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Victorian Infectious Diseases Bulletin Volume 10 Issue 2 June 2007 29 Victorian Infectious Diseases Bulletin Volume 10 Issue 2 June 2007 29 Victorian Infectious Diseases Bulletin ISSN 1 441 0575 Volume 10 Issue 2 June 2007 Contents Aeromonas bloodstream infections in Victoria, 1990 to 2006 30 An outbreak of Salmonella Saintpaul linked to rockmelons 33 Victorian Primary Care Network for Sentinel Surveillance on BBVs and STIs: an update 37 Immunisation update 39 Surveillance report 41 30 Victorian Infectious Diseases Bulletin Volume 10 Issue 2 June 2007 Aeromonas bloodstream infections in Victoria: reports to the Victorian Hospital Pathogen Surveillance Scheme, 1990 to 2006 Marion Easton and Mark Veitch, Microbiological Diagnostic Unit – Public Health Laboratory, The University of Melbourne Introduction Methods Aeromonas can be difficult and may Aeromonads are gram negative bacilli The VHPSS provides voluntary, change as new techniques are applied. that inhabit water, soil and many food laboratory-based surveillance of bacterial Demographic, hospitalisation 1–4 types. Most of the Aeromonas species and fungal agents of blood stream and clinical data have been detected in faecal specimens, infections and meningitis in Victoria. The Ninety-nine per cent of the cases although only a few have been established scheme encompasses infections included demographic data, 77 per cent as aetiological agents of human infections, acquired in both community and included hospital admission dates and 92 typically gastroenteritis. Species healthcare settings. Data are provided by per cent included postcode of residence. pathogenic to humans include public and private, metropolitan and There were more cases in males (60 per A. hydrophila, A. caviae, A. veronii bv regional laboratories. These data include cent) than females. There were few cases sobria and bv veronii, A. jandaei and demographic characteristics (anonymous in persons aged less than 40 years A. schubertii. The most common extra- identifier, age, sex), dates of admission to (figure 1); 124 cases (67 per cent) were intestinal infections are bacteraemia hospital and collection of the diagnostic aged 60 years or more. In contrast with and wound infections; others include specimen, and the identity and many invasive bacterial infections, cases meningitis, endocarditis, peritonitis, antimicrobial susceptibilities of the among neonates and young infants were otitis media and osteomyelitis.1 bacterium or fungus. Although not all rare. Of cases with admission date data, laboratories participate in the VHPSS, the Aeromonas bacteraemia is uncommon most (80 per cent) were diagnosed from data are broadly representative and and often associated with specimens collected on the first or readily interpretable to provide insights immunocompromised patients, second day of hospitalisation. Of cases into the wider population. commonly those with haematological with postcode data, 128 (74 per cent) malignancy or with disease of the upper Results were from metropolitan areas and 45 (26 gastrointestinal tract. Bacteraemia among per cent) were from regional Victoria. One hundred and eighty-five isolates of such patients may be associated with a There were no apparent clusters of cases Aeromonas species from blood cultures mortality of 30 to 50 per cent.5 The in either metropolitan or regional Victoria. pathogenesis of Aeromonas bacteraemia were reported to the VHPSS from 1990 to One hundred and thirty-three reports (72 is not well understood. Most cases are 2006; an average of 11 reports per year per cent) included either clinical assumed to occur through ingestion of (range: 5–19). This was an average annual information or hospital unit data. Of contaminated water or food; disruption of reporting rate of 0.23 per 100,000 these, 32 per cent were for haematology the gastrointestinal mucosa (or altered population. Reports of Aeromonas or oncology patients, and 19 per cent had local defences) then provides a portal of bacteraemia comprised approximately 0.2 clinical data consistent with upper entry for the organism. In some instances per cent of all reports to VHPSS during gastrointestinal or hepatobiliary disease. sepsis is secondary to a wound infection.6 this period. There were no reports of Aeromonas from cerebrospinal fluid. Concerns were raised in the Australian Seven persons had recurrent episodes of Seasonal trend infectious disease community in early Aeromonas bacteraemia (range of interval There was marked seasonality of 2007 when several clinicians and between episodes: 3 weeks–11 months). Aeromonas bacteraemia, with 125 cases microbiologists noted an apparent One hundred and thirty-six (74 per cent) (68 per cent) reported in the five months increase in the number of cases of reports included speciation of the December through April (figure 2). Aeromonas bacteraemia recently Aeromonas. The most common species Antimicrobial susceptibilities diagnosed in several States and reported was A. hydrophila (89 reports, Reports of the susceptibility of Territories. We therefore reviewed reports 65 per cent of speciated isolates). Twenty- Aeromonas sp. to amoxicillin, of Aeromonas species to the Victorian nine A. veronii bv. sobria were reported amoxicillin/clavulinic acid, third Hospital Pathogen Surveillance System (21 per cent of speciated isolates), eight A. generation cephalosporins (3GC), (VHPSS) from 1 January 1990 to 31 veronii, seven A. caviae, and three ciprofloxacin and gentamicin were March 2007 to describe the reported as A. hydrophila/caviae with no available for 89 per cent, 57 per cent, epidemiology of Aeromonas bacteraemia further speciation. Speciation of and assess recent local data. Victorian Infectious Diseases Bulletin Volume 10 Issue 2 June 2007 31 77 per cent, 77 per cent and 96 per cent Figure 1: Aeromonas bacteraemia cases reported to VHPSS, by age group, of isolates respectively. Among 1990–2006 Aeromonas isolates with susceptibility )% data, 98 per cent were reported as (* resistant to amoxicillin, 82 per cent to (% amoxicillin/clavulinic acid, eight per cent to 3GC and two per cent to gentamicin. '* No isolates were resistant to '% ciprofloxacin. Ten isolates were resistant &* &% to amoxicillin, amoxicillin/clavulinic acid CjbWZgd[gZedgih and 3GC, one was resistant to * amoxicillin, amoxicillin/clavulinic acid % and gentamicin, and one was resistant to %·) *·. -% amoxicillin, 3GC and gentamicin. &%·&) &*·&. '%·') '*·'. (%·() (*·(. )%·)) )*·). *%·*) **·*. +%·+) +*·+. ,%·,) ,*·,. 6\Z\gdjenZVgh Cases of Aeromonas bacteraemia Figure 2: Aeromonas bloodstream isolates reported to VHPSS, by month of in the first quarter of 2007 report, 1990–2006 Nine isolates of Aeromonas bacteraemia (* were reported to VHPSS in the first three (% months of 2007, compared with an average of five for the first quarters in the '* period 1990 to 2006. One recent case '% was a neonate; the other eight were aged &* greater than 49 years. The seven cases &% with admission data had specimens CjbWZgd[gZedgih collected on the first day of * hospitalisation. Five isolates were A. % hydrophila, two were A. veronii, one A. ?Vc ;ZW BVg 6eg BVn ?jc ?ja 6j\ HZe DXi Cdk 9ZX caviae and one was not speciated. Four Bdci]d[heZX^bZc of the seven cases with clinical or per 100,000 population per year. Most infection. The particular source of the hospital unit data occurred in cases were in the elderly, often with organism causing each infection usually haematology or oncology patients. underlying malignancy or hepatobiliary remains unknown. Pursuit of the source Discussion disease. All isolates with adequate data is hindered by the possibility that the reported to the VHPSS were susceptible organisms may have been ingested some These data suggest that Aeromonas to ciprofloxacin, and most were unknown time before the onset of bacteraemia is relatively rare in Victoria. susceptible to third generation invasive sepsis, itself perhaps An average of 11 cases was reported to cephalosporins and gentamicin. precipitated by changes in the person’s the VHPSS each year from 1990 through immunological or clinical state. 2006, mostly in the warmer months. The timing of the diagnostic specimen Based on the proportion of hospitals and relative to hospital admission date in the Aeromonas cases occurred throughout laboratories that have contributed data to majority of Aeromonas bacteraemia Victoria, suggesting that environmental the VHPSS from 1990 to 2006, we suggests acquisition of the organism sources of potentially clinically significant estimate 50 to 60 per cent of bacteraemia from a community source. In common organisms are also widespread. The cases that occur in Victoria are reported to with some ecologically similar bacterial marked seasonality of invasive infections the VHPSS. Assuming this reporting rate genera (such as Vibrio), but in contrast implies that exposure to a sufficient dose applies to Aeromonas cases, the true with many other gram negative bacilli, of Aeromonas to cause disease arises population rate may be around 0.4 to 0.5 relatively few Aeromonas cases had through seasonal influences on the onsets suggestive of nosocomial concentration of the pathogen in key 32 Victorian Infectious Diseases Bulletin Volume 10 Issue 2 June 2007 sources, or behavioural determinants of pathogen, such that exposure is common hydrophila wound infections associated the exposure of susceptible hosts to and host vulnerabilities the critical with mud football. Clin Infect Dis. 2004; these sources, or both. determinant of clinically significant 38: 1084–9. The presence of Aeromonas in raw infection. 4.
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