Erythromycin resistance in Streptococcus pyogenes and macrolide consumption in a central Italian region.

BACKGROUND: The study investigated macrolide resistance in Streptococcus pyogenes in a central Italian area from 2001 to 2006 and the possible correlation between antibiotic consumption and fluctuations of resistance percentages. MATERIALS AND METHODS: Macrolide and lincosamide susceptibility of 1,419 S. pyogenes isolates was tested by Kirby Bauer method. Macrolide consumption was evaluated as defined daily dose/1,000 inhabitants per day (DID), according to the World Health Organization anatomic therapeutic chemical classification. Spearman's correlation coefficient was used to assess the association between resistance and use of (1) all macrolides pooled, (2) once daily, (3) twice daily, and (4) three times daily dosage regimens. RESULTS: : In total, 320 strains (22.6%) were erythromycin-resistant, 11.4% with the M phenotype and 11.2% with the MLS phenotype. There was a significant decrease in erythromycin resistance during the study period-from 28.1% in 2001 to 15.6% in 2006 (p < 0.01). No significant correlation was found between erythromycin resistance and local overall macrolide consumption, neither during the same year nor during the previous year. In contrast, a significant correlation was found between resistance rates and once-daily macrolide use during the preceding 6 months in Siena r = 0.747, p = 0.008). CONCLUSION: The known greater selective effect of long-acting agents could establish a pressure outcome, resulting in a specific local epidemiology during a relatively short time gap.

Serological response to hepatitis B virus vaccine in HIV-infected children in Tanzania.

BACKGROUND: HIV-infected children have a lower seroconversion rate to hepatitis B virus (HBV) immunization than healthy children. Previous studies have produced conflicting results on CD4 cell counts as predictors of vaccine response. No study has evaluated the response rate to HBV vaccination in HIV-infected children receiving highly active antiretroviral therapy (HAART). Our aim was to vaccinate HIV-infected children living in a close community and to investigate the anamnestic response rate after vaccination with its predictors. METHODS: Eighty-four HIV-positive children aged 1-10 years who were negative for antibodies to the HBV core antigen (anti-HBc) completed immunization with three doses of 5 microg HBVAXPRO (Aventis, Milan, Italy). Quantitative testing for antibodies to the HBV surface antigen (anti-HBs) was performed: a seroprotective titre was defined as anti-HBs>10 mUI/mL. RESULTS: After the vaccination, the anti-HBs seroconversion rate was 59.5%. It was higher in individuals in Centers for Disease Control and Prevention (CDC) immune category 1 than in those in CDC categories 2 and 3. Seroconversion was found in 70.8% of HAART-treated and 44.4% of treatment-naïve children. In multivariable models, HAART use and absolute CD4 cell counts were independently associated with probability of seroconversion and with higher anti-HBs titres. CONCLUSIONS: We found a higher seroconversion rate compared with previous studies in HIV-infected children. In children who are candidates to receive antiretroviral therapy, it may be advisable to defer HBV vaccination until after treatment initiation.

Outpatient parenteral antibiotic therapy for bone and joint infections: an italian multicenter study.

In the early eighties, the advantages of outpatient parenteral antibiotic therapy (OPAT) (reduced costs, no hospitalization trauma in children, no immobilization syndrome in elderly, reduction in nosocomial infections by multiresistant organisms) were identified in the United States, and suitable therapeutic programs were established. Currently, more than 250,000 patients per year are treated according to an OPAT program. In order to understand the different ways of managing OPAT and its results, a National OPAT Registry was set up in 2003 in Italy. Analysis of data concerning osteomyelitis, septic arthritis, prosthetic joint infection and spondylodiskitis, allowed information to be acquired about 239 cases of bone and joint infections, with particular concern to demographics, therapeutic management, clinical response, and possible side effects. Combination therapy was the first-line choice in 66.9% of cases and frequently intravenous antibiotics were combined with oral ones. Teicoplanin (38%) and ceftriaxone (14.7%), whose pharmacokinetic/pharmacodynamic properties permit once-a-day administration, were the two top antibiotics chosen; fluoroquinolones (ciprofloxacin and levofloxacin) were the most frequently utilized oral drugs. Clinical success, as well as patients' and doctors' satisfaction with the OPAT regimen was high. Side-effects were mild and occurred in 11% of cases. These data confirm that the management of bone and joint infections in an outpatient setting is suitable, effective and safe.

Antimicrobial susceptibility of Streptococcus pyogenes and Streptococcus pneumoniae: surveillance from 1993 to 2004 in Central Italy.

The susceptibility of 1870 Streptococcus pyogenes and 1595 Streptococcus pneumoniae to macrolides and lincosamides has been monitored from 1993 to 2004 in Central Italy. Among S. pyogenes, 30.2% were erythromycin resistant; 18.5% were also resistant to josamycin and clindamycin (MLS phenotype). After an increasing erythromycin resistance rate in 1993-1997 (maximum 53.16%), a definite decrease was observed since 2001 with resistance rates always less than 30%. Thirty six percent of pneumococcal isolates were erythromycin-resistant, with minor temporal fluctuations; the MLS phenotype was the most prevalent overall (32.6%) and in individual years. S. pneumoniae strains were also tested for susceptibility to beta-lactams and other antimicrobial agents: 11.2% were penicillin non-susceptible, with a gradually increasing prevalence after 2001 (maximum rate 17.3% in 2004), 31.15% were resistant to tetracycline, 4.9% to chloramphenicol, 0.74% to rifampin. All pneumococcal isolates were susceptible to teicoplanin and 99.9% to ceftriaxone and ofloxacin.

[Bacterial meningitis in adults: a retrospective multicentric study in Tuscany (Italy)]. / Le meningiti batteriche dell'adulto: studio retrospettivo multicentrico della Toscana.

The Infectious Diseases Unit of Lucca Hospital conducted a multicentric retrospective study to evaluate the epidemiological and clinical features of adult patients affected by bacterial meningitis attending all the Infectious Diseases Units of Tuscany (Italy) from July 1999 to June 2004. A specific questionnaire was sent to all the units to collect information about each case of bacterial meningitis occurring in patients older than sixteen. Patients with meningitis by Mycobacterium tuberculosis were excluded from the analysis. Nine out of 12 Infectious Diseases Units of Tuscany took part in the study and 197 cases were identified. Most cases of meningitis occurred during 2002 with a slight reduction in cases in subsequent years. Streptococcus pneumoniae and Neisseria meningitidis were the most frequently isolated pathogens with an increase in diagnosis from 1999 to 2004; in 23.8% of patients no pathogens were isolated, with a reduction in meningitis from unknown aetiology from 1999 to 2004. Most patients were treated with a combination of two antibiotics, and corticosteroid drugs were added to the therapy; in the group of patients treated with corticosteroid drugs invalidating complications occurred in 23% of cases and 5% of patients died. In all, 27 out of 197 subjects (13.7%) developed invalidating complications and 20 out of 197 patients (10.2%) died.

Occipital intermittent rhythmic delta activity only following eye closure in atypical CNS Salmonellosis.

OBJECTIVE: A statement recently published on the base of a large retrospective analysis, report that the occipital intermittent rhythmic delta activity (OIRDA) "is associated with epilepsy but not acute encephalopathy" [Gullapalli and Fountain. J Clin Neurophysiol 2003;20:35-41]. Our aim is to report, the exception from a child with an intermittent fever, in which the finding of an occipital intermittent rhythmic delta activity (OIRDA) following the eye closure in the EEG recording was the first clinical sign addressing to a CNS involvement. METHODS: To review the record from a five-year-old girl with a normal basal electroencephalogram and OIRDA that only appeared following eye closure. RESULTS: We found OIRDA associated with atypical CNS Salmonellosis. Brain MRI and CSF examination confirmed an acute encephalopathy, which was due to Salmonella infection. The only symptoms of the infection were episodes of nightly fever that had lasted for four weeks, sometimes associated with headache and vomiting. Both OIRDA only induced by eye closing and other symptoms disappeared after starting antimicrobial therapy. CONCLUSIONS: OIRDA only following eye closure is a non-specific abnormality and the present findings, based on a single case, merely indicate that intracranial infection is among the possible causes. SIGNIFICANCE: The new clinical association is certainly worth recording, as the presence of this electrophysiological sign may provoke clinicians to then delve further into a diagnostic work up.

Chlamydia pneumoniae antibodies and angiographically demonstrated coronary artery disease in a sample population from Italy.

Recent reports suggest an association between Chlamydia pneumoniae and chronic coronary heart disease. This case-control study investigates the relationship between the presence of immunoglobin G (IgG) and immunoglobin A (IgA) when measured by means of microimmunofluorescence (MIF) and angiographically diagnosed coronary disease. Cases (n = 150) were angiography patients with at least one coronary artery lesion occupying at least 50% of the luminal diameter. Controls (n = 49) were angiography patients with no detectable signs of coronary artery disease and patients (n = 56) without signs or symptoms of coronary disease and with normal ECG results. No significant differences were revealed between the seroprevalence of IgG and IaA and geometric mean titers (GMT) as measured in cases and controls. When cases were compared with controls whose angiographic results were normal, after adjusting for established risk factors (cholesterol, smoking, hypertension, diabetes, age, gender and family history), the estimated risk of coronary artery disease was 0.79 (95% confidence interval (C.I.), 0.31-1.99) for the presence of IgG and was 0.94 (95 C.I., 0.37-2.39) for IgA. When cases were compared with controls with normal ECG results, the adjusted odds ratio (O.R.) for coronary artery disease was 1.17 (95%, C.I., 0.52-2.62) for the presence of IgG and 0.82 195% C.I., 0.36-1.86) for the presence of IgA. These results do not support an association between C. pneumoniae infection and coronary disease.

Susceptibility of macrolide and beta-lactam antibiotics of Streptococcus pyogenes strains isolated over a four-year period in central Italy.

In vitro susceptibility to erythromycin, azithromycin, penicillin G, ceftriaxone and ceftibuten was investigated in 190 Streptococcus pyogenes strains isolated over a 4-year period (1991-1994) from patients attending a university hospital located in central Italy. The rate of susceptibility to macrolide antibiotics of the S. pyogenes strains showed a progressive decrease (from 90.3% in 1991 to 79.5% in 1994), while all strains were susceptible to the three beta-lactam antibiotics. Owing to the reduced prevalence of macrolide-susceptible S. pyogenes strains, in vitro susceptibility testing of streptococcal isolates appears to be always necessary before starting a macrolide-based chemotherapy. Concerning beta-lactams, ceftriaxone presented minimum inhibitory concentrations (MIC) always equal to or lower than those of penicillin G, while the oral long-acting cephalosporin, ceftibuten, had MICs higher than those of the other beta-lactams, although in the susceptible range. Results of in vitro susceptibility testing are discussed in relation to their implications for antimicrobial chemotherapy of S. pyogenes infections.

Prevalence and chemosusceptibility of Neisseria meningitidis and Haemophilus influenzae in a population of central Italy.

The purpose of this study was to determine the prevalence of nasopharyngeal carriers of Neisseria meningitidis and Haemophilus influenzae, and to evaluate their chemoresistance. N. meningitidis was more frequently isolated in adolescents (10-15 years). All of meningococci were susceptible to ceftriaxone and rifampin, only one isolate showed reduced susceptibility to chloramphenicol and four strains showed reduced penicillin susceptibility. The results show that these drugs are still effective for prophylaxis and treatment in our area. All strains of H. influenzae were susceptible to penicillin, ceftriaxone, chloramphenicol, rifampin, azithromicin and gentamicin. 6 nontypeable strains were resistant to sulfamethoxazole-trimethoprim, 7 strains of type a and c-f, and 3 non-typeable strains showed reduced susceptibility to tetracycline. In contrast with the current trend in the world, in our area the susceptibility of H. influenzae to betalactams was 100%, therefore these antibiotics are still the drugs of choice for treatment of invasive diseases.

Molecular typing of Staphylococcus aureus isolates from an intensive care unit.

Seventeen S. aureus clinical isolates, collected from an Intensive Care Unit (ICU) during a seven-month period were analyzed to investigate their antimicrobial susceptibility and clonal diversity. Eleven isolates (65%) were found to be resistant to methicillin (MRSA). Pulsed-field gel electrophoresis (PFGE) profiles of genomic DNAs, and analysis of the polymorphisms of the variable regions of the protein A (spa) and coagulase (coa) genes revealed a lower clonal heterogeneity among MRSA than among methicillin-susceptible isolates (MSSA). Two of the MRSA clones were repeatedly isolated in different patients, within a variable period of time, suggesting the presence in the ward of a resident, endemic and multi-drug resistant MRSA population. Our results also emphasize the lower discriminatory power of spa and coa typing compared with PFGE typing.

Serological diagnosis of respiratory viral infections. A five-year study of hospitalised patients.

The results of a five-year study of paired sera from 410 hospitalised patients-mainly children-with respiratory illness are reported. Samples were divided into groups based on clinical diagnosis. The data of each group were analysed in relation to patient age (under or over 1 year of age). The percentage of positive serological diagnoses ranged from 29.4% in the respiratory viral illness group to 46.2% in the bronchiolitis group. Each group showed a prevalent serological diagnosis. Respiratory viral illness patients over 1 year were diagnosed mainly with Influenza virus infection (73.8% positive diagnosis), pharyngotonsillitis patients with Adenovirus infection (72.2%), laryngitis patients with Parainfluenza virus infection (100%), pneumonia patients with Mycoplasma pneumoniae infection (56.7%), and bronchiolitis patients with Respiratory Syncytial virus infection (100%). The serological diagnosis patterns of each group or subgroup were statistically significant with respect to the other groups (chi 2 or Fisher exact tests). Unlike previous reports, none of the patients under 1 year in our study was diagnosed with Influenza virus infection or Parainfluenza virus type 3. Conversely, Respiratory Syncytial virus infection data were in line with previous reports, being the most frequently diagnosed infection in the bronchiolitis group and in the subgroups of patients under 1 year of age. The present report provides new information on patterns of respiratory infections.

Retrospective survey on the epidemiology of H. influenzae type B meningitis in Italy (1987-91).

A retrospective survey on the epidemiology of H. Influenzae type b (Hib) meningitis was carried out in seven Italian hospitals. During the period 1987-1991, 95 (16.3%) Hib meningitis cases out of 581 bacterial meningitis cases were observed. The proportion of Hib meningitis was lowest in 1987 (11.3%); elevated in 1988 (17.9%); thereafter it did not change. A male preponderance was observed (Sex ratio 1.6). The age distribution showed that 93.7% of cases occurred in subjects < 5 years, 53.7% of cases in those < 1 year. Although Hib meningitis accounts for a small proportion of all bacterial meningitis, it is also a major problem in Italy in early childhood, because nearly all cases occur in children < 5 years.

[Vaccination against poliomyelitis]. / La vaccinazione antipoliomielitica.

The authors, after a review of some data about the actual poliomyelitis epidemiology in the world, point out the necessity of periodical checks for poliomyelitis vaccination. To this purpose, preliminary data of a research, undertaken in the province of Siena, into the effectiveness and innocuity of oral poliovirus vaccine, are reported. This evaluation has been made through isolation and identification of vaccinal polioviruses from stool after the first, second and then third dose of vaccine, and through titration of serum neutralizing antibodies. Results confirm the high effectiveness and innocuity of oral poliovirus vaccine, but suggest the opportuneness of some changes in the way of giving the oral vaccine.

Age-dependent seroprevalence of Toscana virus in central Italy and correlation with the clinical profile.

In order to estimate the antibody prevalence rates for Toscana virus (TOSV) among children and adults, we evaluated the seroprevalence of TOSV in a population (n = 2,737) living in Tuscany during the period of 1999 to 2006. The seroprevalence rate was 19.8% in adults and 5.8% in children, showing an age-dependent increase in TOSV-specific immunity. Meningitis due to TOSV infection was more frequent in adults than in children.

Outpatient parenteral antibiotic therapy in the elderly: an Italian observational multicenter study.

Bacterial infections are the most frequent cause of hospitalization in elderly patients. In the early eighties, the advantages of Outpatient parenteral Antibiotic therapy (OPAT) were identified in the United States, and suitable therapeutic programs were established. In order to understand the different ways of managing OPAT, a National OPAT Registry was set up in 2003 in Italy. This study analyzes data concerning bacterial infections in 176 elderly patients including demographics, therapeutic management, clinical response, and side-effects. Bone and joint infections (48.9%) and skin and soft tissue infections (27.8%) were the most common infections treated with OPAT. Teicoplanin (28.9%) and ceftriaxone (22.1%) were the top two antibiotics chosen. OPAT was mainly performed at a hospital infusion center (52.8%). The clinical success rate was high and side-effects were low (12.6% of cases). Management of bacterial infections in the elderly with an outpatient program is effective and safe.

Group A streptococcal infections: trend and strain emm typing in an area of central Italy, 1985-2002.

A retrospective study of group A streptococcal (GAS) infections was performed for the period 1985-2002 in an area of central Italy. Although very severe diseases such as streptococcal toxic shock syndrome (STSS) were observed, a general increase in invasive infections was not found. Isolates of GAS were classified by M protein genotyping (emm typing) and analysed according to their origin from invasive and non-invasive infections. The predominant emm types were types 1, 4 and 12, followed by types 3, 6 and 28. During the study period the proportion of isolates of types 1 and 12 fell, while other types (3, 6, 22, 28 and 77) appeared. Isolates from invasive and non-invasive infections shared several emm types; however, most invasive strains belonged to five types only (types 1, 4, 12, 28 and 77), while non-invasive isolates were generally more heterogeneous.

[DNA and proteins in the regenerating liver of rats treated with tetanus toxin]. / DNA e proteine nel fegato di ratto in rigenerazione trattato con tossina tetanica.

The AA. have studied the effects of tetanus toxin on regenerating rat liver, using as parameters regenerating rate, DNA and protein contents. In animals which have been treated with tetanus toxin a decrease of liver regeneration and an increase of DNA and protein contents have been observed. Basing on results, the AA. suppose that tetanus toxin influence cellular cycle, stopping cells in G2 stage.

[Nucleic acids in the liver of rat treated with "E. coli" O 127 lipopolysaccharide (author's transl)]. / Gli acidi nucleici nel fegato di ratto trattato con lipopolisaccaride di "E. coli" O 127.

The Authors have studied the variations of nucleic acids, proteins and histological aspect in the liver of rats, treated with 1 mg of E. coli ) 127 lipopolysaccharide and killed at 24th, 48th, 72th, 96th hour after the inoculation. The endotoxin determines an increase of nucleic acids and a reduction of hepatic proteic contents. The histological observation shows throw-back phenomenons of the hepatocyte with hyperplasy and hypertrophy of Kupffer cells at 24th hour, while at following intervals the phenomenous of hepatic rigeneration emphasize.