RESUMO
BACKGROUND: In spring 2019, an outbreak of Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC HUS) occurred in France. Epidemiological investigations made by Santé publique France in connection with microbiological investigations at the national reference center for STEC promptly identified a common exposure to consumption of raw cow's milk cheese, and confirmed a cluster affiliation of the E. coli O26:H11 outbreak strain. Here, we report the clinical characteristics of the patients, the treatment used, as well as the outcome at 1 month. METHOD: Patients with STEC HUS linked to the E. coli O26:H11 outbreak strain were identified from the national surveillance network of pediatric STEC HUS cases coordinated by Santé publique France. Clinical data were analyzed from the patients' hospital records obtained from the treating physicians. RESULTS: Overall, 20 pediatric cases of STEC HUS linked to the outbreak strain were identified. Their median age of the patients was 16 months (range: 5-60). Most of them presented with diarrhea but none had received prior antibiotherapy. A total of 13 patients required dialysis; 10 patients and four patients had central nervous system (CNS) and cardiac involvement, respectively. No deaths occurred. At the 1-month follow-up, only two patients had a decreased glomerular filtration rate, below 80 mL /min/1.73m2 and four had hypertension. One patient had neurological sequelae. CONCLUSION: The E. coli O26:H11 strain identified as the cause of an STEC HUS outbreak in France in spring 2019 is notable for the initial severe clinical presentation of the patients, with a particularly high frequency of CNS and cardiac involvement similar to the German E. coli O104:H4 outbreak described in 2011. However, despite the initial severity, the 1-month outcome was favorable in most cases. The patients' young age in this outbreak highlights the need to improve information and caregiver awareness regarding consumption of at-risk foods by young children as key preventive measures against STEC infections.
Assuntos
Infecções por Escherichia coli , Síndrome Hemolítico-Urêmica , Escherichia coli Shiga Toxigênica , Animais , Bovinos , Diarreia/complicações , Surtos de Doenças , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Feminino , Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/diagnóstico , Síndrome Hemolítico-Urêmica/epidemiologia , HumanosRESUMO
Multiple locus variable number of tandem repeats (VNTR) analysis (MLVA) has been shown to provide a high level of information for epidemiological investigations and the follow-up of Pseudomonas aeruginosa chronic infection. In the present study, an automatized MLVA assay has been developed for the analysis of 16 VNTRs in two multiplex polymerase chain reactions (PCRs), followed by capillary electrophoresis. The result in the form of a code is directly usable for clustering analyses. This MLVA-16(Orsay) scheme was applied to the genotyping of 83 isolates from eight cystic fibrosis patients, demonstrating that the same genotype persisted during eight years of chronic infection in the majority of cases. Comparison with pulsed-field gel electrophoresis (PFGE) analysis showed that both methods were congruent, MLVA providing, in some cases, additional informativity. The evolution of strains during long-term infection was revealed by the presence of VNTR variants.
Assuntos
Fibrose Cística/complicações , Eletroforese Capilar/métodos , Tipagem Molecular/métodos , Reação em Cadeia da Polimerase/métodos , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/classificação , Análise por Conglomerados , DNA Bacteriano/genética , Genótipo , Humanos , Repetições Minissatélites , Epidemiologia Molecular/métodos , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
Extended-spectrum beta-lactamase (ESBLs) are defined as ß-lactamase capable of hydrolyzine oximino-cephalosporins and aztreonam and are encoded by mobile genes. The most frequently encountered ESBLs belong to the CTX-M, SHV, and TEM families. ESBLs were found first in Klebsiella pneumonia and then predominantly in E. coli. The incidence of patients with ESBLs E. coli increase since 2000 in Robert Debré Hospital. They were responsible of cystitis or pyelopnephritis and rarely of materno-foetal infections or neonatal meningitis. These strains were susceptible to colimycin, carbapenems and fosfomycin.
Assuntos
Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/genética , beta-Lactamases/genética , Proteínas de Bactérias/genética , Criança , Enterobacteriaceae/enzimologia , Infecções por Enterobacteriaceae/transmissão , Escherichia coli/enzimologia , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Saúde Global , Humanos , Recém-Nascido , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/mortalidadeRESUMO
Ureaplasma urealyticum and Mycoplasma hominis colonized 20-40% of newborns and are more frequent in premature. They are responsible for localized infections such as pleural effusion, pneumopathy, adenopathy, abscess or systemic sepsis. An important hyperleukocytosis is often associated with pulmonary infections. Their responsibility, as pathogen agents, is questionable in some non bacterial meningitis. There is large controversy for their role as cofactor, in chronic lung disease (bronchopulmonary dysplasia) and periventricular leukomalacia, because of a too low number of newborns in prospective trials. Genital mycoplamas are resistant to beta lactamines. Macrolides have a good sensitivity, particularly josamycine, but Mycoplasma hominis is resistant to erythromycin. For systemic sepsis, fluoroquinolones such as ciprofloxacine have less deleterious effects than IV erythromycin.
Assuntos
Doenças do Recém-Nascido , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/patologia , Mycoplasma hominis/patogenicidade , Infecções por Ureaplasma/tratamento farmacológico , Infecções por Ureaplasma/patologia , Ureaplasma urealyticum/patogenicidade , Humanos , Recém-Nascido , Macrolídeos/uso terapêutico , Fatores de Risco , Sepse/etiologiaRESUMO
OBJECTIVE: Current guidelines recommend that only tonsillopharyngitis due to group A beta-haemolytic streptococcus (GABHS) diagnosed by rapid diagnostic test should be treated with antibiotics. Empirical antibiotic therapy must be based on epidemiological surveillance of resistance of GABHS to antibiotics. The aim of our study was to assess the activity of antimicrobial agents currently recommended for the treatment of GABHS tonsillopharyngitis. Method The activity of penicillin G, amoxicillin, cefaclor, cefpodoxime, cefuroxime, erythromycin, clarithromycin and clindamycin was determined against 93 consecutive GABHS isolates collected in 2002. MIC50 and MIC90 of antibiotics tested were determined by agar dilution method according to CA-SFM guidelines. Macrolide resistance genes (ermA, ermB, mef) were detected by PCR. Genetic diversity of erythromycin-resistant isolates was analysed by pulsotypic method after digestion by SmaI (Finger-printing II, Biorad). RESULTS: The activity of beta-lactam agents tested was similar and no resistant strain was detected (0%). Nevertheless, this study shows an increasing emergence of erythromycin-resistant GABHS strains reaching 14% in 2002 (vs. 6.2% in a previous study carried out in 1996-1999). CONCLUSION: The empirical antibiotic therapy of tonsillopharyngitis must consider, on the one hand, the high risk of GABHS eradication failure associated with in vitro resistance to erythromycin and clarithromycin, and on the other hand, the sustained susceptibility of GABHS to beta-lactam agents. These results reinforce the recommendations to use beta-lactam agents as first line treatment of GABHS tonsillopharyngitis.
Assuntos
Faringite/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes , Tonsilite/microbiologia , Doença Aguda , Tonsila Faríngea , Proteínas de Bactérias/genética , Contagem de Colônia Microbiana , Impressões Digitais de DNA , DNA Bacteriano/análise , DNA Bacteriano/genética , Farmacorresistência Bacteriana , Eletroforese em Gel de Campo Pulsado , Pesquisa Empírica , Variação Genética , Humanos , Proteínas de Membrana/genética , Metiltransferases/genética , Testes de Sensibilidade Microbiana , Paris/epidemiologia , Seleção de Pacientes , Faringite/tratamento farmacológico , Faringite/epidemiologia , Reação em Cadeia da Polimerase , Vigilância da População , Guias de Prática Clínica como Assunto , Prevalência , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/genética , Streptococcus pyogenes/fisiologia , Tonsilite/tratamento farmacológico , Tonsilite/epidemiologiaRESUMO
Since the CF gene identification in 1989 and despite the improvement of our knowledge in the physiopathology of the disease, bronchopulmonary infection determines the vital prognosis. Following Staphylococcus aureus infection, patients are colonized or colonized by Pseudomonas aeruginosa, greatly involved in the pulmonary deterioration. Other bacteria may be involved Burkholderia cepacia, Stenotrophomonas maltophilia, Alcaligenes sp. Intensive antibiotic treatment of primocolonisation helps to prevent or delay chronic colonisation. Chronic colonization needs a rational long term antibiotic strategy to prevent the occurrence of multiresistant germs; antibiotic cures are performed every 3 or 4 months before pulmonary exacerbation symptoms.
Assuntos
Infecções por Burkholderia/complicações , Fibrose Cística/microbiologia , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Pseudomonas/complicações , Infecções Estafilocócicas/complicações , Stenotrophomonas/patogenicidade , Antibacterianos/uso terapêutico , Infecções por Burkholderia/tratamento farmacológico , Fibrose Cística/patologia , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Prognóstico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/patogenicidade , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
Chronic infection by Pseudomonas aeruginosa (PA) in patients with cystic fibrosis (CF) is preceded by a period of colonization and acute infection. Early aggressive antibiotic treatment of initial colonisation may prevent or at least delay chronic pulmonary infection. We initiated treatment with a combination of IV beta-lactam tobramycin, followed by nebulized colistin when PA was first isolated from patients with CF. Subsequent serial PA isolates obtained from these colonized CF patients were characterized by means of molecular methods to determine whether they were genetically related to the initial strain. Initial colonization was eradicated in all 19 patients. All patients reacquired PA within 3-25 months during the 3 years of follow-up. Fourteen patients acquired a new PA strain with a distinct genotypic profile, suggesting a new source of contamination. Five patients had two PA isolates with identical genotypes, suggesting either previous undetected respiratory tract colonization or a persistent environmental source of contamination.
Assuntos
Fibrose Cística/tratamento farmacológico , DNA Bacteriano/análise , Quimioterapia Combinada/administração & dosagem , Pneumonia Bacteriana/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/genética , Administração por Inalação , Administração Oral , Ceftazidima/administração & dosagem , Criança , Pré-Escolar , Doença Crônica , Colistina/administração & dosagem , Contagem de Colônia Microbiana , Fibrose Cística/microbiologia , Eletroforese em Gel de Campo Pulsado , Feminino , Genótipo , Humanos , Imipenem/administração & dosagem , Lactente , Masculino , Pneumonia Bacteriana/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/efeitos dos fármacos , Medição de Risco , Tobramicina/administração & dosagemRESUMO
Shiga toxin-producing Escherichia coli O111:H2 strains from an outbreak of hemolytic-uremic syndrome showed aggregative adhesion to HEp-2 cells and harbored large plasmids which hybridized with the enteroaggregative E. coli probe PCVD432. These strains present a novel combination of virulence factors and might be as pathogenic to humans as the classic enterohemorrhagic E. coli.
Assuntos
Aderência Bacteriana , Toxinas Bacterianas/biossíntese , Surtos de Doenças , Infecções por Escherichia coli/microbiologia , Escherichia coli/patogenicidade , Síndrome Hemolítico-Urêmica/microbiologia , Colífagos/genética , Colífagos/fisiologia , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Humanos , Plasmídeos , Toxinas Shiga , Células Tumorais Cultivadas , VirulênciaRESUMO
The management of urinary tract infection in children must take into account several factors, namely the type of bacteria, the localization of the infection, the presence of an uropathy and the age of the patient. In acute pyelonephritis, the risk of renal scarring justifies a first line treatment with two antibiotics to be administrated intravenously in newborns and infants. Treatment must be maintained for at least 10 days: double antibiotherapy for 4-5 days, followed by oral monotherapy according to the antibiogram. Cystitis requires an oral monotherapy for 3-7 days. In any case it is important to search for a cause to the infection.
Assuntos
Infecções Urinárias/tratamento farmacológico , Fatores Etários , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Humanos , Infecções Urinárias/classificação , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controleRESUMO
To determine the risk of bacteremia during tonsillectomy, we cultured blood specimens that were taken from 32 children during surgery and tonsillar swabs that were obtained just before excision, and compared the results with quantitative cultures of the excised tonsillar tissue. Twenty-five children had Haemophilus influenzae within the tonsillar tissue (density range, 10(3) to 10(8) colony-forming units per gram), and seven had Streptococcus pyogenes (density, 10(3) colony-forming units per gram in one case, 10(5) colony-forming units per gram in one case, and 10(6) colony-forming units per gram in five cases). Twelve perioperative blood cultures were positive; H influenzae was found nine times, and Micrococcus species was found one time, and alpha-hemolytic streptococci were found two times. Haemophilus influenzae was always present in the corresponding tonsillar specimens, although there was no apparent relationship between the density of colonization of the tonsillar tissue and a positive blood culture.
Assuntos
Bacteriemia/etiologia , Tonsilectomia/efeitos adversos , Bacteriemia/epidemiologia , Pré-Escolar , Feminino , Humanos , Hipertrofia/cirurgia , Masculino , Tonsila Palatina/microbiologia , Tonsila Palatina/patologia , Estudos Prospectivos , Fatores de Risco , Tonsilite/microbiologia , Tonsilite/cirurgiaRESUMO
Ribotyping with a nonradioactive probing system was used for the epidemiological evaluation of 15 Serratia marcescens nosocomial strains isolated from the stools of 12 children with no apparent illness in five different hospital wards over a 20-day period. Our results indicate that the occurrence of S. marcescens colonization was the result of the spread of a single epidemiological strain in the hematology ward, the oncology ward, and the gastroenterology ward and in two neonates in the neonatology ward, suggesting cross-contamination between the patients in these four wards. This isolate was genotypically unrelated to the bacterial strain found in the three other patients in the neonatology ward. Interestingly, one patient in the neonatology ward harbored these two genotypically different strains. Finally, the patient in the intensive care unit was colonized with a different strain. We find ribotyping to be a more reliable technique than biochemical typing. The results of ribotyping are more easily interpreted than are those of total DNA analysis, with an equivalent degree of discrimination.
Assuntos
Técnicas de Tipagem Bacteriana , Serratia marcescens/classificação , Serratia marcescens/genética , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , DNA Bacteriano/genética , DNA Ribossômico/genética , Estudos de Avaliação como Assunto , França/epidemiologia , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Polimorfismo de Fragmento de Restrição , Infecções por Serratia/epidemiologia , Serratia marcescens/isolamento & purificaçãoRESUMO
A dynamic in vitro model was used to determine the killing kinetics of daptomycin against 15 vancomycin-resistant clinical isolates of Enterococcus faecium. Concentration profiles simulating those observed in serum following administration of both low-dose (2 mg/kg) and high-dose (6 mg/kg) daptomycin were bactericidal within 5.5 and 2.8 h, respectively. In contrast, when albumin was added to the growth medium, the corresponding bacterial killing times were slowed to greater than 24 h and 7 h; these results suggest that in the clinical setting, daptomycin dosages of approximately 6 mg/kg are required to achieve bactericidal activity against vancomycin-resistant Enterococcus faecium.
Assuntos
Antibacterianos/farmacologia , Enterococcus faecium/efeitos dos fármacos , Vancomicina/farmacologia , Albuminas/farmacologia , Antibacterianos/sangue , Daptomicina , Relação Dose-Resposta a Droga , Resistência Microbiana a Medicamentos , Testes de Sensibilidade Microbiana , Modelos Biológicos , Peptídeos/sangue , Peptídeos/farmacologia , Teste Bactericida do Soro , Vancomicina/sangueRESUMO
Daptomycin, vancomycin, ampicillin and aminoglycosides, alone or in combination, were tested for their bactericidal activity against 15 isolates of vancomycin-resistant Enterococcus faecium from immunocompromised children. The kill-kinetic studies at clinically achievable concentrations demonstrated that daptomycin alone or in combination with ampicillin had the greatest bactericidal activity.