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1.
Medicine (Baltimore) ; 99(2): e18504, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914021

RESUMEN

We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral-bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07-0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13-0.98), respectively.We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral-bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.


Asunto(s)
Adenoviridae/aislamiento & purificación , Haemophilus influenzae/aislamiento & purificación , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Infecciones por Adenoviridae/diagnóstico , Infecciones por Adenoviridae/virología , Bacterias/genética , Preescolar , Coinfección/microbiología , Coinfección/virología , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Gripe Humana/diagnóstico , Gripe Humana/virología , Masculino , Prevalencia , Ruidos Respiratorios/diagnóstico , Ruidos Respiratorios/etiología , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/virología , Virus Sincitiales Respiratorios/genética , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Staphylococcus aureus/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación , Virus/genética
2.
Medicine (Baltimore) ; 98(35): e16861, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31464913

RESUMEN

Some children hospitalized for severe influenza virus infection require intensive care or die because of disease progression, which may be combined with other complications. The objective of this study was to identify the mortality risk factors in the patients with severe influenza virus infection admitted to the pediatric intensive care unit (PICU).Seventy-seven pediatric patients with severe influenza virus infection who were admitted in the PICU at Guangzhou Women and Children's Medical Center between 2013 and 2017 were evaluated. Data were transcribed and analyzed.The patients' median age was 3.0 years (interquartile range, 1.0-4.0 years), with 59.7% of the patients aged <3 years. The mortality was 16.9%, and patients aged >3 years accounted for 69.2% of the cases. Influenza A virus infection was found in 83.1% of the patients. Coinfection was detected in 58.7% of the patients. Haemophilus influenzae (11.7%) and adenovirus (9.1%) were the predominant bacterial and viral pathogens isolated, respectively. Older age, oxygen saturation level of <90% at admission, acute respiratory distress syndrome, pneumorrhagia, influenza-associated encephalopathy (IEA), septic shock, low ratio of partial pressure of oxygen in arterial blood (PaO2, <60 mm Hg) to the fraction concentration of oxygen in inspired air (FiO2; P/F), higher oxygenation index, increased alanine aminotransferase level (>100 IU/L), increased aspartate aminotransferase level (>100 IU/L), increased lactate dehydrogenase level (>500 IU/L), high fraction concentration of oxygen in inspired air (FiO2 > 60%), and positive end-expiratory pressure (>8 cmH2O) were associated with poor outcome. The deceased patients were more likely to have oxygen saturation levels of <90% at admission and IEA than those who survived. Higher P/F ratio was a protective factor against death in patients.The children with severe influenza virus infection who were admitted in the PICU were mainly aged <3 years. The presence of an oxygen saturation level of <90% at admission and IEA were the prognostic variables independently associated with mortality. Higher P/F ratio was a protective factor against death in patients.


Asunto(s)
Coinfección/epidemiología , Virus de la Influenza A/aislamiento & purificación , Gripe Humana/mortalidad , Adenoviridae/aislamiento & purificación , Preescolar , China/epidemiología , Coinfección/virología , Femenino , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Gripe Humana/virología , Unidades de Cuidado Intensivo Pediátrico , Masculino , Factores de Riesgo
3.
J Med Microbiol ; 68(10): 1466-1470, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31389781

RESUMEN

Introduction. Streptococcus pneumoniae and Haemophilus influenzae are both commensals of the human nasopharynx with a high capacity to cause upper and lower respiratory tract infections.Aim. Molecular testing of nasopharyngeal samples from children at the primary care paediatric department presenting with acute respiratory tract infections (ARTIs).Methodology. From June 2016 to May 2017, 156 nasopharyngeal swabs from children diagnosed with ARTIs who had been admitted to or followed up as outpatients at the Department of Paediatrics, SANADOR Hospital (Bucharest, Romania) were tested for the presence of S. pneumoniae, H. influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, Bordetella pertussis and Bordetella parapertussis DNA.Results. S. pneumoniae had the highest detection rate (53.8 %, n=84/156), followed by H. influenzae (41 %, n=64/156) and S. pneumoniae/H. influenzae co-detection (26.2 %, n=41/156).Conclusion. A definitive laboratory diagnosis of these micro-organisms can be made for invasive disease, but there are difficulties in establishing the aetiology for mucosal infection. Molecular detection tests could complement culture-based tests by strengthening their surveillance.


Asunto(s)
Infecciones por Haemophilus/microbiología , Haemophilus influenzae/aislamiento & purificación , Nasofaringe/microbiología , Infecciones Neumocócicas/microbiología , Streptococcus pneumoniae/aislamiento & purificación , Enfermedad Aguda/terapia , Adolescente , Niño , Preescolar , Femenino , Infecciones por Haemophilus/diagnóstico , Infecciones por Haemophilus/terapia , Haemophilus influenzae/genética , Hospitales/estadística & datos numéricos , Humanos , Lactante , Masculino , Infecciones Neumocócicas/diagnóstico , Infecciones Neumocócicas/terapia , Rumanía , Streptococcus pneumoniae/genética
4.
J Med Microbiol ; 68(10): 1534-1539, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31368885

RESUMEN

Introduction. Certain nontypeable Haemophilus influenzae cannot be assigned a sequence type (ST) by Multilocus Sequence Typing (MLST) due to the lack of the fucK gene, one of seven MLST loci in H. influenzae, which encodes a fucose-operon enzyme.Aims. To confirm whether the loss of fucK is also found in the encapsulated strains, we analysed clinical isolates of H. influenzae serotype e (Hie).Methodology. We conducted MLST, PFGE, and antimicrobial susceptibility tests of 45 Hie strains; the majority (n=43) were derived from respiratory samples of pediatric patients at Chiba Children's Hospital between 2000 and 2016. The two remaining strains were obtained from the blood of elderly patients with invasive H. influenzae diseases (IHiDs) between 2015 and 2016 at general hospitals. For the fucK-negative strains, PCR analysis for fucose operon was also performed.Results. Four STs (ST18, 122, 621 and 1758) were assigned to 13 strains, and remaining 32 (including one associated with IHiD) were fucK-negative, completely missing the fucose operon. The allelic profiles of six other loci were identical among 31 strains and to that of ST18, 122 and 621, and these strains were genetically closely related. Forty of 45 isolates were ampicillin-sensitive.Conclusions. The loss of fucK was frequently observed in clinical isolates of Hie from children. Moreover, fucK-negative Hie may be the cause of IHiD in adult patients. The majority of Hie, including fucK-negative strains, were shown to be clonally related and were ampicillin sensitive. This represents the first report examining fucK losses in encapsulated H. influenzae.


Asunto(s)
Proteínas Bacterianas/genética , Infecciones por Haemophilus/microbiología , Haemophilus influenzae/aislamiento & purificación , Fosfotransferasas (Aceptor de Grupo Alcohol)/genética , Adolescente , Ampicilina/farmacología , Antibacterianos/farmacología , Proteínas Bacterianas/metabolismo , Niño , Preescolar , Femenino , Haemophilus influenzae/clasificación , Haemophilus influenzae/efectos de los fármacos , Haemophilus influenzae/genética , Humanos , Japón , Masculino , Tipificación de Secuencias Multilocus , Operón , Fosfotransferasas (Aceptor de Grupo Alcohol)/deficiencia , Filogenia
5.
Zhonghua Er Ke Za Zhi ; 57(8): 592-596, 2019 Aug 02.
Artículo en Chino | MEDLINE | ID: mdl-31352743

RESUMEN

Objective: To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children. Methods: The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children's hospitals from 2014 to 2018 were analyzed retrospectively. Results: Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27% (22/82) of all HI strains produced ß-lactamases and 48% (37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25% (20/80) , 20% (9/45) , 71% (44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83% (70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13% (11/84) and 4% (3/84) respectively. Conclusions: Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.


Asunto(s)
Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Infecciones por Haemophilus/diagnóstico , Infecciones por Haemophilus/tratamiento farmacológico , Haemophilus influenzae/aislamiento & purificación , Adolescente , Cefalosporinas/farmacología , Cefalosporinas/uso terapéutico , Niño , Preescolar , Farmacorresistencia Bacteriana , Femenino , Infecciones por Haemophilus/epidemiología , Haemophilus influenzae/efectos de los fármacos , Humanos , Lactante , Masculino , Meningitis/epidemiología , Pruebas de Sensibilidad Microbiana , Neumonía/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , beta-Lactamasas/metabolismo
6.
Can J Microbiol ; 65(11): 805-813, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31242396

RESUMEN

In the post-Haemophilus influenzae serotype b (Hib) vaccine era, invasive H. influenzae serotype a (Hia) disease emerged in Canadian First Nation, Inuit, and Alaskan Indigenous populations. Previous studies by our group found a high incidence of invasive Hia disease in northwestern Ontario. We retrospectively reviewed 24 cases (4 pediatric and 20 adult) of invasive H. influenzae disease hospitalized at the northwestern Ontario regional hospital between August 2011 and June 2018. The objectives were to further document the changing epidemiology of invasive H. influenzae disease in the region and to discuss potential control measures. Twenty-two H. influenzae isolates were serotyped and characterized using molecular-biological methods. Of the serotyped cases, there were 2 Hib, 9 Hia, and 11 non-typeable (NTHi). All Hia isolates belonged to the most common sequence types (ST) found in Canada (ST-23 and ST-929); 8 out of 9 were pan susceptible to antibiotics. One (11%) of 9 Hia and 5 (45%) of 11 NTHi cases were fatal. Our data on the consistent presence of serious invasive H. influenzae disease, with 41% prevalence of Hia (9 out of 22 serotyped isolates) and 50% prevalence of NTHi strains (11 out of 22), emphasize the importance of continued surveillance of H. influenzae in the post-Hib vaccine era and are critical information to inform potential vaccine development.


Asunto(s)
Infecciones por Haemophilus/microbiología , Vacunas contra Haemophilus/administración & dosificación , Haemophilus influenzae/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Preescolar , Monitoreo Epidemiológico , Infecciones por Haemophilus/epidemiología , Infecciones por Haemophilus/inmunología , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/inmunología , Haemophilus influenzae/clasificación , Haemophilus influenzae/genética , Haemophilus influenzae/inmunología , Humanos , Incidencia , Lactante , Persona de Mediana Edad , Ontario/epidemiología , Estudios Retrospectivos , Serogrupo , Vacunación , Adulto Joven
7.
J Med Microbiol ; 68(8): 1227-1232, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31215858

RESUMEN

PURPOSE: Haemophilus influenzae strains with low susceptibility to quinolones have recently emerged in the paediatric field in Japan. These strains are judged as 'susceptible' in routine susceptibility tests, although they may survive after quinolone treatment. Therefore, we aimed to construct a simple and cost-effective identification method for low-susceptibility strains using disc diffusion assays. METHODOLOGY: A total of 33 H. influenzae clinical isolates and a control strain were used. For the disc diffusion assay, levofloxacin, norfloxacin, nalidixic acid and pipemidic acid were employed. Correlations between the inhibition zone diameter and amino acid substitutions were evaluated. RESULTS: All of the tested strains formed clear inhibition zones on both levofloxacin and norfloxacin discs. By contrast, none of the low-susceptibility strains showed inhibition zones against nalidixic acid, while the low-susceptibility strains with amino acid substitutions in both GyrA and ParC did not show inhibition zones against pipemidic acid discs, indicating that low-susceptibility strains can be detected with high sensitivity and specificity by the presence or absence of inhibition zones for earlier quinolones. CONCLUSION: A disc diffusion test combining results from nalidixic acid and pipemidic acid can detect low-susceptibility strains harbouring amino acid substitutions without the need for genetic analysis. This test can help reduce inappropriate and unnecessary fluoroquinolone use.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Infecciones por Haemophilus/microbiología , Haemophilus influenzae/efectos de los fármacos , Quinolonas/farmacología , Sustitución de Aminoácidos , Proteínas Bacterianas/genética , Niño , Girasa de ADN/genética , Topoisomerasa de ADN IV/genética , Pruebas Antimicrobianas de Difusión por Disco , Farmacorresistencia Bacteriana/genética , Haemophilus influenzae/genética , Haemophilus influenzae/aislamiento & purificación , Humanos , Japón , Ácido Nalidíxico/farmacología , Ácido Pipemídico/farmacología , Sensibilidad y Especificidad
8.
BMC Infect Dis ; 19(1): 547, 2019 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-31226950

RESUMEN

BACKGROUND: A nationwide investigation on the carriage proportion of H. influenzae among healthy populations is lacking in China. The purpose of the study was to review the prevalence of pharyngeal carriage of H. influenzae among healthy populations in China, and explore its influencing factors. The serotypes distribution of H. influenzae was also analyzed. METHODS: A systematic search was conducted with key words "Haemophilus influenzae", "Carriage", and "China" or "Chinese" from inception to March 2018. After careful screening, the data of included articles were extracted with a pre-designed excel form. Then, the pooled carriage proportion of H. influenzae was calculated using the random effect model. RESULTS: A total of 42 studies with 17,388 participants were included. The overall pooled carriage proportion of H. influenzae was 0.17 (95% CI: 0.13-0.21), and the carriage proportion largely varied by province. Subgroup analysis indicated that the pooled carriage proportion was 0.17 (0.13-0.21) for children, and 0.14 (0.7-0.23) for adults. There were no statistically significant heterogeneity between subgroups by age (p = 0.65), sex (p = 0.88), and season (p = 0.10). The pooled carriage proportion of Hib was 0.01 (0-0.02), while the carriage proportion of NTHi was 0.22 (0.13-0.31). CONCLUSION: In China, the carriage proportion of H. influenzae among healthy population was low, but it largely varied by provinces.


Asunto(s)
Portador Sano/epidemiología , Infecciones por Haemophilus/epidemiología , Haemophilus influenzae/aislamiento & purificación , Faringe/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Asintomáticas/epidemiología , Niño , Preescolar , China/epidemiología , Femenino , Infecciones por Haemophilus/microbiología , Voluntarios Sanos , Humanos , Lactante , Recién Nacido , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Estaciones del Año , Adulto Joven
9.
Int J Pediatr Otorhinolaryngol ; 123: 102-109, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31085462

RESUMEN

OBJECTIVE OF REVIEW: Acute otitis media (AOM) is the largest cause of antimicrobial prescriptions amongst children in developed countries. Excessive and inappropriate prescribing is known to drive antimicrobial resistance, but less is known of antimicrobial resistance in AOM-associated bacteria. TYPE OF REVIEW & SEARCH STRATEGY: We conducted a systematic review and meta-analysis of bacterial prevalence and antimicrobial resistance in studies of paediatric AOM identified from Ovid Medline, Embase and the Cochrane library. RESULTS: From 48 unique studies, 15,871 samples were included. Only 0.67 (CI 0.63-0.71) of all ear samples grew a bacterial pathogen. The most common bacterial causes of AOM in children were Streptococcus pneumoniae 0.30 (CI 0.27-0.32), Haemophilus influenza 0.23 (CI 0.20-0.26), and Moraxella catarrhalis 0.05 (CI 0.04-0.06). Resistance patterns varied amongst organisms and antimicrobial agents. The pooled proportion of bacterial culture-positive episodes of AOM that could be effectively treated with amoxicillin was 0.85 (CI 0.76-0.94), erythromycin was 0.64 (0.48-0.78) and amoxicillin-clavulanate was 0.95 (CI 0.85-0.98). CONCLUSION: We have demonstrated the bacteriology and antimicrobial resistance patterns of AOM. Of samples which grew bacteria, on average approximately 15% of isolates demonstrated resistance to amoxicillin; a typical first-line agent. Greater understanding of local bacteriology and resistance patterns is needed to enable improved antimicrobial stewardship.


Asunto(s)
Farmacorresistencia Bacteriana , Otitis Media/microbiología , Enfermedad Aguda , Amoxicilina , Antibacterianos/uso terapéutico , Niño , Preescolar , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Pruebas de Sensibilidad Microbiana , Otitis Media/epidemiología , Streptococcus pneumoniae/aislamiento & purificación
10.
Biomed Res Int ; 2019: 4834396, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31119172

RESUMEN

Lower respiratory tract infections (LRTIs) remain a challenge in African healthcare settings and only few data are available on their aetiology in Cameroon. The purpose of this study was to access the bacterial cause of LRTIs in patients in Cameroon by two methods. Methods. Participants with LRTIs were enrolled in the referral centre for respiratory diseases in Yaoundé city and its surroundings. To detect bacteria, specimens were tested by conventional bacterial culture and a commercial reverse-transcriptase real-time polymerase chain reaction (RT-PCR) assay. One hundred forty-one adult patients with LRTIs were enrolled in the study. Among the participants, 46.8% were positive for at least one bacterium. Streptococcus pneumoniae and Haemophilus influenzae were the most detected bacteria with 14.2% (20/141) followed by Klebsiella pneumoniae, 9.2% (13/141), Staphylococcus aureus, 7.1% (10/141), and Moraxella catarrhalis, 4.3% (6/141). Bacterial coinfection accounted for 23% (14/61) with Haemophilus influenzae being implicated in 19.7% (12/61). The diagnostic performance of RT-PCR for bacteria detection (43.3%) was significantly different from that of culture (17.7%) (p< 0.001). Only Streptococcus pneumoniae detection was associated with empyema by RT-PCR (p<0.001). These findings enhance understanding of bacterial aetiologies in order to improve respiratory infection management and treatment. It also highlights the need to implement molecular tools as part of the diagnosis of LRTIs.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Camerún/epidemiología , Femenino , Haemophilus influenzae/aislamiento & purificación , Haemophilus influenzae/patogenicidad , Humanos , Klebsiella pneumoniae/aislamiento & purificación , Klebsiella pneumoniae/patogenicidad , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/patogenicidad , Pseudomonas aeruginosa/aislamiento & purificación , Pseudomonas aeruginosa/patogenicidad , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/patología , Staphylococcus aureus/aislamiento & purificación , Staphylococcus aureus/patogenicidad , Streptococcus pneumoniae/aislamiento & purificación , Streptococcus pneumoniae/patogenicidad , Adulto Joven
11.
J Infect Chemother ; 25(9): 720-726, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30987951

RESUMEN

Acute otitis media (AOM) occurs commonly in pediatric populations. We examined resistance genotype, antibiotic susceptibility, quinolone (QL) resistance, and multilocus sequence type (MLST) among Haemophilus influenzae isolates causing AOM following introduction of pneumococcal conjugate vaccines in Japan. The AOM surveillance group included 69 participating otolaryngologists. Causative pathogens isolated from middle ear fluid (MEF) samples collected from 582 children with AOM were identified using both bacterial culture and real-time PCR. H. influenzae isolates among these pathogens were characterized by capsular type, resistance genotype, antibiotic susceptibility, QL resistance, and MLST. In 2016, H. influenzae was identified in 319 samples (54.8%), among which 72.4% (n = 231) tested positive by both culture and PCR; remaining H. influenzae cases were only PCR-positive. This proportion of H. influenzae positivity has increased significantly from 41.2% in 2006 (p < 0.001). Among culture-positive strains, genotypic ß-lactamase-nonproducing ampicillin (AMP)-resistant (gBLNAR) strains were frequent (63.2%), with ß-lactamase-nonproducing AMP-susceptible (gBLNAS) strains accounting for only 24.2%. Susceptibilities of gBLNAR to oral antimicrobials were best for tosufloxacin, followed by cefditoren and tebipenem; MIC90s were 0.031 µg/mL, 0.5 µg/mL, and 1 µg/mL, respectively. In 7 gBLNAR isolates (3.0%), QL susceptibility was low, owing to amino acid substitutions in GyrA and/or ParC. Sequence types identified numbered 107, including 28 that were new. Prevention of further increases in resistance to antimicrobial agents will require antibiotic selection based on characterization of causative pathogens in clinical practice.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple/genética , Infecciones por Haemophilus/tratamiento farmacológico , Infecciones por Haemophilus/microbiología , Haemophilus influenzae/efectos de los fármacos , Haemophilus influenzae/genética , Otitis Media/tratamiento farmacológico , Otitis Media/microbiología , Vacunas Neumococicas/uso terapéutico , Enfermedad Aguda , Ampicilina/uso terapéutico , Antibacterianos/uso terapéutico , Carbapenémicos/uso terapéutico , Cefalosporinas/uso terapéutico , Preescolar , Fluoroquinolonas/uso terapéutico , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Japón , Pruebas de Sensibilidad Microbiana , Tipificación de Secuencias Multilocus , Naftiridinas/uso terapéutico , Quinolonas/uso terapéutico , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación , Vacunas Conjugadas/uso terapéutico , Resistencia betalactámica/genética
12.
Klin Lab Diagn ; 64(2): 117-121, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-30917254

RESUMEN

According to the World Health Organization, every year about 1 million cases of purulent bacterial meningitis (PBM) are registered in the world, of which 200 thousand cases end in death. Bacterial meningitis is polyethiologic, which makes the task of determining the pathogen the main in the organization of epidemiological surveillance, treatment regimens, planning of preventive and anti-epidemic measures. The quality of laboratory diagnostics has a key influence on this. The true incidence of meningitis of different etiology can be altered at low-efficiency laboratory diagnostics. This work was carried out to assess the effectiveness of existing laboratory methods for the detection of PBM pathogens: Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis; as a part of the programme on sentinel surveillance of invasive bacterial diseases (IBD) carried out by the WHO regional office for Europe in a number of countries in Europe (Ukraine, Belarus), Transcaucasia (Azerbaijan, Armenia, Georgia), Asia (Uzbekistan, Kyrgyzstan, Kazakhstan) in the period 2010-2017. 2893 samples of clinical material (CSF and blood) obtained from patients with the meningeal syndrome were studied by four diagnostic methods: cultural method, latex-agglutination test, immunochromatographic test (BinaxNOW), PCR (conventional and real-time), used to identify the following pathogens: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae. When identifying the causative agents of BM, PCR more effective than culture method is 5 times in detecting N. meningitidis; 3 times in the detection of S. pneumoniae; 4 times the detection of H. influenzae b. Latex-agglutination test and immunochromatographic test allow to increase the identification of pathogens of BM for N. meningitidis - by 35.6%; S. pneumoniae - by 67%; H. influenzae b - by 19.2%, it is possible to set them in the field and at the epidpoint if necessary. When working with clinical material from patients diagnosed with GBM, it is advisable for bacteriological laboratories to complement the culture method of microbiological diagnosis of latex-agglutination test, immunochromatographic test or PCR.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Meningitis Bacterianas/diagnóstico , Haemophilus influenzae/aislamiento & purificación , Humanos , Neisseria meningitidis/aislamiento & purificación , Vigilancia de Guardia , Streptococcus pneumoniae/aislamiento & purificación
13.
J Infect Chemother ; 25(7): 509-513, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30879978

RESUMEN

Cefotaxime-non-susceptible Haemophilus influenzae has rarely been isolated from clinical specimens. Although several reports have shown that amino acid (AA) alteration in penicillin-binding protein 3 (PBP3), encoded by the ftsI gene, reduces activity of cefotaxime, precise mechanisms conferring the non-susceptibility have been unclear. We analyzed the ftsI gene of two clinically isolated cefotaxime-non-susceptible H. influenzae strains, 16-11 and 20-07 (minimum inhibitory concentrations [MICs]: 16 and 8 µg/mL, respectively), and found that their deduced AA sequences of PBP3 included two AA substitutions of G555E and Y557H in addition to previously described AA alterations. To clarify whether the two additional substitutions are requisite for cefotaxime non-susceptibility, we produced transformants of Rd KW20 (cefotaxime MIC: ≤0.06 µg/mL) with the ftsI gene of 16-11. Cefotaxime MICs against transformants M1 and M2, of which deduced PBP3s were altered with that of 16-11 entirely and partially (only the N-terminal side up to the AA position 519), were 8 and 0.25 µg/mL, respectively. We also produced M2-555/7 through site-directed mutagenesis inducing additional substitutions of G555E and Y557H into the PBP3 of M2, against which cefotaxime MIC was 8 µg/mL. These findings show that the additional substitutions of G555E and Y557H in PBP3 with previously described alterations cause cefotaxime non-susceptibility. An additional substitution of either G555E or Y557H alone in altered PBP3 reduced cefotaxime activity but the elevation of MICs were within the category of susceptibility. To our knowledge, this is the first study clarifying a genetic factor in the PBP3 causing cefotaxime non-susceptibility among H. influenzae strains.


Asunto(s)
Cefotaxima/farmacología , Resistencia a las Cefalosporinas/genética , Infecciones por Haemophilus/tratamiento farmacológico , Haemophilus influenzae/genética , Proteínas de Unión a las Penicilinas/genética , Sustitución de Aminoácidos , Cefotaxima/uso terapéutico , Infecciones por Haemophilus/microbiología , Haemophilus influenzae/aislamiento & purificación , Humanos , Pruebas de Sensibilidad Microbiana
16.
Braz J Microbiol ; 50(2): 435-443, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30796713

RESUMEN

Considering the great lethality and sequels caused by meningitis, rapid diagnosis and prompt treatment initiation have a great impact on patient outcome. Here, we developed a multiplex-PCR for simultaneous detection of the four most prevalent bacterial pathogens directly in CSF samples. The multiplex-PCR was designed to detect the following genes: fbsA (Streptococcus agalactiae), lytA (Streptococcus pneumoniae), crtA (Neisseria meningitidis), p6 (Haemophilus influenzae), and 16S rRNA (any bacterial agent). The multiplex-PCR showed a DNA detection limit of 1 pg/µL. Among 447 CSF samples tested, 40 were multiplex-PCR positive, in which 27 and 13 had positive and negative bacterial culture, respectively. Our multiplex-PCR is fast, reliable, and easily implementable into a laboratory routine for bacterial meningitis confirmation, especially for patients who previously started antimicrobial therapy. Our molecular approach can substantially improve clinical diagnosis and epidemiological measures of meningitis disease burden.


Asunto(s)
Líquido Cefalorraquídeo/microbiología , Haemophilus influenzae/genética , Meningitis Bacterianas/diagnóstico , Neisseria meningitidis/genética , Streptococcus agalactiae/genética , Streptococcus pneumoniae/genética , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/microbiología , Reacción en Cadena de la Polimerasa Multiplex/métodos , Neisseria meningitidis/aislamiento & purificación , Streptococcus agalactiae/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación
17.
PLoS One ; 14(2): e0211712, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30707730

RESUMEN

After pneumococcal conjugate vaccine (PCV) implementation, the number of acute otitis media (AOM) episodes has decreased, but AOM still remains among the most common diagnoses in childhood. From 2% to 17% of cases of AOM feature spontaneous perforation of the tympanic membrane (SPTM). The aim of this study was to describe the bacteriological causes of SPTM 5 to 8 years years after PCV13 implementation, in 2010. From 2015 to 2018, children with SPTM were prospectively enrolled by 41 pediatricians. Middle ear fluid was obtained by sampling spontaneous discharge. Among the 470 children with SPTM (median age 20.8 months), no otopathogen was isolated for 251 (53.4% [95% CI 48.8%;58.0%]): 47.1% of infants and toddlers, 68.3% older children (p<0.001). Among children with isolated bacterial otopathogens (n = 219), non-typable Haemophilus influenzae (NTHi) was the most frequent otopathogen isolated (n = 106, 48.4% [95% CI 41.6%;55.2%]), followed by Streptoccocus pyogenes (group A streptococcus [GAS]) (n = 76, 34.7% [95% CI 28.4%;41.4%]) and Streptococcus pneumoniae (Sp) (n = 61, 27.9% [95% Ci 22.0%;34.3%]). NTHi was frequently isolated in infants and toddlers (53.1%), whereas the main otopathogen in older children was GAS (52.3%). In cases of co-infection with at least two otopathogens (16.9%, n = 37/219), NTHi was frequently involved (78.4%, n = 29/37). When Sp was isolated, PCV13 serotypes accounted for 32.1% of cases, with serotype 3 the main serotype (16.1%). Among Sp strains, 29.5% were penicillin-intermediate and among NTHi strains, 16.0% were ß-lactamase-producers. More than 5 years after PCV13 implementation, the leading bacterial species recovered from AOM with SPTM was NTHi for infants and toddlers and GAS for older children. In both age groups, Sp was the third most frequent pathogen and vaccine serotypes still played an important role. No resistant Sp strains were isolated, and the frequency of ß-lactamase-producing NTHi did not exceed 16%.


Asunto(s)
Otitis Media/etiología , Otitis Media/microbiología , Perforación de la Membrana Timpánica/etiología , Adolescente , Antibacterianos/uso terapéutico , Bacterias/inmunología , Niño , Preescolar , Femenino , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Masculino , Otitis Media con Derrame/etiología , Otitis Media con Derrame/microbiología , Infecciones Neumocócicas/complicaciones , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Serogrupo , Perforación Espontánea/etiología , Perforación Espontánea/microbiología , Streptococcus pneumoniae/aislamiento & purificación , Streptococcus pyogenes/aislamiento & purificación , Membrana Timpánica/microbiología , Perforación de la Membrana Timpánica/microbiología , Vacunas Conjugadas/inmunología
18.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(2): 179-184, 2019 Feb 06.
Artículo en Chino | MEDLINE | ID: mdl-30744293

RESUMEN

Objective: To analyze epidemiological characteristics of acute bacterial meningitis (ABM) cases and the common pathogens infected in Jinan, Shandong Province. Methods: Epidemiological and clinical informations and cerebrospinal fluid (CSF) and blood specimens of acute meningitis/encephalitis syndrome (AMES) cases (total 3 918 cases) were collected in the six sentinel hospitals from 2013 to 2016. neisseria meningitidis (Nm), streptococcus pneumoniae (Sp) and haemophilus influenza (Hi) were detected by the methods of real-time fluorescent quantitative polymerase chain reaction (Real-time PCR), bacterial culture and latex agglutination. χ(2) test was used to compare ABM cases with different feasures, and compare the difference of Nm, Sp and Hi cases in clinical and epidemiological characteristics. Results: A total of 479 cases were diagnosed as ABM from 2013 to 2016, 82 cases of which were laboratory confirmed, including 54 cases infected with Nm, 25 cases infected with Sp, and 3 cases infected with Hi. The disease course in different age groups of ABM cases has statistically difference (χ(2)=40.95, P<0.001). The disease course of under 6 (63.6%, 161/253) and 7 to 17 (55.9%, 33/59) years old ABM cases mainly required 14-28 days, and over 18 years old cases mainly required less than 14 days (59.9%, 100/167). For Nm cases, there was a main onset period from October to March (75.9%, 41/54); on the disease course, under 6 (81.0%, 17/21) and 7 to 17 (16/18) years old cases mainly required less than 14 days, while over 18 years old cases mainly required 14-28 days (8/15), and there was a statistically difference in different age groups (χ(2)=8.44, P=0.015). For Sp cases, the major onset period was from December to May (84.0%, 21/25); on the disease course, all of under 6 and 7 to 17 years old cases were required 14-28 days, while over 18 years old cases mainly required less than 14 days (9/17), and there was a statistically difference in different age groups (χ(2)=6.62, P=0.037). 91.0% of the ABM cases (436/479) were healed or improvement, with the relatively higher ratio in under 6 (94.9%, 240/253) and 7 to 17 (98.3%, 58/59) years old groups, and poorer ratio in over 18 years old group (82.6%, 138/167), and the difference was significant in different age groups (χ(2)=22.77, P<0.001). For Nm, Sp and Hi cases, the ratio of cases that were healed or improvement were 87.0% (47/54), 92.0% (23/25) and 3/3, respectively, and there were no death cases. Conclusion: ABM cases were found mostly in under 18 years old group in Jinan, Shandong Province, and the bigger age group had poor prognosis. Nm was the major pathogen causing ABM, followed by Sp and Hi. Distinguished differences of epidemiological characteristics were found on ABM cases suffered with different pathogens infected.


Asunto(s)
Meningitis Bacterianas/epidemiología , Meningitis Bacterianas/microbiología , Adolescente , Adulto , Distribución por Edad , Niño , Preescolar , China/epidemiología , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Neisseria meningitidis/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa , Streptococcus pneumoniae/aislamiento & purificación
19.
Int J Pediatr Otorhinolaryngol ; 119: 123-130, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30703661

RESUMEN

OBJECTIVES: To evaluate the epidemiology, microbiology, Streptococcus pneumoniae serotypes distribution and serious bacterial infections (SBIs) occurrence in infants <2 months of age with tympanocentesis-documented acute otitis media (AOM), before and after the introduction of pneumococcal conjugate vaccines (PCVs). METHODS: The medical records of all hospitalized infants with AOM who underwent tympanocentesis during 2005-2014 were reviewed. RESULTS: Of the 303 infants with AOM who were diagnosed by an ENT specialist, 182 underwent tympanocentesis, 92 during 2005-2009 (prevaccine period) and 90 during 2010-2014 (postvaccine period). Streptococcus pneumoniae and nontypeable Hemophilus influenzae were isolated in 46/92 (50%) and 37/92 (40.2%) patients during 2005-2009 and decreased to 27/90 (30%) and 21/90 (23.3%). Respectively, during 2010-2014 (P = 0.006 and P = 0.001). The proportion of culture-negative patients increased from 18/92 (19.6%) during 2005-2009 to 32/90 (35.6%) during 2010-2014 (P = 0.02). There were only 6 (3.3%) patients <2 weeks of age. The most common S. pneumoniae vaccine serotypes isolated during 2005-2009 were 5, 3, 1, 19F and 14 (15.2%, 13.0%, 10.9%, 6.5%, and 4.3%, respectively) and 3, 5, 1, 14 and 19A (22.2%, 11.1%, 7.4%, 7.4%, and 7.4%, respectively) during 2010-2014. The proportion of culture-positive patients decreased during 2013-2014 compared with 2011-2012 (7/18, 38.9% vs. 40/54, 74.1%, P = 0.007). Serotypes 1 and 5 were not isolated during 2013-2014 and serotype 19A was not isolated during 2011-2014. . SBIs were recorded in 23/182 (12.64%) patients and urinary tract infections represented 19/23 (82.61%) of them (Escherichia coli isolated in 12, 63.2%). CONCLUSIONS: The overall number of AOM cases needing tympanocentesis seen at the PER and the proportion of S. pneumoniae and nontypeable H. influenzae-AOM decreased while the proportion of culture-negative AOM increased following the introduction of PCVs. SBIs associated with AOM were frequent and were represented mostly by urinary tract infections caused by pathogens unrelated to the etiologic agents of AOM.


Asunto(s)
Infecciones por Haemophilus/epidemiología , Otitis Media/epidemiología , Infecciones Neumocócicas/epidemiología , Vacunas Neumococicas/administración & dosificación , Antibacterianos/uso terapéutico , Femenino , Infecciones por Haemophilus/tratamiento farmacológico , Haemophilus influenzae/aislamiento & purificación , Humanos , Lactante , Recién Nacido , Israel/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Ventilación del Oído Medio , Otitis Media/microbiología , Otitis Media/prevención & control , Infecciones Neumocócicas/tratamiento farmacológico , Infecciones Neumocócicas/prevención & control , Prevalencia , Estudios Retrospectivos , Serogrupo , Streptococcus pneumoniae/aislamiento & purificación , Timpanocentesis/estadística & datos numéricos
20.
Eur J Clin Microbiol Infect Dis ; 38(4): 747-754, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30788730

RESUMEN

In clinical practice, the diagnosis of lower respiratory tract infections (LRTIs) is based on culture. The aim of this study was to evaluate whether a stepwise approach using microbiota analysis, species-specific quantitative real-time (q)PCRs and culture has the potential to be a more accurate and efficient diagnostic approach than culture alone. Sixty-two sputa obtained in a routine clinical setting from patients with a suspected LRTI were included. All sputa were analysed by culture, microbiota analysis based on the 16S ribosomal RNA gene and multiple species-specific qPCRs. Microbiota and culture data were compared to investigate whether cut-off values for microbiota analysis could be determined. For microbiota analysis, a relative abundance of 25% was identified as the cut-off value for the detection of both genera Streptococcus and Haemophilus. Microbiota analysis combined with species-specific qPCRs resulted in a significant increase in the number of positive sputa (73% vs 58%; p = 0.003) as well as in the number of identified pathogens (51 vs 37; p = 0.049) compared to culture. A stepwise approach using microbiota analysis, species-specific qPCRs and culture has the potential to be used in clinical settings for the diagnosis of LRTIs in the near future.


Asunto(s)
Microbiota , Reacción en Cadena en Tiempo Real de la Polimerasa , Infecciones del Sistema Respiratorio/diagnóstico , Recuento de Colonia Microbiana , ADN Bacteriano/genética , Haemophilus influenzae/genética , Haemophilus influenzae/aislamiento & purificación , Humanos , ARN Ribosómico 16S/genética , Infecciones del Sistema Respiratorio/microbiología , Análisis de Secuencia de ADN , Especificidad de la Especie , Esputo/microbiología , Streptococcus/genética , Streptococcus/aislamiento & purificación , Secuenciación Completa del Genoma
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