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Isolation of fungi in blood cultures
79 Infectious Diseases Newsletter 6(10) October 1987 signs and gradual defervescence. Blood cultures drawn in the recovery room were positive for Aeromonas hydrophilia, susceptible to amikacin, chloramphenicol, gentamicin, mezlocillin, tetracycline, tobramycin, and trimethoprim-sulfamethoxazole. Once identification and susceptibility data were available, treatment was changed to gentamicin (120 mg, IV, 8hourly). Peak and trough concentrations were maintained in the therapeutic range during the two week course of therapy; there was gradual improvement.
Comment Aeromonas spp are gram-negative, nonsporulating, faculatively anaerobic bacilli. They are members of the family Vibrionaceae. Their habitat includes moist soil and water. They are pathogenic for many kinds of fish, frogs, snakes, and lizards.
Aeromonal infections of humans often follow exposure to fresh water, with the majority of isolates recovered in the spring and summer. In patients with a known history of exposure, it has been suggested that infection occurs after ingesting the organism, followed by seeding via the bloodstream. Aeromonas hydrophilia is the species most commonly associated with infections in humans, although Aeromonas punctata and Aeromonas sobria have also been reported. Aeromonas hydrophilia has been implicated as a cause of gastroenteritis, endocarditis, osteomyelitis, meningitis, sepsis, skin and soft tissue infection, and pneumonia. Aeromonas spp are most consistently susceptible to chloramphenicol. Most isolates are also susceptible to trimethoprim-sulfamethoxazole, tetracycline, and the aminocyclitols. Susceptibility to the penicillins and cephalosporins has been variable.
Bibliography Davis WA, Kane JG, Garagusi VF: Human Aeromonas infections: a review of the literature and a case report of endocarditis. Medicine 57:567-670, 1978. Ellis°n RT, Mostow SR: Pyogenic meningitis manifesting during therapy for Aeromonas hydrophilia sepsis. Arch Int Med 144:1078-1079, 1984. Hanson PG, Standridge J, Jarrett F, et al: Freshwater wound infection due to Aeromonas hydrophilia. JAMA 238:1053-1054, 1977. Karam GH, Ackley AM, Dismukes WE: Post-traumatic Aeromonas hydrophilia osteomyelitis. Arch Int Med 143:20732074, 1983. Wolfe RL, Wiseman SL, Kitchens CS: Aeromonas hydrophilia bacteremia in ambulatory immunocompromised hosts. Am J Med 68:238-241, 1980. Mark Lipman, MD Division of Infectious and Immunologic Diseases University of California, Davis Medical Center Sacramento, California
C O M M E N T S ON CURRENT PUBLICATIONS
Eilard T: Isolation of fungi in blood cultures. Scand J Infect Dis 19:145-156, 1987. During the 13-year period 1970-1982, 204 of 208,677 blood cultures processed in a clinical laboratory in Goteborg, Sweden yielded fungi. No special techniques were used to facilitate isolation of fungi, and cultures that yielded "known contaminants," defined as Penicillium spp or other nonpathogens, were excluded from the tally. The patients ranged in age from under six months (11) to over 80 years (10), with a peak at 5 0 - 7 0 years (92). Men outnumbered women by 1.5:1. The 204 fungal isolations were obtained from 200 patients. Candida albicans accounted for 142, Candida glabrata for 27, Candida parapsilosis for 22, and the remainder either other Candida spp or other kinds of fungi.
There were only two isolates of Cryptococcus neoformans, and one of an Aspergillus spp. The clinical associations were highest with abdominal surgery (38%), next highest with malignancies (22%), followed by diabetes mellitus (6%), and miscellaneous other diseases. Disseminated fungemia occurred in patients with a central venous catheter 45% of the time, whereas 49% of patients with transient fungemia (disappearance of the fungemia with removal of a venous or urinary catheter, drainage of an abscess) had central venous catheters. The years of peak incidence of fungemia were 1972-1975, a period that corresponded to extended use of central venous catheters. Implementation of a policy requiring weekly changes of venous catheters, and introduction of recommendations for management of fungemia (withdrawal of antibacterial therapy, reduction or withdrawal © 1987 Elsevier Science Publishing Co., Inc. 0278-2316/87/$0.00 + 2.20
of glucosteroids, correction of hyperglycemia) coincided with decreased incidence of fungemia.
Comment The relative infrequency of Aspergillus spp and C. neoformans, as compared with the situation in some areas in the United States, is notable in this very well studied experience with fungemia. It is possible that the mortality of 30% despite antifungal therapy was related in part to a reluctance to employ amphotericin B. Perhaps there would have been more frequent isolation of fungi from blood cultures had a method, such as the lysis-centrifugation technique (Roberts GD: Detection of fungemia. Infect Dis Newsl 4:19-21, 1985), been used. PDH []
Comment Aeromonas spp are gram-negative, nonsporulating, faculatively anaerobic bacilli. They are members of the family Vibrionaceae. Their habitat includes moist soil and water. They are pathogenic for many kinds of fish, frogs, snakes, and lizards.
Aeromonal infections of humans often follow exposure to fresh water, with the majority of isolates recovered in the spring and summer. In patients with a known history of exposure, it has been suggested that infection occurs after ingesting the organism, followed by seeding via the bloodstream. Aeromonas hydrophilia is the species most commonly associated with infections in humans, although Aeromonas punctata and Aeromonas sobria have also been reported. Aeromonas hydrophilia has been implicated as a cause of gastroenteritis, endocarditis, osteomyelitis, meningitis, sepsis, skin and soft tissue infection, and pneumonia. Aeromonas spp are most consistently susceptible to chloramphenicol. Most isolates are also susceptible to trimethoprim-sulfamethoxazole, tetracycline, and the aminocyclitols. Susceptibility to the penicillins and cephalosporins has been variable.
Bibliography Davis WA, Kane JG, Garagusi VF: Human Aeromonas infections: a review of the literature and a case report of endocarditis. Medicine 57:567-670, 1978. Ellis°n RT, Mostow SR: Pyogenic meningitis manifesting during therapy for Aeromonas hydrophilia sepsis. Arch Int Med 144:1078-1079, 1984. Hanson PG, Standridge J, Jarrett F, et al: Freshwater wound infection due to Aeromonas hydrophilia. JAMA 238:1053-1054, 1977. Karam GH, Ackley AM, Dismukes WE: Post-traumatic Aeromonas hydrophilia osteomyelitis. Arch Int Med 143:20732074, 1983. Wolfe RL, Wiseman SL, Kitchens CS: Aeromonas hydrophilia bacteremia in ambulatory immunocompromised hosts. Am J Med 68:238-241, 1980. Mark Lipman, MD Division of Infectious and Immunologic Diseases University of California, Davis Medical Center Sacramento, California
C O M M E N T S ON CURRENT PUBLICATIONS
Eilard T: Isolation of fungi in blood cultures. Scand J Infect Dis 19:145-156, 1987. During the 13-year period 1970-1982, 204 of 208,677 blood cultures processed in a clinical laboratory in Goteborg, Sweden yielded fungi. No special techniques were used to facilitate isolation of fungi, and cultures that yielded "known contaminants," defined as Penicillium spp or other nonpathogens, were excluded from the tally. The patients ranged in age from under six months (11) to over 80 years (10), with a peak at 5 0 - 7 0 years (92). Men outnumbered women by 1.5:1. The 204 fungal isolations were obtained from 200 patients. Candida albicans accounted for 142, Candida glabrata for 27, Candida parapsilosis for 22, and the remainder either other Candida spp or other kinds of fungi.
There were only two isolates of Cryptococcus neoformans, and one of an Aspergillus spp. The clinical associations were highest with abdominal surgery (38%), next highest with malignancies (22%), followed by diabetes mellitus (6%), and miscellaneous other diseases. Disseminated fungemia occurred in patients with a central venous catheter 45% of the time, whereas 49% of patients with transient fungemia (disappearance of the fungemia with removal of a venous or urinary catheter, drainage of an abscess) had central venous catheters. The years of peak incidence of fungemia were 1972-1975, a period that corresponded to extended use of central venous catheters. Implementation of a policy requiring weekly changes of venous catheters, and introduction of recommendations for management of fungemia (withdrawal of antibacterial therapy, reduction or withdrawal © 1987 Elsevier Science Publishing Co., Inc. 0278-2316/87/$0.00 + 2.20
of glucosteroids, correction of hyperglycemia) coincided with decreased incidence of fungemia.
Comment The relative infrequency of Aspergillus spp and C. neoformans, as compared with the situation in some areas in the United States, is notable in this very well studied experience with fungemia. It is possible that the mortality of 30% despite antifungal therapy was related in part to a reluctance to employ amphotericin B. Perhaps there would have been more frequent isolation of fungi from blood cultures had a method, such as the lysis-centrifugation technique (Roberts GD: Detection of fungemia. Infect Dis Newsl 4:19-21, 1985), been used. PDH []