Browsing by Author "Pitout, Johann"

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    Late Presentation of Cryptococcus gattii Meningitis in a Traveller to Vancouver Island: A Case Report
    (2007-01-01) Levy, Ron; Pitout, Johann; Long, Patricia; Gill, M John
    Since 1999, Cryptococcus gattii has been identified as a primary pathogen on Vancouver Island in British Columbia, and it has resulted in infection of both people and animals living in that area. A previously healthy 45-year-old female resident of Alberta developed C gattii infection 11 months after travelling to an endemic region of Vancouver Island. A case of an immunocompetent patient, with an atypically long incubation time, who presented with subacute meningitis secondary to disseminated pulmonary cryptococcosis is presented. The present report highlights the need for clinical vigilance in treating patients presenting with atypical pulmonary infections or meningitis who have been holiday travellers to endemic areas of Vancouver Island.
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    Utilization of Colistin for Treatment of Multidrug-Resistant Pseudomonas aeruginosa
    (2008-01-01) Sabuda, Deana M; Laupland, Kevin; Pitout, Johann; Dalton, Bruce; Rabin, Harvey; Louie, Thomas; Conly, John
    BACKGROUND: Colistin is uncommonly used in clinical practice; however, the emergence of multidrug-resistant organisms has rekindled interest in this potentially toxic therapeutic option. The present study describes the authors’ experience with colistin in the management of patients who were infected with metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa within the Calgary Health Region (Calgary, Alberta).METHOD: Adult patients who received colistimethate sodium (colistin) between January 2000 and December 2005 were identified via pharmacy records, and their charts were reviewed retrospectively. Patients with cystic fibrosis were excluded. Patient demographics, clinical course and relevant laboratory data were extracted.RESULTS: Twenty-eight courses of colistin were received by 22 patients. The majority of these treatments were directed at MBL-producing Pseudomonas. One-half of the patients received nebulized colistin. Intravenous (IV) colistin was administered to 12 patients for a mean ± SD of 14.7±13.8 days (range 3.7 to 46 days). The highest IV dose used was 125 mg every 6 h or 6 mg/kg/day. Eight of 12 patients (67%) treated with IV colistin responded either fully or partially. Two patients received IV colistin as outpatients. Adverse effects considered to be due to colistin included drug fever, nephrotoxicity and neurotoxicity. Five of nine patients (56%) who had complete data available for evaluation had at least a doubling of creatinine levels from baseline.CONCLUSION: Patients in the present study received both IV and nebulized colistin for multidrug-resistant P aeruginosa. The use of IV colistin was associated with a favourable response, but mild nephrotoxicity occurred in two-third of patients. It was concluded that colistin may be a useful drug when choices are limited.
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    Wastewater-Based Surveillance of Antimicrobial Resistance Genes in Hospitals
    (2024-01-04) Au, Emily; Parkins, Michael; Conly, John; Harrison, Joe; Pitout, Johann; Rennert-May, Elissa
    Background: Antimicrobial resistance poses a significant threat to public health and healthcare-associated infections with antimicrobial-resistant organisms contribute to increased patient morbidity, mortality, and healthcare costs. We adapted wastewater-based surveillance (WBS) as a novel tool to quantify and longitudinally monitor the abundance of antimicrobial resistance genes (ARGs) comprehensively and inclusively in tertiary care hospitals. Methods: Wastewater was collected weekly from March 2022 to March 2023 from four Calgary hospitals: RGH (615 beds), PLC (517 beds), FMC (1100 beds), and ACH (141 beds). A Calgary wastewater treatment plant (WWTP) served as a community control (population ~1 million). DNA extracted from wastewater pellets was used to detect the following ARGs with qPCR: Clostridioides difficile (C. difficile 16S rRNA, tcdA, tcdB), vancomycin-resistant enterococci (vanA, vanB), and Gram-negative ARGs (blaNDM-like, blaVIM-like, mcr-like). ARG copy numbers were assessed as raw (copies/ mL of wastewater processed) and normalized with three fecal biomarkers (total bacterial 16S rRNA, Bacteroides HF183 16S rRNA, human 18S rRNA). Mann-Whitney comparisons were determined with GraphPad Prism (v9.0). Results: Across one year, all ARGS were detected in hospital and community wastewater with qPCR. Mean abundances of C. difficile 16S rRNA, tcdA, and tcdB normalized with bacterial 16S rRNA were respectively 1.5- to 62-, 1.4- to 6-, and 1- to 344-times greater in hospitals than the WWTP, but only significantly in RGH, PLC, and FMC (p<0.05). Mean 16S-normalized abundances of vanA and vanB were respectively 26- to 2953- and 1.7- 108-times higher in RGH, PLC, and FMC relative to the WWTP (p<0.0001). Mean 16S-normalized abundance of blaNDM-like was 8- to 184-times greater in all hospitals (p<0.01) and blaVIM-like was 2- to 95-times greater in PLC and FMC than the WWTP (p<0.0001). mcr-like resistance was only occasionally detected at low levels in hospitals and was considered non-significant. Conclusion: WBS is a novel tool that can be used in real time to monitor ARGs across a range of scales with the potential to augment antimicrobial stewardship and infection control programs and elucidate potential contributing factors of ARG selection and colonization.