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P1065 S. agalactiae invasive infections in male adults
S286
17th ECCMID / 25th ICC, Posters
Increased awareness of Lemierre’s syndrome by the clinicians and the clinical microbiologists is mandatory, along with long-term antibiotic therapy, often combined with aggressive surgery and repeated drainage, to lower mortality and morbidity. Table 1. Prospective study of Fusobacterium necrophorum infections in Denmark, 1998–2001 Male Female Total no. Mortality
Lemierre’s syndrome Other disseminated cases Local infections In the head and neck Caudally from the head Unknown primary focus No signs of infection Total
no.
(%)
33 24
24 12
57 36
5 10
(9%) (28%)
160 13 5 1 236
107 9 1 2 155
267 22 6 3 391
0 0 1 0 16
(17%) (4%)
P1065 S. agalactiae invasive infections in male adults M. Makarona, N. Tsagarakis, H. Moraitou, N. Kentrou, A. Gioga, C. Kapotis, A. Pefanis, S. Kanavaki (Athens, GR) Objectives: To investigate S. agalactiae invasive infections in our hospital. In particular, S. agalactiae has been considered a major pathogen in neonates and pregnant women. However, there is accumulating concern about its significance in non-pregnant adults, because it has been recently recognized as an important and increasingly common cause of invasive diseases in the previous. Specifically, it can cause disease in adult patients with underlying medical conditions, including diabetes mellitus, malignancies and liver disease. Skin and soft tissue infections are common presentations of invasive S. agalactiae infections, while nosocomial infections and polymicrobial bacteraemia occur in a significant proportion of patients. The annual incidence of invasive disease has been estimated at 4.4 per 100,000 non-pregnant adults, whereas the incidence of infections due to S. agalactiae has increased among diabetic patients. Mortality rates in invasive diseases are particularly high (20−70%). Materials: We retrospectively studied 9 cases of systemic infections due to S. agalactiae in male adults, during the last five-year period. Results: From a total of nine cases of S. agalactiae infection, 6 (66.6%) concerned male patients that had all been hospitalised within this recent year, 2006, in various departments of our hospital. S. agalactiae was isolated and identified in various clinical specimens: blood, pus, cerebrospinal fluid, sputum, urine, pleural effusion and synovial fluid. Five out of nine strains (56%) were responsible for bacteraemia, from which 2/5 where responsible for bacteraemia only, 2/5 for bacteraemia as well as for diabetic foot, while 1/5 was simultaneously isolated in blood and cerebrospinal fluid. Among the others, 1/9 (11.1%) was isolated from pleural effusion, 1/9 (11.1%) from synovial fluid, 1/9 (11.1%) from urine and 1/9 (11.1%) from sputum. Eight out of nine patients (88.9%) were suffering from a serious underlying disease: 4 from diabetes mellitus, 2 from diabetes mellitus and malignancy, 1 had malignancy only, 1 suffered from chronic renal failure, while only 1 had a free previous medical history. One patient died, while all the rest had an improved clinical outcome. Conclusion: S. agalactiae invasive infections seem to gain ground as a significant problem in male adults, especially in those with chronic diseases, such as diabetes mellitus. Efforts should be made to be identified and treated early for a successful clinical outcome.
P1066 Nineteen cases of Actinobaculum schaalii identified in Viborg County, Denmark T.F. Jakobsen, H.L. Nielsen, K.M. Søby, J. Prag (Viborg, DK) Objectives: Actinobaculum schaalii is a Gram-positive, non-sporeforming, facultative anaerobic, catalase-negative, rod-shaped bacillus, usually associated with urinary tract infection, and human infections are currently limited to a few reports. A. schaalii was identified in blood and/or urine from 18 patients in 18 months by the Department of Clinical Microbiology at Viborg Hospital, Denmark. Nine cases with clear pathological findings are described. Methods: In our department urine cultures are routinely incubated in a CO2-enriched atmosphere and this practice has proved to facilitate the finding of A. schaalii, since it grows poorly or not at all in ambient air. Identification of A. schaalii is initially done by use of the API Coryne and Rapid ID32A test systems eventually followed by 16S rRNA sequencing to verify the identity of isolated bacteria for publication. Results: Between February 2005 and July 2006, we identified A. schaalii in blood and urine from 18 patients (age range 60−92 years) in Viborg County, with a population of 230,000. Clinical data and predisposing conditions from nine patients are summarised in Table 1. Although A. schaalii was found in urine from the remaining 9 patients as well, they had no clear clinical symptoms of urinary tract infection at the time of sampling. The asymptomatic patients suffered from recurrent UTIs and/or conditions, such as prostate cancer, urethrastenosis, cystocele and diabetes mellitus, that may predispose bacteuria. Table 1. In vitro activities of some antibiotics against multi-resistant bloodstream infections of Acinetobacter spp. Antibiotics
MIC MIC50 MIC90 Range
% Resistance 1996–2000 2001–2005 (n = 60) (n = 104)
Amikacin Netilmicin Imipenem Piperacillin-tazobactam Cefoperazone-sulbactam Colistine Tigecycline Ciprofloxacin Tetracycline
128 4 32 256 256 2 1 32 32
86.0 46.7 65.0 81.7 68.3 63.3
256 32 >32 >256 256 1024 2 >32 256
0.25–256 0.125−64 0.064->32 0.016->256 0.125->256 0.19–1024 0.047−16 0.064->32 0.125->256
66.7 91.7
74.0 25.0 63.5 84.6 63.5 25.0 1.0 83.7 86.5
Conclusion: Our findings confirm the importance of A. schaalii as a pathogen in UTIs as it can cause serious infections, such as pyleonephritis and urosepsis, but may also be present in cystitis as well as in asymptomatic bacteuria. The fact that A. schaalii was found in a patient in Viborg each month strongly suggests that A. schaalii infections are more common than previously recognized. Clinicians should be aware of A. schaalii in cases of unexplained pyuria, especially if the initial microscopic bacterial findings differ from the growth results under aerobic conditions. P1067 Fusobacterium necrophorum severe sepsis associated with Lemierre’s syndrome and pulmonary metastatic septic embolisation G. Magnani, E. Gabbi, A. Catania, L. Ricci, C. Guidetti, L. Vecchia (Reggio Emilia, IT) Objectives: Fusobacterium necrophorum is an unusual but potentially lethal pathogen, associated with Lemierre’s syndrome, an oropharyngeal infection complicated by internal jugular vein (IJV) thrombophlebitis and metastatic septic embolisation. We report a case of this disease with a secondary pulmonary abscess, following F. necrophorum severe sepsis. Case report: A 34-year-old female was admitted because of fever, abdominal pain and diarrhoea. She referred an acute tonsillitis 2 weeks before. Tonsils hypertrophy, but normal aspect of the neck was observed.
17th ECCMID / 25th ICC, Posters
Increased awareness of Lemierre’s syndrome by the clinicians and the clinical microbiologists is mandatory, along with long-term antibiotic therapy, often combined with aggressive surgery and repeated drainage, to lower mortality and morbidity. Table 1. Prospective study of Fusobacterium necrophorum infections in Denmark, 1998–2001 Male Female Total no. Mortality
Lemierre’s syndrome Other disseminated cases Local infections In the head and neck Caudally from the head Unknown primary focus No signs of infection Total
no.
(%)
33 24
24 12
57 36
5 10
(9%) (28%)
160 13 5 1 236
107 9 1 2 155
267 22 6 3 391
0 0 1 0 16
(17%) (4%)
P1065 S. agalactiae invasive infections in male adults M. Makarona, N. Tsagarakis, H. Moraitou, N. Kentrou, A. Gioga, C. Kapotis, A. Pefanis, S. Kanavaki (Athens, GR) Objectives: To investigate S. agalactiae invasive infections in our hospital. In particular, S. agalactiae has been considered a major pathogen in neonates and pregnant women. However, there is accumulating concern about its significance in non-pregnant adults, because it has been recently recognized as an important and increasingly common cause of invasive diseases in the previous. Specifically, it can cause disease in adult patients with underlying medical conditions, including diabetes mellitus, malignancies and liver disease. Skin and soft tissue infections are common presentations of invasive S. agalactiae infections, while nosocomial infections and polymicrobial bacteraemia occur in a significant proportion of patients. The annual incidence of invasive disease has been estimated at 4.4 per 100,000 non-pregnant adults, whereas the incidence of infections due to S. agalactiae has increased among diabetic patients. Mortality rates in invasive diseases are particularly high (20−70%). Materials: We retrospectively studied 9 cases of systemic infections due to S. agalactiae in male adults, during the last five-year period. Results: From a total of nine cases of S. agalactiae infection, 6 (66.6%) concerned male patients that had all been hospitalised within this recent year, 2006, in various departments of our hospital. S. agalactiae was isolated and identified in various clinical specimens: blood, pus, cerebrospinal fluid, sputum, urine, pleural effusion and synovial fluid. Five out of nine strains (56%) were responsible for bacteraemia, from which 2/5 where responsible for bacteraemia only, 2/5 for bacteraemia as well as for diabetic foot, while 1/5 was simultaneously isolated in blood and cerebrospinal fluid. Among the others, 1/9 (11.1%) was isolated from pleural effusion, 1/9 (11.1%) from synovial fluid, 1/9 (11.1%) from urine and 1/9 (11.1%) from sputum. Eight out of nine patients (88.9%) were suffering from a serious underlying disease: 4 from diabetes mellitus, 2 from diabetes mellitus and malignancy, 1 had malignancy only, 1 suffered from chronic renal failure, while only 1 had a free previous medical history. One patient died, while all the rest had an improved clinical outcome. Conclusion: S. agalactiae invasive infections seem to gain ground as a significant problem in male adults, especially in those with chronic diseases, such as diabetes mellitus. Efforts should be made to be identified and treated early for a successful clinical outcome.
P1066 Nineteen cases of Actinobaculum schaalii identified in Viborg County, Denmark T.F. Jakobsen, H.L. Nielsen, K.M. Søby, J. Prag (Viborg, DK) Objectives: Actinobaculum schaalii is a Gram-positive, non-sporeforming, facultative anaerobic, catalase-negative, rod-shaped bacillus, usually associated with urinary tract infection, and human infections are currently limited to a few reports. A. schaalii was identified in blood and/or urine from 18 patients in 18 months by the Department of Clinical Microbiology at Viborg Hospital, Denmark. Nine cases with clear pathological findings are described. Methods: In our department urine cultures are routinely incubated in a CO2-enriched atmosphere and this practice has proved to facilitate the finding of A. schaalii, since it grows poorly or not at all in ambient air. Identification of A. schaalii is initially done by use of the API Coryne and Rapid ID32A test systems eventually followed by 16S rRNA sequencing to verify the identity of isolated bacteria for publication. Results: Between February 2005 and July 2006, we identified A. schaalii in blood and urine from 18 patients (age range 60−92 years) in Viborg County, with a population of 230,000. Clinical data and predisposing conditions from nine patients are summarised in Table 1. Although A. schaalii was found in urine from the remaining 9 patients as well, they had no clear clinical symptoms of urinary tract infection at the time of sampling. The asymptomatic patients suffered from recurrent UTIs and/or conditions, such as prostate cancer, urethrastenosis, cystocele and diabetes mellitus, that may predispose bacteuria. Table 1. In vitro activities of some antibiotics against multi-resistant bloodstream infections of Acinetobacter spp. Antibiotics
MIC MIC50 MIC90 Range
% Resistance 1996–2000 2001–2005 (n = 60) (n = 104)
Amikacin Netilmicin Imipenem Piperacillin-tazobactam Cefoperazone-sulbactam Colistine Tigecycline Ciprofloxacin Tetracycline
128 4 32 256 256 2 1 32 32
86.0 46.7 65.0 81.7 68.3 63.3
256 32 >32 >256 256 1024 2 >32 256
0.25–256 0.125−64 0.064->32 0.016->256 0.125->256 0.19–1024 0.047−16 0.064->32 0.125->256
66.7 91.7
74.0 25.0 63.5 84.6 63.5 25.0 1.0 83.7 86.5
Conclusion: Our findings confirm the importance of A. schaalii as a pathogen in UTIs as it can cause serious infections, such as pyleonephritis and urosepsis, but may also be present in cystitis as well as in asymptomatic bacteuria. The fact that A. schaalii was found in a patient in Viborg each month strongly suggests that A. schaalii infections are more common than previously recognized. Clinicians should be aware of A. schaalii in cases of unexplained pyuria, especially if the initial microscopic bacterial findings differ from the growth results under aerobic conditions. P1067 Fusobacterium necrophorum severe sepsis associated with Lemierre’s syndrome and pulmonary metastatic septic embolisation G. Magnani, E. Gabbi, A. Catania, L. Ricci, C. Guidetti, L. Vecchia (Reggio Emilia, IT) Objectives: Fusobacterium necrophorum is an unusual but potentially lethal pathogen, associated with Lemierre’s syndrome, an oropharyngeal infection complicated by internal jugular vein (IJV) thrombophlebitis and metastatic septic embolisation. We report a case of this disease with a secondary pulmonary abscess, following F. necrophorum severe sepsis. Case report: A 34-year-old female was admitted because of fever, abdominal pain and diarrhoea. She referred an acute tonsillitis 2 weeks before. Tonsils hypertrophy, but normal aspect of the neck was observed.