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1.
Epidemiol Infect ; 148: e132, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32611465

RESUMO

Hubei province in China has had the most confirmed coronavirus disease 2019 (COVID-19) cases and has reported sustained transmission of the disease. Although Lu'an city is adjacent to Hubei province, its community transmission was blocked at the early stage, and the impact of the epidemic was limited. Therefore, we summarised the overall characteristics of the entire epidemic course in Lu'an to help cities with a few imported cases better contain the epidemic. A total of 69 confirmed COVID-19 cases and 11 asymptomatic carriers were identified in Lu'an during the epidemic from 12 January to 21 February 2020. Fifty-two (65.0%) cases were male, and the median age was 40 years. On admission, 56.5% of cases had a fever as the initial symptom, and pneumonia was present in 89.9% of cases. The mean serial interval and the mean duration of hospitalisation were 6.5 days (95% CI: 4.8-8.2) and 18.2 days (95% CI: 16.8-19.5), respectively. A total of 16 clusters involving 60 cases (17 first-generation cases and 43 secondary cases) were reported during the epidemic. We observed that only 18.9% (7/37) index cases resulted in community transmission during the epidemic in Lu'an, indicating that the scale of the epidemic was limited to a low level in Lu'an city. An asymptomatic carrier caused the largest cluster, involving 13 cases. Spread of COVID-19 by asymptomatic carriers represents an enormous challenge for countries responding to the pandemic.


Assuntos
Portador Sadio/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Portador Sadio/epidemiologia , Portador Sadio/transmissão , Criança , Pré-Escolar , China/epidemiologia , Cidades/epidemiologia , Análise por Conglomerados , Infecções por Coronavirus/transmissão , Feminino , Febre , Humanos , Lactente , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/transmissão , Vigilância da População/métodos , Fatores de Tempo , Adulto Jovem
2.
Radiat Oncol ; 15(1): 165, 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32646505

RESUMO

BACKGROUND: Starting in December 2019, the current pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confronts the world with an unprecedented challenge. With no vaccine or drug being currently available to control the pandemic spread, prevention and PCR (Polymerase chain reaction) testing becomes a crucial pillar of medical systems. Aim of the present study was to report on the first results of the measures taken in a large German Department of Radiation Oncology, including PCR testing of asymptomatic cancer patients. METHODS: Pandemic-adapted hygiene regulations and prevention measures for patients and staff were implemented. A visiting ban on both wards was implemented from the beginning and medical staff and patients were required to wear face masks at all times. The waiting rooms were rearranged to ensure distance between patients of at least 1.5 m. Clinical follow up was mainly done by telephone and all patients had to complete a questionnaire regarding symptoms and contacts with COVID-19 patients before entering our department. Educational documents were created for patients to raise awareness of symptoms and avoidance strategies for interactions with other people. Indications for therapy and fractionation schemes were adapted when possible. In a subsequent step, all new asymptomatic patients were tested via nasopharyngeal swab at our screening station shortly before their simulation CT. RESULTS: All these measures and implementations have been well accepted semiquantitatively measured by the consent received from patients and staff. Regarding the PCR testing, only 1 out of 139 asymptomatic patients of our cohort so far tested positive for SARS-CoV-2, reflecting a prevalence of 0.72% in this cancer patient population. Up to this point no staff members was tested positive. The start of the treatment for the PCR-positive patient was deferred for 2 weeks. CONCLUSION: Due to the pandemic-adapted implementations, our department seems well prepared during this crisis. The initial screening helps to identify asymptomatic COVID-19 patients in order to protect other patients and our staff from infection and the observed PCR prevalence is in line with comparable studies. A regular PCR testing (e.g. twice a week) of all patients and staff would in principle be desirable but is limited due to testing capacities at present.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias/virologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Portador Sadio , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Reação em Cadeia da Polimerase , Prevalência
3.
Medicine (Baltimore) ; 99(26): e20517, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590733

RESUMO

Literature regarding the value of pre-operative nasal methicillin resistant Staphylococcus aureus (MRSA) swabs to predict surgical site infections (SSIs) in children undergoing lower extremity surgery is limited. The purpose of our study was to determine if pre-operative nasal MRSA swab results were predictive of SSI development in children undergoing a femoral varus derotational osteotomy (VDRO).Patients who underwent VDRO between 2004-2016 were reviewed to determine pre-operative MRSA colonization rates and SSI devolvement rates. Patients with less than 1 year of follow-up, previous history of infections, or absent pre-operative MRSA swab were excluded. SSI rates of patients with negative MRSA and positive MRSA swab result were compared using the Fisher exact test. Aside from contact isolation precautions, no other changes in treatment were made during inpatient hospital course based on positive pre-operative nasal MRSA swab results.247 patients met the inclusion criteria (mean age: 9.3 ±â€Š3.6 years, 62% male). There were 242 (98%) patients with a negative MRSA swab and 5 (2%) patients with a positive MRSA swab. Out of the 242 patients with a negative MRSA swab, 4 developed an SSI. Of the patients with positive MRSA swab results, 0% (0/5) developed an SSI compared to 1.7% (4/242) of negative MRSA swab results who developed an SSI. Results indicated no significant difference in SSI development rates between the groups (P = 1.00).In this series of children undergoing VDRO surgery, the results of a pre-operative MRSA nasal swab had no relationship to SSI incidence and no impact on clinical patient care. Pre-operative MRSA nasal swabs appear to be of limited benefit for routine pre-operative screening in this patient population.Level III, retrospective comparative.


Assuntos
Portador Sadio , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Cavidade Nasal/microbiologia , Osteotomia , Infecção da Ferida Cirúrgica/epidemiologia , Criança , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Cuidados Pré-Operatórios , Infecções por Pseudomonas/epidemiologia , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-32574282

RESUMO

To investigate the early epidemic of COVID-19, a total of 176 confirmed COVID-19 cases in Shiyan city, Hubei province, China were surveyed. Our data indicated that the rate of emergence of early confirmed COVID-19 cases in Hubei province outside Wuhan was dependent on migration population, and the second-generation of patients were family clusters originating from Wuhan travelers. Epidemiological investigation indicated that the reproductive number (R0) under containment strategies was 1.81, and asymptomatic SARS-CoV-2 carriers were contagious with a transmission rate of 10.7%. Among the 176 patients, 53 were admitted to the Renmin Hospital of Hubei University of Medicine. The clinical characteristics of these 53 patients were collected and compared based on a positive RT-PCR test and presence of pneumonia. Clinical data showed that 47.2% (25/53) of COVID-19 patients were co-infected with Mycoplasma pneumoniae, and COVID-19 patients coinfected with M. pneumoniae had a higher percentage of monocytes (P < 0.0044) and a lower neutrophils percentage (P < 0.0264). Therefore, it is important to assess the transmissibility of infected asymptomatic individuals for SARS-CoV-2 transmission; moreover, clinicians should be alert to the high incidence of co-infection with M. pneumoniae in COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Assintomáticas/epidemiologia , Contagem de Células Sanguíneas , Portador Sadio/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Coinfecção/epidemiologia , Busca de Comunicante , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Feminino , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia por Mycoplasma/complicações , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Tomografia Computadorizada por Raios X , Viagem , Adulto Jovem
6.
J Med Microbiol ; 69(4): 600-604, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32427561

RESUMO

Introduction. Nasal and skin colonization by methicillin-resistant Staphylococcus aureus (MRSA) are linked to a higher incidence of infection after total joint replacement. The prevalence of colonization is poorly defined in Latin American countries.Aim. The aim of the present study was to determine the prevalence of MRSA colonization in the nostrils and groin using real-time polymerase chain reaction (RT-PCR) in patients undergoing total hip arthroplasty (THA).Methodology. In this cross-sectional study, 146 patients undergoing THA between December 2015 and March 2017 in a tertiary-care university-affiliated hospital in Chile were screened for MRSA colonization before the procedure using RT-PCR independently in the nostrils and groin. Risk factors for colonization were documented.Results. Seven of the 146 (5 %) patients undergoing THA were carriers of MRSA in the nostrils and/or the groin. Recent antibiotic use was identified as a risk factor for colonization, OR=4.86 [95 % confidence interval (CI): 1.56-13.96]. Patients reporting at least one of the seven surveyed risk factors had an OR of 2.39 (95 % CI: 0.37-25.77) for colonization. MRSA colonization frequency was twofold higher in the groin as opposed to the nostrils (P=0.014).Conclusion. Five percent of the patients undergoing THA were identified as carriers of MRSA. Recent antibiotic use is a relevant risk factor for MRSA colonization in patients undergoing primary total hip arthroplasty.


Assuntos
Artroplastia de Quadril/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Antibacterianos/administração & dosagem , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Estudos Transversais , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Adulto Jovem
7.
APMIS ; 128(6): 451-462, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32358920

RESUMO

Bacteria and viruses were analysed in the upper respiratory tract of symptomatic pig farmers and their domestic pigs. Eighty six human nasal and 495 (50 pools) porcine snout swabs were collected in Schleswig-Holstein, Germany. Staphylococcus (S.) aureus (62.8%, 54/86), human rhino- and coronaviruses (HRV, 29.1%, 25/86; HCoV, 16.3%, 14/86) were frequently detected in humans, while Haemophilus parasuis (90.0%, 45/50), Mycoplasma hyorhinis (78.6%, 11/14), Enterovirus G (EV-G, 56.0%, 28/50) and S. aureus (36.0%, 18/50), respectively, were highly prevalent in pigs. The detection of S. aureus in human follow-up samples indicates a carrier status. The methicillin-resistant phenotype (MRSA) was identified in 33.3% (18/54) of nasal swabs and in one of 18 (5.6%) pooled snout swabs that were tested positive for S. aureus. Strains were indicative of the livestock-associated clonal complex CC398, with t011 being the most common staphylococcal protein A type. Enterobacterales and non-fermenters were frequently isolated from swabs. Their detection in follow-up samples suggests a carrier status. All were classified as being non-multiresistant. There was no example for cross-species transmission of viruses. In contrast, transmission of S. aureus through occupational contact to pigs seems possible. The study contributes to the 'One Health' approach.


Assuntos
Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Infecções Estafilocócicas/veterinária , Sus scrofa/microbiologia , Sus scrofa/virologia , Doenças dos Suínos/epidemiologia , Animais , Portador Sadio , Humanos , Gado , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana , Mucosa Nasal/microbiologia , Mucosa Nasal/virologia , Doenças Profissionais/microbiologia , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/transmissão , Suínos , Doenças dos Suínos/microbiologia , Doenças dos Suínos/transmissão , Doenças dos Suínos/virologia , Viroses/epidemiologia , Viroses/transmissão , Viroses/veterinária
9.
BMC Infect Dis ; 20(1): 358, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434569

RESUMO

BACKGROUND: Globally, in 2012, about 1.2 million estimated cases were reported with ~ 135,000 deaths annually. In Ethiopia, specifically in our study area, limited information is found on the oropharyngeal carriage, antimicrobial resistance pattern, and associated risk factors for N. meningitidis among school children. So, the aim of this study was to assess oropharyngeal carriage rate of N. meningitidis, antibiotic susceptibility pattern and associated risk factors among primary school children in Gondar town, Northwest Ethiopia. METHODS: A cross sectional study was conducted from January to April, 2019 in Gondar town. Multi stage simple random sampling technique was used. A total of 524 oropharyngeal swabs were collected using sterile plastic cotton swabs. Modified Thayer Martin media was used for primary isolation. Antimicrobial susceptibility pattern was done based on Kirby-Bauer method on Muller-Hinton agar supplemented with 5% sheep blood. Multidrug resistance was defined as resistance of an isolate to two or more antimicrobial classes tested. Logistic regression model was used to see the association between dependent variables (Carriage rate of Neisseria meningitidis, Serogroups of Neisseria meningitidis and Antimicrobial susceptibility patterns) and independent variables (Socio-demographic data and risk factors). Variables with a P- value ≤0.2 during bivariable analysis was taken to multivariable analysis to check significant association of meningococcal carriage with risk factors. Finally, a P-value < 0.05 was considered as statistically significant. Data was summarized using numbers, percentages and tables. RESULTS: A total of 53(10.1%) (CI: 7.6-12.8) N. meningitidis isolates were identified. Serogroup A 13 (24.5%) was the most prevalent followed by Y/W135 11(20.7%) whereas serogroup B 4(7.6%) was the least identified serotype. Meningococcal isolates were resistant to ciprofloxacin (45.3%) and trimethoprim-sulfamethoxazole (73.6%). Overall, most of meningococcal isolates showed about 32(60.4%) multidrug resistance. Meningococcal carriage rate was significantly associated with family size, tonsillectomy, passive smoking, number of students per class, sharing utensils, history of visiting healthcare institutions, and indoor kitchen. CONCLUSION: This study highlights the need for reinforcement of case-based, laboratory confirmed surveillance of N. meningitidis carriage in Ethiopian elementary school students to enable mapping of distribution of serotypes of the causative organisms across the country and determine the current potential necessity of vaccination.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/efeitos dos fármacos , Adolescente , Portador Sadio/epidemiologia , Criança , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Infecções Meningocócicas/epidemiologia , Testes de Sensibilidade Microbiana , Neisseria meningitidis/isolamento & purificação , Orofaringe/microbiologia , Prevalência , Fatores de Risco , Instituições Acadêmicas/estatística & dados numéricos , Sorogrupo
10.
Epidemiol Infect ; 148: e80, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32228726

RESUMO

Teenagers have a higher risk of invasive meningococcal disease (IMD) than the general population. This cross-sectional study aimed to characterise strains of Neisseria meningitidis circulating among Norwegian teenagers and to assess risk factors for meningococcal carriage. Oropharyngeal swabs were collected from secondary-school students in southeastern Norway in 2018-2019. Meningococcal isolates were characterised using whole genome sequencing. Risk factors for meningococcal carriage were assessed from questionnaire data. Samples were obtained from 2296 12-24-year-olds (majority 13-19-year-olds). N. meningitidis was identified in 167 (7.3%) individuals. The highest carriage rate was found among 18-year-olds (16.4%). Most carriage isolates were capsule null (40.1%) or genogroup Y (33.5%). Clonal complexes cc23 (35.9%) and cc198 (32.3%) dominated and 38.9% of carriage strains were similar to invasive strains currently causing IMD in Norway. Use of Swedish snus (smokeless tobacco) (OR 1.56, 95% CI 1.07-2.27), kissing >two persons/month (OR 2.76, 95% CI 1.49-5.10) and partying >10 times/3months (OR 3.50, 95% CI 1.45-8.48) were associated with carriage, while age, cigarette smoking, sharing of drinking bottles and meningococcal vaccination were not. The high meningococcal carriage rate among 18-year-olds is probably due to risk-related behaviour. Use of Swedish snus is possibly a new risk factor for meningococcal carriage. Almost 40% of circulating carriage strains have invasive potential.


Assuntos
Portador Sadio/epidemiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Portador Sadio/microbiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Noruega/epidemiologia , Filogenia , Fatores de Risco , Adulto Jovem
11.
PLoS One ; 15(4): e0231041, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236150

RESUMO

This study describes predictors of pneumococcal nasopharyngeal carriage and density in Fiji. We used data from four annual (2012-2015) cross-sectional surveys, pre- and post-introduction of ten-valent pneumococcal conjugate vaccine (PCV10) in October 2012. Infants (5-8 weeks), toddlers (12-23 months), children (2-6 years), and their caregivers participated. Pneumococci were detected and quantified using lytA qPCR, with molecular serotyping by microarray. Logistic and quantile regression were used to determine predictors of pneumococcal carriage and density, respectively. There were 8,109 participants. Pneumococcal carriage was negatively associated with years post-PCV10 introduction (global P<0.001), and positively associated with indigenous iTaukei ethnicity (aOR 2.74 [95% CI 2.17-3.45] P<0.001); young age (infant, toddler, and child compared with caregiver participant groups) (global P<0.001); urban residence (aOR 1.45 [95% CI 1.30-2.57] P<0.001); living with ≥2 children <5 years of age (aOR 1.42 [95% CI 1.27-1.59] P<0.001); low family income (aOR 1.44 [95% CI 1.28-1.62] P<0.001); and upper respiratory tract infection (URTI) symptoms (aOR 1.77 [95% CI 1.57-2.01] P<0.001). Predictors were similar for PCV10 and non-PCV10 carriage, except PCV10 carriage was negatively associated with PCV10 vaccination (0.58 [95% CI 0.41-0.82] P = 0.002) and positively associated with exposure to household cigarette smoke (aOR 1.21 [95% CI 1.02-1.43] P = 0.031), while there was no association between years post-PCV10 introduction and non-PCV10 carriage. Pneumococcal density was positively associated with URTI symptoms (adjusted median difference 0.28 [95% CI 0.16, 0.40] P<0.001) and toddler and child, compared with caregiver, participant groups (global P = 0.008). Predictors were similar for PCV10 and non-PCV10 density, except infant, toddler, and child participant groups were not associated with PCV10 density. PCV10 introduction was associated with reduced the odds of overall and PCV10 pneumococcal carriage in Fiji. However, after adjustment iTaukei ethnicity was positively associated with pneumococcal carriage compared with Fijians of Indian Descent, despite similar PCV10 coverage rates.


Assuntos
Portador Sadio/epidemiologia , Infecções Pneumocócicas/epidemiologia , Adolescente , Adulto , Fatores Etários , Portador Sadio/microbiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Fiji/epidemiologia , Humanos , Lactente , Modelos Logísticos , Masculino , Infecções Pneumocócicas/etiologia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Fatores de Risco , Adulto Jovem
13.
J Infect Dis ; 221(12): 1940-1947, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32318703

RESUMO

BACKGROUND: We retrospectively analyzed 26 persistently asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) carriers. METHODS: Epidemiological and clinical characteristics from the 26 asymptomatic patients with positive results for SARS-CoV-2 ribonucleic acid testing were obtained. RESULTS: Twenty-two patients (84.6%) correlated with clustering occurrence. The median period from contact to diagnosis and the last positive nucleic acid test was 19 (8-24 days) and 21.5 days (10-36 days), respectively. The median period from diagnosis to negative nucleic acid test was significantly different between patients with normal or atypical chest computed tomography (CT) findings (n = 16, 61.5%; 7.5 days [2-20 days]) and patients with typical ground-glass or patchy opacities on CT (n = 10, 38.5%; 12.5 days [8-22 days]; P < .01). Seven patients (70.0%) with initial positive nucleic acid test results had a negative result simultaneously with improved CT findings. Obvious improvement in CT findings was observed in 3 patients (30.0%) despite positive nucleic acid test results. CONCLUSIONS: In asymptomatic patients, changes in biochemical and inflammatory variables are small and changes on chest CT can occur. It is worth noting that the long existence of SARS-CoV-2 in some asymptomatic patients and false-negative results need to be considered in SARS-CoV-2 nucleic acid test.


Assuntos
Infecções Assintomáticas , Portador Sadio/virologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Criança , Pré-Escolar , China , Infecções por Coronavirus/diagnóstico por imagem , Reações Falso-Negativas , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , RNA Viral/isolamento & purificação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
BMC Infect Dis ; 20(1): 279, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293324

RESUMO

BACKGROUND: The 13-valent Pneumococcal Conjugate Vaccine (PCV-13) was introduced in the National Immunization Programme (NIP) schedule in Russia in March 2014. Previously, the 7-valent Pneumococcal Conjugate Vaccine (PCV-7) was marketed in Russia in 2009 but has never been offered for mass vaccination. A carriage study was performed among children in Arkhangelsk in 2006. The objective was to determine the prevalence of carriage, serotype distribution, antimicrobial susceptibility and the molecular structure of Streptococcus pneumoniae strains before marketing and introduction of PCV-13. METHODS: A cross-sectional study was conducted on a cluster-randomized sample of children and a self-administrated questionnaire for parents/guardians.  Nasopharyngeal samples were collected from 438 children younger than 7 years attending nurseries and kindergartens in the Arkhangelsk region, Russia. Detailed demographic data, as well as information about the child's health, traveling, exposure to antimicrobials within the last 3 months and anthropometric measurements were collected for all study subjects. Variables extracted from the questionnaire were analysed using statistic regression models to estimate the risk of carriage. All pneumococcal  isolates were examined with susceptibility testing, serotyping and multilocus sequence typing. RESULTS: The overall prevalence of asymptomatic carriage was high and peaking at 36 months with a rate of 57%. PCV-13 covered 67.3% of the detected strains. High rates of non-susceptibility to penicillin, macrolides and multidrug resistance were associated with specific vaccine serotypes, pandemic clones, and local sequence types. Nine percent of isolates represented three globally disseminated disease-associated pandemic clones; penicillin- and macrolide-resistant clones NorwayNT-42 and Poland6B-20, as well as penicillin- and macrolide-susceptible clone Netherlands3-31. A high level of antimicrobial consumption was noted by the study. According to the parent's reports, 89.5% of the children used at least one antimicrobial regime since birth. None of the hypothesised predictors of S. pneumoniae carriage were statistically significant in univariable and multivariable logistic models. CONCLUSIONS: The study identified a high coverage of the PCV-13-vaccine, but serotype replacement and expansion of globally disseminated disease-associated clones with non-vaccine serotypes may be expected. Further surveillance of antimicrobial resistance and serotype distribution is therefore required.


Assuntos
Portador Sadio/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/imunologia , Vacinas Conjugadas/imunologia , Antibacterianos/uso terapêutico , Portador Sadio/microbiologia , Criança , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Lactente , Macrolídeos/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Nasofaringe/microbiologia , Penicilinas/uso terapêutico , Infecções Pneumocócicas/tratamento farmacológico , Prevalência , Federação Russa/epidemiologia , Sorogrupo , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação
15.
Clin Gastroenterol Hepatol ; 18(8): 1753-1759.e2, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32311512

RESUMO

BACKGROUND & AIMS: We compared clinical, laboratory, radiological, and outcome features of patients with SARS-CoV-2 infection (COVID-19) with pneumonia, with vs without diarrhea. METHODS: We performed a retrospective, single-center analysis of 84 patients with SARS-CoV-2 pneumonia in Wuhan Union Hospital, China, from January 19 through February 7, 2020. Cases were confirmed by real-time reverse-transcriptase PCR of nasal and pharyngeal swab specimens for SARS-CoV-2 RNA. Blood samples were analyzed for white blood cell count, lymphocyte count, alanine aminotransferase, creatine kinase, lactate dehydrogenase, D-dimer, C-reactive protein, and in some cases, immunoglobulins, complement, lymphocyte subsets, and cytokines. Virus RNA was detected in stool samples by real-time PCR. RESULTS: Of the 84 patients with SARS-CoV-2 pneumonia, 26 (31%) had diarrhea. The duration of fever and dyspnea in patients with diarrhea was significantly longer than those without diarrhea (all P < .05). Stool samples from a higher proportion of patients with diarrhea tested positive for virus RNA (69%) than from patients without diarrhea (17%) (P < .001). As of February 19, a lower proportion of patients with diarrhea had a negative result from the latest throat swab for SARS-CoV-2 (77%) than patients without diarrhea (97%) (P = .010), during these patients' hospitalization. Of 76 patients with a negative result from their latest throat swab test during hospitalization, a significantly higher proportion of patients with diarrhea had a positive result from the retest for SARS-CoV-2 in stool (45%) than patients without diarrhea (20%) (P = .039). CONCLUSIONS: At a single center in Wuhan, China, 31% of patients with SARS-CoV-2 pneumonia had diarrhea. A significantly higher proportion of patients with diarrhea have virus RNA in stool than patients without diarrhea. Elimination of SARS-CoV-2 from stool takes longer than elimination from the nose and throat.


Assuntos
Betacoronavirus/isolamento & purificação , Portador Sadio/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Diarreia/epidemiologia , Diarreia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Adulto , Idoso , Contagem de Células Sanguíneas , Análise Química do Sangue , China , Diarreia/patologia , Fezes/virologia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/virologia , Pandemias , Faringe/virologia , RNA Viral/análise , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Adulto Jovem
16.
Niger Postgrad Med J ; 27(2): 136-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32295946

RESUMO

Context: Bowel carriage has been identified as the main reservoir of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and hospital-acquired infections. There are gaps in the knowledge of trends of these rates, which need to be filled for the development and implementation of hospital surveillance systems and antibiotic stewardship programmes in Nigeria. Aim: This study investigated the carriage rates of ESBL-PE among 273 children admitted to the paediatric wards of a university teaching hospital, Nigeria, using a prospective cohort study design over a 6-month period. Settings and Design: The study explored the role of new and transferred patients in introducing resistant strains of ESBLs into paediatric wards and how quickly paediatric patients that were previously free of resistant strains acquired these within the hospital environment. Materials and Methods: E-swabs (Copan Diagnostics, Italy) were used to obtain rectal samples from participants. Positive colonies were Gram stained and subcultured onto purity plates for further identification, and antibiotic susceptibility pattern of identified ESBL-PE was obtained using a range of antibiotics. Statistical Analysis Used: Data were analysed using SPSS statistics 20 (IBM SPSS Statistics, version 20). Statistical significance was determined using the Chi-square test and Fisher's exact test. A logistic regression analysis was also conducted to identify independent risk factors for colonisation. Results: The findings showed that transferred patients contributed to the introduction of ESBLs into the hospital. Independent multivariate risk factors for colonisation of ESBL-PE were age >10-14 years, instrumentation (odds ratio [OR]: 0.2 [P < 0.05]) and sharing of thermometers (OR: 0.11 [P < 0.05]). Conclusions: The carriage rate of ESBL-PE is high (25.3%) among children, and none-carriers may become colonised within 14 days of hospitalisation.


Assuntos
Antibacterianos/uso terapêutico , Portador Sadio/epidemiologia , Infecção Hospitalar/microbiologia , Infecções por Enterobacteriaceae/diagnóstico , Enterobacteriaceae/isolamento & purificação , Hospitalização/estatística & dados numéricos , beta-Lactamases/biossíntese , Adolescente , Antibacterianos/farmacologia , Portador Sadio/microbiologia , Criança , Infecção Hospitalar/epidemiologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Hospitais de Ensino , Humanos , Nigéria/epidemiologia , Prevalência , Estudos Prospectivos , Fatores de Risco
17.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(4): 485-488, 2020 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-32141279

RESUMO

COVID-19 is rapidly spreading. Patients in incubation period and healthy carriers are possible sources for transmission. However, such sources of infection cannot be effectively identified due to the symptoms absent. The research evidence is very lacking so far, although there are a few studies suggesting that presymptomatic or asymptomatic carrier may cause COVID-19 transmission. Nearly half of the literature is in the state of preprint without peer review. The question of "the degree to which presymptomatic or asymptomatic infections can transmit" is not fully understood. There is an urgent need to screen infected carriers in larger close contacts or in the general population, and assess their risk for transmission.


Assuntos
Infecções Assintomáticas , Portador Sadio/virologia , Infecções por Coronavirus/transmissão , Pneumonia Viral/transmissão , Betacoronavirus , Humanos , Programas de Rastreamento , Pandemias
18.
PLoS One ; 15(3): e0230332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182260

RESUMO

BACKGROUND: Penicillin non-susceptible (PNSP) and multi-resistant pneumococci have been prevalent in Iceland since early nineties, mainly causing problems in treatment of acute otitis media. The 10-valent protein conjugated pneumococcal vaccine (PHiD-CV) was introduced into the childhood vaccination program in 2011. The aim of the study was to investigate the changes in antimicrobial susceptibility and serotype distribution of penicillin non-susceptible pneumococci (PNSP) in Iceland 2011-2017. METHODS AND FINDINGS: All pneumococcal isolates identified at the Landspítali University Hospital in 2011-2017, excluding isolates from the nasopharynx and throat were studied. Susceptibility testing was done according to the EUCAST guidelines using disk diffusion with chloramphenicol, erythromycin, clindamycin, tetracycline, trimethoprim/sulfamethoxazole and oxacillin for PNSP screening. Penicillin and ceftriaxone minimum inhibitory concentrations (MIC) were measured for oxacillin resistant isolates using the E-test. Serotyping was done using latex agglutination and/or multiplex PCR. The total number of pneumococcal isolates that met the study criteria was 1,706, of which 516 (30.2%) were PNSP, and declining with time. PNSP isolates of PHiD-CV vaccine serotypes (VT) were 362/516 (70.2%) declining with time, 132/143 (92.3%) in 2011 and 17/54 (31.5%) in 2017. PNSP were most commonly of serotype 19F, 317/516 isolates declining with time, 124/143 in 2011 and 15/54 in 2017. Their number decreased in all age groups, but mainly in the youngest children. PNSP isolates of non PHiD-CV vaccine serotypes (NVT) were 154/516, increasing with time, 11/14, in 2011 and 37/54 in 2017. The most common emerging NVTs in 2011 and 2017 were 6C, 1/143 and 10/54 respectively. CONCLUSIONS: PNSP of VTs have virtually disappeared from children with pneumococcal diseases after the initiation of pneumococcal vaccination in Iceland and a clear herd effect was observed. This was mainly driven by a decrease of PNSP isolates belonging to a serotype 19F multi-resistant lineage. However, emerging multi-resistant NVT isolates are of concern.


Assuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/uso terapêutico , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Pré-Escolar , Farmacorresistência Bacteriana Múltipla , Feminino , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Islândia/epidemiologia , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Otite Média , Resistência às Penicilinas , Faringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Avaliação de Programas e Projetos de Saúde , Sorotipagem/estatística & dados numéricos , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/imunologia
19.
R I Med J (2013) ; 103(2): 18-20, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122094

RESUMO

Hospital antibiograms, because they are typically derived from samples obtained from hospitalized patients, may overestimate the prevalence of methicillin resistance in S. aureus in individuals presenting to the hospital for surgery. Because hospital antibiograms are commonly used to justify empiric perioperative prophylactic antibiotic selection prior to surgery, this may lead to unnecessary treatment with broad-spectrum antibiotics such as vancomycin. In a single-institution study, we observed that in our hospital antibiogram the proportion of S. aureus that are methicillin-resistant (MRSA) was significantly higher (45%) than isolates in preoperative nasal cultures obtained at the same hospital in outpatients prior to their lower extremity joint replacement surgery (13%): mean difference 0.32, [95% CI 0.25, 0.39], p <0.0001. These data suggest that hospital antibiograms may overstate the true prevalence of MRSA in those at risk for MRSA surgical site infections who present from the outpatient setting.


Assuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Cavidade Nasal/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Portador Sadio/epidemiologia , Feminino , Humanos , Masculino , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Período Pré-Operatório , Prevalência , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Staphylococcus aureus/efeitos dos fármacos
20.
Epidemiol Infect ; 148: e68, 2020 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-32081112

RESUMO

Infections due to extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) are often preceded by asymptomatic carriage. Higher incidences in enteric infectious diseases during summer have been reported. Here, we assessed whether the presence of seasonality in intestinal ESBL-Escherichia coli/Klebsiella pneumoniae (ESBL-E/K) carriage in the general Dutch population exists. From 2014 to 2017, the faecal carriage of ESBL-E/K in healthy individuals was determined in three cross-sectional studies in the Netherlands, including 5985 subjects. Results were pooled to identify seasonal trends in prevalence (by month of sampling). Multivariate logistic regression analysis was used to calculate pooled odds ratios and 95% confidence intervals. Results were adjusted for age, sex, antibiotic use and travel. Overall prevalence of ESBL-E/K carriage was 4.3% (n = 260 ESBL-E/K-positive), with differences between months ranging from 2.6% to 7.4%. Compared to January, the monthly prevalence of ESBL-E carriage was highest in August (OR 1.88, 95% CI 1.02-3.49) and September (OR 2.25, 95% CI 1.30-3.89). The observed monthly differences in ESBL-E/K carriage rates suggest that there is seasonal variation in exposure to ESBL-E/K other than due to travelling and antibiotic use. This should be taken into account in designing future ESBL-E prevalence studies in temperate regions.


Assuntos
Portador Sadio , Farmacorresistência Bacteriana , Infecções por Enterobacteriaceae , Escherichia coli , Klebsiella pneumoniae , Adolescente , Adulto , Idoso , Proteínas de Bactérias , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Estudos Transversais , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Escherichia coli/isolamento & purificação , Fezes/microbiologia , Feminino , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Prevalência , Estações do Ano , Adulto Jovem , beta-Lactamases
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