Peptoniphilus is a rare but important cause of BSI. Gram-positive anaerobic cocci GPAC are not routinely recovered or identified from many types of clinical specimens because they may be difficult to grow in culture and are frequently isolated as part of mixed polymicrobial infections 1. Peptoniphilus are commensals of the human vagina and gut that were formerly classified in the genus Peptostreptococcus 2. There are now more than 15 Peptoniphilus species within the genus, seven of which were discovered in 3 — Several new Peptoniphilus spp.

To date, Peptoniphilus spp. A recent study of pre-term labour and early neonatal sepsis also isolated Peptoniphilus spp. To our knowledge, our study is the first case series of Peptoniphilus spp.

Nucleotide Sequence Accession Numbers

All cases were diagnosed by the regional centralized clinical microbiology laboratory, Calgary Laboratory Services CLS , between 1 July and 31 December All isolates were recovered from blood cultures. Positive blood cultures were immediately pelleted, Gram stained and plated to standard aerobic and anaerobic culture media. All isolates were susceptible to penicillin and metronidazole, and all but one of the isolates case 7 was also susceptible to clindamycin. A maximum likelihood phylogeny was produced illustrating the relation of the 15 clinical isolates with publicly available sequences 19 , These sequences were also highly similar Fasttree 2 software was used to create the tree using the generalized time-reversible nucleotide substitution model During the study period, 15 hospitalized patients were diagnosed with Peptoniphilus BSI; nine women and six men.

BSI due to P. All of the other patients with Peptoniphilus spp. Most polymicrobial BSIs originated from a bowel or bladder source, except for one patient with diabetes mellitus and severe necrotizing infection of the leg, and one elderly patient with aspiration pneumonia. All of the other patients with Peptoniphilus BSI were successfully treated with antibiotics and discharged from hospital.

We would therefore expect to recover Peptoniphilus spp. The recovery of Peptoniphilus alone indicates that this organism is a rare but important cause of BSI as a primary pathogen in certain clinical settings i. Most of our isolates had highly similar sequences to a reference Peptoniphilus spp. However, it is clear from our phylogenetic analysis Fig. Our results support a previous report of We have therefore chosen for now to designate most of our isolates as Peptoniphilus spp. In summary, clinical microbiology laboratories should be aware that Peptoniphilus are rare but important causes of BSI infection either as the primary pathogen or as part of a polymicrobial infection.

Isolates meeting the preliminary phenotypic characteristics for GPAC should be referred for definitive identification using partial 16S rDNA sequencing. Delineation of the clinical and epidemiological significance and pathogenic potential of Peptoniphilus spp. Deirdre Church and Daniel Gregson: National Center for Biotechnology Information , U. Clinical Microbiology and Infection. Antimicrob Agents Chemother ; Risk factors and mortality of healthcare-associated and community-acquired Staphylococcus aureus bacteraemia.

Bloodstream infections in the Intensive Care Unit

A survey on infection management practices in Italian ICUs. Evaluation of vancomycin and daptomycin MIC trends for methicillin-resistant Staphylococcus aureus blood isolates over an 11 year period. Daptomycin versus vancomycin for bloodstream infections due to methicillin-resistant Staphylococcus aureus with a high vancomycin minimum inhibitory concentration: Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized patients.

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Lancet Infect Dis ; Bloodstream infections in ICU with increased resistance: Minerva Anestesiol ; Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. Importance of combination therapy. Treatment outcome of bacteremia due toKPC-producing Klebsiella pneumoniae: Superiority of combination antimicrobialregimens. Prevalence of Klebsiella pneumoniae strains producing carbapenemases and increase of resistance to colistin in an Italian teaching hospital from January To December Colistin resistance in Klebsiella pneumoniae.

Int J Antimicrob Agents ; Bassetti M, Righi E.. SDD and colistin resistance: End of a dream? Intensive Care Med ; Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: A multi-centre study on clinical outcome and therapeutic options. Clin Microbiol Infect ; Last access 1 September Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. J Clin Microbiol ; Fecal colonization and infection with Pseudomonas aeruginosa in recipients of allogeneic hematopoietic stem cell transplantation.

Transpl Infect Dis ; Nasal carriage as a source of Staphylococcus aureus bacteremia. Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: A prospective observational multicentre study.

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Risk factors and clinical impact. Fournier PE, Richet H.. The epidemiology and control of Acinetobacter baumannii in health care facilities. Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients: Risk factors for acquisition, infection and their consequences. Carbapenem resistance among Klebsiella pneumoniae isolates: Risk factors, molecular characteristics, and susceptibility patterns. Predictive models for identification of hospitalized patients harboring KPC-producing Klebsiella pneumoniae.

Clinical implications of antibiotic pharmacokinetic principles in the critically ill. Extended-infusion cefepime reduces mortality in patients with Pseudomonas aeruginosa infections. Continuous infusion of beta-lactam antibiotics in severe sepsis: A multicenter double-blind, randomized controlled trial. Piperacillin-tazobactam for Pseudomonas aeruginosa infection: Clinical implications of an extended- infusion dosing strategy. Revisiting the loading dose of amikacin for patients with severe sepsis and septic shock. Meropenem by continuous versus intermittent infusion in ventilator-associated pneumonia due to gram-negative bacilli.

Ann Pharmacother ; Diagn Microbiol Infect Dis ; A multicenter study of septic shock due to candidemia: Outcomes and predictors of mortality. Impact of antibiotic exposure on occurrence of nosocomial carbapenem-resistant Acinetobacter baumannii infection: A case control study. J Infect Chemother ; Acquisition of carbapenem-resistant Gram-negative bacilli in intensive care unit: Predictors and molecular epidemiology.


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Med Mal Infect ; Emergence of imipenem-resistant gram-negative bacilli in intestinal flora of intensive care patients. In vitro activities of daptomycin against 2, clinical isolates from 11 North American medical centers. Daptomycin activity and spectrum: A worldwide sample of clinical Gram-positive organisms.

Is empiric daptomycin effective in reducing mortality in Staphylococcus aureus bacteraemia? Intensive Care Med ; 41 Risk factors associated with the onset of daptomycin non-susceptibility in Staphylococcus aureus infections in critically ill patients. High-dose daptomycin in documented Staphylococcus aureus infections. A combined pharmacodynamic quantitative and qualitative model reveals the potent activity of daptomycin and delafloxacin against Staphylococcus aureus biofilms.

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Safety of high-dose intravenous daptomycin treatment: Three-year cumulative experience in a clinical program. Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: Antibiotic prescription patterns in the empiric therapy of severe sepsis: Combination of antimicrobials with different mechanisms of action reduces mortality. Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia?

Lancet Infect Dis ; 4: Beta lactam antibioticmonotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis.

Cochrane Database Syst Rev ; 1: Influence of empiric therapy with a beta-lactam alone or combined with an aminoglycoside on prognosis of bacteremia due to gram-negative microorganisms. Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: Antimicrob Agents Chemother ; 56 4: Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment.

Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: Lowering mortality by antibiotic combination schemes and the role of carbapenems. Infections caused by KPC-producing Klebsiella pneumoniae: Differences in therapy and mortality in a multicentre study. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: A potential risk factor for hospital mortality. Clin Microbiol Infect ; 18 Suppl 7: A prospective multicenter study. Empirical antifungal therapy with an echinocandin in critically-ill patients: Prospective evaluation of a pragmatic Candida score-based strategy in one medical ICU.

Procalcitonin levels in surgical patients at risk of candidemia. J Infect ; Crit Care Clin ; De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock. De-escalation of antimicrobial treatment in neutropenic patients with severe sepsis: Results from an observational study. De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: A multicenter non-blinded randomized noninferiority trial.

Antibiotic treatment duration for bloodstream infections in critically ill patients: A national survey of Canadian infectious diseases and critical care specialists. Rubinstein E, Keynan Y.. Short-course therapy for severe infections. Int J Antimicrob Agents ; 42 Suppl: Short antibiotic treatment courses or how short is short?


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    6. Int J Antimicrob Agents ; 30 Suppl 1: Duration of antibiotic therapy for bacteremia: Bacteraemia incidence, causative organisms and resistance patterns, antibiotic strategies and outcomes in a single university hospital ICU: Continuing improvement between and Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock—a systematic review and meta-analysis. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection.

    Success of an infection control program to reduce the spread of carbapenem-resistant Klebsiella pneumoniae. Catheter application, insertion vein and length of ICU stay prior to insertion affect the risk of catheter-related bloodstream infection. Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences. Am J Infect Control ; Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA.

    BMJ Open ; 4: