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  • 1
    Language: English
    In: Journal of clinical microbiology, October 2015, Vol.53(10), pp.3110-5
    Description: The first FDA-approved multiplex PCR panel for a large number of respiratory pathogens was introduced in 2008. Since then, other PCR panels for detection of several respiratory and gastrointestinal pathogens have been approved by the FDA and are commercially available, and more such panels are likely to become available. These assays detect 12 to 20 pathogens, and some include pathogens that typically cause different manifestations of infection, although they infect the same organ system. Some of these tests are labor-intensive, while others require little labor, and all of them are expensive, both for the laboratory and for the patient or insurer. They include a bundle of tests with limited or no options for selecting which tests will be performed. Laboratories and hospitals have adopted different strategies for offering these assays. Some have implemented strategies to limit the use of the tests, such as limiting the frequency with which patients can be tested, restricting testing to specific groups of patients (e.g., immunocompromised patients), or providing education to encourage the use of less expensive tests before using large multiplex panels. Others have offered these assays without limiting their use, either relying on the ordering provider to exercise good judgment or because such assays are thought to be appropriate for first-line diagnostic testing. In this Point-Counterpoint, Paul Schreckenberger of Loyola University Medical Center explains why his laboratory offers these assays without restriction. Alex McAdam of Boston's Children Hospital explains the concerns about the use of these assays as first-line tests and why some limitations on their use might be appropriate.
    Keywords: Gastroenteritis -- Diagnosis ; Molecular Diagnostic Techniques -- Methods ; Multiplex Polymerase Chain Reaction -- Methods ; Respiratory Tract Infections -- Diagnosis
    ISSN: 00951137
    E-ISSN: 1098-660X
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  • 2
    In: American Journal of Health-System Pharmacy, 2016, Vol.73(5), pp.279-285
    Description: PURPOSE.: The evidence supporting the potential use of i.v. minocycline for serious infections caused by multidrug-resistant organisms (MDROs) is summarized. SUMMARY.: Minocycline achieves good tissue penetration and excellent oral absorption. Minocycline achieves serum concentrations comparable to other tetracyclines, with peak serum concentrations ranging from 3 to 8.75 mg/L following i.v. administration of 200 mg. Minocycline retains antimicrobial activity against methicillin-sensitive and methicillin-resistant Staphylococcus aureus as well as many gram-negative pathogens, such as Acinetobacter species, Citrobacter species, Enterobacter species, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Stenotrophomonas maltophilia. Minocycline has been used to treat respiratory infections caused by Acinetobacter baumannii and bloodstream infections. The majority of these gram-negative infections were treated with combination therapy, with results similar to those seen with first-line agents. The ability to switch from parenteral to oral therapy and its favorable tissue penetration make minocycline an attractive option for severe respiratory or skin and skin structure infections. For A. baumannii infections, minocycline is the second most active agent in vitro and may be the only therapeutic option in certain cases. The overall clinical experience with minocycline supports its use to treat A. baumannii infections alone or in combination with other agents. Minocycline could be used to treat other MDRO gram-negative infections but only as an agent of last resort due to the limited data available. CONCLUSION.: The available pharmacokinetic and clinical data support the use of i.v. minocycline for the treatment of MDRO infections, including infections due to S. aureus coagulase-negative and gram-negative pathogens.
    Keywords: Minocycline -- Patient Outcomes ; Microbial Drug Resistance -- Research ; Communicable Diseases -- Drug Therapy ; Pharmacological Research;
    ISSN: 1079-2082
    E-ISSN: 15352900
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  • 3
    Language: English
    In: Journal of clinical microbiology, July 2015, Vol.53(7), pp.2385-8
    Description: Laribacter hongkongensis is a potential emerging pathogen associated with community-acquired gastroenteritis and traveler's diarrhea. We report the isolation of L. hongkongensis from the stool of a patient who had no history of travel outside the United States. The organism was identified by phenotypic tests, mass spectrometry, and gene sequencing.
    Keywords: Bacterial Infections -- Diagnosis ; Betaproteobacteria -- Classification ; Feces -- Microbiology ; Gastroenteritis -- Diagnosis
    ISSN: 00951137
    E-ISSN: 1098-660X
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  • 4
    Language: English
    In: Journal of clinical microbiology, September 2017, Vol.55(9), pp.2874-2875
    Keywords: Histoplasma ; Laryngeal
    E-ISSN: 1098-660X
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  • 5
    Language: English
    In: Journal of clinical microbiology, May 2014, Vol.52(5), pp.1313, 1810
    Description: A 62-year-old male with a past medical history of orthotopic heart transplant in 1995, hypertension, ulcerative colitis, prostate cancer (5 years prior to the current episode) treated with radiotherapy, hyperlipidemia, and type 2 diabetes mellitus presented in April 2011 for evaluation of left knee drainage, sore throat, and multiple skin lesions. His sore throat had started several weeks before and was associated with dry cough, low-grade fever, and intermittent chills. The patient denied recent contact with persons suffering from illness. There were no associated upper respiratory symptoms, chest pain, shortness of breath, or postnasal drip. He also reported bilateral knee pain, with the right knee worse than the left knee, which was exacerbated by movement. A cortisol injection into the right knee 3 weeks prior to his admission provided partial relief of his symptoms. The patient noted left knee drainage with manual expression, which was empirically treated for 4 days with an unknown combination of antibiotics. The drainage had worsened the week prior to his admission.
    Keywords: Alternaria -- Isolation & Purification ; Knee -- Microbiology
    E-ISSN: 1098-660X
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  • 6
    Language: English
    In: American Journal of Clinical Pathology, 09/01/2013, Vol.140(suppl 1), pp.A207-A207
    Description: Human coronaviruses (HCoV) NL63 and HCoV-HKU1 have been identified but few studies have evaluated infection rates. Our institution began routine testing for HCoV-NL63 and HCoV-HKU1 in the fall of 2011 giving us the opportunity to determine the prevalence of infection. A retrospective analysis of 1,163 respiratory specimens submitted to Loyola University for evaluation using the Idaho Technology FilmArray Respiratory …
    Keywords: Medicine ; Biology;
    ISSN: 0002-9173
    E-ISSN: 1943-7722
    Source: Oxford University Press (via CrossRef)
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  • 7
    Language: English
    In: Antimicrobial agents and chemotherapy, June 2011, Vol.55(6), pp.2986-8
    Description: An NDM-1 carbapenemase-producing Escherichia coli isolate of sequence type 131 (ST131) that belonged to phylogenetic group B2 was obtained from a patient with a urinary tract infection who returned to the United States after a recent hospitalization while visiting India. NDM-1-producing E. coli ST131 had significantly more virulence factors than NDM-1-producing E. coli ST101, previously isolated from a patient in Canada. The presence of NDM β-lactamases in a very successful and virulent E. coli sequence type is of concern.
    Keywords: Escherichia Coli -- Classification ; Beta-Lactamases -- Biosynthesis
    ISSN: 00664804
    E-ISSN: 1098-6596
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  • 8
    Language: English
    In: Journal of clinical microbiology, May 2016, Vol.54(5), pp.1216-22
    Description: Enhanced quantitative urine culture (EQUC) detects live microorganisms in the vast majority of urine specimens reported as "no growth" by the standard urine culture protocol. Here, we evaluated an expanded set of EQUC conditions (expanded-spectrum EQUC) to identify an optimal version that provides a more complete description of uropathogens in women experiencing urinary tract infection (UTI)-like symptoms. One hundred fifty adult urogynecology patient-participants were characterized using a self-completed validated UTI symptom assessment (UTISA) questionnaire and asked "Do you feel you have a UTI?" Women responding negatively were recruited into the no-UTI cohort, while women responding affirmatively were recruited into the UTI cohort; the latter cohort was reassessed with the UTISA questionnaire 3 to 7 days later. Baseline catheterized urine samples were plated using both standard urine culture and expanded-spectrum EQUC protocols: standard urine culture inoculated at 1 μl onto 2 agars incubated aerobically; expanded-spectrum EQUC inoculated at three different volumes of urine onto 7 combinations of agars and environments. Compared to expanded-spectrum EQUC, standard urine culture missed 67% of uropathogens overall and 50% in participants with severe urinary symptoms. Thirty-six percent of participants with missed uropathogens reported no symptom resolution after treatment by standard urine culture results. Optimal detection of uropathogens could be achieved using the following: 100 μl of urine plated onto blood (blood agar plate [BAP]), colistin-nalidixic acid (CNA), and MacConkey agars in 5% CO2 for 48 h. This streamlined EQUC protocol achieved 84% uropathogen detection relative to 33% detection by standard urine culture. The streamlined EQUC protocol improves detection of uropathogens that are likely relevant for symptomatic women, giving clinicians the opportunity to receive additional information not currently reported using standard urine culture techniques.
    Keywords: Bacterial Load ; Bacteria -- Isolation & Purification ; Bacterial Infections -- Diagnosis ; Bacteriological Techniques -- Methods ; Urinary Tract Infections -- Diagnosis ; Urine -- Microbiology
    E-ISSN: 1098-660X
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  • 9
    Language: English
    In: Journal of clinical microbiology, April 2018, Vol.56(4)
    Description: We describe results from a multicenter study evaluating the Accelerate Pheno system, a first of its kind diagnostic system that rapidly identifies common bloodstream pathogens from positive blood cultures within 90 min and determines bacterial phenotypic antimicrobial susceptibility testing (AST) results within ∼7 h. A combination of fresh clinical and seeded blood cultures were tested, and results from the Accelerate Pheno system were compared to Vitek 2 results for identification (ID) and broth microdilution or disk diffusion for AST. The Accelerate Pheno system accurately identified 14 common bacterial pathogens and two spp. with sensitivities ranging from 94.6 to 100%. Of fresh positive blood cultures, 89% received a monomicrobial call with a positive predictive value of 97.3%. Six common Gram-positive cocci were evaluated for ID. Five were tested against eight antibiotics, two resistance phenotypes (methicillin-resistant and spp. [MRSA/MRS]), and inducible clindamycin resistance (MLSb). From the 4,142 AST results, the overall essential agreement (EA) and categorical agreement (CA) were 97.6% and 97.9%, respectively. Overall very major error (VME), major error (ME), and minor error (mE) rates were 1.0%, 0.7%, and 1.3%, respectively. Eight species of Gram-negative rods were evaluated against 15 antibiotics. From the 6,331 AST results, overall EA and CA were 95.4% and 94.3%, respectively. Overall VME, ME, and mE rates were 0.5%, 0.9%, and 4.8%, respectively. The Accelerate Pheno system has the unique ability to identify and provide phenotypic MIC and categorical AST results in a few hours directly from positive blood culture bottles and support accurate antimicrobial adjustment.
    Keywords: FISH ; MIC ; Antimicrobial Susceptibility Testing ; Bacteremia ; Blood Culture ; Candidemia ; Identification ; Morphokinetic Cellular Analysis ; Phenotypic ; Rapid
    ISSN: 00951137
    E-ISSN: 1098-660X
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  • 10
    Language: English
    In: Journal of clinical microbiology, September 2016, Vol.54(9), pp.2251-61
    Description: Rapid diagnosis and treatment of infectious meningitis and encephalitis are critical to minimize morbidity and mortality. Comprehensive testing of cerebrospinal fluid (CSF) often includes Gram stain, culture, antigen detection, and molecular methods, paired with chemical and cellular analyses. These methods may lack sensitivity or specificity, can take several days, and require significant volume for complete analysis. The FilmArray Meningitis/Encephalitis (ME) Panel is a multiplexed in vitro diagnostic test for the simultaneous, rapid (∼1-h) detection of 14 pathogens directly from CSF specimens: Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae, cytomegalovirus, enterovirus, herpes simplex virus 1 and 2, human herpesvirus 6, human parechovirus, varicella-zoster virus, and Cryptococcus neoformans/Cryptococcus gattii We describe a multicenter evaluation of 1,560 prospectively collected CSF specimens with performance compared to culture (bacterial analytes) and PCR (all other analytes). The FilmArray ME Panel demonstrated a sensitivity or positive percentage of agreement of 100% for 9 of 14 analytes. Enterovirus and human herpesvirus type 6 had agreements of 95.7% and 85.7%, and L. monocytogenes and N. meningitidis were not observed in the study. For S. agalactiae, there was a single false-positive and false-negative result each, for a sensitivity and specificity of 0 and 99.9%, respectively. The specificity or negative percentage of agreement was 99.2% or greater for all other analytes. The FilmArray ME Panel is a sensitive and specific test to aid in diagnosis of ME. With use of this comprehensive and rapid test, improved patient outcomes and antimicrobial stewardship are anticipated.
    Keywords: Cerebrospinal Fluid -- Microbiology ; Encephalitis -- Diagnosis ; Meningitis -- Diagnosis ; Molecular Diagnostic Techniques -- Methods
    ISSN: 00951137
    E-ISSN: 1098-660X
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