Propionibacterium acnes is a known cause of postneurosurgical meningitis; however, it is rarely implicated in de novo meningitis. Herein we report a case of a 49-year-old male with de novo meningitis ...caused by P. acnes with metastatic melanoma as the only identified risk factor for his infection.
Clinical microbiology laboratories face challenges with workload and understaffing that other clinical laboratory sections have addressed with automation. In this issue of the
, M. L. Faron, B. W. ...Buchan, R. F. Relich, J. Clark, and N. A. Ledeboer (J Clin Microbiol 58:e01683-19, 2020, https://doi.org/10.1128/JCM.01683-19) evaluate the performance of automated image analysis software to screen urine cultures for further workup according to their total number of CFU. Urine cultures are the highest volume specimen type for most laboratories, so this software has the potential for tremendous gains in laboratory efficiency and quality due to the consistency of colony quantification.
Seasonal influenza virus causes significant morbidity and mortality each year. Point-of-care (POC) testing using rapid influenza diagnostic tests (RIDTs), immunoassays that detect viral antigens, are ...often used for diagnosis by physician offices and urgent care centers. These tests are rapid but lack sensitivity, which is estimated to be 50 to 70%. Testing by PCR is highly sensitive and specific, but historically these assays have been performed in centralized clinical laboratories necessitating specimen transport and increasing the time to result. Recently, Clinical Laboratory Improvement Amendments (CLIA)-waived, POC PCR influenza assays have been developed with >95% sensitivity and specificity compared to centralized PCR assays. To determine the clinical impact of a POC PCR test for influenza, we compared antimicrobial prescribing patterns of one urgent care location using the Cobas LIAT Influenza A/B assay (LIAT assay; Roche Diagnostics, Indianapolis, IN) to other urgent care centers in our health system using traditional RIDT, with negative specimens being reflexed to PCR. Antiviral prescribing was lower in patients with a negative LIAT PCR result (2.3%) than in patients with a negative RIDT result (25.3%;
< 0.005). Antivirals were prescribed more often in patients that tested positive by LIAT PCR (82.4%) than in those testing positive by either RIDT or reflex PCR (69.9%;
< 0.05). Antibacterial prescriptions for patients testing negative by LIAT PCR were higher (44.5%) than for those testing negative by RIDT (37.7%), although the difference was not statistically significant. In conclusion, having results from a PCR POC test during the clinic visit improved antiviral prescribing practices compared to having rapid results from an RIDT.
Abstract
Background
The rapid and accurate detection of ESBL production in Gram-negative rod (GNR) bacteremia is critical as recent data suggest that carbapenem treatment decreases mortality. At the ...same time, avoiding widespread empiric carbapenem prescribing is an important goal of antimicrobial stewardship teams. The aim of this retrospective review was to determine the accuracy of a nucleic acid–based test, Luminex Verigene BC-GN panel, to detect ESBL-positive GNRs direct from blood cultures.
Methods
The Verigene BC-GN was performed on all first positive GNR blood cultures. In addition, routine antibiotic susceptibility testing was performed on all isolates by the disk-diffusion method and included phenotypic ESBL testing using cefotaxime and ceftazidime with and without clavulanate. Escherichia coli, Klebsiella spp., and Proteus mirabilis–positive blood cultures were identified as ESBL producers through either Verigene or phenotypic disk testing. Positive GNR blood cultures from February 2016 to July 2017 were included for review. The primary objective was to determine the sensitivity and specificity of Verigene for detection of ESBLs. The secondary objective was assessing the percent of community-onset and hospital-acquired ESBL-positive blood cultures.
Results
There were 83 positive blood cultures with ESBL producing GNR included in the primary review. A total of 82 of 83 positive GNR blood cultures were CTX-M gene positive via Verigene (sensitivity 98.8%). All 83 cultures were confirmed as ESBL producers via phenotypic tests. There were no positive Verigene cases with negative phenotypic results. All 68 ESBL E coli–positive cultures were detected by Verigene (100%), 10 ESBL K pneumoniae (100%), and four of the five ESBL P mirabilis–positive cultures (80%). Of the 73 results available for review in the secondary objectives, 68 were community onset (93%) and five were hospital acquired (7%).
Conclusion
The majority of ESBL-positive blood cultures in a low-prevalence setting were due to CTX-M producers. The Luminex Verigene BC-GN was accurate in detecting ESBL-producing Enterobacteriaceae from blood cultures and can be reliably used to guide antimicrobial therapy.
CD14 is an essential mediator of LPS-induced airway disease Brass, David M; Hollingsworth, John W; McElvania-Tekippe, Erin ...
American journal of physiology. Lung cellular and molecular physiology,
07/2007, Letnik:
293, Številka:
1
Journal Article
Recenzirano
1 National Institute of Environmental Health Sciences, Research Triangle Park, and 2 Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
...Submitted 26 July 2006
; accepted in final form 22 March 2007
Chronic lipopolysaccharide (LPS) inhalation in rodents recapitulates many classic features of chronic obstructive pulmonary disease seen in humans, including airways hyperresponsiveness, neutrophilic inflammation, cytokine production in the lung, and small airways remodeling. CD14-deficient mice (C57BL/6 CD14/ ) have an altered response to systemic LPS, and yet the role of CD14 in the response to inhaled LPS has not been defined. We observed that C57BL/6 CD14/ mice demonstrate no discernable physiological or inflammatory response to a single LPS inhalation challenge. However, the physiological (airways hyperresponsiveness) and inflammatory (presence of neutrophils and TNF- in whole lung lavage fluid) responsiveness to inhaled LPS in C57BL/6 CD14/ mice was restored by instilling soluble CD14 intratracheally. Intratracheal instillation of wild-type macrophages into C57BL/6 CD14/ mice restored neutrophilic inflammation only and failed to restore airways hyperresponsiveness or TNF- protein in whole lung lavage. These findings demonstrate that CD14 is critical to LPS-induced airway disease and that macrophage CD14 is sufficient to initiate neutrophil recruitment into the airways but that CD14 may need to interact with other cell types as well for the development of airways hyperresponsiveness and for cytokine production.
lipopolysaccharide; airways hyperresponsiveness; tumor necrosis factor; inflammation
Address for reprint requests and other correspondence: D. M. Brass, National Institute of Environmental Health Sciences, Rall Bldg., Rm. C224, P.O. Box 12233 MD C2-15, 111 Alexander Dr., Research Triangle Park, NC 27709 (e-mail: brassd{at}niehs.nih.gov )
PDF
