Clinical relevance of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin susceptible Staphylococcus aureus (MSSA) for mothers during pregnancy.

PURPOSE: The impact of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin-sensitive Staphylococcus aureus (MSSA) of healthy pregnant women is not described in detail in Germany. In this study, we screened for MSSA and AMRB, especially for methicillin-resistant S. aureus (MRSA) as well as extended-spectrum beta-lactamase (ESBL)-producing E. coli. Potential risk factors for colonization with AMRB/MSSA and the potential effects of colonization with these on the obstetric population were investigated. METHODS: From October 2013 until December 2015 pregnant women were screened before birth for colonization with AMRB/MSSA from the mammillae, nose, perianal and vaginal area. Before birth, the expectant mother was administered a standardized interview questionnaire by a trained interviewer. Data from the hospital admission records were also included. RESULTS: Samples from 651 pregnant women were analyzed. Colonization with MSSA was detected in 14.3% (n = 93), AMRB in 3.5% [(n = 23); MRSA: n = 3/ESBL: n = 20]. Significantly more colonization of AMRB/MSSA could be detected in women who had previously given birth compared to women who were nulliparous (p < 0.05). MSSA colonization was significantly associated with self-reported respiratory diseases during pregnancy (p < 0.05), but AMRB/MSSA colonization was not statistically associated with other types of infection. CONCLUSION: Our results demonstrate a low overall rate of colonization with AMRB/MSSA, as well as a low percentage of colonized pregnant women who developed infections. Multiparous women are at higher risk for colonization with MSSA/MRSA or ESBL. Because the prevalence of AMRB/MSSA is low, this study suggests that general screening of pregnant women without risk factors is not recommended.

[Increasing frequency of onychomycoses--is there a change in the spectrum of infectious agents?]. / Steigende Häufigkeit der Onychomykose--Andert sich das Erregerspektrum?

The recently developed antifungal drugs are not equally effective against the fungi causing onychomycoses: dermatophytes, yeasts and non-dermatophyte filamentous fungi (NDFF). Therapeutic failures may be due to the use of antifungal agents not primarily effective against the particular fungus. Considering the high costs of systemic antifungal therapy, it is necessary to know the frequency distribution of the different fungi causing onychomycosis. In a retrospective study, we have analysed results of fungal cultures performed between 1974 and 1994. In particular, we have compared the time periods 1982-1984 and 1992-1994. Culture results from toe nails showed in 1982-1984 the following fungal pattern (n = 833): dermatophytes 61%, yeasts 15%, NDFF 17%, mixed infections 7%. Results from 1992-1994 (n = 930) revealed an increase of dermatophytes 86% at the expense of yeasts (7%), NDFF (3%) and mixed infections (3%). In finger nails, we found a more pronounced change of infectious agents from 1982-1984 (n = 509; dermatophytes 62%, yeasts 29%, NDFF 1%, mixed infections 7%) to 1992-1994 (n = 348; dermatophytes 45%, yeasts 52%, NDFF 0.3%, mixed infections 3%). The high rate of yeast isolations (52%) from finger nails in 1992-1994 is striking. The role of yeast isolates for pathogenesis of onychomycosis remains to be elucidated. Differentiation between colonisation and infection would be necessary. The effectiveness of oral antifungal drugs against dermatophytic nail infections is well documented. The effectiveness against yeasts and NDFF, however, has not been studied thoroughly, but is not supposed to be equal with the different antifungal agents. Determination of the infectious agents in onychomycoses is recommended in order to avoid therapeutic failures.