Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction.

Background: To compare the sensitivity and specificity of the recommended 2-step rapid antigen detection test (RADT) with confirmatory culture vs the point-of-care (POC) polymerase chain reaction (PCR) Roche cobas® Liat® Strep A test for detection of group A Streptococcus (GAS) in pediatric patients with pharyngitis, and to investigate the impact of these tests on antibiotic use in a large pediatric clinic.

Methods: This prospective, open-label study was conducted at a single site during fall/winter 2016-2017. A total of 275 patients aged 3 to 18 years with symptoms of pharyngitis had a throat-swab specimen analyzed using RADT, POC PCR, and culture.

A rationale for combination ampicillin and daptomycin in renal transplant patients with enterococcal infective endocarditis.

Treatment of enterococcal endocarditis in patients with history of renal transplantation is complicated. Treatment failure and/or drug toxicities are not uncommon. Treatment with ampicillin and daptomycin in a renal transplant patient has been rarely reported.

infection in a non-HIV non-endemic population.

Introduction: infection is a systemic mycosis, caused by a dimorphic fungus, an opportunistic pathogen formerly known as . This disease is endemic to Southeast Asia and common in human immunodeficiency virus (HIV) infected patients with low CD4 counts. Here we present a very rarely reported case of infection in an apparent non-immunosuppressed patient presenting decades later in a non-endemic setting (United States).

Dipping into the Clostridium difficile pool: Are alcohol-based dispensers fomites for C difficile?

The purpose of this study was to evaluate alcohol-based dispensers as potential fomites for Clostridium difficile. A convenience sample of 120 alcohol-based dispensers was evaluated for the presence of C difficile either by culture or polymerase chain reaction for C difficile toxin. The results demonstrated that C difficile was not cultured, and C difficile toxin was not detected using polymerase chain reaction; however, gram-positive rods, Clostridium perfringens, Pantoea agglomerans, coagulase-negative Staphylococcus, Peptostreptococcus, Bacillus spp, and microaerophilic Streptococcus were present within the overflow basins of the alcohol-based dispensers.

Development of a Multilocus Sequence Typing System for Medically Relevant Bipolaris Species.

Multilocus sequence typing (MLST) is the gold standard genotyping technique for many microorganisms. This classification approach satisfies the requirements for a high-resolution, standardized, and archivable taxonomic system. Here, we describe the development of a novel MLST system to assist with the investigation of an unusual cluster of surgical site infections caused by Bipolaris spp.

Infection with a chlorophyllic eukaryote after a traumatic freshwater injury.

Infections with chlorophyllic algae are uncommon. Invasive infection with Desmodesmus armatus developed in two patients independently after they each sustained a penetrating freshwater injury.

Multicenter evaluation of the Verigene Clostridium difficile nucleic acid assay.

The Verigene Clostridium difficile Nucleic Acid test (Verigene CDF test) (Nanosphere, Northbrook, IL) is a multiplex qualitative PCR assay that utilizes a nanoparticle-based array hybridization method to detect C. difficile tcdA and tcdB in fecal specimens. In addition, the assay detects binary toxin gene sequences and the single base pair deletion at nucleotide 117 (Δ 117) in tcdC to provide a presumptive identification of the epidemic strain 027/NAP1/BI (referred to here as ribotype 027).

Multilaboratory study of the Biomic automated well-reading instrument versus MicroScan WalkAway for reading MicroScan antimicrobial susceptibility and identification panels.

This study compared the Biomic automated well reader results to the MicroScan WalkAway results for reading MicroScan antimicrobial susceptibility and identification panels at four different sites. Routine fresh clinical isolates and quality control (QC) organisms were tested at each study site. A total of 46,176 MicroScan panel drug-organism combinations were read.

Pleural infections: a 9-year review of bacteriology, case characteristics and mortality.

Background: Despite advances in medical therapies, pleural infections remain a common disease. The characteristics of this disease seem to change over time, with alterations in patient characteristics and bacteriology. The purpose of this study was to provide a retrospective descriptive analysis of pleural infections during a 9-year period.

Nocardia neocaledoniensis [corrected] as a cause of skin and soft tissue infection.

Nocardia neocaledoniensis was introduced as a new environmental species of Nocardia in 2004. We present the first case of human skin and soft tissue infection caused by this species in a patient with rheumatoid arthritis receiving prednisone and methotrexate therapy.

Multicenter evaluation of the LightCycler MRSA advanced test, the Xpert MRSA Assay, and MRSASelect directly plated culture with simulated workflow comparison for the detection of methicillin-resistant Staphylococcus aureus in nasal swabs.

Rapid detection of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) followed by appropriate infection control procedures reduces MRSA infection and transmission. We compared the performance and workflow of two Food and Drug Administration-approved nucleic acid amplification assays, the LightCycler MRSA Advanced Test and the Xpert MRSA test, with those of directly plated culture (MRSASelect) using 1202 nasal swabs collected at three U.S.

Universal MRSA nasal surveillance: characterization of outcomes at a tertiary care center and implications for infection control.

Background: Recognition of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage by active surveillance cultures has been widely debated. Our institution implemented universal nasal screening by polymerase chain reaction (PCR) for MRSA and isolation of screen positive patients in December 2007. Here we present data about the correlation between screen positivity and subsequent development of infection and the impact of isolation on surgical site infection rates.

Freshwater non-O1 Vibrio cholerae infection.

It is not appreciated by most physicians that vibrio infections can be acquired from freshwater exposure. A case of non-O1 Vibrio cholerae urinary tract infection associated with freshwater exposure is reported. The potential for vibrios to grow in brachish water and for summer heat to cause evaporation leading to relative increased salinity in freshwater bodies and the broad geographic range of these occurrences to include North American and both eastern and western Europe is noted.

Brevibacillus brevis peritonitis.

We present what we believe is the first case of Brevibacillus (Bacillus) brevis peritonitis in a patient with hepatocellular carcinoma, possibly caused by the ingestion of fermented foods containing B. brevis spores. This case also demonstrates a pattern of antibiotic susceptibility with differing in vitro and in vivo bactericidal efficacy.

Pharmacokinetics of topical and intravenous cefazolin in patients with clean surgical wounds.

Background: Surgical-site infection is a common postoperative nosocomial infection. Surgeons frequently treat operative patients with protective antibiotics and often choose cefazolin as the drug. Treatment schemes include both preoperative intravenous dosing and intraoperative dosing by irrigation.

Cluster of Mycobacterium fortuitum prosthetic joint infections.

Mycobacterium fortuitum is a member of the rapidly growing nontuberculous mycobacteria. Although mortality is rare from M. fortuitum, morbidity depends on the localized site of infection.

An in vitro analysis of microbial transmission during EUS-guided FNA and the utility of sterilization agents.

Background: The risk of infection and potential microbial transmission with EUS-guided FNA (EUS-FNA) of cystic lesions remains unknown.

Objective: We developed an in vitro model to study the incidence of transmucosal microbial transmission during EUS-FNA of cystic lesions and to evaluate the in vitro efficacy of bacteriocidal agent washings of mucosa before FNA under experimental conditions.

Design: Conical tubes, 15 mL, filled with aerobic blood culture bottle media were prepared.

Comparison of the Binax NOW Flu A enzyme immunochromatographic assay and R-Mix shell vial culture for the 2003-2004 influenza season.

The Binax NOW Flu A enzyme immunochromatographic assay was compared to viral culture with R-Mix shell vials for 455 nasal-wash or nasal-aspirate specimens. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 64.9%, 98.

Clinical significance of Aerococcus urinae: a retrospective review.

A retrospective chart review was performed on 54 patients with positive urine cultures during a 1-year period to assess the clinical significance of Aerococcus urinae. Based on predetermined criteria, patients were classified into 2 groups: those with urinary tract infections (UTIs) and those who were considered colonized. The majority of the patients were > or =65 years old and were female.

Tubo-ovarian abscess caused by Vibrio vulnificus.

Vibrio vulnificus is a Gram-negative bacterium that causes an aggressive infection with high mortality, especially in patients with liver disease. Wound infections due to V. vulnificus occur via direct contamination of cutaneous tissues and can include the uterus.

Delayed-onset mycobacterial keratitis after LASIK.

Purpose: To describe the time course, diagnosis, clinical features, and treatment of seven patients with Mycobacterium szulgai keratitis that developed from 7 to 24 weeks after laser in situ keratomileusis (LASIK).

Methods: Seven of 30 eyes of 18 patients were identified with keratitis after LASIK. The first two patients presented 12 to 14 weeks after LASIK; nontuberculous mycobacteria were identified 1 month after the flaps were cultured.