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Bock M, Van Hasselt JGC, Schwartz F, Wang H, Høiby N, Fuursted K, Ihlemann N, Gill S, Christiansen U, Bruun NE, Elming H, Povlsen JA, Køber L, Høfsten DE, Fosbøl EL, Pries-Heje MM, Christensen JJ, Rosenvinge FS, Torp-Pedersen C, Helweg-Larsen J, Tønder N, Iversen K, Bundgaard H, Moser C. Rifampicin reduces plasma concentration of linezolid in patients with infective endocarditis. J Antimicrob Chemother 2023; 78:2840-2848. [PMID: 37823408 DOI: 10.1093/jac/dkad316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Linezolid in combination with rifampicin has been used in treatment of infective endocarditis especially for patients infected with staphylococci. OBJECTIVES Because rifampicin has been reported to reduce the plasma concentration of linezolid, the present study aimed to characterize the population pharmacokinetics of linezolid for the purpose of quantifying an effect of rifampicin cotreatment. In addition, the possibility of compensation by dosage adjustments was evaluated. PATIENTS AND METHODS Pharmacokinetic measurements were performed in 62 patients treated with linezolid for left-sided infective endocarditis in the Partial Oral Endocarditis Treatment (POET) trial. Fifteen patients were cotreated with rifampicin. A total of 437 linezolid plasma concentrations were obtained. The pharmacokinetic data were adequately described by a one-compartment model with first-order absorption and first-order elimination. RESULTS We demonstrated a substantial increase of linezolid clearance by 150% (95% CI: 78%-251%), when combined with rifampicin. The final model was evaluated by goodness-of-fit plots showing an acceptable fit, and a visual predictive check validated the model. Model-based dosing simulations showed that rifampicin cotreatment decreased the PTA of linezolid from 94.3% to 34.9% and from 52.7% to 3.5% for MICs of 2 mg/L and 4 mg/L, respectively. CONCLUSIONS A substantial interaction between linezolid and rifampicin was detected in patients with infective endocarditis, and the interaction was stronger than previously reported. Model-based simulations showed that increasing the linezolid dose might compensate without increasing the risk of adverse effects to the same degree.
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Affiliation(s)
- Magnus Bock
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Johan G C Van Hasselt
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Franziska Schwartz
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hengzhuang Wang
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sabine Gill
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Niels Eske Bruun
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jonas A Povlsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Køber
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Dan E Høfsten
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mia M Pries-Heje
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Regional Department of Clinical Microbiology, Region Zealand, Slagelse, Denmark
| | - Flemming S Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Tønder
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Bock M, Theut AM, van Hasselt JGC, Wang H, Fuursted K, Høiby N, Lerche CJ, Ihlemann N, Gill S, Christiansen U, Nielsen HL, Lemming L, Elming H, Povlsen JA, Bruun NE, Høfsten D, Fosbøl EL, Køber L, Schultz M, Pries-Heje MM, Kristensen JH, Christensen JJ, Rosenvinge FS, Pedersen CT, Helweg-Larsen J, Tønder N, Iversen K, Bundgaard H, Moser C. Attainment of target antibiotic levels by oral treatment of left-sided infective endocarditis: a POET substudy. Clin Infect Dis 2023:7083738. [PMID: 36947131 DOI: 10.1093/cid/ciad168] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In the POET (Partial Oral Endocarditis Treatment) trial, oral step-down therapy was noninferior to full-length intravenous antibiotic administration. The aim of the present study was to perform pharmacokinetic/pharmacodynamic analyses for oral treatments of infective endocarditis to assess the probabilities of target attainment (PTAs). METHODS Plasma concentrations of oral antibiotics were measured at day 1 and 5. Minimal inhibitory concentrations (MICs) were determined for the bacteria causing infective endocarditis (streptococci, staphylococci, or enterococci). Pharmacokinetic/pharmacodynamic targets were predefined according to literature using time above MIC or the ratio of area under the curve to MIC. Population pharmacokinetic modeling and pharmacokinetic/pharmacodynamic analyses were done for amoxicillin, dicloxacillin, linezolid, moxifloxacin, and rifampicin, and PTAs were calculated. RESULTS A total of 236 patients participated in this POET substudy. For amoxicillin and linezolid, the PTAs were 88%-100%. For moxifloxacin and rifampicin, the PTAs were 71%-100%. Using a clinical breakpoint for staphylococci, the PTAs for dicloxacillin were 9%-17%.Seventy-four patients at day 1 and 65 patients at day 5 had available pharmacokinetic and MIC data for two oral antibiotics. Of those, 13 patients at day 1 and 14 patients at day 5 did only reach the target for one antibiotic. One patient did not reach target for any of the two antibiotics. CONCLUSION For the individual orally administered antibiotic, the majority of patients reached the target level. Patients with sub-target levels were compensated by the administration of two different antibiotics. The findings support the efficacy of oral step-down antibiotic treatment in patients with infective endocarditis.
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Affiliation(s)
- Magnus Bock
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna Marie Theut
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Johan G C van Hasselt
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Hengzhuang Wang
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Christian Johann Lerche
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sabine Gill
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Lemming
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jonas A Povlsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Eske Bruun
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Schultz
- Department of Internal Medicine, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Mia M Pries-Heje
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jonas Henrik Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Regional Department of Clinical Microbiology, Region Zealand, Denmark
| | - Flemming S Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Christian Torp Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Tønder
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Eriksen HB, Fuursted K, Jensen A, Jensen CS, Nielsen X, Christensen JJ, Shewmaker P, Rebelo AR, Aarestrup FM, Schønning K, Slotved HC. Predicting β-lactam susceptibility from the genome of Streptococcus pneumoniae and other mitis group streptococci. Front Microbiol 2023; 14:1120023. [PMID: 36937294 PMCID: PMC10018206 DOI: 10.3389/fmicb.2023.1120023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction For Streptococcus pneumoniae, β-lactam susceptibility can be predicted from the amino acid sequence of the penicillin-binding proteins PBP1a, PBP2b, and PBP2x. The combination of PBP-subtypes provides a PBP-profile, which correlates to a phenotypic minimal inhibitory concentration (MIC). The non-S. pneumoniae Mitis-group streptococci (MGS) have similar PBPs and exchange pbp-alleles with S. pneumoniae. We studied whether a simple BLAST analysis could be used to predict phenotypic susceptibility in Danish S. pneumoniae isolates and in internationally collected MGS. Method Isolates with available WGS and phenotypic susceptibility data were included. For each isolate, the best matching PBP-profile was identified by BLAST analysis. The corresponding MICs for penicillin and ceftriaxone was retrieved. Category agreement (CA), minor-, major-, and very major discrepancy was calculated. Genotypic-phenotypic accuracy was examined with Deming regression. Results Among 88 S. pneumoniae isolates, 55 isolates had a recognized PBP-profile, and CA was 100% for penicillin and 98.2% for ceftriaxone. In 33 S. pneumoniae isolates with a new PBP-profile, CA was 90.9% (penicillin) and 93.8% (ceftriaxone) using the nearest recognized PBP-profile. Applying the S. pneumoniae database to non-S. pneumoniae MGS revealed that none had a recognized PBP-profile. For Streptococcus pseudopneumoniae, CA was 100% for penicillin and ceftriaxone in 19 susceptible isolates. In 33 Streptococcus mitis isolates, CA was 75.8% (penicillin) and 86.2% (ceftriaxone) and in 25 Streptococcus oralis isolates CA was 8% (penicillin) and 100% (ceftriaxone). Conclusion Using a simple BLAST analysis, genotypic susceptibility prediction was accurate in Danish S. pneumoniae isolates, particularly in isolates with recognized PBP-profiles. Susceptibility was poorly predicted in other MGS using the current database.
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Affiliation(s)
- Helle Brander Eriksen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, Herlev, Denmark
- *Correspondence: Helle Brander Eriksen,
| | - Kurt Fuursted
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Jensen
- Department of Clinical Microbiology, Sygehus Lillebælt, Vejle, Denmark
| | | | - Xiaohui Nielsen
- The Regional Department of Clinical Microbiology, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- The Regional Department of Clinical Microbiology, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Ana Rita Rebelo
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Frank Møller Aarestrup
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Kristian Schønning
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Hans-Christian Slotved
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Hans-Christian Slotved,
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4
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Østergaard L, Voldstedlund M, Bruun NE, Bundgaard H, Iversen K, Køber N, Dahl A, Chamat-Hedemand S, Petersen JK, Jensen AD, Christensen JJ, Rosenvinge FS, Jarløv JO, Moser C, Andersen CØ, Coia J, Marmolin ES, Søgaard KK, Lemming L, Køber L, Fosbøl EL. Prevalence and Mortality of Infective Endocarditis in Community-Acquired and Healthcare-Associated Staphylococcus aureus Bacteremia: A Danish Nationwide Registry-Based Cohort Study. Open Forum Infect Dis 2022; 9:ofac647. [PMID: 36540385 PMCID: PMC9757695 DOI: 10.1093/ofid/ofac647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteremia (SAB) can be community-acquired or healthcare-associated, and prior small studies have suggested that this mode of acquisition impacts the subsequent prevalence of infective endocarditis (IE) and patient outcomes. METHODS First-time SAB was identified from 2010 to 2018 using Danish nationwide registries and categorized into community-acquired (no healthcare contact within 30 days) or healthcare-associated (SAB >48 hours of hospital admission, hospitalization within 30 days, or outpatient hemodialysis). Prevalence of IE (defined from hospital codes) was compared between groups using multivariable adjusted logistic regression analysis. One-year mortality of S aureus IE (SAIE) was compared between groups using multivariable adjusted Cox proportional hazard analysis. RESULTS We identified 5549 patients with community-acquired SAB and 7491 with healthcare-associated SAB. The prevalence of IE was 12.1% for community-acquired and 6.6% for healthcare-associated SAB. Community-acquired SAB was associated with a higher odds of IE as compared with healthcare-associated SAB (odds ratio, 2.12 [95% confidence interval {CI}, 1.86-2.41]). No difference in mortality was observed with 0-40 days of follow-up for community-acquired SAIE as compared with healthcare-associated SAIE (HR, 1.07 [95% CI, .83-1.37]), while with 41-365 days of follow-up, community-acquired SAIE was associated with a lower mortality (HR, 0.71 [95% CI, .53-.95]). CONCLUSIONS Community-acquired SAB was associated with twice the odds for IE, as compared with healthcare-associated SAB. We identified no significant difference in short-term mortality between community-acquired and healthcare-associated SAIE. Beyond 40 days of survival, community-acquired SAIE was associated with a lower mortality.
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Affiliation(s)
- Lauge Østergaard
- Correspondence: Lauge Østergaard, MD, PhD, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark ()
| | | | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark,Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark,Clinical Institutes, Copenhagen and Aalborg University, Aalborg, Denmark
| | - Henning Bundgaard
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nana Køber
- Department of Cardiology, Regionshospital Nord, Hjørring, Denmark
| | - Anders Dahl
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Chamat-Hedemand
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark,Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jens Jørgen Christensen
- Regional Department of Clinical Microbiology, Zealand University Hospital, Køge and Institute of Clinical Medicine, University of Copenhagen, Køge, Denmark
| | - Flemming Schønning Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Denmark and Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - John Coia
- Department of Clinical Microbiology, Hospital of South-west Jutland and Institute for Regional Health Research University of South Denmark, Esbjerg, Denmark
| | | | - Kirstine K Søgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Lemming
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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5
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Østergaard L, Voldstedlund M, Bruun NE, Bundgaard H, Iversen K, Køber N, Christensen JJ, Rosenvinge FS, Jarløv JO, Moser C, Andersen CØ, Coia J, Marmolin ES, Søgaard KK, Lemming L, Køber L, Fosbøl EL. Temporal Changes, Patient Characteristics, and Mortality, According to Microbiological Cause of Infective Endocarditis: A Nationwide Study. J Am Heart Assoc 2022; 11:e025801. [PMID: 35946455 PMCID: PMC9496298 DOI: 10.1161/jaha.122.025801] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Monitoring of microbiological cause of infective endocarditis (IE) remains key in the understanding of IE; however, data from large, unselected cohorts are sparse. We aimed to examine temporal changes, patient characteristics, and in‐hospital and long‐term mortality, according to microbiological cause in patients with IE from 2010 to 2017. Methods and Results Linking Danish nationwide registries, we identified all patients with first‐time IE. In‐hospital and long‐term mortality rates were assessed according to microbiological cause and compared using multivariable adjusted logistic regression analysis and Cox proportional hazard analysis, respectively. A total of 4123 patients were included. Staphylococcus aureus was the most frequent cause (28.1%), followed by Streptococcus species (26.0%), Enterococcus species (15.5%), coagulase‐negative staphylococci (6.2%), and “other microbiological causes” (5.3%). Blood culture–negative IE was registered in 18.9%. The proportion of blood culture–negative IE declined during the study period, whereas no significant changes were seen for any microbiological cause. Patients with Enterococcus species were older and more often had a prosthetic heart valve compared with other causes. For Streptococcus species IE, in‐hospital and long‐term mortality (median follow‐up, 2.3 years) were 11.1% and 58.5%, respectively. Compared with Streptococcus species IE, the following causes were associated with a higher in‐hospital mortality: S aureus IE (odds ratio [OR], 3.48 [95% CI, 2.74–4.42]), Enterococcus species IE (OR, 1.48 [95% CI, 1.11–1.97]), coagulase‐negative staphylococci IE (OR, 1.79 [95% CI, 1.21–2.65]), “other microbiological cause” (OR, 1.47 [95% CI, 0.95–2.27]), and blood culture–negative IE (OR, 1.99 [95% CI, 1.52–2.61]); and the following causes were associated with higher mortality following discharge (median follow‐up, 2.9 years): S aureus IE (hazard ratio [HR], 1.39 [95% CI, 1.19–1.62]), Enterococcus species IE (HR, 1.31 [95% CI, 1.11–1.54]), coagulase‐negative staphylococci IE (HR, 1.07 [95% CI, 0.85–1.36]), “other microbiological cause” (HR, 1.45 [95% CI, 1.13–1.85]), and blood culture–negative IE (HR, 1.05 [95% CI, 0.89–1.25]). Conclusions This nationwide study showed that S aureus was the most frequent microbiological cause of IE, followed by Streptococcus species and Enterococcus species. Patients with S aureus IE had the highest in‐hospital mortality.
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Affiliation(s)
- Lauge Østergaard
- The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Department of Cardiology Bispebjerg-Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
| | | | - Niels Eske Bruun
- Department of Cardiology Zealand University Hospital Roskilde Denmark.,Department of Cardiology Herlev-Gentofte Hospital University of Copenhagen Copenhagen Denmark.,Clinical Institutes Copenhagen and Aalborg University Denmark
| | - Henning Bundgaard
- The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Kasper Iversen
- Department of Cardiology Herlev-Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Nana Køber
- Department of Cardiology Bispebjerg-Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
| | - Jens Jørgen Christensen
- The Regional Department of Clinical Microbiology Zealand University Hospital Køge and Institute of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Flemming Schønning Rosenvinge
- Department of Clinical Microbiology Odense University Hospital and Research Unit of Clinical Microbiology University of Southern Denmark Odense Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology Herlev-Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - Claus Moser
- Department of Clinical Microbiology Rigshospitalet University of Copenhagen Copenhagen Denmark.,Department of Immunology and Microbiology University of Copenhagen Copenhagen Denmark
| | | | - John Coia
- Department of Clinical Microbiology Esbjerg Hospital Esbjerg Denmark
| | | | - Kirstine K Søgaard
- Department of Clinical Microbiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Lars Lemming
- Department of Clinical Microbiology Aarhus University Hospital Aarhus Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Emil Loldrup Fosbøl
- The Heart Centre, Rigshospitalet University of Copenhagen Copenhagen Denmark
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6
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Pries-Heje MM, Hasselbalch RB, Wiingaard C, Fosbøl EL, Glenthøj AB, Ihlemann N, Gill SUA, Christiansen U, Elming H, Bruun NE, Povlsen JA, Helweg-Larsen J, Schultz M, Østergaard L, Fursted K, Christensen JJ, Rosenvinge F, Køber L, Tønder N, Moser C, Iversen K, Bundgaard H. Severity of anaemia and association with all-cause mortality in patients with medically managed left-sided endocarditis. Heart 2021; 108:882-888. [PMID: 34611042 DOI: 10.1136/heartjnl-2021-319637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/01/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the prevalence and severity of anaemia in patients with left-sided infective endocarditis (IE) and association with mortality. METHODS In the Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis trial, 400 patients with IE were randomised to conventional or partial oral antibiotic treatment after stabilisation of infection, showing non-inferiority. Haemoglobin (Hgb) levels were measured at randomisation. Primary outcomes were all-cause mortality after 6 months and 3 years. Patients who underwent valve surgery were excluded due to competing reasons for anaemia. RESULTS Out of 400 patients with IE, 248 (mean age 70.6 years (SD 11.1), 62 women (25.0%)) were medically managed; 37 (14.9%) patients had no anaemia, 139 (56.1%) had mild anaemia (Hgb <8.1 mmol/L in men and Hgb <7.5 mmol/L in women and Hgb ≥6.2 mmol/L) and 72 (29.0%) had moderate to severe anaemia (Hgb <6.2 mmol/L). Mortality rates in patients with no anaemia, mild anaemia and moderate to severe anaemia were 2.7%, 3.6% and 15.3% at 6-month follow-up and 13.5%, 20.1% and 34.7% at 3-year follow-up, respectively. Moderate to severe anaemia was associated with higher mortality after 6 months (HR 4.81, 95% CI 1.78 to 13.0, p=0.002) and after 3 years (HR 2.14, 95% CI 1.27 to 3.60, p=0.004) and remained significant after multivariable adjustment. CONCLUSION Moderate to severe anaemia was present in 29% of patients with medically treated IE after stabilisation of infection and was independently associated with higher mortality within the following 3 years. Further investigations are warranted to determine whether intensified treatment of anaemia in patients with IE might improve outcome.
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Affiliation(s)
- Mia Marie Pries-Heje
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Christoffer Wiingaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Birkedal Glenthøj
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Cardiology, Odense Universitetshospital, Odense, Denmark
| | | | | | - Hanne Elming
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Niels Eske Bruun
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Schultz
- Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kurt Fursted
- Bacteriology Reference Department, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Flemming Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Tønder
- Department of Cardiology, Hillerød Hospital, Hillerod, Denmark
| | - Claus Moser
- Department of Microbiology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Kasper Iversen
- Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology and Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Jensen CS, Dargis R, Shewmaker P, Nielsen XC, Christensen JJ. Identification of Streptococcus pseudopneumoniae and other mitis group streptococci using matrix assisted laser desorption/ionization - time of flight mass spectrometry. Diagn Microbiol Infect Dis 2021; 101:115487. [PMID: 34339919 DOI: 10.1016/j.diagmicrobio.2021.115487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/19/2022]
Abstract
This study evaluated the ability of the MALDI-ToF MS from Bruker Daltonics to identify clinical Mitis-Group-Streptococcus isolates with a focus on Streptococcus pseudopneumoniae. The results were analyzed using the standard log(score) and the previously published list(score). Importantly, using the log(score) no misidentifications occurred and 27 of 29 (93%) S. pneumoniae and 27 of 30 (90%) S. oralis strains were identified, but only 1 of 31 (3%) S. pseudopneumoniae and 1 of 13 (8%) S. mitis strains were identified. However, our results show that 30 of 31 S. pseudopneumoniae strains had a S. pseudopneumoniae Main Spectral Profiles within the 3 best matches. Using the list(score) all S. oralis and S. pneumoniae strains were identified correctly, but list(score) misidentified 10 S. pseudopneumoniae and 5 S. mitis. We propose to use the log(score) for identification of S. pneumoniae, S. pseudopneumoniae, S. mitis and S. oralis, but for some strains additional testing may be needed.
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Affiliation(s)
| | - Rimtas Dargis
- The Regional Department of Clinical Microbiology, Region Zealand, Denmark
| | | | | | - Jens Jørgen Christensen
- The Regional Department of Clinical Microbiology, Region Zealand, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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8
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Jensen VVS, Dargis R, Nielsen XC, Wiese L, Christensen JJ. Actinotignum schaalii and Aerococcus urinae as Etiology of Infected Kidney Cyst: A Diagnostic Challenge. Open Microbiol J 2020. [DOI: 10.2174/1874434602014010247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The case presented here illustrates a sometimes complex disease presentation where interdisciplinary teamwork is essential. A 74-years-old woman with stable chronic obstructive pulmonary lung disease and a composite graft aortic valve implant was admitted to hospital with an episode of acute lower back pain combined with long-term fever. The final diagnoses of a left-sided, infected and radiologically evident kidney cyst caused by the urinary tract pathogens Actinotignum schaalii and Aerococcus urinae was established by the use of partial 16S/18S rRNA gene sequence analysis on kidney cyst drainage material taken after four weeks of relevant antibiotic therapy.
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9
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Marbjerg LH, Holzknecht BJ, Dargis R, Dessau RB, Nielsen XC, Christensen JJ. Commercial bacterial and fungal broad-range PCR (Micro-Dx™) used on culture-negative specimens from normally sterile sites: diagnostic value and implications for antimicrobial treatment. Diagn Microbiol Infect Dis 2020; 97:115028. [PMID: 32278620 DOI: 10.1016/j.diagmicrobio.2020.115028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/09/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
The aim of this study was to evaluate the clinical value of partial 16S/18S rRNA gene sequencing with the commercial kit Micro-Dx™ used with the SelectNA™plus instrument on culture-negative samples. A retrospective study of microbiological and clinical data from a 2.5-year period was performed. Assessment of the clinical relevance of the 16S/18S rRNA gene sequencing results was based on evaluation of the results in the clinical context and changes in antimicrobial therapy. Included were 529 samples from 223 patients, representing 251 episodes. In 191 samples (36.1%), bacterial/fungal DNA was detected. Positive results were judged clinically relevant in 79 (31.5%) episodes. Antimicrobial treatment was adjusted according to the 16S/18S rRNA gene sequence analysis result in 42 (16.7%) episodes. The results from 16S/18S rRNA gene sequence analysis were highly clinically relevant. These findings support the use of this analysis in a routine setting.
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Affiliation(s)
- L H Marbjerg
- Department of Clinical Microbiology, Slagelse Hospital, Region Zealand, Denmark; Department of Clinical microbiology, Odense University Hospital, Odense, Denmark; Department of Clinical microbiology, Vejle Hospital, Vejle, Denmark.
| | - B J Holzknecht
- Department of Clinical Microbiology, Slagelse Hospital, Region Zealand, Denmark; Department of Clinical Microbiology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - R Dargis
- Department of Clinical Microbiology, Slagelse Hospital, Region Zealand, Denmark
| | - R B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Region Zealand, Denmark; Department of Regional Health Research, University of Southern Denmark
| | - X C Nielsen
- Department of Clinical Microbiology, Slagelse Hospital, Region Zealand, Denmark
| | - J J Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Region Zealand, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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10
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Jensen CS, Norsigian CJ, Fang X, Nielsen XC, Christensen JJ, Palsson BO, Monk JM. Reconstruction and Validation of a Genome-Scale Metabolic Model of Streptococcus oralis (iCJ415), a Human Commensal and Opportunistic Pathogen. Front Genet 2020; 11:116. [PMID: 32194617 PMCID: PMC7063969 DOI: 10.3389/fgene.2020.00116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/31/2020] [Indexed: 11/22/2022] Open
Abstract
The mitis group of streptococci (MGS) is a member of the healthy human microbiome in the oral cavity and upper respiratory tract. Troublingly, some MGS are able to escape this niche and cause infective endocarditis, a severe and devastating disease. Genome-scale models have been shown to be valuable in investigating metabolism of bacteria. Here we present the first genome-scale model, iCJ415, for Streptococcus oralis SK141. We validated the model using gene essentiality and amino acid auxotrophy data from closely related species. iCJ415 has 71-76% accuracy in predicting gene essentiality and 85% accuracy in predicting amino acid auxotrophy. Further, the phenotype of S. oralis was tested using the Biolog Phenotype microarrays, giving iCJ415 a 82% accuracy in predicting carbon sources. iCJ415 can be used to explore the metabolic differences within the MGS, and to explore the complicated metabolic interactions between different species in the human oral cavity.
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Affiliation(s)
- Christian S Jensen
- The Regional Department of Clinical Microbiology, Region Zealand, Slagelse, Denmark
| | - Charles J Norsigian
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Xin Fang
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Xiaohui C Nielsen
- The Regional Department of Clinical Microbiology, Region Zealand, Slagelse, Denmark
| | - Jens Jørgen Christensen
- The Regional Department of Clinical Microbiology, Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bernhard O Palsson
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Lyngby, Denmark
| | - Jonathan M Monk
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
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11
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Narverud I, Christensen JJ, Bakke SS, Ulven SM, Rundblad A, Aukrust P, Espevik T, Bogsrud MP, Retterstøl K, Ueland T, Halvorsen B, Holven KB. Profiling of immune-related gene expression in children with familial hypercholesterolaemia. J Intern Med 2020; 287:310-321. [PMID: 31631426 DOI: 10.1111/joim.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Innate and adaptive immune responses are pivotal in atherosclerosis, but their association with early-stage atherosclerosis in humans is incompletely understood. In this regard, untreated children with familial hypercholesterolaemia may serve as a human model to investigate the effect of elevated low-density lipoprotein (LDL)-cholesterol. OBJECTIVES We aimed to study the immunological and inflammatory pathways involved in early atherosclerosis by examining mRNA molecules in peripheral blood mononuclear cells (PBMCs) from children with FH. METHODS We analysed the level of 587 immune-related mRNA molecules using state-of-the-art Nanostring technology in PBMCs from children with (n = 30) and without (n = 21) FH, and from FH children before and after statin therapy (n = 10). RESULTS 176 genes (30%) were differentially expressed between the FH and healthy children at P < 0.05. Compared to healthy children, the dysregulated pathways in FH children included the following: T cells (18/19); B cells (5/6); tumour necrosis factor super family (TNFSF) (6/8); cell growth, proliferation and differentiation (5/7); interleukins (5/9); toll-like receptors (2/5); apoptosis (3/7) and antigen presentation (1/7), where the ratio denotes higher expressed genes to total number of genes. Statin therapy reversed expression of thirteen of these mRNAs in FH children. CONCLUSION FH children display higher PBMC expression of immune-related genes mapped to several pathways, including T and B cells, and TNFSF than healthy children. Our results suggest that LDL-C plays an important role in modulating expression of different immune-related genes, and novel data on the involvement of these pathways in the early atherosclerosis may represent future therapeutic targets for prevention of atherosclerotic progression.
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Affiliation(s)
- I Narverud
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - J J Christensen
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - S S Bakke
- Center of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - A Rundblad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - P Aukrust
- Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - T Espevik
- Center of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - M P Bogsrud
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - K Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - T Ueland
- Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K.G. Jebsen TREC, The Faculty of Health Sciences, The Arctic University of Tromsø, Tromsø, Norway
| | - B Halvorsen
- Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K B Holven
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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12
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Holmgaard DB, Marina D, Hansen F, Christensen JJ. Bacteremia and urogenital infection with Actinomyces urogenitalis following prolonged urinary retention. APMIS 2019; 128:20-24. [PMID: 31630449 DOI: 10.1111/apm.13000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/07/2019] [Indexed: 11/29/2022]
Abstract
A case of bacteremia with the fastidious bacteria Actinomyces urogenitalis following lengthy urinary retention is reported in a sixty-year-old man. In 2013, the first case of bacteremia due to A. urogenitalis was presented, secondary to a tubo-ovarian abscess following transvaginal oocyte retrieval. To the best of our knowledge, this is the first male bacteremic episode involving A. urogenitalis related to a urinary tract focus. The patient had no prior urogenital medical history. Extensive susceptibility testing was done on isolates from urinary and blood cultures. The organism exhibited fluoroquinolone resistance but was susceptible to most other antibiotics used in the treatment of urinary infections. Due to its unusual growth requirements infections with A. urogenitalis are most likely an underdiagnosed entity.
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Affiliation(s)
| | - Djordje Marina
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | - Frank Hansen
- Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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13
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Holzknecht BJ, Dargis R, Pedersen M, Pinholt M, Christensen JJ. Typing of vancomycin-resistant enterococci with MALDI-TOF mass spectrometry in a nosocomial outbreak setting. Clin Microbiol Infect 2018; 24:1104.e1-1104.e4. [PMID: 29581054 DOI: 10.1016/j.cmi.2018.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/11/2018] [Accepted: 03/13/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate the usefulness of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) typing as a first-line epidemiological tool in a nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VREfm). METHODS Fifty-five VREfm isolates, previously characterized by whole-genome sequencing (WGS), were included and analysed by MALDI-TOF MS. To take peak reproducibility into account, ethanol/formic acid extraction and other steps of the protocol were conducted in triplicate. Twenty-seven spectra were generated per isolate, and spectra were visually inspected to determine discriminatory peaks. The presence or absence of these was recorded in a peak scheme. RESULTS Nine discriminatory peaks were identified. A characteristic pattern of these could distinguish between the three major WGS groups: WGS I, WGS II and WGS III. Only one of 38 isolates belonging to WGS I, WGS II or WGS III was misclassified. However, ten of the 17 isolates not belonging to WGS I, II or III displayed peak patterns indistinguishable from those of the outbreak strain. CONCLUSIONS Using visual inspection of spectra, MALDI-TOF MS typing proved to be useful in differentiating three VREfm outbreak clones from each other. However, as non-outbreak isolates could not be reliably differentiated from outbreak clones, the practical value of this typing method for VREfm outbreak management was limited in our setting.
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Affiliation(s)
- B J Holzknecht
- Department of Clinical Microbiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark.
| | - R Dargis
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - M Pedersen
- Department of Clinical Microbiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - M Pinholt
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J J Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Carkaci D, Højholt K, Nielsen XC, Dargis R, Rasmussen S, Skovgaard O, Fuursted K, Andersen PS, Stegger M, Christensen JJ. Genomic characterization, phylogenetic analysis, and identification of virulence factors in Aerococcus sanguinicola and Aerococcus urinae strains isolated from infection episodes. Microb Pathog 2017; 112:327-340. [PMID: 28943151 DOI: 10.1016/j.micpath.2017.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
Abstract
Aerococcus sanguinicola and Aerococcus urinae are emerging pathogens in clinical settings mostly being causative agents of urinary tract infections (UTIs), urogenic sepsis and more seldomly complicated infective endocarditis (IE). Limited knowledge exists concerning the pathogenicity of these two species. Eight clinical A. sanguinicola (isolated from 2009 to 2015) and 40 clinical A. urinae (isolated from 1984 to 2015) strains from episodes of UTIs, bacteremia, and IE were whole-genome sequenced (WGS) to analyze genomic diversity and characterization of virulence genes involved in the bacterial pathogenicity. A. sanguinicola genome sizes were 2.06-2.12 Mb with 47.4-47.6% GC-contents, and 1783-1905 genes were predicted whereof 1170 were core-genes. In case of A. urinae strains, the genome sizes were 1.93-2.44 Mb with 41.6-42.6% GC-contents, and 1708-2256 genes of which 907 were core-genes. Marked differences were observed within A. urinae strains with respect to the average genome sizes, number and sequence identity of core-genes, proteome conservations, phylogenetic analysis, and putative capsular polysaccharide (CPS) loci sequences. Strains of A. sanguinicola showed high degree of homology. Phylogenetic analyses showed the 40 A. urinae strains formed two clusters according to two time periods: 1984-2004 strains and 2010-2015 strains. Genes that were homologs to virulence genes associated with bacterial adhesion and antiphagocytosis were identified by aligning A. sanguinicola and A. urinae pan- and core-genes against Virulence Factors of Bacterial Pathogens (VFDB). Bacterial adherence associated gene homologs were present in genomes of A. sanguinicola (htpB, fbpA, lmb, and ilpA) and A. urinae (htpB, lap, lmb, fbp54, and ilpA). Fifteen and 11-16 CPS gene homologs were identified in genomes of A. sanguinicola and A. urinae strains, respectively. Analysis of these genes identified one type of putative CPS locus within all A. sanguinicola strains. In A. urinae genomes, five different CPS loci types were identified with variations in CPS locus sizes, genetic content, and structural organization. In conclusion, this is the first study dealing with WGS and comparative genomics of clinical A. sanguinicola and A. urinae strains from episodes of UTIs, bacteremia, and IE. Gene homologs associated with antiphagocytosis and bacterial adherence were identified and genetic variability was observed within A. urinae genomes. These findings contribute with important knowledge and basis for future molecular and experimental pathogenicity study of UTIs, bacteremia, and IE causing A. sanguinicola and A. urinae strains.
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Affiliation(s)
- Derya Carkaci
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Science and Environment, Roskilde University, Roskilde, Denmark; Department of Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - Katrine Højholt
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Bio and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark.
| | | | - Rimtas Dargis
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark.
| | - Simon Rasmussen
- Department of Bio and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark.
| | - Ole Skovgaard
- Department of Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Kurt Fuursted
- Department of Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - Paal Skytt Andersen
- Department of Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark; Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Marc Stegger
- Department of Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - Jens Jørgen Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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15
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Rasmussen LH, Højholt K, Dargis R, Christensen JJ, Skovgaard O, Justesen US, Rosenvinge FS, Moser C, Lukjancenko O, Rasmussen S, Nielsen XC. In silico assessment of virulence factors in strains of Streptococcus oralis and Streptococcus mitis isolated from patients with Infective Endocarditis. J Med Microbiol 2017; 66:1316-1323. [PMID: 28874232 DOI: 10.1099/jmm.0.000573] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose. Streptococcus oralis and Streptococcus mitis belong to the Mitis group, which are mostly commensals in the human oral cavity. Even though S. oralis and S. mitis are oral commensals, they can be opportunistic pathogens causing infective endocarditis. A recent taxonomic re-evaluation of the Mitis group has embedded the species Streptococcus tigurinus and Streptococcus dentisani into the species S. oralis as subspecies. In this study, the distribution of virulence factors that contribute to bacterial immune evasion, colonization and adhesion was assessed in clinical strains of S. oralis (subsp. oralis, subsp. tigurinus and subsp. dentisani) and S. mitis. Methodology. Forty clinical S. oralis (subsp. oralis, subsp. dentisani and subsp. tigurinus) and S. mitis genomes were annotated with the pipeline PanFunPro and aligned against the VFDB database for assessment of virulence factors.Results/Key findings. Three homologues of pavA, psaA and lmb, encoding adhesion proteins, were present in all strains. Seven homologues of nanA, nanB, ply, lytA, lytB, lytC and iga, of importance regarding survival in blood and modulation of the human immune system, were variously present in the genomes. Few S. oralis subspecies specific differences were observed. iga homologues were identified in S. oralis subsp. oralis, whereas lytA homologues were identified in S. oralis subsp. oralis and subsp. tigurinus. Conclusion. Differences in the presence of virulence factors among the three S. oralis subspecies were observed. The virulence gene profiles of the 40 S. mitis and S. oralis (subsp. oralis, subsp. dentisani and subsp. tigurinus) contribute with important new knowledge regarding these species and new subspecies.
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Affiliation(s)
- Louise H Rasmussen
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 46, 4200 Slagelse, Denmark.,Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark
| | - Katrine Højholt
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 46, 4200 Slagelse, Denmark.,Center for Biological Sequence Analysis, Department of Systems Biology, Technical University of Denmark, Kemitorvet, Building 208, 2800 Kgs Lyngby, Denmark
| | - Rimtas Dargis
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 46, 4200 Slagelse, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 46, 4200 Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Ole Skovgaard
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark
| | - Ulrik S Justesen
- Department of Clinical Microbiology, Odense University Hospital, J. B. Winsløws Vej 21, 2, 5000 Odense C, Denmark.,Department of Clinical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Flemming S Rosenvinge
- Department of Clinical Microbiology, Vejle Hospital, Kabbeltoft 25, 7100 Vejle, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Oksana Lukjancenko
- National Food Institute, Technical University of Denmark, Søltofts plads, Building 221, 2800 Kgs Lyngby, Denmark
| | - Simon Rasmussen
- Center for Biological Sequence Analysis, Department of Systems Biology, Technical University of Denmark, Kemitorvet, Building 208, 2800 Kgs Lyngby, Denmark
| | - Xiaohui C Nielsen
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 46, 4200 Slagelse, Denmark
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16
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Abstract
Chancroid is a sexually acquired infection caused by Haemophilus ducreyi. The infection is characterized by one or more genital ulcers, which are soft and painful, and regional lymphadenitis, which may develop into buboes. The infection may easily be misidentified due to its rare occurrence in Europe and difficulties in detecting the causative pathogen. H. ducreyi is difficult to culture. Nucleic acid amplification tests can demonstrate the bacterium in suspected cases. Antibiotics are usually effective in curing chancroid.
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Affiliation(s)
- Stephan Lautenschlager
- 1 Outpatient Clinic of Dermatology & Venereology, City Hospital Triemli, Zurich, Switzerland
| | - Michael Kemp
- 2 Department of Clinical Microbiology, Odense University Hospital, University of Southern Denmark, Denmark
| | | | - Marti Vall Mayans
- 4 STI Unit Vall d'Hebron-Drassanes, Hospital Vall d'Hebron, Barcelona, Spain
| | - Harald Moi
- 5 Section of STI, Olafia Clinic, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
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17
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Bonavent TB, Nielsen XC, Kristensen KS, Ihlemann N, Moser C, Christensen JJ. Cardiobacterium hominis and Cardiobacterium valvarum: Two Case Stories with Infective Episodes in Pacemaker Treated Patients. Open Microbiol J 2016; 10:183-187. [PMID: 28077974 PMCID: PMC5204057 DOI: 10.2174/1874285801610010183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Cardiobacterium hominis and Cardiobacterium valvarum are well known, though rare, etiologic agents of infective endocarditis. Cardiac devices are increasingly implanted. CASE REPORTS Two cases of infective episodes in pacemaker (PM) treated patients with respectively C. hominis and C. valvarum are presented. In one case blood-culture bottles yielded growth of C. hominis at two episodes with two years apart. At the second episode a vegetation was recognized at the PM lead and the PM device and lead was removed. In the C. valvarum case, echocardiography revealed a bicuspid aortic valve with severe regurgitation and a more than 1 cm sized vegetation. CONCLUSION The cases illustrate the diversity in disease severity by Cardiobacterium species. Careful follow up has to be performed in order not to overlook a relatively silent relapsing infection.
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Affiliation(s)
| | | | | | | | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
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18
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Heidemann CH, Lous J, Berg J, Christensen JJ, Håkonsen SJ, Jakobsen M, Johansen CJ, Nielsen LH, Hansen MP, Poulsen A, Schousboe LP, Skrubbeltrang C, Vind AB, Homøe P. Danish guidelines on management of otitis media in preschool children. Int J Pediatr Otorhinolaryngol 2016; 87:154-63. [PMID: 27368465 DOI: 10.1016/j.ijporl.2016.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatment for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME. METHODS The GRADE system (The Grading of Recommendations Assessment, Development and Evaluation) was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted between July and December 2014. The quality of the existing literature was assessed using AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR (assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic Accuracy Studies), Cochrane Risk of Bias Tool for randomized trials and ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies). The working group consisted of otolaryngologists, general practitioners, pediatricians, microbiologists and epidemiologists. CONCLUSION Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline.
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Affiliation(s)
- C H Heidemann
- Danish Health and Medicines Authority, Denmark; Department of ENT - Head & Neck Surgery, Odense University Hospital, Denmark; Department of Otorhinolaryngology, Vejle Hospital, Denmark.
| | - J Lous
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Denmark
| | - J Berg
- ENT Private Clinic, Århus, Denmark
| | - J J Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Denmark
| | - S J Håkonsen
- Danish Health and Medicines Authority, Denmark; Centre for Clinical Guidelines, Department of Health Science and Technology, University of Aalborg, Denmark
| | - M Jakobsen
- Danish Health and Medicines Authority, Denmark
| | | | - L H Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Denmark
| | - M P Hansen
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Denmark; Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - A Poulsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Denmark
| | - L P Schousboe
- Department of Otorhinolaryngology, Vejle Hospital, Denmark
| | - C Skrubbeltrang
- Danish Health and Medicines Authority, Denmark; Medical Library, Aalborg University Hospital, Denmark
| | - A B Vind
- Danish Health and Medicines Authority, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Denmark
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19
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Carlstein C, Marie Søes L, Jørgen Christensen J. Aerococcus christensenii as Part of Severe Polymicrobial Chorioamnionitis in a Pregnant Woman. Open Microbiol J 2016; 10:27-31. [PMID: 27014376 PMCID: PMC4787314 DOI: 10.2174/1874285801610010027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/03/2015] [Accepted: 02/23/2015] [Indexed: 11/22/2022] Open
Abstract
Chorioamnionitis is a potentially life threatening infection of the fetal
membranes, commonly caused by ascending bacteria from the vagina and cervix. In
our case, a healthy nullipara with a term pregnancy presented clinical signs of
infection after induced labour with an intracervical balloon. Thick green and
foul smelling amniotic fluid was observed and culture showed massive growth of
Aerococcus christensenii, a facultative anaerob species found in the
human vagina, previously only rarely alleged to cause invasive infection.
Additional testing with 16S rRNA gene analysis also identified the presence of
Gemella asaccharolytica, Snethia sanguinegens, Parvimonas
micra and Streptobacillus moniliformis. The patient was
treated with cefuroxime and metronidazole and recovered quickly. The newborn
showed no signs of infection. This case points at the possible role of these
pathogens in female genital tract infections. The case also underlines the
importance of the combination of culture and culture independent diagnostic
approaches to reveal possible polymicrobial natures of selected infections, in
this case chorioamnionitis.
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Affiliation(s)
- Catrine Carlstein
- Department of Gynaecology and Obstetrics, Næstved Hospital, Ringstedgade 61, 4700 Næstved, Denmark
| | - Lillian Marie Søes
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 18, 4200 Slagelse, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 18, 4200 Slagelse, Denmark
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20
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Jansen LC, Dargis R, Bundgaard H, Moser C, Christensen JJ, Kemp M. Infective endocarditis caused by Bartonella quintana in Greenland. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.003475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Louise C. Jansen
- Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Rimtas Dargis
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
- Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
- Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Michael Kemp
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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21
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Bartels MD, Nielsen XC, Christensen JJ, Westh H. [Not Available]. Ugeskr Laeger 2014; 176:V66252. [PMID: 25186705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Mette Damkjær Bartels
- Mette Damkjær Bartels, Klinisk Mikrobiologisk Afdeling 445, Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre.
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22
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Bank S, Cattoir V, Lienhard R, Grisold AJ, Thomsen TR, Reinhard M, Olsen AB, Christensen JJ, Søby KM, Prag J. Recommendations for optimal detection and identification ofActinobaculum schaaliiin urine. APMIS 2014; 122:1043-4. [DOI: 10.1111/apm.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Steffen Bank
- Department of Clinical Microbiology; Viborg Regional Hospital; Viborg Denmark
| | | | | | - Andrea J. Grisold
- Institute of Hygiene, Microbiology and Environmental Medicine; Medical University of Graz; Graz Austria
| | - Trine R. Thomsen
- Department of Biotechnology; Aalborg University and Section for Medical Biotechnology; The Danish Technological Institute; Taastrup Denmark
| | - Mark Reinhard
- Department of Internal Medicine; Viborg Regional Hospital; Viborg Denmark
| | | | | | - Karen Marie Søby
- Department of Clinical Microbiology; Viborg Regional Hospital; Viborg Denmark
| | - Jørgen Prag
- Department of Clinical Microbiology; Viborg Regional Hospital; Viborg Denmark
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23
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Ingels H, Lambertsen L, Harboe ZB, Marquart HV, Konradsen H, Christensen JJ, Heilmann C. Recurrent invasive pneumococcal disease in children: Epidemiological, microbiological, and clinical aspects from a Danish 33-year nationwide survey (1980–2013). ACTA ACUST UNITED AC 2014; 46:265-71. [DOI: 10.3109/00365548.2013.877156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Kemp M, Bangsborg J, Kjerulf A, Schmidt TA, Christensen J, Irmukhamedov A6, Bruun NE, Dargis R, Andresen K, Christensen JJ. Advantages and limitations of ribosomal RNA PCR and DNA sequencing for identification of bacteria in cardiac valves of danish patients. Open Microbiol J 2013; 7:146-51. [PMID: 24403979 PMCID: PMC3883160 DOI: 10.2174/1874285801307010146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 11/29/2022] Open
Abstract
Studies on the value of culture-independent molecular identification of bacteria in cardiac valves are mostly restricted to comparing agreement of identification to what is obtained by culture to the number of identified bacteria in culture-negative cases. However, evaluation of the usefulness of direct molecular identification should also address weaknesses, their relevance in the given setting, and possible improvements. In this study cardiac valves from 56 Danish patients referred for surgery for infective endocarditis were analysed by microscopy and culture as well as by PCR targeting part of the bacterial 16S rRNA gene followed by DNA sequencing of the PCR product. PCR and DNA sequencing identified significant bacteria in 49 samples from 43 patients, including five out of 13 culture-negative cases. No rare, exotic, or intracellular bacteria were identified. There was a general agreement between bacterial identity obtained by ribosomal PCR and DNA sequencing from the valves and bacterial isolates from blood culture. However, DNA sequencing of the 16S rRNA gene did not discriminate well among non-haemolytic streptococci, especially within the Streptococcus mitis group. Ribosomal PCR with subsequent DNA sequencing is an efficient and reliable method of identifying the cause of IE, but exact species identification of some of the most common causes, i.e. non-haemolytic streptococci, may be improved with other molecular methods.
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Affiliation(s)
- Michael Kemp
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Herlev University hospital, Copenhagen, Denmark
| | - Anne Kjerulf
- Department of Clinical Microbiology, Herlev University hospital, Copenhagen, Denmark
| | | | - John Christensen
- Department of Cardiothoracic Surgery, Gentofte University Hospital, Copenhagen, Denmark
| | | | - Niels Eske Bruun
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Rimtas Dargis
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Keld Andresen
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
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25
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Jensen KH, Dargis R, Christensen JJ, Kemp M. Ribosomal PCR and DNA sequencing for detection and identification of bacteria: experience from 6 years of routine analyses of patient samples. APMIS 2013; 122:248-55. [PMID: 23879657 DOI: 10.1111/apm.12139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 05/22/2013] [Indexed: 11/29/2022]
Abstract
The use of broad range PCR and DNA sequencing of bacterial 16S ribosomal RNA genes for routine diagnostics of bacterial infections was evaluated. Here, the results from more than 2600 analyses during a 6-year period (2003-2009) are presented. Almost half of the samples were from joints and bones, and the second most frequent origin of samples was from the central nervous system. Overall, 26% of all samples were positive for bacterial DNA and bacterial identification was obtained in 80% of the PCR-positive samples by subsequent DNA sequencing. Ambiguous species identification was noticed among non-haemolytic streptococci, especially within the mitis group. The data show that ribosomal PCR with subsequent DNA sequencing of the PCR product is a most valuable supplement to culture for identifying bacterial agents of both acute and prolonged infections. However, some bacteria, including non-haemolytic streptococci, may not be precisely identified.
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Affiliation(s)
- Kristine Helander Jensen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark; Department of Science, Systems and Model, Roskilde University, Roskilde, Denmark; Department of Clinical Microbiology, Odense university Hospital, Odense, Denmark
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26
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Affiliation(s)
- Dana Bailey
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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27
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Iversen K, Høst N, Bruun NE, Elming H, Pump B, Christensen JJ, Gill S, Rosenvinge F, Wiggers H, Fuursted K, Holst-Hansen C, Korup E, Schønheyder HC, Hassager C, Høfsten D, Larsen JH, Moser C, Ihlemann N, Bundgaard H. Partial oral treatment of endocarditis. Am Heart J 2013; 165:116-22. [PMID: 23351813 DOI: 10.1016/j.ahj.2012.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 11/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Guidelines for the treatment of left-sided infective endocarditis (IE) recommend 4 to 6 weeks of intravenous antibiotics. Conversion from intravenous to oral antibiotics in clinically stabilized patients could reduce the side effects associated with intravenous treatment and shorten the length of hospital stay. Evidence supporting partial oral therapy as an alternative to the routinely recommended continued parenteral therapy is scarce, although observational data suggest that this strategy may be safe and effective. STUDY DESIGN This is a noninferiority, multicenter, prospective, randomized, open-label study of partial oral treatment with antibiotics compared with full parenteral treatment in left-sided IE. Stable patients (n = 400) with streptococci, staphylococci, or enterococci infecting the mitral valve or the aortic valve will be included. After a minimum of 10 days of parenteral treatment, stable patients are randomized to oral therapy or unchanged parenteral therapy. Recommendations for oral treatment have been developed based on minimum inhibitory concentrations and pharmacokinetic calculations. Patients will be followed up for 6 months after completion of antibiotic therapy. The primary end point is a composition of all-cause mortality, unplanned cardiac surgery, embolic events, and relapse of positive blood cultures with the primary pathogen. CONCLUSION The Partial Oral Treatment of Endocarditis study tests the hypothesis that partial oral antibiotic treatment is as efficient and safe as parenteral therapy in left-sided IE. The trial is justified by a review of the literature, by pharmacokinetic calculations, and by our own experience.
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28
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Jansen LC, Justesen US, Roos SM, Dargis R, Jensen JS, Christensen JJ, Kemp M. [Seal finger in Denmark diagnosed by PCR-technique]. Ugeskr Laeger 2012; 174:426-427. [PMID: 22331047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Seal finger is an unusual infection in Denmark but is seen quite often in Greenland. A 69 year-old Danish man developed severe infection after cutting his finger on a sea urchin while handling a fishing net. Treatment with beta-lactam antibiotics had no effect. Standard culture from the lesion was negative. A Mycoplasma species was detected by PCR and DNA sequencing and subsequently cultured on special media. Specifically asked about exposure to sea mammals the patient could inform that a dead seal had also been trapped in the fishing net.
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29
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Gjødsbøl K, Skindersoe ME, Christensen JJ, Karlsmark T, Jørgensen B, Jensen AM, Klein BM, Sonnested MK, Krogfelt KA. No need for biopsies: comparison of three sample techniques for wound microbiota determination. Int Wound J 2011; 9:295-302. [PMID: 22067000 DOI: 10.1111/j.1742-481x.2011.00883.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of the study was to compare three sampling techniques used in routine diagnostics to identify the microbiota in chronic venous leg ulcers. A total of 46 patients with persisting venous leg ulcers were included in the study. At inclusion, swab, biopsy and filter paper pad samples were collected. After 4 weeks, additional biopsy and filter paper pad samples were collected. Bacteria were isolated and identified at species level by standard methods. The most common bacterial species detected was Staphylococcus aureus found in 89% of the ulcers. No methicillin-resistant S. aureus isolates were found. We did not find any significant differences regarding the bacterial species isolated between the three sampling techniques. However, using multiple techniques led to identification of more species. Our study suggests that it is sufficient to use swab specimens to identify the bacterial species present in chronic wounds, thus avoiding complications during and after biopsy sampling.
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Affiliation(s)
- Kristine Gjødsbøl
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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30
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Mirhendi H, Bruun B, Schønheyder HC, Christensen JJ, Fuursted K, Gahrn-Hansen B, Johansen HK, Nielsen L, Knudsen JD, Arendrup MC. Differentiation of Candida glabrata, C. nivariensis and C. bracarensis based on fragment length polymorphism of ITS1 and ITS2 and restriction fragment length polymorphism of ITS and D1/D2 regions in rDNA. Eur J Clin Microbiol Infect Dis 2011; 30:1409-16. [PMID: 21607825 DOI: 10.1007/s10096-011-1235-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 03/20/2011] [Indexed: 12/11/2022]
Abstract
Different molecular methods for the discrimination of Candida glabrata, C. bracarensis and C. nivariensis were evaluated and the prevalence of these species among Danish blood isolates investigated. Control strains were used to determine fragment length polymorphism in the ITS1, ITS2, ITS1-5.8S-ITS2 regions and in the D1/D2 domain of 26S rDNA using primers designed for this study. A total of 133 blood isolates previously identified as C. glabrata were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and the peptide nucleic acid-fluorescent in situ hybridization (PNA-FISH) method. The size of ITS1 allowed differentiation between C. glabrata (483), C. nivariensis (361) and C. bracarensis (385), whereas the ITS2 region was of similar size in C. nivariensis (417) and C. glabrata (418). Sequence analysis of the ITS region suggested that many restriction enzymes were suitable for RFLP differentiation of the species. Enzymatic digestion of the D1/D2 domain with TatI produced unique band sizes for each of the three species. PCR-RFLP and PNA-FISH were in agreement for all of the isolates tested. None of the 133 Danish blood isolates were C. nivariensis or C. bracarensis. Fragment size polymorphism of ITS1 and RFLP of the D1/D2 domain or the ITS region are useful methods for the differentiation of the species within the C. glabrata group. C. bracarensis and C. nivariensis are rare among Danish C. glabrata blood isolates.
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Affiliation(s)
- H Mirhendi
- Department of Medical Mycology and Parasitology, School of Public Health and National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Chancroid is a sexually acquired disease caused by Haemophilus ducreyi. The infection is characterized by one or more genital ulcers, which are soft and painful, and regional lymphadenitis which may develop into buboes. The infection may easily be misidentified due to its rare occurrence in Europe and difficulties in detecting the causative pathogen. H. ducreyi is difficult to culture. Polymerase chain reaction (PCR) can demonstrate the bacterium in suspected cases. Antibiotics will usually be efficient for curing chancroid.
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Affiliation(s)
- M Kemp
- Department of Clinical Microbiology, Odense University Hospital, University of Southern Denmark
| | - J J Christensen
- Slagelse Sygehus, Department of Clinical Microbiology, Denmark
| | - S Lautenschlager
- Outpatient Clinic of Dermatology & Venereology, City Hospital Triemli, Zurich, Switzerland
| | - M Vall-Mayans
- STI Unit CAP Drassanes, Catalan Health Institute Barcelona, Catalonia, Spain
| | - H Moi
- Section of STI, Department of Rheumatology, Dermatology, and Infectious Diseases, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Norway
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32
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Chen M, Kemp M, Bruun NE, Bangsborg JM, Højlyng N, Hesselbjerg A, Dargis R, Christensen JJ. Cardiobacterium valvarum infective endocarditis and phenotypic/molecular characterization of 11 Cardiobacterium species strains. J Med Microbiol 2011; 60:522-528. [DOI: 10.1099/jmm.0.025353-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cardiobacterium valvarum is a newly recognized human pathogen related to infective endocarditis. Cardiobacterium species are, however, only rarely the aetiology of infective endocarditis. An infective endocarditis case is presented and, additionally, phenotypic and phylogenetic comparison of a further 10 collection strains, representing the two species within the genus, was performed. C. valvarum was isolated from the blood and DNA was present in valvular tissue (partial 16S rRNA gene analysis) from a 64-year-old man with infective endocarditis of the mitral valve, rupture of chordae and prolapse of pulmonary valves in addition to a fluttering excrescence. A mechanical mitral valve and neochordae were inserted successfully. Phenotypically, the two species within the genus Cardiobacterium resemble each other greatly. When using the Vitek 2 Neisseria–Haemophilus identification card, the reaction for phenylphosphonate was positive for all Cardiobacterium hominis strains, but negative for all C. valvarum strains, thereby separating the two species. The two species made up two separate clusters by phylogenetic examination using 16S rRNA gene sequence analysis.
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Affiliation(s)
- Ming Chen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Michael Kemp
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Niels E. Bruun
- Department of Cardiology, Gentofte University Hospital, Gentofte, Denmark
| | - Jette M. Bangsborg
- Department of Clinical Microbiology, Herlev University Hospital, Herlev, Denmark
| | - Niels Højlyng
- Infectious Diseases Unit, Medical Department, Roskilde University Hospital, Roskilde, Denmark
| | - Annemarie Hesselbjerg
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Rimtas Dargis
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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33
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Arendrup MC, Bruun B, Christensen JJ, Fuursted K, Johansen HK, Kjaeldgaard P, Knudsen JD, Kristensen L, Møller J, Nielsen L, Rosenvinge FS, Røder B, Schønheyder HC, Thomsen MK, Truberg K. National surveillance of fungemia in Denmark (2004 to 2009). J Clin Microbiol 2011; 49:325-34. [PMID: 20980569 PMCID: PMC3020479 DOI: 10.1128/jcm.01811-10] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 09/24/2010] [Accepted: 10/12/2010] [Indexed: 12/12/2022] Open
Abstract
A 6-year nationwide study of fungemia in Denmark was performed using data from an active fungemia surveillance program and from laboratory information systems in nonparticipating regions. A total of 2,820 episodes of fungemia were recorded. The incidence increased from 2004 to 2007 (7.7 to 9.6/100,000) and decreased slightly from 2008 to 2009 (8.7 to 8.6/100,000). The highest incidences were seen at the extremes of age (i.e., 11.3 and 37.1/100,000 for those <1 and 70 to 79 years old, respectively). The rate was higher for males than for females (10.1 versus 7.6/100,000, P = 0.003), with the largest difference observed for patients >50 years of age. The species distribution varied significantly by both age and gender. Candida species accounted for 98% of the pathogens, and C. albicans was predominant, although the proportion decreased (64.4% to 53.2%, P < 0.0001). C. glabrata ranked second, and the proportion increased (16.5% to 25.9%, P = 0.003). C. glabrata was more common in adults and females than in children and males, whereas C. tropicalis was more common in males (P = 0.020). C. krusei was a rare isolate (4.1%) except at one university hospital. Acquired resistance to amphotericin and echinocandins was rare. However, resistance to fluconazole (MIC of >4 μg/ml) occurred in C. albicans (7/1,183 [0.6%]), C. dubliniensis (2/65 [3.1%]), C. parapsilosis (5/83 [6.0%]), and C. tropicalis (7/104 [6.7%]). Overall, 70.8% of fungemia isolates were fully fluconazole susceptible, but the proportion decreased (79.7% to 68.9%, P = 0.02). The study confirmed an incidence rate of fungemia in Denmark three times higher than those in other Nordic countries and identified marked differences related to age and gender. Decreased susceptibility to fluconazole was frequent and increasing.
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Affiliation(s)
- Maiken Cavling Arendrup
- Unit of Mycology, Department of Microbiological Surveillance and Research 43/117, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark.
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Sönksen UW, Christensen JJ, Nielsen L, Hesselbjerg A, Hansen DS, Bruun B. Fastidious Gram-Negatives: Identification by the Vitek 2 Neisseria-Haemophilus Card and by Partial 16S rRNA Gene Sequencing Analysis. Open Microbiol J 2010; 4:123-31. [PMID: 21347215 PMCID: PMC3043276 DOI: 10.2174/1874285801004010123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 10/31/2010] [Accepted: 11/02/2010] [Indexed: 11/22/2022] Open
Abstract
Taxonomy and identification of fastidious Gram negatives are evolving and challenging. We compared identifications achieved with the Vitek 2 Neisseria-Haemophilus (NH) card and partial 16S rRNA gene sequence (526 bp stretch) analysis with identifications obtained with extensive phenotypic characterization using 100 fastidious Gram negative bacteria. Seventy-five strains represented 21 of the 26 taxa included in the Vitek 2 NH database and 25 strains represented related species not included in the database. Of the 100 strains, 31 were the type strains of the species. Vitek 2 NH identification results: 48 of 75 database strains were correctly identified, 11 strains gave `low discrimination´, seven strains were unidentified, and nine strains were misidentified. Identification of 25 non-database strains resulted in 14 strains incorrectly identified as belonging to species in the database. Partial 16S rRNA gene sequence analysis results: For 76 strains phenotypic and sequencing identifications were identical, for 23 strains the sequencing identifications were either probable or possible, and for one strain only the genus was confirmed. Thus, the Vitek 2 NH system identifies most of the commonly occurring species included in the database. Some strains of rarely occurring species and strains of non-database species closely related to database species cause problems. Partial 16S rRNA gene sequence analysis performs well, but does not always suffice, additional phenotypical characterization being useful for final identification.
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Affiliation(s)
- Ute Wolff Sönksen
- Department of Clinical Microbiology, Hillerød Hospital, Hillerød, Denmark
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Abdul-Redha RJ, Kemp M, Bangsborg JM, Arpi M, Christensen JJ. Infective Endocarditis: Identification of Catalase-Negative, Gram-Positive Cocci from Blood Cultures by Partial 16S rRNA Gene Analysis and by Vitek 2 Examination. Open Microbiol J 2010; 4:116-22. [PMID: 21673976 PMCID: PMC3111702 DOI: 10.2174/1874285801004010116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 10/31/2010] [Accepted: 11/02/2010] [Indexed: 12/04/2022] Open
Abstract
Streptococci, enterococci and Streptococcus-like bacteria are frequent etiologic agents of infective endocarditis and correct species identification can be a laboratory challenge. Viridans streptococci (VS) not seldomly cause contamination of blood cultures. Vitek 2 and partial sequencing of the 16S rRNA gene were applied in order to compare the results of both methods. Strains originated from two groups of patients: 149 strains from patients with infective endocarditis and 181 strains assessed as blood culture contaminants. Of the 330 strains, based on partial 16S rRNA gene sequencing results, 251 (76%) were VS strains, 10 (3%) were pyogenic streptococcal strains, 54 (16%) were E. faecalis strains and 15 (5%) strains belonged to a group of miscellaneous catalase-negative, Gram-positive cocci. Among VS strains, respectively, 220 (87,6%) and 31 (12,3%) obtained agreeing and non-agreeing identifications with the two methods with respect to allocation to the same VS group. Non-agreeing species identification mostly occurred among strains in the contaminant group, while for endocarditis strains notably fewer disagreeing results were observed. Only 67 of 150 strains in the mitis group strains obtained identical species identifications by the two methods. Most VS strains belonging to the groups of salivarius, anginosus, and mutans obtained agreeing species identifications with the two methods, while this only was the case for 13 of the 21 bovis strains. Pyogenic strains (n=10), Enterococcus faecalis strains (n=54) and a miscellaneous group of catalase-negative, Gram-positive cocci (n=15) seemed well identified by both methods, except that disagreements in identifications in the miscellaneous group of strains occurred for 6 of 15 strains.
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Affiliation(s)
- Rawaa Jalil Abdul-Redha
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut; Department of Clinical Microbiology
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Badran S, Pedersen TI, Roed C, Lunding S, Birk N, Vestergaard H, Røder B, Lillelund HK, Kurtzhals JAL, Kemp M, Christensen JJ. Imported melioidosis in Danish travellers: a diagnostic challenge. ACTA ACUST UNITED AC 2010; 42:445-9. [PMID: 20297927 DOI: 10.3109/00365540903582467] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infections with Burkholderia pseudomallei (melioidosis) are rare events in Scandinavian countries, but the bacterium may be contracted during travel to endemic areas, i.e. Southeast Asia (especially Thailand) and northern Australia. Here, 5 travel-related cases occurring within the last 3 y in Denmark are reported, with particular emphasis on diagnostic and therapeutic challenges posed to health staff with little experience in the management of melioidosis. A newly developed B. pseudomallei-specific polymerase chain reaction test was applied and was able to correctly identify all isolates.
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Affiliation(s)
- Shadia Badran
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
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Kemp M, Jensen KH, Dargis R, Christensen JJ. Routine ribosomal PCR and DNA sequencing for detection and identification of bacteria. Future Microbiol 2010; 5:1101-7. [DOI: 10.2217/fmb.10.59] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Detection and identification of bacteria by PCR and DNA sequencing from clinical sample material has been introduced as a diagnostic routine analysis during the last 5–10 years. Assays analyzing ribosomal genes have been found to be particularly useful. The technique has identified unusual bacteria as well as well-known bacteria in unusual infectious foci. Thereby, it has proven its value both in diagnosing infections in individual patients and as a tool to establish the pathogenic potential of bacteria not previously associated with disease. To be of clinical relevance, results from ribosomal PCR and DNA sequencing must be obtained fast and at acceptable costs. Processing of a high number of samples by individual laboratories can ensure both speed and low price. By continued technical development and further investigations of its usefulness in various clinical settings ribosomal DNA sequencing will most probably become as common a part of clinical bacteriology as culture is today.
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Affiliation(s)
| | - Kristine H Jensen
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark
| | - Rimtas Dargis
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark
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Lambertsen L, Brendstrup M, Friis H, Christensen JJ. Molecular characterization of invasive penicillin non-susceptible Streptococcus pneumoniae from Denmark, 2001 to 2005. ACTA ACUST UNITED AC 2010; 42:333-40. [PMID: 20121651 DOI: 10.3109/00365540903501616] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to characterize invasive penicillin non-susceptible pneumococci (PNSP) isolated in Denmark from 2001 to 2005, describe the genetic changes in the penicillin-binding proteins (PBPs) and compare the isolates to the international recognized PNSP clones. All isolates were characterized using serotyping; 43 isolates were also characterized by multilocus sequence typing (MLST) and sequence determination of the PBP genes, pbp1a, pbp2b and pbp2x. In addition, isolates were tested for susceptibility to various antimicrobial agents. From 2001 to 2005, 178 invasive PNSP isolates were found among all invasive isolates. Of these, 13% were penicillin-resistant pneumococci (PRP). The PRP isolates were different to the penicillin intermediate-resistant pneumococci (PIRP) as they were co-resistant to a higher number of antimicrobial agents, and the serotype diversity was lower for the PRP isolates compared to the PIRP isolates. Changes in the PBPs were found to be the same as those observed in other studies. Most PRP isolates were found to belong to the clonal complex CC156 of which most were ST156 serotype 9V or 14. ST156 is a well known multiresistant widespread international PMEN (Pneumococcal Molecular Epidemiology Network) clone, Spain(9V)-3, which is also present as one of the dominant clones in our neighbour countries of Sweden, Norway and Germany.
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Affiliation(s)
- Lotte Lambertsen
- The Neisseria and Streptococcus Reference Centre, Department for Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark.
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Ances BM, Christensen JJ, Teshome M, Taylor J, Xiong C, Aldea P, Fagan AM, Holtzman DM, Morris JC, Mintun MA, Clifford DB. Cognitively unimpaired HIV-positive subjects do not have increased 11C-PiB: a case-control study. Neurology 2010; 75:111-5. [PMID: 20534887 DOI: 10.1212/wnl.0b013e3181e7b66e] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Diagnostic challenges exist for differentiating HIV dementia from Alzheimer disease (AD) in older HIV-infected (HIV+) individuals. Similar abnormalities in brain amyloid-beta42 (Alphabeta42) metabolism may be involved in HIV-associated neuropathology and AD. We evaluated the amyloid-binding agent (11)C-Pittsburgh compound B ((11)C-PiB), a biomarker for Alphabeta42 deposition, in cognitively unimpaired HIV+ (n = 10) participants and matched community controls without dementia (n = 20). METHODS In this case-control study, all participants had an (11)C-PiB scan within 2 years of concomitant CSF studies and neuropsychometric testing. Statistical differences between HIV+ and community controls for demographic and clinical values were assessed by chi(2) tests. Participants were further divided into either low (<500 pg/mL) or normal (>or=500 pg/mL) CSF Alphabeta42 groups with Student t tests performed to determine if regional differences in fibrillar amyloid plaque deposition varied with CSF Alphabeta42. RESULTS Regardless of CSF Alphabeta42 level, none of the HIV+ participants had fibrillar amyloid plaques as assessed by increased (11)C-PiB mean cortical binding potential (MCBP) or binding potential within 4 cortical regions. In contrast, some community controls with low CSF Alphabeta42 (<500 pg/mL) had high (11)C-PiB MCBP with elevated binding potentials (>0.18 arbitrary units) within cortical regions. CONCLUSIONS Cognitively unimpaired HIV+ participants, even with low CSF Alphabeta42 (<500 pg/mL), do not have (11)C-PiB parameters suggesting brain fibrillar amyloid deposition. The dissimilarity between unimpaired HIV+ and preclinical AD may reflect differences in Abeta42 production and/or formation of diffuse plaques. Future longitudinal studies of HIV+ participants with low CSF Abeta42 and normal (11)C-PiB are required.
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Affiliation(s)
- B M Ances
- Department of Neurology, Washington University, St Louis, MO 63110, USA.
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Kvistholm Jensen A, Ethelberg S, Smith B, Møller Nielsen E, Larsson J, Mølbak K, Christensen JJ, Kemp M. Substantial increase in listeriosis, Denmark 2009. Euro Surveill 2010. [DOI: 10.2807/ese.15.12.19522-en] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2009, 97 cases of listeriosis were reported in Denmark (1.8 per 100,000), a significant rise over the previous year. The increase was seen both in cases of bacteraemia and meningitis and affected mainly people aged 70 years and older. A foodborne outbreak of eight cases was identified by pulsed-field gel electrophoresis typing. No explanation has so far been found for the marked increase in incidence. An increasing trend has been observed since 2003 and possible explanations are discussed.
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Affiliation(s)
- A Kvistholm Jensen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - S Ethelberg
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - B Smith
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - E Møller Nielsen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - J Larsson
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - K Mølbak
- Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - J J Christensen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - M Kemp
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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Kvistholm Jensen A, Ethelberg S, Smith B, Moller Nielsen E, Larsson J, Molbak K, Christensen JJ, Kemp M. Substantial increase in listeriosis, Denmark 2009. Euro Surveill 2010; 15:19522. [PMID: 20350498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
In 2009, 97 cases of listeriosis were reported in Denmark (1.8 per 100,000), a significant rise over the previous year. The increase was seen both in cases of bacteraemia and meningitis and affected mainly people aged 70 years and older. A foodborne outbreak of eight cases was identified by pulsed-field gel electrophoresis typing. No explanation has so far been found for the marked increase in incidence. An increasing trend has been observed since 2003 and possible explanations are discussed.
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Affiliation(s)
- A Kvistholm Jensen
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark.
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Harboe ZB, Benfield TL, Valentiner-Branth P, Hjuler T, Lambertsen L, Kaltoft M, Krogfelt K, Slotved HC, Christensen JJ, Konradsen HB. Temporal trends in invasive pneumococcal disease and pneumococcal serotypes over 7 decades. Clin Infect Dis 2010; 50:329-37. [PMID: 20047478 DOI: 10.1086/649872] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pneumococcal infections have historically played a major role in terms of morbidity and mortality. We explored historical trends of invasive pneumococcal disease (IPD) and pneumococcal serotypes in a population exposed to limited antibiotic selective pressure and conjugate pneumococcal vaccination (PCV). METHODS Retrospective cohort study based on nationwide laboratory surveillance data on IPD collected uninterruptedly in Denmark during 1938-2007. Changes in the reported incidence and trends of pneumococcal serotypes were explored using nonlinear regression analysis. RESULTS There were 25,502 IPD cases included in our study. The median incidence of IPD increased from 2.8 cases per 100,000 population (interquartile range [IQR], 1.5-2.6) during the first 4 decades to 15.7 cases per 100,000 population (IQR, 7-20.4) during the 1980s and 1990s, mainly attributed to an increase in the number of bacteremia cases. The incidence of meningitis remained relatively stable, with a median of 1.3 cases per 100,000 population (IQR, 0.9-1.6). The proportions of serotypes/groups 4 and 9 increased; the proportion of serotype 18C decreased; the proportions of serotypes 6, 7F, 14, and 23F remained stable; and serotype 2 nearly disappeared. Before the 1960s, serotypes 1, 2, 3, and 5 presented peaks every 2-3 years, becoming less frequent during the 1970s with peaks every 7-10 years. Between 20% and 90% of IPD in children <5 years were caused by PCV serotypes during the last 4 decades. Cases of IPD caused by serotype 19A increased before introduction of PCV. Between 1993 and 2007, the level of resistance to macrolides and beta-lactams was 6%. CONCLUSIONS The epidemiology of IPD and single serotypes has constantly changed over the past 7 decades. PCV serotypes appeared to dominate the pneumococcal population.
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Affiliation(s)
- Zitta B Harboe
- National Neisseria and Streptococcus Reference Center, Department of Bacteriology, Mycology, and Parasitology, Statens Serum Institut, Copenhagen, Denmark.
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Nielsen HL, Søby KM, Christensen JJ, Prag J. Actinobaculum schaalii: a common cause of urinary tract infection in the elderly population. Bacteriological and clinical characteristics. ACTA ACUST UNITED AC 2010; 42:43-7. [PMID: 19883165 DOI: 10.3109/00365540903289662] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To-date only 21 clinical cases of Actinobaculum schaalii infection have been published, and A. schaalii has been considered a rare cause of urinary tract infection (UTI) and urosepsis. Between y 2005 and 2008, we isolated A. schaalii from 55 predisposed elderly patients. In these cases, microscopic findings of coccoid rods in wet smears of urine gave rise to clinical suspicion and subsequently to its isolation from urine. Typically only scant growth of A. schaalii occurred after incubation of the urine for 24 h, but it became visible after 2 days of incubation in 5% CO(2). Preliminary biochemical identification was carried out by combining the API Coryne and Rapid ID32A test systems, and the identification was later confirmed by partial 16S rDNA gene sequencing. During the 4-y period, A. schaalii caused septicaemia, UTIs and asymptomatic bacteriuria. One patient was later infected with Actinobaculum massiliense. The incidence of A. schaalii infections is much higher than previously reported. We present numerous case reports and describe the bacteriological and clinical characteristics of this overlooked uropathogen.
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Affiliation(s)
- Hans Linde Nielsen
- Department of Clinical Microbiology, Viborg Hospital, Heibergs Allé 4, Viborg, Denmark
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Harboe ZB, Valentiner-Branth P, Benfield TL, Christensen JJ, Andersen PH, Howitz M, Krogfelt KA, Lambertsen L, Konradsen HB. Early effectiveness of heptavalent conjugate pneumococcal vaccination on invasive pneumococcal disease after the introduction in the Danish Childhood Immunization Programme. Vaccine 2010; 28:2642-7. [PMID: 20096392 DOI: 10.1016/j.vaccine.2010.01.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 12/18/2009] [Accepted: 01/10/2010] [Indexed: 11/25/2022]
Abstract
We evaluated the effectiveness of the heptavalent pneumococcal conjugate vaccine (PCV7) on invasive pneumococcal disease (IPD) 1 year after PCV7's introduction in the childhood immunization programme through a nationwide cohort study based on laboratory surveillance data. There was a decline in the overall incidence of IPD from 19.4 to 17.1 cases per 100,000 population (incidence rate ratios (IRR) 0.87; 95% confidence interval (CI) [0.81-0.96]), and of meningitis from 1.56 to 1.16 (IRR 0.74; 95% CI [0.57-0.97]) comparing pre-PCV7 (years 2000-2007) and PCV7 (year 2008) periods. In children <2 years, the incidence decreased from 54 to 23 cases per 100,000 (IRR 0.43; 95% CI [0.29-0.62]) and for vaccine-serotypes from 36.7 to 7.7 (IRR 0.20; 95% CI [0.09-0.38]). The incidence of IPD declined approximately 10% (IRR 0.90; 95% CI [0.84-0.97]) in patients aged >or=2 years. The case fatality was 17% in both periods. The administration of PCV7 was followed by a marked decline in the incidence of IPD in both vaccinated and non-vaccinated individuals.
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Affiliation(s)
- Zitta B Harboe
- National Neisseria and Streptococcus Reference Center, Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark.
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Mirhendi H, Bruun B, Schønheyder HC, Christensen JJ, Fuursted K, Gahrn-Hansen B, Johansen HK, Nielsen L, Knudsen JD, Arendrup MC. Molecular screening for Candida orthopsilosis and Candida metapsilosis among Danish Candida parapsilosis group blood culture isolates: proposal of a new RFLP profile for differentiation. J Med Microbiol 2010; 59:414-420. [PMID: 20056771 DOI: 10.1099/jmm.0.017293-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Candida orthopsilosis and Candida metapsilosis are recently described species phenotypically indistinguishable from Candida parapsilosis . We evaluated phenotyping and molecular methods for the detection of these species among 79 unique blood culture isolates of the C. parapsilosis group obtained during the years 2004-2008. The isolates were screened by PCR amplification of the secondary alcohol dehydrogenase-encoding gene ( SADH) followed by digestion with the restriction enzyme Ban I, using C. parapsilosis ATCC 22019, C. orthopsilosis ATCC 96139 and C. metapsilosis ATCC 96144 as controls. Isolates with RFLP patterns distinct from C. parapsilosis were characterized by sequence analysis of the ITS1-ITS2, 26S rRNA (D1/D2) and SADH regions. Restriction patterns for the 3 species with each of 610 restriction enzymes were predicted in silico using 12 available sequences. By PCR-RFLP of the SADH gene alone, four isolates (5.1 %) had a pattern identical to the C. orthopsilosis reference strain. Sequence analysis of SADH and ITS (internal transcribed spacer) regions identified two of these isolates as C. metapsilosis. These results were confirmed by creating a phylogenetic tree based on concatenated sequences of SADH, ITS and 26S rRNA gene sequence regions. Optimal differentiation between C. parapsilosis, C. metapsilosis and C. orthopsilosis was predicted using digestion with NlaIII, producing discriminatory band sizes of: 131 and 505 bp; 74, 288 and 348 bp; and 131, 217 and 288 bp, respectively. This was confirmed using the reference strains and 79 clinical isolates. In conclusion, reliable discrimination was obtained by PCR-RFLP profile analysis of the SADH gene after digestion with NlaIII but not with BanI. C. metapsilosis and C. orthopsilosis are involved in a small but significant number of invasive infections in Denmark.
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Affiliation(s)
- Hossein Mirhendi
- Mycology and Parasitology Unit, Statens Serum Institut,Copenhagen, Denmark
- Department of Medical Mycology and Parasitology,Faculty of Public Health and National Institute of Health Research, TehranUniversity of Medical Sciences, Tehran, Iran
| | - Brita Bruun
- Department of Clinical Microbiology, HillerødHospital, Hillerød, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg Hospital,Aarhus University Hospital, Aalborg, Denmark
| | | | - Kurt Fuursted
- Department of Clinical Microbiology, Skejby Hospital,Aarhus University Hospital, Aarhus, Denmark
| | - Bente Gahrn-Hansen
- Department of Clinical Microbiology, Odense UniversityHospital, Odense, Denmark
| | - Helle Krogh Johansen
- Department of Clinical Microbiology, Rigshospitalet,Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Herlev UniversityHospital, Herlev, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Hvidovre UniversityHospital, Hvidovre, Denmark
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Lambertsen LM, Harboe ZB, Konradsen HB, Christensen JJ, Hammerum AM. Non-invasive erythromycin-resistant pneumococcal isolates are more often non-susceptible to more antimicrobial agents than invasive isolates. Int J Antimicrob Agents 2010; 35:72-5. [DOI: 10.1016/j.ijantimicag.2009.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 08/27/2009] [Accepted: 09/02/2009] [Indexed: 11/25/2022]
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Nielsen XC, Nielsen FT, Kurtzhals JAL, Moser C, Boye K, Christensen JJ, Johansen UR, Westh H. Management of recurrent pacemaker-related bacteraemia with small colony variant Staphylococcus aureus in a haemodialysis patient. BMJ Case Rep 2009; 2009:bcr05.2009.1910. [PMID: 21857872 DOI: 10.1136/bcr.05.2009.1910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient with chronic haemodialysis with a cardiac pacemaker was admitted for five episodes of bacteraemia with Staphylococcus during an 8-month period. The species identification was complicated since the morphological characters and biochemical reactions were unusual and differing. Molecular biological identification and typing methods revealed that the pathogens for all the episodes were the same strain of Staphylococcus aureus that had small colony variant characteristics. Continuous suppressive antibiotic treatment initiated after the last infection episode has been able to keep the patient free of bacteraemia relapse during the past 24 months without removing the pacemaker.
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Hansen JM, Fjeldsøe-Nielsen H, Sulim S, Kemp M, Christensen JJ. Actinomyces species: A danish survey on human infections and microbiological characteristics. Open Microbiol J 2009; 3:113-20. [PMID: 19657460 PMCID: PMC2720514 DOI: 10.2174/1874285800903010113] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 06/24/2009] [Accepted: 06/26/2009] [Indexed: 12/05/2022] Open
Abstract
This study compared phenotypic and genotypic identification of Actinomyces strains, tested susceptibility to antibiotics and evaluated their clinical importance. Thirty-four Actinomyces strains were examined; sixteen type strains, and 18 clinical strains from different hospitals in Denmark from the period 2003-2005. Partial 16S rDNA sequencing using a stretch of 526 bases was used for genotypic identification. Susceptibility testing was done by E-test. The antibiotics examined were: benzylpenicillin, piperacillin with tazobactam, ceftriaxone, meropenem, erythromycin, clindamycin, linezolid, moxifloxacin, tetracycline and tigecycline. Clinical parameters were obtained by reviewing patient records. There was poor agreement between the phenotypic and genotypic identification. Phenotypic tests were helpful in identifying strains closely related by DNA sequences. The strains were sensitive to the examined antibiotics except for moxifloxacin to which most strains were resistant, and a few strains were resistant to meropenem and tetracycline. The clinical strains were from many different types of infections and locations. None of the patients was described as having typical actinomycetic lesions, and an apparently good outcome was obtained with different treatment regimens.
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Affiliation(s)
- J M Hansen
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institute, Copenhagen, Departments of Clinical Microbiology.
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Abstract
We report a case of Lemierre's syndrome caused by Fusobacterium necrophorum and discuss characteristics of this potentially fatal condition which, though rare, may have a rising frequency. Familiarity with the signs and symptoms of Lemierre's syndrome is therefore of great importance.
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Affiliation(s)
- Tomaas Ravn
- Department of Otolaryngology, Head and Neck Surgery, Gentofte University Hospital, Copenhagen, Denmark.
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50
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Harboe ZB, Thomsen RW, Riis A, Valentiner-Branth P, Christensen JJ, Lambertsen L, Krogfelt KA, Konradsen HB, Benfield TL. Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study. PLoS Med 2009; 6:e1000081. [PMID: 19468297 PMCID: PMC2680036 DOI: 10.1371/journal.pmed.1000081] [Citation(s) in RCA: 215] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 04/17/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pneumococcal disease is a leading cause of morbidity and mortality worldwide. The aim of this study was to investigate the association between specific pneumococcal serotypes and mortality from invasive pneumococcal disease (IPD). METHODS AND FINDINGS In a nationwide population-based cohort study of IPD in Denmark during 1977-2007, 30-d mortality associated with pneumococcal serotypes was examined by multivariate logistic regression analysis after controlling for potential confounders. A total of 18,858 IPD patients were included. Overall 30-d mortality was 18%, and 3% in children younger than age 5 y. Age, male sex, meningitis, high comorbidity level, alcoholism, and early decade of diagnosis were significantly associated with mortality. Among individuals aged 5 y and older, serotypes 31, 11A, 35F, 17F, 3, 16F, 19F, 15B, and 10A were associated with highly increased mortality as compared with serotype 1 (all: adjusted odds ratio >or=3, p<0.001). In children younger than 5 y, associations between serotypes and mortality were different than in adults but statistical precision was limited because of low overall childhood-related mortality. CONCLUSIONS Specific pneumococcal serotypes strongly and independently affect IPD associated mortality.
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Affiliation(s)
- Zitta B Harboe
- Department of Bacteriology, Statens Serum Institut, Copenhagen.
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