Jung-Hyun Byun, Dong-Hyun Lee, Sunjoo Kim
Ann Clin Microbiol 2018 June, 21(2): 23-27. Published on 20 June 2018.
Background: Fast identification of Candida glabrata is important, because empirical antifungal therapy for fungemia with C. glabrata and non-C. glabrata varies. We proposed an algorithm for rapid presumptive diagnosis to identify fungemia with C. glabrata using earlier or only growth from anaerobic bottles and longer time to positivity (TTP) in blood cultures.
Methods: Positivity and TTP using the BacT/Alert 3D system (bioMerieux Inc, USA) with resin bottles (FA Plus and FN Plus) were analyzed in 215 candidemia patients from June 2014 to June 2016 in a university-affiliated hospital in Korea.
Results: A higher proportion of earlier or only growth from anaerobic bottles was observed in C. glabrata (38.8%, 7/18) than in C. albicans (7.6%, 8/105), C. parapsilosis (10.5%, 4/138), and C. tropicalis (9.2%, 5/54) (P=0.006). The mean (±standard deviation) TTP for C. glabrata was 41.7 h (±16.3 h) compared with 26.7 h (±15.9 h) for C. albicans, 33.4 h (±8.4 h) for C. parapsilosis, and 23.1 h (±17.3 h) for C. tropicalis (P＜0.0001). We could predict fungemia with C. glabrata with a sensitivity of 94.4%, specificity of 63.9%, positive predictive value of 19.3%, and negative predictive value of 99.2% using a two-step algorithm: earlier or only growth from anaerobic bottles and TTP ＞31.4 h.
Conclusion: This two-step algorithm in the BacT/Alert 3D system could be the basis for an initial empirical antifungal therapy for fungemia with C. glabrata prior to final identification.
Young Ah Kim, Yoon Soo Park, Hyunsoo Kim, Young Hee Seo, Kyungwon Lee
Ann Clin Microbiol 2018 June, 21(2): 28-35. Published on 20 June 2018.
Background: In the present study, the prevalence and risk factors for acquisition of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in intensive care unit (ICU) settings without outbreak in the situation of widespread sequence type (ST) 131 ESBL-producing E. coli in a Korean community was investigated.
Methods: Consecutive and prospective screening of ESBL-producing E. coli colonization was performed in all patients admitted to surgical or medical ICUs within 48 hours for two months. ESBL genotype was determined based on PCR and sequencing. PCR for O16-ST131/O25-ST131 was performed for all ESBL producers. Clinical information was obtained from a review of electronic medical record to determine the risk factors for ESBL-producing E. coli colonization.
Results: The colonization rate of ESBL-producing E. coli at ICU admission was 14.9% (42/281). CTX-M-15 (N=15), CTX-M-14 (N=12), and CTX-M-27 (N=10) were commonly detected using PCR of ESBL genes. Approximately half (45.2%, 19/42) of ESBL producers were ST131 clone with 14 ST131-O25 and 5 ST131- O16. In univariate analysis, independent risk factor for acquisition of ESBL-producing E. coli compared with controls was ICU type (odds ratio, 2.05; P＜ 0.032); however, site of acquisition, previous antibiotic use, and hospital stay were not significant risk factors.
Conclusion: In this study, the colonization of ESBL- producing E. coli at ICU admission without outbreak was frequent and it could be an infection source, regardless of acquisition site. We recommend routine use of ASC to control endemic ESBL-producing E. coli considering the wide distribution of ST131-ESBL- producing E. coli in the Korean community.
[in Korean]
Jae Hyeon Park
Ann Clin Microbiol 2018 June, 21(2): 36-39. Published on 20 June 2018.
The Korean Society of Clinical Microbiology (KSCM) has supported participation in the European Society of Clinical Microbiology and Infectious Disease (ESCMID) Summer School for several years. The school is held every year in Europe for one week and in 2017 was held at the Borstel Research Center, located in Borstel, a small town near Hamburg, Germany. A total of 80 participants from 26 countries attended and included 42.5% (34) males, 57.5% (46) females, and most were residents. The summer school was held for 6 days except for moving time, and there were 29 lectures, 4 small group tutorials, and 80 student presentations. The lecture subject areas included overall topics of clinical microbiology and infectious diseases. Experts from all over Europe gave lectures explaining the basics as well as recent discoveries. Small group tutorials were mainly focused on tuberculosis. Student presentations included active discussions by the students regarding their research subjects or cases. There were also social events such as dinners, visiting museums, cruise ship excursions, and watching outdoor play. Based on personal experience, I recommend young KSCM members attend the ESCMID Summer School because communicating with people from various countries broadens horizons despite a long itinerary and a busy schedule.
[in Korean]
Kwangjin Ahn, Gyu Yel Hwang, Kap Jun Yoon, Young Uh
Ann Clin Microbiol 2018 June, 21(2): 40-44. Published on 20 June 2018.
Globicatella sanguinis is an unusual pathogen causing bacteremia, meningitis, and urinary tract infection, and can be misidentified as Streptococcus pneumoniae or viridans streptococci due to its colonial morphology. A 76-year-old female patient with hypertension and degenerative arthritis was admitted to the hospital complaining of knee joint pain. Blood culture revealed the presence of Gram-positive cocci, and the isolated organism was equally identified as S. pneumoniae using the MicroScan identification system (Beckman Coulter, USA) and Vitek 2 identification system (bioMérieux, USA). However, the isolate showed optochin resistance based on the optochin disk susceptibility test. The organism was finally confirmed to be G. sanguinis based on 16S rRNA sequencing and hydrogen sulfide production testing. Accurate identification of G. sanguinis isolated from aseptic body fluids including blood is important for appropriate antibiotic selection based on accurate application of interpretative criteria of antimicrobial susceptibility test.
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