Emergence of Citrobacter freundii carrying IMP-8 metallo-β-lactamase in Germany

Metallo-β-lactamases (MBLs) in Enterobacteriaceae are an increasing problem worldwide. This report describes the isolation of Citrobacter freundii carrying IMP-8 MBL from three patients during the period from March 2012 until March 2013 in Germany. The bla_IMP-8 enzyme is predominantly found in Asia, where IMP-8 has spread to various enterobacterial species causing serious infections. To our best knowledge, this is the first report of bla_IMP-8 habouring Enterobacteriaceae in Europe.

Acute musculoskeletal infection: comparison of different methods for intraoperative bacterial identification

PURPOSE OF THE STUDY

Various techniques are used for detection of pathogens in musculoskeletal infection. These methods differ with respect to reliability and ease of handling. A prospective study was performed to evaluate the efficacy of three intraoperative techniques.

MATERIAL AND METHODS

In 20 cases (18 patients) with clinically confirmed acute musculoskeletal infections, intraoperative collected swab samples, tissue samples and fluid samples injected into standard blood culture vials were used for microbiological diagnosis. Identification of bacteria, time necessary for detection and ease of handling during surgery was evaluated.

RESULTS

In 19 cases bacterial growth was demonstrated using either intraoperative swabs or blood culture technique (95% sensitivity), whereas 18 tissue biopsies were positive (90% sensitivity. 27 bacterial species were isolated. In 18 instances for the swab technique, 14 instances for the tissue biopsy and 4 operations for the blood culture vials, ease of handling was rated as excellent.

DISCUSSION

The study demonstrated differences between the three tested methods with respect to ease of handling. With respect to the number of detected organisms and time for their detection there are no significant differences. These last findings are in contrast to of the results of other authors. The reason for this could be that during operative dissection an accurate and specific collection of specimens from the acute deep infected soft tissues and bones independent from the type of surgical procedure is possible. Therefore, even with the swab method a high amount of microorganisms can be recovered. Especially for intraarticular infections, fluid samples injected into standard blood vials is a practical method for the surgeon. In acute musculoskeletal infections other than joint infections, there is less benefit for the blood culture vials.

CONCLUSION

Intraoperative swab technique yields valid results comparable to other techniques and is an accurate technique for detection of pathogens from acute musculoskeletal infections. Key words: implant, infections, bacteriological techniques, comparative study.

Metallo-β-lactamase expressing multi-resistant Acinetobacter baumannii transmitted in the operation area

Outbreaks of Acinetobacter baumannii demonstrating multiple antibiotic resistance, including meropenem resistance, have been described as severe therapeutic problems. Here we describe a monoclonal outbreak of infection and colonization with multidrug-resistant A. baumannii over a two-month period. Resistance to meropenem was mediated by expression of a metallo-beta-lactamase enzyme. Four of 14 patients showed clinical signs of infection and two died. Contamination of the environment, water, or instruments were excluded as causes of the outbreak. All patients, except one, underwent surgery in a specific operation theatre where surgery of contamination class IV (infected, dirty) was performed. Although individual surgeon error was eliminated, analyses of the patients' histories suggested that bacterial transmission had occurred during surgery. Five patients showed signs of A. baumannii infection and two of these patients suffered from large abdominal wounds infected with a high density of A. baumannii requiring repeated revisions. Presumably, these revisions favoured the transmission of A. baumannii, which is remarkably resistant to various environmental stresses including soaps, disinfectants and dry conditions. No case of meropenem-resistant A. baumannii had been observed in the hospital before the outbreak. Interestingly, the resistant bacteria appear to have been imported by a patient returning from West Africa. This indicates that, similar to MRSA, multiresistant A. baumannii may be introduced by patients from foreign hospitals. The outbreak was stopped in the following months by reinforcing standard procedures and by taking all necessary precautions such as patient isolation, and finally only one new case was detected.