. This article describes a study in which 160 Escherichia coli isolates collected from hospitals in the interior of British Columbia were tested for susceptibility to fosfomycin and tigecycline.

Catheter removal versus retention in the management of catheter-associated enterococcal bloodstream infections
J Marschall, ML Piccirillo, VJ Fraser, JA Doherty, DK Warren, for the CDC Prevention Epicenters Program

Infection with enterococci is a common cause of catheter-associated bloodstream infections (CA-BSI). The presence of biofilm on indwelling catheters can be difficult to eradicate and, therefore, it is recommended that catheters be removed in the context of CA-BSI. However, this has not been specifically examined in CA-BSI caused by enterococci. This study compared mortality rates in individuals with CA-BSI caused by enterococci who had their catheter removed with individuals whose catheter was retained.

Successful management of nosocomial ventriculitis and meningitis caused by extensively drug-resistant Acinetobacter baumanii in Austria
M Hoenigl, M Drescher, G Feierl, T Valentin, G Zarfel, K Seeber, R Krause, AJ Grisold

Acinetobacter baumannii is a Gram-negative coccobacillus that has been increasingly identified as a cause of hospital-acquired infections in recent years. This article describes a case involving a 66-year-old woman who underwent a neurosurgical procedure and subsequently developed meningitis caused by A baumanii, which proved to be resistant to multiple antibiotics. The authors describe the course of treatment for this patient, and highlight the need for additional anti-infective agents to combat such drug-resistant strains.

Amniocentesis in the HIV-infected pregnant woman: Is there still cause for concern in the era of combination antiretroviral therapy?
N Andany, M Letchumanan, L Bondy, K Murphy, MR Loutfy

Amniocentesis is performed during pregnancy to diagnose chromosomal abnormalities and other genetic disorders. However, use of the procedure has been avoided in HIV-positive women due to the risk of transmission of the virus to the fetus. The emergence of antiretroviral drugs means that the viral load can, in some cases, be reduced to undetectable levels. This article describes a case involving a pregnant HIV-positive woman with undetectable viral load who chose to undergo amniocentesis.

Pets are 'risky business' for patients undergoing continuous ambulatory peritoneal dialysis
YSY Al-Fifi, C Sathianathan, B-L Murray, MJ Alfa

Proper hygiene is important for individuals undergoing continuous ambulatory peritoneal dialysis to avoid infection. The authors of this article describe a case involving a 49-year-old man who experienced multiple infections while undergoing continuous ambulatory peritoneal dialysis, including several zoonotic infections that were likely caused by poor hygiene after interaction with his pets.

Primary musculoskeletal hydatid cyst of the thigh: Diagnostic and curative challenge for an unusual localization
N Argy, A Abou Bacar, C Boeri, C Lohmann, AW Pfaff, Y Hansmann, D Christmann, E Candolfi, N Lefebvre

The dog tapeworm Echinococcus granulosus can cause hyatid disease in humans, usually presenting as hyatid cysts in the liver or lungs. The authors of this article describe a case of E granulosus infection in a 60-year-old woman, which presented as an intramuscular hyatid cyst in her thigh. The diagnostic and therapeutic challenges associated with this particular manifestation of hyatid disease are discussed.


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