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1.
Microorganisms ; 11(5)2023 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-37317288

RESUMEN

BACKGROUND: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a life-threatening healthcare-associated infection affecting especially patients with immunosuppression and comorbidities. We investigated the association between the incidence of CRPA bacteremia, antibiotic consumption, and infection control measures in a hospital during 2013-2018. METHODS: We prospectively recorded the incidence of CRPA bacteremia, antibiotic consumption, use of hand-hygiene solutions, and isolation rates of multidrug-resistant (MDR) carrier patients. FINDINGS: The consumption of colistin, aminoglycosides, and third-generation cephalosporins decreased significantly in the total hospital and its divisions (p-value < 0.001 for all comparisons) while the consumption of carbapenems decreased significantly in the adults ICU (p-value = 0.025). In addition, the incidence of CRPA significantly decreased in the total hospital clinics and departments (p-values = 0.027 and 0.042, respectively) and in adults clinics and departments (p-values = 0.031 and 0.051, respectively), while in the adults ICU, the incidence remained unchanged. Increased isolation rates of MDR carrier patients, even two months before, significantly correlated with decreased incidence of CRPA bacteremia (IRR: 0.20, 95% CI: 0.05-0.73, p-value = 0.015) in the adults ICU. Interestingly, when the use of hand-hygiene solutions (alcohol and/or scrub) increased, the consumption of advanced, nonadvanced, and all antibiotics decreased significantly. CONCLUSION: In our hospital, multimodal infection control interventions resulted in a significant reduction of CRPA bacteremia, mostly due to the reduction of all classes of antibiotics.

2.
Infect Dis Health ; 27(3): 119-128, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35153189

RESUMEN

BACKGROUND: To investigate the association between Clostridioides difficile infection (CDI), antibiotic use, and infection control interventions, during an antibiotic stewardship program (ASP) implemented in a tertiary-care hospital in Greece from 2013 to 2018. METHODS: Analysis was applied for the following monthly indices: 1. consumption of antibiotics; 2. use of hand hygiene disinfectant solutions; 3. percentage of isolations of patients either with multidrug-resistant (MDR) bacteria, or CDI, or admitted from another hospital; and 4. percentage of patients with CDI divided into two groups: community-acquired CDI (CACDI) and hospital-associated CDI (HACDI) (onset ≤72 h and >72 h after admission, respectively). RESULTS: During the study, a significant reduction in CACDI rate from 0.3%/admissions [95% CI 0.1-0.6] to 0.1%/admissions [95% CI 0.0-0.3] (p-value = 0.035) was observed in adults ICU, while CDI rates were stable in the rest of the hospital. Antibiotic consumption showed a significant reduction in total hospital, from 91.7 DDDs [95% CI 89.7-93.7] to 80.1 DDDs [95% CI 79.1-81.1] (p-value<0.001), except adults ICU. Non-advanced antibiotics correlated with decreased CDI rates in Adults Clinic Departments and ICU. Isolation of patients one and two months earlier correlated with decreased CACDI rates per 20% [95% CI 0.64-1.00, p-value = 0.046] and HACDI per 23% [95% CI 0.60-1.00, p-value = 0.050] in Adults Clinic Departments. Consumption of disinfectant solutions current month correlated with decreased rate for CACDI per 33% [95% CI 0.49-0.91, p-value = 0.011] and HACDI per 38% [95% CI 0.40-0.98, p-value = 0.040] in total Hospital Clinics. CONCLUSION: Rational antibiotic prescribing during ASP along with multipronged intervention strategy focusing on hand hygiene and patient isolation measures prevent and control CDI outbreaks in the hospital setting.


Asunto(s)
Clostridioides difficile , Infecciones por Clostridium , Infección Hospitalaria , Desinfectantes , Adulto , Antibacterianos/uso terapéutico , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/microbiología , Infecciones por Clostridium/prevención & control , Infección Hospitalaria/epidemiología , Desinfectantes/uso terapéutico , Grecia/epidemiología , Humanos , Control de Infecciones , Centros de Atención Terciaria
3.
Antibiotics (Basel) ; 11(8)2022 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-36009998

RESUMEN

Ventilator-associated pneumonia (VAP) occurs more than 48h after mechanical ventilation and is associated with a high mortality rate. The current hospital-based study aims to investigate the association between VAP rate, incidence of bacteremia from multidrug-resistant (MDR) pathogens, and infection control interventions in a single case mix ICU from 2013 to 2018. Methods: The following monthly indices were analyzed: (1) VAP rate; (2) use of hand hygiene disinfectants; (3) isolation rate of patients with MDR bacteria; and (4) incidence of bacteremia/1000 patient-days (total cases, total carbapenem-resistant cases, and carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae cases separately). Results: Time trends of infection control interventions showed increased rates in isolation of patients with MDR pathogens (p <0.001) and consumption of hand disinfectant solutions (p =0.001). The last four years of the study an annual decrease of VAP rate by 35.12% (95% CI: −53.52 to −9.41; p =0.01) was recorded, which significantly correlated not only with reduced trauma and cardiothoracic surgery patients (IRR:2.49; 95% CI: 2.09−2.96; p <0.001), but also with increased isolation rate of patients with MDR pathogens (IRR: 0.52; 95% CI: 0.27−0.99; p = 0.048), and hand disinfectants use (IRR: 0.40; 95% CI: 0.18−0.89; p =0.024). Conclusions: Infection control interventions significantly contributed to the decrease of VAP rate. Constant infection control stewardship has a stable time-effect and guides evidence-based decisions.

4.
Vaccine ; 40(34): 5079-5087, 2022 08 12.
Artículo en Inglés | MEDLINE | ID: mdl-35871868

RESUMEN

BACKGROUND: As Greece is a country which has introduced the 13-valent pneumococcal conjugate vaccine (PCV13) both in the infant and in the adult immunization programs, the aim of the study was to investigate age-specific and serotype-specific trends of pneumococcal meningitis over an 11-year period (2010-2020). MATERIALS AND METHODS: Data are reported from pneumococcal meningitis cases [notified to the National Public Health Organization (NPHO)], with clinical samples and bacterial isolates sent for pneumococcal identification and serotyping at the National Meningitis Reference Laboratory (NMRL). Pneumococcal identification was performed directly on clinical samples or bacterial isolates by multiplex PCR (mPCR) assay, while serotyping was carried out by application of the Capsular Sequence Typing (CST) method with the combination of single tube PCR assays. RESULTS: A total of 427 pneumococcal meningitis cases were notified to the NPHO between 2010 and 2020. Among those, 405 (94.8%) were microbiologically confirmed, while samples from 273 patients were sent to the NMRL for identification and/or further typing. The annual notification rate peaked at 0.47/100,000 in 2016 and since then has been decreasing. The incidence was highest in infants and in older adults. Pneumococcal serotypes were identified in 260/273 (95.2%) cases, where clinical samples were sent to the NMRL. The most prevalent serotypes (≥5%) were 3, 19A, 23B, 15B/C, 11A/D, 23A, 22F. During the study period there has been a decrease of PCV13 serotypes combined with an increase of non-PCV13 serotypes (p = 0.0045). CONCLUSIONS: This is the first study to report serotypes for pneumococcal meningitis across all ages in the post-PCV13 era in Greece. There is a need to enhance surveillance, by close monitoring of the emerging serotypes and the impact of vaccination programs. Higher-valency PCVs may help to improve the coverage of pneumococcal disease.


Asunto(s)
Meningitis Neumocócica , Infecciones Neumocócicas , Anciano , Grecia/epidemiología , Humanos , Lactante , Meningitis Neumocócica/epidemiología , Meningitis Neumocócica/prevención & control , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Estudios Retrospectivos , Serogrupo , Serotipificación , Streptococcus pneumoniae , Vacunas Conjugadas
5.
Antimicrob Agents Chemother ; 55(6): 3025-30, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21444701

RESUMEN

In this study, the first such study in Greece, we used polyphasic identification combined with antifungal susceptibility study to analyze Aspergillus clinical isolates comprising 102 common and rare members of sections Fumigati, Flavi, Terrei, Nidulantes, Nigri, Circumdati, Versicolores, and Usti. High amphotericin B MICs (>2 µg/ml) were found for 17.6% of strains. Itraconazole, posaconazole, and voriconazole MICs of >4 µg/ml were shown in 1%, 5%, and 0% of the isolates, respectively. Anidulafungin, micafungin, and caspofungin minimum effective concentrations (MECs) of ≥2 µg/ml were correspondingly recorded for 4%, 9%, and 33%, respectively, of the strains.


Asunto(s)
Antifúngicos/farmacología , Aspergillus/efectos de los fármacos , Farmacorresistencia Fúngica , Grecia , Humanos , Huésped Inmunocomprometido , Pruebas de Sensibilidad Microbiana
6.
Pediatr Allergy Immunol ; 22(2): 243-8, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20573034

RESUMEN

The hypothesis whether exposure to certain infections protects from atopy remains equivocal. To further investigate this, we compared serologic markers of infection and allergic sensitization prevalence in Roma children, who live under unfavorable hygienic conditions that facilitate the spread of infections, and non-Roma children who live in the same area. Analyses included 98 Roma and 118 non-Roma children. Serum IgG antibodies for 13 foodborne- airborne- and bloodborne infectious agents were determined, and a cumulative index of exposure was calculated by adding one point for each positive infection. Specific serum IgE to certain common food- and aero-allergens was also tested. and positivity to any of them was defined as indication of atopy. Roma children were found significantly more seropositive for T. gondii, Hepatitis A, H. pylori, HSV-1, CMV, and Hepatitis B (p < 0.0001). Non-Roma children were found more seropositive for RSV and M. pneumonia (p < 0.0001). Regarding the overall prevalence of atopy or the specific IgE responses to the allergens tested, no statistically significant differences were found between Roma and non-Roma children. A positive association of the cumulative index of exposure to infections with atopy was found in the non-Roma children (OR: 1.38, 95% CI: 1.08-1.75, p = 0.01) and in the total population (OR: 1.42, 95% CI: 1.11-1.83, p = 0.01). Regarding the specific infectious agents tested, a statistically significant positive association of atopy with seropositivity was found for M. pneumoniae in the non-Roma children (OR: 3.93, 95% CI: 1.39) as well as in the total population studied (OR: 2.83, 95% CI: 1.32-6.07, p = 0.01). Despite the higher burden of exposure to the battery of the infectious agents tested among Roma children, no protective effect for allergic disease development was evident. On the contrary, a positive association of exposure to infections with evidence of atopy was found, especially evident in the non-Roma children.


Asunto(s)
Hipersensibilidad/etiología , Hipersensibilidad/inmunología , Infecciones , Mycoplasma pneumoniae/inmunología , Niño , Europa (Continente)/epidemiología , Femenino , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/inmunología , Hepatitis A/complicaciones , Hepatitis A/epidemiología , Hepatitis A/inmunología , Herpesvirus Humano 1/inmunología , Humanos , Hipersensibilidad/etnología , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Inmunoglobulina G/sangre , Infecciones/complicaciones , Infecciones/etnología , Infecciones/inmunología , Masculino , Prevalencia , Toxoplasmosis/complicaciones , Toxoplasmosis/epidemiología , Toxoplasmosis/inmunología
7.
Diagn Microbiol Infect Dis ; 60(4): 393-8, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18077121

RESUMEN

Six hundred twelve invasive and noninvasive Streptococcus pneumoniae isolates were examined. Serogrouping was performed by the latex agglutination test and serotyping by the quellung reaction. Susceptibilities to macrolides were determined by Etest. The presence of mef(A), mef(E), and erm(B) genes were detected by polymerase chain reaction. Outpatient macrolide and lincosamide consumption was expressed in defined daily doses per 1000 inhabitants daily (DID). A significant increase in macrolide resistance rate was noted from 7.4% (14/190) in the period 1985 to 1996 to 53.7% (144/268) in 2001 to 2004 (P = 0.003). An increase in macrolide and lincosamide consumption was also observed from 4.31 +/- 0.72 in 1990 to 1996 to 6.97 +/- 1.02 DID in 2001 to 2004 (P = 0.002). Macrolide resistance was mediated by mef(E) gene in 44.5% of isolates, mef(A) in 25.6%, erm(B) in 19.8%, both erm(B) and mef(E) genes in 4.8%, and none of the examined genes in 5.3%. In the setting of increasing macrolide use, there has been a parallel increase in macrolide resistance among pneumococci in our region. The predominant resistance determinants were the mef(A) and mef(E) genes.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana/genética , Evolución Molecular , Macrólidos/farmacología , Infecciones Neumocócicas/microbiología , Streptococcus pneumoniae/efectos de los fármacos , Proteínas Bacterianas/genética , Niño , Humanos , Lincosamidas , Macrólidos/uso terapéutico , Proteínas de la Membrana/genética , Metiltransferasas/genética , Pruebas de Sensibilidad Microbiana , Serotipificación , Streptococcus pneumoniae/clasificación
8.
BMC Infect Dis ; 7: 101, 2007 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-17760993

RESUMEN

BACKGROUND: Bacterial meningitis remains a source of substantial morbidity and mortality in childhood. During the last decades gradual changes have been observed in the epidemiology of bacterial meningitis, related to the introduction of new polysaccharide and conjugate vaccines. The study presents an overview of the epidemiological patterns of acute bacterial meningitis in a tertiary children 's hospital during a 32-year period, using information from a disease registry. Moreover, it discusses the contribution of communicable disease registries in the study of acute infectious diseases. METHODS: In the early 1970s a Meningitis Registry (MR) was created for patients admitted with meningitis in Aghia Sofia Children's Hospital in Athens. The MR includes demographic, clinical and laboratory data as well as treatment, complications and outcome of the patients. In 2000 a database was created and the collected data were entered, analyzed and presented in three chronological periods: A (1974-1984), B (1985-1994) and C (1995-2005). RESULTS: Of the 2,477 cases of bacterial meningitis registered in total, 1,146 cases (46.3%) were classified as "probable" and 1,331 (53.7%) as "confirmed" bacterial meningitis. The estimated mean annual Incidence Rate (IR) was 16.9/100,000 for bacterial meningitis, 8.9/100,000 for Neisseria meningitidis, 1.3/100,000 for Streptococcus pneumoniae, 2.5/100,000 for Haemophilus influenzae type b (Hib) before vaccination and 0.4/100,000 for Hib after vaccination. Neisseria meningitis constituted the leading cause of childhood bacterial meningitis for all periods and in all age groups. Hib was the second most common cause of bacterial meningitis before the introduction of Hib conjugate vaccine, in periods A and B. The incidence of bacterial meningitis due to Streptococcus pneumoniae was stable. The long-term epidemiological pattern of Neisseria meningitidis appears in cycles of approximately 10 years, confirmed by a significant rise of IR in period C. The Case Fatality Rate (CFR) from all causes was 3.8%, while higher CFR were estimated for Streptococcus pneumoniae (7.5%, RR=2.1, 95% CI 1.2-3.7) and Neisseria meningitidis (4.8%, RR=1.7, 95% CI 1.1-2.5) compared to other pathogens. Moreover, overall CFR varied significantly among the three time periods (p = 0.0015), and was estimated to be higher in period C. CONCLUSION: By using the MR we were able to delineate long-term changes in the epidemiology of bacterial meningitis. Thus the MR proved to be a useful tool in the study and the prevention of communicable diseases in correlation with prevention strategies, such as vaccinations.


Asunto(s)
Hospitalización/estadística & datos numéricos , Meningitis Bacterianas/epidemiología , Sistema de Registros , Enfermedad Aguda , Adolescente , Niño , Preescolar , Femenino , Grecia/epidemiología , Vacunas contra Haemophilus , Haemophilus influenzae tipo b/aislamiento & purificación , Humanos , Incidencia , Lactante , Masculino , Meningitis Bacterianas/prevención & control , Meningitis por Haemophilus/epidemiología , Meningitis por Haemophilus/prevención & control , Meningitis Meningocócica/epidemiología , Meningitis Meningocócica/prevención & control , Meningitis Neumocócica/epidemiología , Meningitis Neumocócica/prevención & control , Neisseria meningitidis/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación , Factores de Tiempo
9.
PLoS One ; 12(8): e0182799, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28813492

RESUMEN

BACKGROUND: The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013. METHODS: There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea. RESULTS: 5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy [odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019] and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009). CONCLUSIONS: The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6.


Asunto(s)
Clostridioides difficile , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/microbiología , Infección Hospitalaria , Hospitales , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Biomarcadores , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Comorbilidad , Diarrea/epidemiología , Diarrea/microbiología , Femenino , Grecia/epidemiología , Instituciones de Salud , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Vigilancia de la Población , Prevalencia , Modelos de Riesgos Proporcionales , Factores de Riesgo , Sensibilidad y Especificidad
10.
FEMS Immunol Med Microbiol ; 39(1): 31-6, 2003 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-14556993

RESUMEN

Antibiotic treatment prior to transport or admission to hospital has reduced the proportion of cases of invasive meningococcal disease (IMD) from which Neisseria meningitidis can be isolated by standard microbiological techniques. Identification of meningococci by polymerase chain reaction (PCR) was assessed in relation to microbiological diagnosis for cases over a 4-year period between 1998 and 2001. A screening assay for the IS1106 gene was used to detect meningococcal DNA and five additional assays for siaD and orf-2 genes were performed to determine the serogroup. PCR results were compared with results of bacteriological culture, other laboratory test results and clinical data. The sensitivity of the PCR assay for culture-confirmed cases was 98.5%. The specificity of the assay was 96% based on test results for patients from whom other bacteria were isolated, children with viral meningitis and afebrile negative controls. The siaD B/C/W-135 and Y as well as the orf-2 gene for serogroup A PCR assays were able to determine the serogroup for 75.2% of cases that were positive by PCR screening assay. When isolates from patients with IMD were tested by both agglutination and PCR, the results agreed in all cases. PCR is a useful tool for diagnosis of IMD when Gram stain and culture tests are negative due to antibiotic treatment prior to collection of samples for microbiological analyses.


Asunto(s)
Infecciones Meningocócicas/diagnóstico , Infecciones Meningocócicas/microbiología , Neisseria meningitidis/genética , Neisseria meningitidis/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Técnicas Bacteriológicas/estadística & datos numéricos , Secuencia de Bases , Estudios de Casos y Controles , Niño , ADN Bacteriano/genética , Genes Bacterianos , Humanos , Neisseria meningitidis/clasificación , Reacción en Cadena de la Polimerasa/estadística & datos numéricos , Sensibilidad y Especificidad
11.
FEMS Immunol Med Microbiol ; 36(1-2): 87-94, 2003 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-12727371

RESUMEN

In response to an increase in the incidence in invasive meningococcal disease (IMD) due to Neisseria meningitidis, a system of hospital- and laboratory-based surveillance was used in a prospective epidemiological and clinical assessment of IMD in children 0-13 years of age hospitalized in the Athens area between 1 January 1999 and 31 December 2000. The annual incidence of laboratory-confirmed disease was 10.2/100,000. Serogroup B strains were predominant. There was a sharp decrease in serogroup C from 19% of cases in 1999 to 3% in 2000 (P=0.013). Of note was the emergence of serogroup A responsible for 7% of the cases. The overall case fatality rate was 4.5%, but 2.8% for microbiologically confirmed cases. A remarkable decrease in disease severity assessed by admissions to intensive care units was noted during the second study year. Polymerase chain reaction-based methods for detection of meningococcal DNA were the sole positive laboratory test in 45% of the cases and the only test on which serogroup determination was based in 52% of groupable cases. The epidemiological and clinical profile of meningococcal disease appears to be rapidly evolving and close monitoring is required particularly for input into decisions regarding use of meningococcal vaccines.


Asunto(s)
Meningitis Meningocócica/epidemiología , Neisseria meningitidis/aislamiento & purificación , Adolescente , Factores de Edad , Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/líquido cefalorraquídeo , Niño , Preescolar , ADN Bacteriano/química , ADN Bacteriano/genética , Femenino , Grecia/epidemiología , Humanos , Lactante , Masculino , Meningitis Meningocócica/sangre , Meningitis Meningocócica/líquido cefalorraquídeo , Meningitis Meningocócica/microbiología , Neisseria meningitidis/genética , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Estaciones del Año , Serotipificación
13.
J Clin Virol ; 46(3): 270-4, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19699142

RESUMEN

BACKGROUND: Aseptic meningitis is the most commonly observed CNS infection and is mainly attributed to Non-Polio Enteroviruses (EV). OBJECTIVE: Identification and genetic analysis of the EV involved in the recent aseptic meningitis outbreak which occurred in Greece, during the summer of 2007. STUDY DESIGN: In total, 213 CSF and faecal samples were examined for EV presence by culture, while enteroviral RNA detection was performed by nucleic acid sequence-based amplification assay (NASBA). EV strains were typed by seroneutralization, as well as nested RT-PCR followed by VP1-2A gene partial sequencing. Phylogenetic analysis was carried out for the identification of the genetic relatedness among the isolated EV strains. RESULTS: EV detection rate in CSF and faecal samples was 43.9% and 70.8%, respectively. EV serotyping and VP1 region analysis revealed the predominance of echovirus 4 (ECV4) serotype and the circulation of ECV6, 9, 14, 25, Coxsackie A6, A15, A24 and Coxsackie B1 serotypes. All ECV4 isolates presented a 98.7% similarity in nucleotide sequence, with a Spanish ECV4 strain, isolated during a meningitis outbreak in 2006. CONCLUSIONS: It is the first time that ECV4 is associated with an aseptic meningitis outbreak in Greece, during which 9 different EV serotypes were co-circulating. All Greek ECV4 isolates were closely related to the Spanish ECV4 strain. Genetic analysis of the VP1 gene can significantly contribute to the revelation of the endemic EV strains circulation pattern and their phylogenetic relationship with enteroviruses involved in epidemics of distant geographical areas at different time periods.


Asunto(s)
Brotes de Enfermedades , Infecciones por Enterovirus/virología , Enterovirus/genética , Meningitis Aséptica/virología , Niño , Preescolar , Enterovirus/clasificación , Infecciones por Enterovirus/líquido cefalorraquídeo , Infecciones por Enterovirus/epidemiología , Infecciones por Enterovirus/inmunología , Heces/virología , Femenino , Grecia/epidemiología , Humanos , Masculino , Meningitis Aséptica/líquido cefalorraquídeo , Meningitis Aséptica/epidemiología , Meningitis Aséptica/inmunología , Filogenia , ARN Viral/análisis , ARN Viral/líquido cefalorraquídeo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Replicación de Secuencia Autosostenida/métodos , Serotipificación
14.
Diagn Microbiol Infect Dis ; 64(3): 295-9, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19395219

RESUMEN

To investigate the antimicrobial resistance trends and the distribution of emm types of group A streptococci (GAS), we examined 1160 clinical isolates of GAS collected between 2003 and 2006. Susceptibilities to commonly used antimicrobial agents were determined by Etest, and macrolide resistance genes were detected by polymerase chain reaction (PCR). GAS isolates were typed by polymerase chain reaction PCR and sequencing of emm gene. The rates of resistance to erythromycin (ERY), clindamycin, azithromycin, tetracycline, and chloramphenicol were 14.9%, 1.4%, 14.9%, 18.9%, 0.6%, respectively. None of the isolates exhibited resistance to penicillin, ceftriaxone, linezolid, moxifloxacin, rifampicin, or vancomycin. Macrolide resistance increased from 12.1% in 2003 to 18.8% in 2006 (P = 0.02). Of 173 ERY-resistant GAS isolates, 93 (53.7%) harbored the mefA gene, 70 (40.4%) the ermA, and 10 (5.8%) the ermB. Eighty percent of the observed emm types are covered by the proposed 26-valent GAS vaccine. Among 173 ERY-resistant isolates, the predominant emm types were 12 (19.5%), 77 (17.9%), and 4 (16.8%), and among 770 ERY-susceptible isolates, the predominant types were 1 (18.8%), 12 (17.5%), 28 (13.8%). The observed antimicrobial resistance trends and the distribution of specific emm types have implications in guiding empiric therapy and in developing vaccine strategies to prevent GAS infections.


Asunto(s)
Antibacterianos/farmacología , Antígenos Bacterianos/genética , Proteínas de la Membrana Bacteriana Externa/genética , Proteínas Portadoras/genética , Farmacorresistencia Bacteriana , Macrólidos/farmacología , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/efectos de los fármacos , Niño , Preescolar , ADN Bacteriano/genética , Genes Bacterianos , Genotipo , Humanos , Lactante , Pruebas de Sensibilidad Microbiana , Serotipificación , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/aislamiento & purificación
15.
Support Care Cancer ; 14(3): 277-84, 2006 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-16270193

RESUMEN

GOALS: To assess the type, frequency, severity, and outcome of all infectious episodes in a pediatric patient cohort with acute lymphoblastic leukemia (ALL) from a single institution during the entire length of leukemia treatment. PATIENTS AND METHODS: Eighty-six patients were treated according to a modified ALL Berlin-Frankfurt-Munster protocol. Retrospective analysis of all types of infections according to the treatment phase and the degree of neutropenia is presented. RESULTS: A total of 610 infectious episodes were recorded. Most infections were documented during maintenance (57%), followed by the induction phase (20.3%). During maintenance, 347 episodes were encountered, with nonspecific viral upper respiratory tract infections (URIs) being the commonest diagnosis (40.0%). Additionally, 38 of 58 total specific viral infections occurred during maintenance: 16 herpes simplex, 7 varicella, 10 herpes zoster infections [varicella-zoster virus (VZV), 45%]. The majority of bacteremia and fever of unknown origin occurred during induction (20%). The number of Gram-negative bacteremia was 50% of the total (26 of 52). The majority of the infections (59.5%) occurred without neutropenia [absolute neutrophil count (ANC) >1,000 microl(-1)]. Fewer infections (9.3%) were recorded with concurrent very severe neutropenia (ANC <100 microl(-1)), although 38.5% of positive blood cultures were documented with severe neutropenia. No infection-related fatality occurred. CONCLUSIONS: Most of the severe infections occurred during induction. Gram-positive bacteremia and Gram-negative bacteremia were almost equal. URIs were the commonest infections during the entire treatment and during maintenance. Specific viral infections represented a smaller percentage of the total (VZV was the commonest pathogen). Infectious complications represented a significant morbidity factor, but notably, mortality was negligible.


Asunto(s)
Infecciones/epidemiología , Leucemia Linfoide/tratamiento farmacológico , Enfermedad Aguda , Adolescente , Antineoplásicos/uso terapéutico , Niño , Preescolar , Estudios de Cohortes , Femenino , Alemania/epidemiología , Humanos , Lactante , Infecciones/clasificación , Infecciones/virología , Masculino , Pediatría
16.
Vaccine ; 24(6): 819-25, 2006 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-16153759

RESUMEN

Serogroup B is the major isolate from patients with invasive meningococcal disease (IMD) in Greece. This study used the whole cell enzyme-linked immuosorbent assay (ELISA) with monoclonal antibodies to screen Neisseria meningitidis isolates obtained from patients with IMD between 1993 and 2003 to determine if serosubtypes included in the hexavalent Por A OMP vaccines being tested in northern Europe were prevalent in Greece. During this period there were significant changes in the proportions of serogroups B and C isolated from patients. Serogroup C was predominant in 1996-1997 but fell sharply with corresponding increases in serogroup B. Of the 591 isolates sent to the National Meningitis Reference Laboratory in Athens during this period, 325 (55%) were serogroup B. Among those tested for serosubtype, porA proteins used for the vaccine being tested in Britain were detected on 85/284 (30%) strains and for the vaccine being tested in the Netherlands 175/284 (62%). P1.14 (58/284, 20%) the predominant serosubtype among the Greek isolates, is not present in either vaccine formulation; 23/284 (8%) strains did not react with any of the monoclonal antibodies. Our results indicate that introduction of the vaccines currently being evaluated in northern Europe would not be warranted in the Greek population.


Asunto(s)
Vacunas Bacterianas/inmunología , Meningitis Bacterianas/microbiología , Neisseria meningitidis/aislamiento & purificación , Porinas/inmunología , Antígenos Bacterianos/inmunología , Grecia , Humanos , Meningitis Bacterianas/inmunología , Meningitis Bacterianas/prevención & control , Porinas/clasificación
17.
Scand J Infect Dis ; 36(8): 547-51, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15370664

RESUMEN

A retrospective study was conducted between July 1990 and July 2002 to investigate the epidemiology, clinical characteristics, and the outcome of Salmonella bacteraemia in children. A total of 148 episodes of bacteraemia were identified in 144 children. The annual incidence ranged from 1.6 to 8.3 cases per 100,000 children < or = 14 y of age, and higher numbers of cases occurred in summer than in winter months. In 22 children the bacteraemia was caused by S. typhi and in 122 by S. non-typhi. S. enteritidis was the most common serotype isolated. Resistance to ampicillin was exhibited by 28.5% of Salmonella isolates, whereas all S. typhi isolates were susceptible to commonly used antibiotics. The mean age was 40.3 months (range 50 d to 14 y). Children with S. typhi bacteraemia were significantly older than children with S. non-typhi bacteraemia (7.8 vs 2.4 y, p < 0.01). 11 children were immunosuppressed. The immunosuppressed children had longer duration of fever, longer hospitalization stay, and higher relapse rates compared to normal children (p < 0.05). Four children developed complications and 1 died. Although the incidence of S. typhi bacteraemia is decreasing, the non-typhi species continue to cause significant morbidity in our geographical region.


Asunto(s)
Bacteriemia/epidemiología , Infecciones por Salmonella/epidemiología , Salmonella/clasificación , Adolescente , Distribución por Edad , Antibacterianos , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Niño , Preescolar , Quimioterapia Combinada/uso terapéutico , Femenino , Estudios de Seguimiento , Grecia/epidemiología , Hospitales Pediátricos , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Probabilidad , Estudios Retrospectivos , Medición de Riesgo , Salmonella/aislamiento & purificación , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Distribución por Sexo , Tasa de Supervivencia
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