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Nonfermenting Gram-negative Bacilli other than Pseudomonas aeruginosa and Acinetobacter Spp. Background: Nonfermenting gram-negative bacilli have emerged as important healthcare-associated pathogens.
The respiratory part is lined by respiratory mucosa (pseudostratified columnar epithelium with cilia and goblet cells), which is also found elsewhere in the respiratory system. Medical fact: Cigarette smoking causes irritation to the mucosa of the larynx, resulting in changes of the epithelium.
Medical fact: The cilia are paralysed by cigarette smoking and viral infections, causing the accumulation of mucus. Medical fact: Contraction of bronchiolar smooth muscle is an important factor in asthma, causing increased airway resistance.
Medical fact: Elastic tissues play a very important role in the conducting system of the lungs. The walls of the respiratory bronchioles are the same as other small bronchioles, except that here and there it has an alveolus in its walls.
Medical fact: Alveolar pores and Lambert sinuses are very important safety mechanisms in the lungs. Lung lobules are pyramid shaped, with an apex (towards the hilum) and a basis (towards the surface of the lungs).
Medical fact: The walls of the pleural cavity are very permeable to water and other substances, and therefore fluid accumulation (pleural effusion) occurs frequently. It is important to correctly identify all clinically significant nonfermenting gram-negative bacilli considering the intrinsic multidrug resistance exhibited by these bacteria. In the hospital environment, they may be isolated from instruments such as ventilator machine humidifiers, mattresses, and other equipments as well as from the skin of healthcare workers.
High interlaboratory reproducibility of matrix-assisted laser desorption ionization-time of flight mass spectrometry-based species identification of nonfermenting bacteria. In vitro activities of quinolones, beta-lactams, tobramycin, and trimethoprim-sulfamethoxazole against nonfermentative gram-negative bacilli.
Evaluation of the new VITEK 2 card for identification of clinically relevant gram-negative rods. Nonfermenting gram-negative bacilli infections in a tertiary care hospital in Kolar, Karnataka. Nosocomial outbreak of colonization and infection with Stenotrophomonas maltophilia in preterm infants associated with contaminated tap water. Class 1 integrons increase trimethoprim-sulfamethoxazole MICs against epidemiologically unrelated Stenotrophomonas maltophilia isolates. Nosocomial infection caused by Xanthomonas maltophilia: A case-control study of predisposing factors. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer. Molecular epidemiology of Xanthomonas maltophilia colonization and infection in the hospital environment. Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital. Rapid inter-strain comparison by pyrolysis mass spectrometry in nosocomial infection with Xanthomonas maltophilia. Infections caused by Pseudomonas maltophilia with emphasis on bacteremia: Case reports and a review of the literature.
Evolving epidemiology of Pseudomonas aeruginosa and the Burkholderia cepacia complex in cystic fibrosis lung infection. Epidemiology and resistance of Achromobacter xylosoxidans from cystic fibrosis patients in Dijon, Burgundy: First French data. Antibiotic resistance among gram-negative bacteria of lower respiratory tract secretions in hospitalized patients.
The respiratory epithelium will change into squamous epithelium, and if the irritation continues this will change into squamous cell carcinoma.
The gap at the back, at the openings of the cartilage rings, is filled by the paries membranaceous.
The bronchi have abundant lymphoid tissues in the form of nodules containing B- and T- lymphocytes. In small babies the smooth muscle is not well developed, therefore medications acting on the smooth muscle is not effective in treating babies with bronchiolitis. A deficiency of surfactant causes respiratory distress syndrome in newborns, and is associated with prematurity. These can exist either as alveolar pores between adjacent pores, or as short canals where the terminal bronchioles open directly into the adjacent alveolar sacs (Lambert sinuses). In the interalveolar septae these blood vessels become capillaries that merge to form interlobular veins. Materials and Methods: A retrospective study was undertaken to identify the various nonfermenting gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp.
Its purpose is to moisten, protect the airways and form a barrier to potential pathogens and foreign particles, preventing infection and tissue injury.
Neighbouring rings are joined by connective tissue, which is continuous with the perichondrium.
The elastic components enable the tubes to elongate, and move back to their original position with expiration. These interalveolar septae comprise of blood vessels, elastic fibres and reticular fibres, lined by epitehelial and other cells.
Both membranes are composed of mesothelial cells resting on a fine connective tissue layer with collagen and elastic fibres.


The epiglottis forms part of the larynx, and is a leaf-like structure with hyaline cartilage in it centre. In the normal newborn, the onset of breathing is associated with a massive release of stored surfactant, which lowers the surface tension in the alveoli.
These two layers define a cavity lined entirely with mesothelial cells which is filled with a thin layer of fluid.
On the basis of clinicomicrobiological correlation, pathogenicity was observed in 69.7% (n = 23) isolates.
So, it becomes imperative to know about the occurrence and susceptibility pattern of these non-fermenters.This study was undertaken to identify the various NFGNB other than P. All the respiratory samples (sputum or bronchoalveolar lavage fluid) received during this time period were included. Sputum gram stains were read at ×100 magnification and evaluated according to the Bartlett criteria. Specimens with total scores of 0 or less were considered inadequate and heavily contaminated with oropharyngeal flora. Those containing greater than 25 leucocytes and fewer than 10 squamous epithelial cells per field were optimal specimens and further processed for culture. The organisms isolated were subjected to routine biochemical reactions like oxidase test, growth on Triple Sugar Iron agar, mannitol motility test medium, indole production, hydrogen sulfide production, urea hydrolysis, and citrate utilization.
The non-fermenters which could not be identified on the basis of above-mentioned biochemical reactions were subjected to Vitek 2 system for identification. The susceptibility testing was performed using Kirby-Bauer disc diffusion method using commercially available discs according to Clinical Laboratory Standards Institute guidelines.
The clinical significance of the NFGNB isolates was assessed by correlating with clinical and radiological findings of the patient.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Descriptive analysis of results was performed using statistical software, SPSS version 16.0. Demographic parameters and various clinical presentations of the patients are shown in [Table 2]. The pathogens were responsible for hospital-acquired pneumonia in 24.24% (n = 8) patients including S. The importance of isolation of non-fermenters has increased in last decade, after more and more reports are correlating them with the either infection outbreaks in hospitals, or healthcare-associated infections.
17 of 90 patients who undergone voiding cistouretrography (VCUG) had vesicoureteral reflux.
But, now with the availability of commercial systems like Vitek-2 or API, the identification has become easier. In order to ensure a successful empirical treatment, protocols should be based on local epidemiology and susceptibility rates. These nosocomial pneumonia are frequently associated with mechanical ventilation, tracheostomy, previous exposure to broad-spectrum antibiotics, the use of respiratory tract equipment such as nebulizers [14],[15],[16],[17],[18],[19],[20],[21] and therapy with aerosolized polymyxin.
Malini et al.,[9] have documented 100% sensitivity to ciprofloxacin and trimethoprim-sulfamethoxazole. It is known to cause disease in cystic fibrosis (CF) patients and once infected, it is very difficult to eradicate.
BCC is known for its intrinsic resistance to many beta-lactam drugs, aminoglycosides, colistin and polymixin B, the first-line therapeutics of choice against serious pseudomonal infections. It is generally considered an opportunistic pathogen and has attracted attention as an emerging pathogen in CF. These isolates have shown 100% sensitivity to beta-lactam-beta-lactamase inhibitor combination antimicrobials.B. It is responsible for forming abscesses in multiple organs besides lungs like kidney, skin, musculoskeletal tissue, heart, etc.
One of the nasty things about this bacterium is that the incubation period can be anywhere from a couple of days to couple of years.
The other interesting fact about this pathogen is that it demands prolonged treatment first in intensive phase, followed by prolonged continuation phase.
About 5% of girls and 2% of boys experience at least one episode of urinary tract infection5. The presentation of UTI can be limited with compromise of the lower urinary tract or may be extend to the renal parenchyma and produce a systemic inflammatory response1.
The other patient was empirically started on amoxicillin-clavulanic acid and amikacin but after culture report was changed to ceftazidime and trimethoprim-sulphamethoxazole and he showed improvement.Differentiation between colonization and infection by these pathogens is of utmost importance. In infants, due to their inability to identify or communicate their symptoms, a high degree of suspiciousness by the physician is required to make an early diagnosis in order to initiate appropriate treatment and avoid later complications, such as renal scarring, hypertension and chronic renal disease7. Otherwise, unnecessary institution of antibiotics will contribute to further increase in resistance. This should ideally be supported by local epidemiological services at each institution to increase the likelihood of therapeutic success.
It supports the fact that these patients may have acquired these pathogens in hospital settings from one source of other. There is now a greater concern with the increased likelihood of antimicrobial resistance which is reflected in a greater number of treatment failures with drugs that have previously been considered frontline.
To reduce the rate of resistance it is important to redirect antibiotic treatment after microbiological confirmation and determination of its sensitivity8. The aminoglycosides that are considered as good option for life-threatening lower respiratory infections have shown high resistance in the present study for these non-fermenters wherever tested.
It may be due to poor penetration of aminoglycosides from blood into infected respiratory tissues so as to reach the local drug concentration above the minimum inhibitory concentration necessary for the infecting organisms.


This study has the objective of describing the demographic characteristics, etiologic agent, resistance profile and response to empirical treatment for a pediatric population cared for at a medical institution in Medellin that provides for diagnosis UTI during the years 2010 and 2011. Hence, correct identification of these non-fermenters is very important for choosing correct antibiotic so as to reduce the morbidity and mortality.
This study evaluated positive urine cultures processed in the microbiology laboratory of HPTU taken from pediatric patients (ages 0-14 years) who were seen in the emergency department or outpatient clinic for suspected UTI during the period between January 2010 and December 2011. The mortality may be due to underlying illness contributing to their immuno-compromised state or late institution of treatment.Any NFGNB culture isolate from respiratory tract infection should not be ignored as just contaminant but correlated clinically for its pathogenic potential and identified using standard methods, so as to institute appropriate and timely antibiotic coverage. The diagnosis of UTI was made by means of a positive urine culture for one organism with a count greater than or equal to 50,000 colony forming units (CFU) if it was collected by a urinary evacuating catheter and greater than or equal to 100,000 UFC, if it was collected by spontaneous voiding, according to criteria established by the American Pediatric Academy9.
Also excluded were patients in which a urine culture was first taken 24 hours after admission to the emergency room. Demographic data were collected including age in months at time of diagnosis, sex, clinical diagnoses, results of urine cultures and antibiogram, full blood count, C-reactive protein (CRP) and urinalysis.
Also included were data on utilized empirical treatments (previously used antibiotics before knowing microbiological isolations and sensitivity profile), antibiotic treatment time in days, clinical response (resolution of fever and other clinical improvements in the symptoms reported at the time of diagnosis) and complications associated with the infection, such as abscess, nephronia or pyelonephritis. A descriptive analysis of the data was performed, including calculations of frequencies and proportions for the qualitative variables and quantitative variables were described in terms of means or medians with their respective standard deviations or percentiles according to the distribution of the data identified by the Shapiro Wilkerson test. To assess association between qualitative variables chi-square tests were run with a significance level of 0.05. It followed the rules on ethical aspects of research on human subjects contained in Resolution 008430 of 1993 from the Ministry of Health in Colombia and the confidentiality of the data from patients included in the study was honored.
Vomiting, abdominal pain and dysuria predominated in those over two years of age, and in children under two years of age irritability, diarrhea and vomiting were predominant (Table 2). Urine cultures were taken by catheterization in 75% of children under three years and in 34% of those over four years. Only five episodes were observed of UTI by Enterococcus faecalis, none of these were resistant to vancomycin. Of the patients who had previously presented with UTI, 36.4% were resistant to ampicillin sulbactam vs. This study describes the resistance profile of uropathogens causing UTI in a pediatric population of a hospital in the city of Medellin, Colombia. This is consistent with the microbiological profile of patients with acquired UTI in the community that has been reported in articles published in recent years in different regions of the world4 10. Drugs such as cephalosporins, sulfamethoxazole trimethoprim and amoxicillin-clavulanate are the most utilized oral antibiotics11, 12.
For intravenous treatment there is ampicillinsulbactam, cephalosporins of second and third generation and aminoglycosides. Resistance of enterobacteriaceae to beta-lactam antibiotics has increased in the past 30 years11. This was first detected in Germany in 1980 and was quickly reported in the United States13. This is similar to recent articles in which several authors report resistances that fluctuate between 24 and 58% for ampicillin sulbactam and are up to 36% for trimethoprim sulfametoxazol10, 14, 15. For example, the patient with complicated UTI, pyelonephritis, or uro sepsis10 should receive intravenous antibiotic treatment.
In these cases, cephalosporins of the third and fourth generation could be an option as their resistance profile was low. Some studies have shown that nitrofurantoin has an adequate renal excretion and is recommended for complicated urinary tract infections17.
In this study little resistance was found to nitrofurantoin, but for being only a bacteriostatic antibiotic it is not recommended in complicated urinary tract infections.
Other medications that showed low resistance (7%) was ciprofloxacin for reported uropathogens. In our study, the average treatment time was 7 days (p25-75: 7-10) with an adequate clinical response to the treatment used.
It is noteworthy that some studies have shown that the presence of respiratory symptoms does not exclude the possibility of presenting with UTI5. These findings suggest the need to search for UTI in pediatric patients under two years of age with respiratory symptoms.
For this reason, it is suggested that UTI in a pediatric population is a marker of malformations of the urinary tract as it is found in up to 78.3% of patients diagnosed with febrile UTI20 and that may promote the development of renal scarring with the long-term risk of hypertension, proteinuria and chronic renal failure21. These data highlight the importance of evaluation and imaging follow-up in all pediatric patients diagnosed with urinary tract infection.
Conversely, amikacin, ciprofloxacin and nitrofurantoin would be therapeutic alternatives in pediatric patients with uncomplicated UTI and cephalosporins of the 3rd or 4th generation in those with more severity, as in the case of urosepsis. Febrile urinary tract infection in children: ampicillin and trimethoprim insufficient as empirical monotherapy. Etiology and sensitivity of uropathogens in outpatients and inpatients with urinary tract infection: Implications on empiric therapy.
Characteristics of first urinary tract infection with fever in children: a prospective clinical and imaging study. Antibiotic resistance in urinary isolates of Escherichia coli from college women with urinary tract infections. Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis. Risk of serious bacterial infection in young febrile infants with respiratory syn- cytial virus infections.




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