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  • Conduct of Scientific ResearchEditorial02 April 2025

    A call for the United States to continue investing in science

    The U.S. life science research mission is critical not only to human health and understanding the natural world but also to agriculture and food production, technological innovations, socioeconomic progress, and our national defense and leadership worldwide. A 2025 Research!America survey reveals that 92% of Americans want government to actively work to promote medical progress, in part by funding infectious and chronic disease research. Why? Because biomedical research saves lives, prevents suffering, and increases quality of life for not only Americans but for people throughout the world. While less well appreciated, science also drives enormous economic growth. Indeed, historically there has been widespread bipartisan support for biomedical funding by the federal government. Below we discuss the U.S. scientific research enterprise and provide evidence and arguments we hope the ASM community can use to advocate for science.
  • Research Article01 August 2015

    Risk Factors for Acquisition and Loss of Clostridium difficile Colonization in Hospitalized Patients

    Asymptomatic colonization may contribute to Clostridium difficile transmission. Few data identify which patients are at risk for colonization. We performed a prospective cohort study of C. difficile colonization and risk factors for C. difficile acquisition and loss in hospitalized patients. Patients admitted to medical or surgical wards at a tertiary care hospital were enrolled; interviews and chart review were performed to determine patient demographics, C. difficile infection (CDI) history, medications, and health care exposures. Stool samples/rectal swabs were collected at enrollment and discharge; stool samples from clinical laboratory tests were also included. Samples were cultured for C. difficile, and the isolates were tested for toxins A and B and ribotyped. Chi-square tests and univariate logistic regression were used for the analyses. Two hundred thirty-five patients were enrolled. Of the patients, 21% were colonized with C. difficile (toxigenic and nontoxigenic) at admission and 24% at discharge. Ribotype 027 accounted for 6% of the strains at admission and 12% at discharge. Of the patients colonized at admission, 78% were also colonized at discharge. Cephalosporin use was associated with C. difficile acquisition (47% of patients who acquired C. difficile versus 25% of patients who did not; P = 0.03). β-lactam–β-lactamase inhibitor combinations were associated with a loss of C. difficile colonization (36% of patients who lost C. difficile colonization versus 8% of patients colonized at both admission and discharge; P = 0.04), as was metronidazole (27% versus 3%; P = 0.03). Antibiotic use affects the epidemiology of asymptomatic C. difficile colonization, including acquisition and loss, and it requires additional study.
  • Research Article01 September 2016

    Impact of Time to Appropriate Therapy on Mortality in Patients with Vancomycin-Intermediate Staphylococcus aureus Infection

    Despite the increasing incidence of vancomycin-intermediate Staphylococcus aureus (VISA) infections, few studies have examined the impact of delay in receipt of appropriate antimicrobial therapy on outcomes in VISA patients. We examined the effects of timing of appropriate antimicrobial therapy in a cohort of patients with sterile-site methicillin-resistant S. aureus (MRSA) and VISA infections. In this single-center, retrospective cohort study, we identified all patients with MRSA or VISA sterile-site infections from June 2009 to February 2015. Clinical outcomes were compared according to MRSA/VISA classification, demographics, comorbidities, and antimicrobial treatment. Thirty-day all-cause mortality was modeled with Kaplan-Meier curves. Multivariate logistic regression analysis (MVLRA) was used to determine odds ratios for mortality. We identified 354 patients with MRSA (n = 267) or VISA (n = 87) sterile-site infection. Fifty-five patients (15.5%) were nonsurvivors. Factors associated with mortality in MVLRA included pneumonia, unknown source of infection, acute physiology and chronic health evaluation (APACHE) II score, solid-organ malignancy, and admission from skilled care facilities. Time to appropriate antimicrobial therapy was not significantly associated with outcome. Presence of a VISA infection compared to that of a non-VISA S. aureus infection did not result in excess mortality. Linezolid use was a risk for mortality in patients with APACHE II scores of ≥14. Our results suggest that empirical vancomycin use in patients with VISA infections does not result in excess mortality. Future studies should (i) include larger numbers of patients with VISA infections to confirm the findings presented here and (ii) determine the optimal antibiotic therapy for critically ill patients with MRSA and VISA infections.
  • Research Article01 November 2017

    When Good Bugs Go Bad: Epidemiology and Antimicrobial Resistance Profiles of Corynebacterium striatum, an Emerging Multidrug-Resistant, Opportunistic Pathogen

    Infections with Corynebacterium striatum have been described in the literature over the last 2 decades, with the majority being bacteremia, central line infections, and occasionally, endocarditis. In recent years, the frequency of C. striatum infections appears to be increasing; a factor likely contributing to this is the increased ease and accuracy of the identification of Corynebacterium spp., including C. striatum, from clinical cultures. The objective of this study was to retrospectively characterize C. striatum isolates recovered from specimens submitted as part of routine patient care at a 1,250-bed, tertiary-care academic medical center. Multiple strain types were recovered, as demonstrated by repetitive-sequence-based PCR. Most of the strains of C. striatum characterized were resistant to antimicrobials commonly used to treat Gram-positive organisms, such as penicillin, ceftriaxone, meropenem, clindamycin, and tetracycline. The MIC50 for ceftaroline was >32 μg/ml. Although there are no interpretive criteria for susceptibility with telavancin, it appeared to have potent in vitro efficacy against this species, with MIC50 and MIC90 values of 0.064 and 0.125 μg/ml, respectively. Finally, as previously reported in case studies, we demonstrated rapid in vitro development of daptomycin resistance in 100% of the isolates tested (n = 50), indicating that caution should be exhibited when using daptomycin for the treatment of C. striatum infections. C. striatum is an emerging, multidrug-resistant pathogen that can be associated with a variety of infection types.
  • Antimicrobial ChemotherapyBrief Report18 October 2021

    Elevated MICs of Susceptible Antipseudomonal Cephalosporins in Non-Carbapenemase-Producing, Carbapenem-Resistant Pseudomonas aeruginosa: Implications for Dose Optimization

    The present study evaluated the in vitro potency of ceftazidime and cefepime among carbapenem-resistant Pseudomonas aeruginosa isolates collected as part of a global surveillance program and assessed the pharmacodynamic implications using previously published population pharmacokinetics. When susceptible, MICs resulted at the high end of distribution for both ceftazidime and cefepime, thus 6 g/day was required to achieve optimal pharmacodynamic profiles. These findings should be considered in the clinic and for the application of CLSI susceptibility breakpoints.
  • Research Article01 December 2016

    Topical Decolonization Does Not Eradicate the Skin Microbiota of Community-Dwelling or Hospitalized Adults

    Topical antimicrobials are often employed for decolonization and infection prevention and may alter the endogenous microbiota of the skin. The objective of this study was to compare the microbial communities and levels of richness and diversity in community-dwelling subjects and intensive care unit (ICU) patients before and after the use of topical decolonization protocols. We enrolled 15 adults at risk for Staphylococcus aureus infection. Community subjects (n = 8) underwent a 5-day decolonization protocol (twice daily intranasal mupirocin and daily dilute bleach-water baths), and ICU patients (n = 7) received daily chlorhexidine baths. Swab samples were collected from 5 anatomic sites immediately before and again after decolonization. A variety of culture media and incubation environments were used to recover bacteria and fungi; isolates were identified using matrix-assisted laser desorption ionization–time of flight mass spectrometry. Overall, 174 unique organisms were recovered. Unique communities of organisms were recovered from the community-dwelling and hospitalized cohorts. In the community-dwelling cohort, microbial richness and diversity did not differ significantly between collections across time points, although the number of body sites colonized with S. aureus decreased significantly over time (P = 0.004). Within the hospitalized cohort, richness and diversity decreased over time compared to those for the enrollment sampling (from enrollment to final sampling, P = 0.01 for both richness and diversity). Topical antimicrobials reduced the burden of S. aureus while preserving other components of the skin and nasal microbiota.
  • Brief Report01 October 2015

    Antimicrobial Susceptibility Profiles of Staphylococcus aureus Isolates Recovered from Humans, Environmental Surfaces, and Companion Animals in Households of Children with Community-Onset Methicillin-Resistant S. aureus Infections

    Our objective was to determine the antibiotic susceptibility profiles of Staphylococcus aureus isolates recovered from 110 households of children with community-onset methicillin-resistant S. aureus (MRSA) infections. Cultures were obtained from household members, household objects, and dogs and cats, yielding 1,633 S. aureus isolates. The S. aureus isolates were heterogeneous, although more than half were methicillin resistant. The highest proportion of MRSA was found in bathrooms. The majority of isolates were susceptible to antibiotics prescribed in outpatient settings.
  • Brief Report01 November 2015

    Ceftolozane-Tazobactam Activity against Phylogenetically Diverse Clostridium difficile Strains

    Ceftolozane-tazobactam (C/T) is approved for the treatment of complicated intra-abdominal and urinary tract infections and has varied activity against anaerobic bacteria. Here, we evaluate the activity of C/T against a phylogenetically diverse collection of Clostridium difficile isolates and report uniformly high MICs (≥256 μg/ml) to C/T.
  • Brief Report01 April 2018

    Importance of Site of Infection and Antibiotic Selection in the Treatment of Carbapenem-Resistant Pseudomonas aeruginosa Sepsis

    In a retrospective analysis of 215 patients with carbapenem-resistant Pseudomonas aeruginosa sepsis, we observed a significantly higher risk of mortality associated with respiratory tract infection (risk ratio [RR], 1.20; 95% confidence interval [CI], 1.04 to 1.39; P = 0.010) and lower risk with urinary tract infection (RR, 0.80; 95% CI, 0.71 to 0.90; P = 0.004). Aminoglycoside monotherapy was associated with increased mortality, even after adjusting for confounders (adjusted RR, 1.72; 95% CI, 1.03 to 2.85; P = 0.037), consistent across multiple sites of infection.
  • Research Article01 May 2017

    Antibiotic Prophylaxis Is Associated with Subsequent Resistant Infections in Children with an Initial Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae Infection

    The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and the occurrence of subsequent resistant infections in children with index infections due to extended-spectrum-cephalosporin-resistant Enterobacteriaceae. We also investigated the concordance of the index and subsequent isolates. Extended-spectrum-cephalosporin-resistant Escherichia coli and Klebsiella spp. isolated from normally sterile sites of patients aged <22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, and fumC-fimH (E. coli) or tonB (Klebsiella pneumoniae) type were identical to those of the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between the index and first subsequent infections was 123 (interquartile range, 43 to 225) days. In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate, and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 of 17 (71%) patients with E. coli sequence type 131 (ST131)-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum-cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections.
  • Conduct of Scientific ResearchEditorial23 April 2025

    A call for the United States to continue investing in science

    The U.S. life science research mission is critical not only to human health and understanding the natural world but also to agriculture and food production, technological innovations, socioeconomic progress, and our national defense and leadership worldwide. A 2025 Research!America survey reveals that 92% of Americans want government to actively work to promote medical progress, in part by funding infectious and chronic disease research. Why? Because biomedical research saves lives, prevents suffering, and increases quality of life for not only Americans but for people throughout the world. While less well appreciated, science also drives enormous economic growth. Indeed, historically there has been widespread bipartisan support for biomedical funding by the federal government. Below we discuss the U.S. scientific research enterprise and provide evidence and arguments we hope the ASM community can use to advocate for science.
  • Clinical MicrobiologyEditorial07 January 2025

    A dazzle of zebras: launch of ASM Case Reports

    The American Society for Microbiology (ASM) journals are some of the most prominent and well respected in the microbial sciences. This high-quality portfolio is home to a wide variety of scholarly publications, ranging from exceptional basic and clinical research to widely read and cited review journals. Together, these journals span the microbial sciences and serve as an important vehicle to communicate the latest information and advances. A missing element in this outstanding portfolio (until now) is a home for case reports relevant to the microbial sciences. Thus, ASM Case Reports is launching, with the first issue anticipated in January 2025.
  • Conduct of Scientific ResearchEditorial06 May 2025

    A call for the United States to continue investing in science

    The U.S. life science research mission is critical not only to human health and understanding the natural world but also to agriculture and food production, technological innovations, socioeconomic progress, and our national defense and leadership worldwide. A 2025 Research!America survey reveals that 92% of Americans want government to actively work to promote medical progress, in part by funding infectious and chronic disease research. Why? Because biomedical research saves lives, prevents suffering, and increases quality of life for not only Americans but for people throughout the world. While less well appreciated, science also drives enormous economic growth. Indeed, historically there has been widespread bipartisan support for biomedical funding by the federal government. Below we discuss the U.S. scientific research enterprise and provide evidence and arguments we hope the ASM community can use to advocate for science.
  • Conduct of Scientific ResearchEditorial12 June 2025

    A call for the United States to continue investing in science

    The U.S. life science research mission is critical not only to human health and understanding the natural world but also to agriculture and food production, technological innovations, socioeconomic progress, and our national defense and leadership worldwide. A 2025 Research!America survey reveals that 92% of Americans want government to actively work to promote medical progress, in part by funding infectious and chronic disease research. Why? Because biomedical research saves lives, prevents suffering, and increases quality of life for not only Americans but for people throughout the world. While less well appreciated, science also drives enormous economic growth. Indeed, historically there has been widespread bipartisan support for biomedical funding by the federal government. Below we discuss the U.S. scientific research enterprise and provide evidence and arguments we hope the ASM community can use to advocate for science.
  • Announcement20 July 2017

    Draft Genome Sequence of the blaOXA-436- and blaNDM-1-Harboring Shewanella putrefaciens SA70 Isolate

    We sequenced a carbapenem-resistant Shewanella putrefaciens isolate cultured from the sink handle of a Pakistan hospital room. Assembly annotation indicates that the isolate has a chromosomal blaOXA-436 carbapenemase and a plasmid-borne blaNDM-1 gene. To our knowledge, this is the first report of a Shewanella species harboring blaNDM.
  • Conduct of Scientific ResearchEditorial08 April 2025

    A call for the United States to continue investing in science

    The U.S. life science research mission is critical not only to human health and understanding the natural world but also to agriculture and food production, technological innovations, socioeconomic progress, and our national defense and leadership worldwide. A 2025 Research!America survey reveals that 92% of Americans want government to actively work to promote medical progress, in part by funding infectious and chronic disease research. Why? Because biomedical research saves lives, prevents suffering, and increases quality of life for not only Americans but for people throughout the world. While less well appreciated, science also drives enormous economic growth. Indeed, historically there has been widespread bipartisan support for biomedical funding by the federal government. Below we discuss the U.S. scientific research enterprise and provide evidence and arguments we hope the ASM community can use to advocate for science.
  • Research Article01 March 2013

    MAPK-Activated Protein Kinase 2 Contributes to Clostridium difficile-Associated Inflammation

    Clostridium difficile infection (CDI) results in toxin-induced epithelial injury and marked intestinal inflammation. Fecal markers of intestinal inflammation correlate with CDI disease severity, but regulation of the inflammatory response is poorly understood. Previous studies demonstrated that C. difficile toxin TcdA activates p38 kinase in tissue culture cells and mouse ilium, resulting in interleukin-8 (IL-8) release. Here, we investigated the role of phosphorylated mitogen-activated protein kinase (MAPK)-activated protein kinase (MK2 kinase, pMK2), a key mediator of p38-dependent inflammation, in CDI. Exposure of cultured intestinal epithelial cells to the C. difficile toxins TcdA and TcdB resulted in p38-dependent MK2 activation. Toxin-induced IL-8 and GROα release required MK2 activity. We found that p38 and MK2 are activated in response to other actin-disrupting agents, suggesting that toxin-induced cytoskeleton disruption is the trigger for kinase-dependent cytokine response. Phosphorylated MK2 was detected in the intestines of C. difficile-infected hamsters and mice, demonstrating for the first time that the pathway is activated in infected animals. Furthermore, we found that elevated pMK2 correlated with the presence of toxigenic C. difficile among 100 patient stool samples submitted for C. difficile testing. In conclusion, we find that MK2 kinase is activated by TcdA and TcdB and regulates the expression of proinflammatory cytokines. Activation of p38-MK2 in infected animals and humans suggests that this pathway is a key driver of intestinal inflammation in patients with CDI.
  • Conduct of Scientific ResearchEditorial17 April 2025

    A call for the United States to continue investing in science

    The U.S. life science research mission is critical not only to human health and understanding the natural world but also to agriculture and food production, technological innovations, socioeconomic progress, and our national defense and leadership worldwide. A 2025 Research!America survey reveals that 92% of Americans want government to actively work to promote medical progress, in part by funding infectious and chronic disease research. Why? Because biomedical research saves lives, prevents suffering, and increases quality of life for not only Americans but for people throughout the world. While less well appreciated, science also drives enormous economic growth. Indeed, historically there has been widespread bipartisan support for biomedical funding by the federal government. Below we discuss the U.S. scientific research enterprise and provide evidence and arguments we hope the ASM community can use to advocate for science.
  • Clinical MicrobiologyResearch Article18 June 2021

    SARS-CoV-2 E Gene Variant Alters Analytical Sensitivity Characteristics of Viral Detection Using a Commercial Reverse Transcription-PCR Assay

    Diagnostic assays for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are essential for patient management, infection prevention, and the public health response for coronavirus disease 2019 (COVID-19). The efficacy and reliability ...
  • Photo Quiz01 July 2011

    A 2-Year-Old Female with Fever and Rash

    A previously healthy 2-year-old Caucasian female from southeast Missouri presented to the emergency department of St. Louis Children's Hospital in June 2010 with a week-long fever. Her history included the removal of a small tick engorged with blood several days prior to fever onset. She exhibited high fevers of up to 104°F, with associated rhinorrhea, a mild cough, and episodes of emesis and diarrhea causing moderate dehydration. After several days at home, she was admitted to the hospital, where she was treated with ceftriaxone and azithromycin for otitis media without overall improvement. She developed an erythematous, maculopapular rash that blanched with pressure and that initially began on her cheeks and then spread down her neck to her trunk and extremities, sparing her palms and soles; no petechiae were observed. A complete blood count (CBC) revealed a low-normal white blood cell (WBC) count of 4.9 × 109 cells/liter, a (low) hemoglobin concentration of 10.9 g/dl, and a low platelet count of 102 × 109 cells/liter. Her serum metabolic panel indicated hyponatremia (133 mmol of sodium/liter) with mildly elevated liver transaminase levels (asparatate transaminase [AST], 56 U/liter; alanine transaminase [ALT], 48 U/liter). Routine bacterial cultures of blood and urine were negative for growth. After further evaluation, a lumbar puncture was performed, with analysis of cerebrospinal fluid (CSF) showing a total cell count of 95 × 106 cells/liter, with a nucleated cell count of 93 × 106 cells/liter, including 84% lymphocytes and 13% monocytes; the CSF glucose level was 52 mg/dl, and the CSF protein level was 53 mg/dl. Geimsa staining of the CSF specimen was performed as part of her evaluation and revealed inclusion bodies present in the cytoplasm of monocytes (Fig. 1). A PCR assay of whole blood was performed and confirmed the diagnosis.
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