Clinical significance of alimentary tract microbes in bone marrow transplant recipients.
Yuen KY. Woo PC. Liang RH. Chiu EK. Chen FF. Wong SS. Lau YL. Ha SY. Peiris JS. Siau H. Chan TK.
Department of Microbiology, University of Hong Kong, Queen Mary Hospital, Hong Kong.
A prospective study on the microbes isolated from the alimentary tract in 120 bone marrow transplant (BMT) recipients (1991-1993) was undertaken to define the spectrum of organisms isolated under antimicrobial prophylaxis, their temporal sequence of emergence, and the associated morbidity and mortality. Clostridium difficile (n = 20), isolated in the pre-engraftment and early post-engraftment periods (day 2-45 post-BMT), was the most common microbe recovered from stool of patients with diarrhea. In contrast to previous reports, no significant difference in mortality was observed between patients with and without C. difficile isolated in stool. Two patients had neutropenic ileocecitis with concomitant bacteremia due to Escherichia coli and Klebsiella pneumoniae. One patient was found to have astrovirus gastroenteritis (day 7), and Giardia lamblia was recovered from the stool of another (day -7). Heavy growth of Staphylococcus aureus from direct smear-positive specimens was found from the upper airway of two patients with severe mucositis and complete dysphagia (day 12 and 23). Salmonella spp. of groups B and E were found in the stool of five asymptomatic patients at the time of conditioning. No specific organisms was recovered from the endoscopic brushing of two patients with lower end esophagitis, three patients with upper gastrointestinal bleeding, and three patients with perirectal cellulitis. During the post-engraftment period, five patients had documented cytomegalovirus gastroenterocolitis (days 34-97), one had Mycobacterium chelonae colitis (day 70), and another had nodular gastritis due to Acremonium falciforme (day 270). Overall, only 28% of patients with alimentary tract symptoms/syndrome had specific pathogens isolated from clinical specimens. Differentiation of the causation of alimentary tract symptoms was often difficult because noninfectious complications such as conditioning toxicity, graft-versus-host disease, and its treatment often caused alimentary tract symptoms in addition to predisposed BMT patient to infection. The reluctance of obtaining tissue biopsy for ascertaining the importance of those potential alimentary tract pathogens often dictate the use of empirical treatment.
Comparison of bedside- and laboratory-inoculated Bactec high- and low-volume resin bottles for the recovery of microorganisms causing peritonitis in CAPD patients.
Blondeau JM. Pylypchuk GB. Kappel JE. Pilkey B. Lawler C.
Department of Clinical Microbiology, University of Saskatchewan, Saskatoon, Canada.
There is not yet a universally accepted protocol for the recovery of microorganisms causing peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). We prospectively analyzed 343 peritoneal effluent specimens by three protocols: 1) 10 ml of effluent centrifuged and the pellet plated onto blood, MacConkey agars, and into thioglycolate broth (routine method); 2) 5 ml and 10 ml inoculated at the bedside into Bactec 16A and 26A aerobic resin-containing blood culture bottles, respectively; and 3) 5 ml and 10 ml inoculated in the laboratory into Bactec 16A and 26A media, respectively. One hundred and forty (41%) peritoneal effluent specimens had microorganisms recovered, and, of these, 101 were recovered by routine culture compared to 117 (p < .021), 125 (p < .0001), 115 (p < .047), and 116 (p < .032) for bedside-inoculated 16A and 26A and for laboratory-inoculated 16A and 26A, respectively. Bedside-inoculated bottles were not significantly better than laboratory-inoculated bottles, and high-volume bottles were not significantly better than low-volume bottles for detection of patients positive for microorganisms; however, the number of total microorganisms recovered were significantly better from all inoculated blood culture bottles compared to routine culture. Bedside- and laboratory-inoculated resin-containing blood culture bottles are superior to the routine method for recovery of microorganisms causing peritonitis in CAPD patients.
Acalculous cholecystitis and septicemia caused by non-O1 Vibrio cholerae: first reported case and review of biliary infections with Vibrio cholerae.
West BC. Silberman R. Otterson WN.
Department of Medicine, Meridia Huron Hospital, Cleveland, OH 44112, USA.
The first case of septicemic acute acalculous cholecystitis caused by non-O1 Vibrio cholerae is described in a healthy traveler, and biliary tract infections from V. cholerae are reviewed. Immediately after a vacation in Cancun, Mexico, a 55-year-old man developed acute cholecystitis. Blood and bile cultures grew non-O1 V. cholerae. At surgery, the gallbladder was acalculous, inflamed, distended, and nearly ruptured. Pathogenetic factors may have included diarrhea prophylaxis with bismuth subsalicylate, distension of the gallbladder from illness-induced fasting, and bacterial toxins in the gallbladder. The patient received i.v. cephapirin, followed by oral cephradine for a total of 10 days, and he made a quick and complete recovery. V. cholerae should be considered in the differential diagnosis of persons from endemic areas who present with cholecystitis or acute jaundice.