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1.
Artículo en Inglés | MEDLINE | ID: mdl-32574282

RESUMEN

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.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Asintomáticas/epidemiología , Recuento de Células Sanguíneas , Portador Sano/epidemiología , Niño , Preescolar , China/epidemiología , Coinfección/epidemiología , Trazado de Contacto , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Lactante , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Neumonía por Mycoplasma/complicaciones , Neumonía Viral/complicaciones , Neumonía Viral/transmisión , Tomografía Computarizada por Rayos X , Viaje , Adulto Joven
2.
BMC Infect Dis ; 20(1): 358, 2020 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-32434569

RESUMEN

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.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Infecciones Meningocócicas/microbiología , Neisseria meningitidis/efectos de los fármacos , Adolescente , Portador Sano/epidemiología , Niño , Estudios Transversales , Etiopía/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Infecciones Meningocócicas/epidemiología , Pruebas de Sensibilidad Microbiana , Neisseria meningitidis/aislamiento & purificación , Orofaringe/microbiología , Prevalencia , Factores de Riesgo , Instituciones Académicas/estadística & datos numéricos , Serogrupo
3.
BMC Infect Dis ; 20(1): 279, 2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-32293324

RESUMEN

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.


Asunto(s)
Portador Sano/epidemiología , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/inmunología , Vacunas Conjugadas/inmunología , Antibacterianos/uso terapéutico , Portador Sano/microbiología , Niño , Preescolar , Estudios Transversales , Farmacorresistencia Bacteriana Múltiple , Femenino , Humanos , Lactante , Macrólidos/uso terapéutico , Masculino , Pruebas de Sensibilidad Microbiana , Tipificación de Secuencias Multilocus , Nasofaringe/microbiología , Penicilinas/uso terapéutico , Infecciones Neumocócicas/tratamiento farmacológico , Prevalencia , Federación de Rusia/epidemiología , Serogrupo , Serotipificación , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación
4.
Niger Postgrad Med J ; 27(2): 136-142, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32295946

RESUMEN

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.


Asunto(s)
Antibacterianos/uso terapéutico , Portador Sano/epidemiología , Infección Hospitalaria/microbiología , Infecciones por Enterobacteriaceae/diagnóstico , Enterobacteriaceae/aislamiento & purificación , Hospitalización/estadística & datos numéricos , beta-Lactamasas/biosíntesis , Adolescente , Antibacterianos/farmacología , Portador Sano/microbiología , Niño , Infección Hospitalaria/epidemiología , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Hospitales de Enseñanza , Humanos , Nigeria/epidemiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo
5.
R I Med J (2013) ; 103(2): 18-20, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32122094

RESUMEN

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.


Asunto(s)
Antibacterianos/farmacología , Portador Sano/microbiología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Cavidad Nasal/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Portador Sano/epidemiología , Femenino , Humanos , Masculino , Resistencia a la Meticilina , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Cuidados Preoperatorios , Periodo Preoperatorio , Prevalencia , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/efectos de los fármacos
6.
PLoS One ; 15(3): e0230332, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32182260

RESUMEN

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.


Asunto(s)
Antibacterianos/farmacología , Portador Sano/microbiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/uso terapéutico , Streptococcus pneumoniae/aislamiento & purificación , Antibacterianos/uso terapéutico , Portador Sano/diagnóstico , Portador Sano/epidemiología , Preescolar , Farmacorresistencia Bacteriana Múltiple , Femenino , Implementación de Plan de Salud/organización & administración , Implementación de Plan de Salud/estadística & datos numéricos , Humanos , Islandia/epidemiología , Programas de Inmunización/organización & administración , Programas de Inmunización/estadística & datos numéricos , Esquemas de Inmunización , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Otitis Media , Resistencia a las Penicilinas , Faringe/microbiología , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Evaluación de Programas y Proyectos de Salud , Serotipificación/estadística & datos numéricos , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/inmunología
7.
PLoS One ; 15(2): e0229021, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32032364

RESUMEN

BACKGROUND: The nasopharynx can from time to time accommodate otherwise pathogenic bacteria. This phenomenon is called asymptomatic carriage. However, in case of decreased immunity, viral infection or any other enhancing factors, severe disease can develop. Our aim in this study was to survey the nasal carriage rates of four important respiratory pathogens in three different age groups of children attending nurseries, day-care centres and primary schools. This is the first study from Hungary about the asymptomatic carriage of H. influenzae and M. catarrhalis. METHODS: Altogether 580 asymptomatic children were screened in three Hungarian cities. Samples were collected from both nostrils with cotton swabs. The identification was based on both colony morphology and species-specific PCRs. Serotyping was performed for S. pneumoniae, H. influenzae and M. catarrhalis. Antibiotic susceptibility was determined with agar dilution, according to the EUCAST guidelines. Clonality was examined by PFGE. RESULTS AND CONCLUSIONS: Whereas the carriage rates of S. pneumoniae, H. influenzae and M. catarrhalis clearly decreased with age, that of S. aureus showed an opposite tendency. Multiple carriage was least prevalent if S. aureus was one of the participants. The negative association between this bacterium and the others was statistically significant. For pneumococcus, the overall carriage rate was lower compared to earlier years, and PCV13 serotypes were present in only 6.2% of the children. The majority of H. influenzae isolates was non-typeable and no type b was detected; serotype A was dominant among M. catarrhalis. All four bacteria were more sensitive to antibiotics compared to clinical isolates. No MRSAs were detected, but we found three mupirocin resistant strains. The positive effect of Hib- and PCV-vaccination is undoubted. Continued surveillance of these pathogens is required.


Asunto(s)
Portador Sano/epidemiología , Portador Sano/microbiología , Haemophilus influenzae , Moraxella catarrhalis , Nasofaringe/microbiología , Staphylococcus aureus , Streptococcus pneumoniae , Adolescente , Factores de Edad , Antibacterianos/farmacología , Niño , Preescolar , Coinfección/epidemiología , Coinfección/microbiología , Femenino , Infecciones por Haemophilus/epidemiología , Infecciones por Haemophilus/microbiología , Haemophilus influenzae/clasificación , Haemophilus influenzae/efectos de los fármacos , Haemophilus influenzae/genética , Haemophilus influenzae/aislamiento & purificación , Humanos , Hungría/epidemiología , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Moraxella catarrhalis/clasificación , Moraxella catarrhalis/efectos de los fármacos , Moraxella catarrhalis/genética , Moraxella catarrhalis/aislamiento & purificación , Infecciones por Moraxellaceae/epidemiología , Infecciones por Moraxellaceae/microbiología , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Vigilancia en Salud Pública , Factores de Riesgo , Serogrupo , Staphylococcus aureus/clasificación , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/aislamiento & purificación
8.
PLoS Negl Trop Dis ; 14(2): e0007875, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32084128

RESUMEN

BACKGROUND: Clinical observations and animal studies have suggested that Salmonella intestinal carriage is promoted by concurrent Schistosoma infection. The present study assessed association of Salmonella intestinal carriage and Schistosoma mansoni infection among individuals in a Schistosoma endemic area in sub-Saharan Africa. METHODS: From November 2015 to March 2016, a cross-sectional community-wide study was conducted in Kifua II, a rural village in Kongo Central Province, Democratic Republic of Congo. Stool samples were collected and analyzed for Salmonella intestinal carriage (culture) and Schistosoma mansoni infection (Kato Katz microscopy with determination of egg load). Salmonella Typhimurium and Enteritidis isolates were assessed for genetic similarity with blood culture isolates obtained during the same period in a neighboring hospital using multi-locus variable-numbers tandem repeat analysis (MLVA). RESULTS: A total of 1,108 participants were included (median age 15 years (IQR: 7-36), male-to-female ratio of 1:1.1). The overall prevalence of Schistosoma mansoni infection and non-typhoidal Salmonella carriage was 51.2% (95% CI: 48.2-54.1) and 3.4% (95% CI: 2.5-4.7) respectively, with 2.2% (95% CI: 1.5-3.2) of participants coinfected. The proportion of Salmonella carriage tended to be higher among Schistosoma mansoni infected participants compared to non-infected participants but this difference did not reach statistical significance (4.2% versus 2.6%, p = 0.132). However, the proportion of Salmonella carriage among participants with a heavy Schistosoma mansoni infection was significantly higher compared to those with a light and moderate infection (8.7% versus 3.2%, p = 0.012) and compared to Schistosoma mansoni negatives (8.7% versus 2.6%, p = 0.002). The 38 Salmonella isolates comprised five and four Enteritidis and Typhimurium serotypes respectively, the majority of them had MLVA types identical or similar to those observed among blood culture isolates. CONCLUSION: Salmonella intestinal carriage was associated with a heavy intensity of Schistosoma mansoni infection. Further studies are needed to address causation.


Asunto(s)
Portador Sano/microbiología , Intestinos/microbiología , Salmonella typhimurium/aislamiento & purificación , Esquistosomiasis mansoni/parasitología , Adolescente , Adulto , Animales , Portador Sano/epidemiología , Niño , Coinfección/epidemiología , Coinfección/microbiología , Coinfección/parasitología , Estudios Transversales , República Democrática del Congo/epidemiología , Femenino , Humanos , Masculino , Población Rural , Salmonella typhimurium/genética , Schistosoma mansoni/genética , Schistosoma mansoni/aislamiento & purificación , Schistosoma mansoni/fisiología , Esquistosomiasis mansoni/epidemiología , Adulto Joven
9.
BMC Infect Dis ; 20(1): 29, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31924177

RESUMEN

BACKGROUND: Streptococcus pneumoniae carriage is often asymptomatic but can cause invasive pneumococcal disease. Pneumococcal carriage is a prerequisite for disease, with children as main reservoir and transmitters. Childhood carriage can therefore be used to determine which serotypes circulate in the population and which may cause disease in the non-vaccinated population. In 2006, a pneumococcal conjugate vaccine (PCV7) was introduced into the Norwegian Childhood Immunisation Programme, which was replaced by the more valent PCV13 in 2011. We investigated changes in pneumococcal carriage prevalence 4 years after switching to PCV13 compared to three previous surveys, and analysed factors associated with carriage in children. METHODS: We conducted a cross-sectional study in Norway, autumn 2015, among children attending day-care centres. We collected questionnaire data and nasopharyngeal swabs to identify pneumococcal serotypes. We compared the carriage prevalence in 2015 with surveys conducted in the same setting performed before widespread vaccination (2006; n = 610), 2 years after PCV7 introduction (2008; n = 600), and 2 years after switching to PCV13 (2013; n = 874). Using multilevel logistic regression we determined the association between pneumococcal carriage and previously associated factors. RESULTS: In 2015, 896 children participated, with age ranging from 8 to 80 months. The overall carriage prevalence was 48/100 children [95%CI 44-53] in 2015, 38% [29-46] lower than in 2006 pre-PCV7, and 23% [12-32] lower than in 2013, 2 years after switching to PCV13. The PCV13 carriage prevalence was 2.8/100 children [1.9-4.2] in 2015. Increasing age (p < 0.001), recent antimicrobial use (odds ratio = 0.42 [0.21-0.57]) and being vaccinated (odds ratio = 0.37 [0.29-0.47]) were negatively associated with carriage. CONCLUSIONS: Our study showed a continued decrease in overall pneumococcal carriage, mainly fuelled by the decline in vaccine serotypes after vaccine introduction. Childhood vaccination with PCV13 should be continued to keep low PCV13 carriage, transmission and disease. Furthermore, the low prevalence of PCV13-type carriage in children endorse the choice of not recommending PCV13 in addition to the 23-valent pneumococcal polysaccharide vaccine to most medical risk groups in Norway, as little disease caused by these serotypes can be expected.


Asunto(s)
Portador Sano/epidemiología , Portador Sano/microbiología , Factores Inmunológicos/uso terapéutico , Vacunas Neumococicas/uso terapéutico , Streptococcus pneumoniae/inmunología , Portador Sano/prevención & control , Niño , Preescolar , Estudios Transversales , Análisis Factorial , Femenino , Vacuna Neumocócica Conjugada Heptavalente/uso terapéutico , Humanos , Programas de Inmunización/tendencias , Lactante , Pruebas de Fijación de Látex , Masculino , Noruega/epidemiología , Oportunidad Relativa , Prevalencia , Serogrupo , Encuestas y Cuestionarios , Vacunación , Vacunas Conjugadas/uso terapéutico
10.
N Engl J Med ; 382(4): 318-327, 2020 01 23.
Artículo en Inglés | MEDLINE | ID: mdl-31971677

RESUMEN

BACKGROUND: The meningococcal group B vaccine 4CMenB is a new, recombinant protein-based vaccine that is licensed to protect against invasive group B meningococcal disease. However, its role in preventing transmission and, therefore, inducing population (herd) protection is uncertain. METHODS: We used cluster randomization to assign, according to school, students in years 10 to 12 (age, 15 to 18 years) in South Australia to receive 4CMenB vaccination either at baseline (intervention) or at 12 months (control). The primary outcome was oropharyngeal carriage of disease-causing Neisseria meningitidis (group A, B, C, W, X, or Y) in students in years 10 and 11, as identified by polymerase-chain-reaction assays for PorA (encoding porin protein A) and N. meningitidis genogroups. Secondary outcomes included carriage prevalence and acquisition of all N. meningitidis and individual disease-causing genogroups. Risk factors for carriage were assessed at baseline. RESULTS: A total of 237 schools participated. During April through June 2017, a total of 24,269 students in years 10 and 11 and 10,220 students in year 12 were enrolled. At 12 months, there was no difference in the prevalence of carriage of disease-causing N. meningitidis between the vaccination group (2.55%; 326 of 12,746) and the control group (2.52%; 291 of 11,523) (adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.80 to 1.31; P = 0.85). There were no significant differences in the secondary carriage outcomes. At baseline, the risk factors for carriage of disease-causing N. meningitidis included later year of schooling (adjusted odds ratio for year 12 vs. year 10, 2.75; 95% CI, 2.03 to 3.73), current upper respiratory tract infection (adjusted odds ratio, 1.35; 95% CI, 1.12 to 1.63), cigarette smoking (adjusted odds ratio, 1.91; 95% CI, 1.29 to 2.83), water-pipe smoking (adjusted odds ratio, 1.82; 95% CI, 1.30 to 2.54), attending pubs or clubs (adjusted odds ratio, 1.54; 95% CI, 1.28 to 1.86), and intimate kissing (adjusted odds ratio, 1.65; 95% CI, 1.33 to 2.05). No vaccine safety concerns were identified. CONCLUSIONS: Among Australian adolescents, the 4CMenB vaccine had no discernible effect on the carriage of disease-causing meningococci, including group B. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT03089086.).


Asunto(s)
Portador Sano/prevención & control , Infecciones Meningocócicas/prevención & control , Vacunas Meningococicas/inmunología , Neisseria meningitidis Serogrupo B/aislamiento & purificación , Neisseria meningitidis/aislamiento & purificación , Adolescente , Australia/epidemiología , Portador Sano/epidemiología , Femenino , Humanos , Masculino , Neisseria meningitidis/genética , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Serogrupo , Método Simple Ciego
11.
APMIS ; 128(1): 35-40, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31628868

RESUMEN

Kingella kingae colonizes the upper airways in children and has been recognized as the most common causative agent of osteoarticular infections (OAI) in children below 4 years of age. This is the first Scandinavian study to investigate oropharyngeal K. kingae carriage in healthy children. From June 2015 to August 2016, we recruited 198 healthy children aged 11-14 months from routine consultations at health promotion centers in Hordaland County, Norway for a cross-sectional study. After their parents had provided informed consent; demographic data were registered, and an oropharyngeal swab was collected. The oropharyngeal swab was analyzed with a real-time PCR assay specific to K. kingae targeting the RTX toxin locus. Results showed an asymptomatic carriage rate of 12.6%. A striking and highly significant difference was observed between the children that had started attending day care facilities as compared with children still being at home (33.33% vs 8.5%; p < 0.001). K. kingae is prevalent in young children in Norway. This study emphasize that K. kingae should be considered an important etiological agent in OAI. Transmission seems to be facilitated in day care facilities. The correlation between oropharyngeal carriage and OAI needs to be further explored.


Asunto(s)
Portador Sano/epidemiología , Portador Sano/microbiología , Jardines Infantiles , Kingella kingae/aislamiento & purificación , Infecciones por Neisseriaceae/epidemiología , Orofaringe/microbiología , Infecciones Asintomáticas/epidemiología , Proteínas Bacterianas/genética , Estudios Transversales , Femenino , Humanos , Lactante , Kingella kingae/genética , Masculino , Noruega/epidemiología , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Reacción en Cadena de la Polimerasa , Prevalencia , Estudios Prospectivos
12.
Diagn Microbiol Infect Dis ; 96(1): 114914, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31704066

RESUMEN

Russia introduced PCV13 in 2014. We studied the serotype composition of S. pneumoniae isolated from the nasopharynx of healthy children younger than 6 years in St. Petersburg, Smolensk, Perm, Krasnoyarsk, Khanty-Mansiysk and Khabarovsk, between 2016 and 2018. 2.4% of children had completed a 3-dose course of PCV13, while 25.6% had received 1 or 2 doses. Pneumococcal DNA detection by PCR demonstrated S. pneumoniae in 37.2% of samples with regional variation between sites (27.3 to 56.9%). There was little difference between vaccinated, partially vaccinated and un-vaccinated children. Children who had received at least 1 dose of PCV13 had lower carriage rates of vaccine serotypes than their unvaccinated peers (49.9 vs. 61.4%; p < 0.001). Children who had received at least 1 dose of PCV13 showed increased carriage rates of non-vaccine serotypes (50 vs 38.6%; P < 0.001). Especially serogroup 15AF was more prevalent among fully immunized children than among their peers (12.5 vs 2.7%; P < 0.05).


Asunto(s)
Portador Sano/microbiología , Programas de Inmunización , Nasofaringe/microbiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , Streptococcus pneumoniae/clasificación , Portador Sano/epidemiología , Niño , Preescolar , Voluntarios Sanos , Humanos , Lactante , Recién Nacido , Infecciones Neumocócicas/epidemiología , Prevalencia , Federación de Rusia/epidemiología , Serogrupo , Streptococcus pneumoniae/genética
13.
BMC Infect Dis ; 19(1): 1023, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791276

RESUMEN

BACKGROUND: Staphylococcus aureus carriage is a known risk factor for staphylococcal disease. However, the carriage rates vary by country, demographic group and profession. This study aimed to determine the S. aureus carriage rate in children in Eastern Uganda, and identify S. aureus lineages that cause infection in Uganda. METHODS: Nasopharyngeal samples from 742 healthy children less than 5 years residing in the Iganga/Mayuge Health and Demographic Surveillance Site in Eastern Uganda were processed for isolation of S. aureus. Antibiotic susceptibility testing based on minimum inhibitory concentrations (MICs) was determined by the BD Phoenix™ system. Genotyping was performed by spa and SCCmec typing. RESULTS: The processed samples yielded 144 S. aureus isolates (one per child) therefore, the S. aureus carriage rate in children was 19.4% (144/742). Thirty one percent (45/144) of the isolates were methicillin resistant (MRSA) yielding a carriage rate of 6.1% (45/742). All isolates were susceptible to rifampicin, vancomycin and linezolid. Moreover, all MRSA were susceptible to vancomycin, linezolid and clindamycin. Compared to methicillin susceptible S. aureus (MSSA) isolates (68.8%, 99/144), MRSA isolates were more resistant to non-beta-lactam antimicrobials -trimethoprim/sulfamethoxazole 73.3% (33/45) vs. 27.3% (27/99) [p < 0.0001]; erythromycin 75.6% (34/45) vs. 24.2% (24/99) [p < 0.0001]; chloramphenicol 60% (27/45) vs. 19.2% (19/99) [p < 0.0001]; gentamicin 55.6% (25/45) vs. 25.3% (25/99) [p = 0.0004]; and ciprofloxacin 35.6% (16/45) vs. 2% (2/99) [p < 0.0001]. Furthermore, 42 MRSA (93.3%) were multidrug resistant (MDR) and one exhibited high-level resistance to mupirocin. Overall, 61 MSSA (61.6%) were MDR, including three mupirocin and clindamycin resistant isolates. Seven spa types were detected among MRSA, of which t037 and t064 were predominant and associated with SCCmec types I and IV, respectively. Fourteen spa types were detected in MSSA which consisted mainly of t645 and t4353. CONCLUSIONS: S. aureus carriage rate in healthy children in Eastern Uganda is high and comparable to rates for hospitalized patients in Kampala. The detection of mupirocin resistance is worrying as it could rapidly increase if mupirocin is administered in a low-income setting. S. aureus strains of spa types t064, t037 (MRSA) and t645, t4353 (MSSA) are prevalent and could be responsible for majority of staphylococcal infections in Uganda.


Asunto(s)
Antígenos Bacterianos/análisis , Portador Sano/epidemiología , Farmacorresistencia Bacteriana , Nariz/microbiología , Faringe/microbiología , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Antígenos Bacterianos/clasificación , Antígenos Bacterianos/genética , Portador Sano/microbiología , Preescolar , Estudios Transversales , Farmacorresistencia Bacteriana/genética , Femenino , Técnicas de Genotipaje/métodos , Humanos , Lactante , Recién Nacido , Masculino , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Tipificación Molecular/métodos , Mupirocina/farmacología , Mupirocina/uso terapéutico , Mucosa Nasal/microbiología , Vigilancia de la Población/métodos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/genética , Uganda/epidemiología
14.
BMC Pregnancy Childbirth ; 19(1): 480, 2019 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-31805881

RESUMEN

BACKGROUND: Despite the well-documented associations between poor maternal oral health and increased risk for adverse birth outcomes and dental caries in children after birth, prenatal oral health care is under-utilized, especially among the underserved population. In addition, oral Candida has recently been suggested as a potential culprit for children's dental caries, with evident maternal contributions. Therefore, this study aimed to obtain epidemiological data on the oral health and oral Candida carriage in a cohort of underserved US pregnant women, and reveal factors associated with their oral Candida carriage. METHODS: Demographic-medical-oral hygiene practice data were collected. Comprehensive oral examination was conducted. Caries status and plaque index were recorded. Oral samples (saliva, plaque and swab) were processed to identify Candida species and Streptococcus mutans by culturing-dependent and -independent methods. Multiple logistic regression analyses were used to identify factors associated with oral Candida carriage and caries severity. RESULTS: Eighty-two socioeconomically disadvantaged women (48 pregnant and 34 non-pregnant) were enrolled. More pregnant women (79.1%) had > = 1 untreated decayed tooth when compared to their non-pregnant counterparts (47.1%) (p = 0.01). The average number of decayed teeth in pregnant and non-pregnant women was 3.9 and 3.1 (p > 0.05). Caries severity was positively associated with race (African American vs. white), plaque index and salivary Candida albicans level. C. albicans was the most predominant/abundant Candida strain, with cheek and tonsil as the most common colonized sites. The detection of C. albicans was 56%/56% in saliva and 40%/47% in plaque of the pregnant and non-pregnant groups, respectively. Study women's oral Candida carriage is positively associated with hypertension [p = 0.03, odds ratio = 14.47(1.28, 163.51)], decayed teeth number [p = 0.04, odds ratio = 1.31 (1.01,1.69)] and salivary S. mutans level [p = 0.03, odds ratio = 4.80 (1.18-19.43)]. CONCLUSIONS: Socioeconomically disadvantaged US women are in need of improved prenatal oral health, a large proportion of them have untreated decayed teeth and high carriage of oral Candida. Due to the observed significant association between the decayed teeth number and oral Candida carriage, providing oral health care during pregnancy (including limiting decayed teeth) will not only improve women's oral health, but also present as a promising approach to reduce oral Candida carriage in women.


Asunto(s)
Candida/aislamiento & purificación , Portador Sano/epidemiología , Boca/microbiología , Salud Bucal/estadística & datos numéricos , Poblaciones Vulnerables/estadística & datos numéricos , Adulto , Candida albicans/aislamiento & purificación , Candidiasis Bucal/epidemiología , Portador Sano/microbiología , Estudios de Casos y Controles , Caries Dental/microbiología , Femenino , Humanos , Modelos Logísticos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal/estadística & datos numéricos , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiología , Vagina/microbiología , Adulto Joven
15.
Pan Afr Med J ; 33: 239, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692895

RESUMEN

Introduction: Streptococcus pneumonia is a leading cause of bacterial pneumonia, meningitis and sepsis in children, and pneumococcal carriage is an important source of horizontal spread of these pathogens within the community. Methods: A questionnaire was addressed to parents for the collection of sociodemographic and medical information. Nasopharyngeal swabbing was processed using a molecular method. We used logistic regression models to examine independent associations between pneumococcal carriage and potential risk factors. All associations with a p-value of < 0.25 in the bivariate regression analyses were subsequently entered in the multivariate regression model. Results: A total of 637 children aged 1 to 59 months admitted for acute respiratory infection were included. The rate of respiratory virus carriage was 76%, whereas that of bacteria was 47% and that of bacteria-virus co-colonization was 42%. A bivariate analysis showed that carriage was not related to gender, father's or mother's education level, father's occupation, type of housing or lighting, or passive exposure to cigarette smoking in the house. It was also not linked to complete vaccination with PCV-13 or PPSV-23 and antibiotic treatment prior to hospitalization. A multivariate analysis showed that carriage was related to age greater than 3 months, maternal occupation, house flooring type, and co-colonization of another bacterium and virus. Conclusion: These results can be helpful to understand the dynamics of pneumococcal nasopharyngeal colonization; they confirm the interest of vaccinating infants before the age of 3 months with appropriate vaccine to prevent spread nasopharyngeal colonization and pneumococcal diseases in children.


Asunto(s)
Portador Sano/epidemiología , Nasofaringe/microbiología , Infecciones del Sistema Respiratorio/epidemiología , Streptococcus pneumoniae/aislamiento & purificación , Antibacterianos/administración & dosificación , Portador Sano/microbiología , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Niger , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Vacunas Neumococicas/administración & dosificación , Infecciones del Sistema Respiratorio/microbiología , Factores de Riesgo , Encuestas y Cuestionarios
16.
J Med Microbiol ; 68(12): 1793-1801, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31674897

RESUMEN

Introduction. Colonization by Neisseria meningitidis is the pre-requisite for the development of disease. We present the findings of a cross-sectional investigation onto the oropharyngeal carriage of N. meningitidis and Neisseria species in the population aged 3 to 21 in Paraguay.Aim. Carriage prevalence by age groups, risk factors associated with carriage, and phenotypic and genotypic characteristics of strains are described.Methodology. We collected 2011 oropharyngeal swabs from consenting participants aged 3-21 years. Infants were recruited at immunization clinics, and older children and young adults were identified at schools and universities. A single oropharyngeal swab was collected and processed for the identification and isolation of Neisseria. Additionally, participants, or their legal guardian if these were minors, were requested to fill a standardized questionnaire.Results. N. meningitidis was isolated in 42/2011 (2.1 %) participants, while other Neisseria spp. were identified in 306/2011 (15.2 %) subjects: N. cinerea and N. lactamica were identified in 39/2011 (1.9 %) and 43/2011 (2.2 %), respectively. Meningococcal strains belonged to ten different clonal complexes, of which six are associated with invasive disease (ST-32/ET5 complex, ST-11/ET37 complex, ST-103 complex, ST-167 complex, ST-35 complex and ST-41/44 complex/lineage 3).Conclusion. Prevalence of N. meningitidis carriage was low compared to that reported from other settings, however, the overall carriage of Neisseria spp. (including N. meningitidis) was comparable to meningococcal carriage prevalence reported in the literature. This study is the first of its kind conducted in Paraguay, and one of the few known in the Southern Cone of Latin America.


Asunto(s)
Portador Sano/epidemiología , Neisseria meningitidis/aislamiento & purificación , Neisseria/aislamiento & purificación , Orofaringe/microbiología , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Neisseria/clasificación , Paraguay , Adulto Joven
17.
Ann Clin Microbiol Antimicrob ; 18(1): 28, 2019 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-31601221

RESUMEN

BACKGROUND: The emergence of vancomycin-resistant Staphylococcus aureus (VRSA) has become a global concern for public health. The proximity of vancomycin-resistant enterococcus (VRE) and methicillin-resistant S. aureus (MRSA) is considered to be one of the foremost risk factors for the development of VRSA. This study aimed to determine the incidence, risk factors, and clinical outcomes of intestinal co-colonization with VRE and MRSA. METHODS: A case-control study was conducted in 52-bed intensive care units (ICUs) of a university-affiliated hospital from September 2012 to October 2017. Active surveillance using rectal cultures for VRE were conducted at ICU admission and on a weekly basis. Weekly surveillance cultures for detection of rectal MRSA were also conducted in patients with VRE carriage. Patients with intestinal co-colonization of VRE and MRSA were compared with randomly selected control patients with VRE colonization alone (1:1). Vancomycin minimum inhibitory concentrations (MICs) for MRSA isolates were determined by the Etest. RESULTS: Of the 4679 consecutive patients, 195 cases and 924 controls were detected. The median monthly incidence and duration of intestinal co-colonization with VRE and MRSA were 2.3/1000 patient-days and 7 days, respectively. The frequency of both MRSA infections and mortality attributable to MRSA were higher in the case group than in the control group: 56.9% vs. 44.1% (P = 0.011) and 8.2% vs. 1.0% (P = 0.002), respectively. Independent risk factors for intestinal co-colonization were enteral tube feeding (odds ratio [OR], 2.09; 95% confidence interval [CI] 1.32-3.32), metabolic diseases (OR, 1.75; 95% CI 1.05-2.93), male gender (OR, 1.62; 95% CI 1.06-2.50), and Charlson comorbidity index < 3 (OR, 3.61; 95% CI 1.88-6.94). All MRSA isolates from case patients were susceptible to vancomycin (MIC ≤ 2 mg/L). CONCLUSIONS: Our study indicates that intestinal co-colonization of VRE and MRSA occurs commonly among patients in the ICU with MRSA endemicity, which might be associated with poor clinical outcomes.


Asunto(s)
Portador Sano/epidemiología , Coinfección/epidemiología , Tracto Gastrointestinal/microbiología , Infecciones por Bacterias Grampositivas/epidemiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Anciano , Antibacterianos/farmacología , Portador Sano/microbiología , Estudios de Casos y Controles , Coinfección/microbiología , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Hospitales Universitarios , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Factores de Riesgo
18.
PLoS One ; 14(10): e0223599, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31647842

RESUMEN

OBJECTIVE: To comprehensively determine the prevalence of MRSA in healthy Chinese population, the influencing factors of MRSA colonization and its antibiotic resistance. METHODS: Articles that studied prevalence or influencing factors of MRSA carriage in healthy Chinese population were retrieved from PubMed, Ovid database, three Chinese electronic databases. The pooled prevalence of MRSA, its antibiotic resistance and influencing factors were analyzed by STATA12.0. RESULTS: 37 studies were included. The pooled prevalence of MRSA was 21.2% (95% CI: 18.5%-23.9%), and the prevalence of S.aureus was 15% (95% CI: 10%-19%), with a significant heterogeneity (MRSA: I2 = 97.6%, P<0.001; S.aureus: I2 = 98.4%, P < 0.001). In subgroup analysis, the pooled prevalence of MRSA was 28% (95%CI: 10%-51%) for Livestock-related workers, 18% (95%CI: 11%-26%) for children, 20% (95%CI: 12%-29%) for healthcare workers, 7% (95%CI: 3%-13%) for community residents. The prevalence of MRSA in studies with oxacillin disk diffusion method (28%, 95%CI: 21%-35%) seemed higher than that with the mecA gene method(12%, 95%CI: 7%-19%). MRSA in studies conducted in Taiwan was more common than in Mainland China and Hong Kong. Similar results were found in meta-regression. Influencing factors for MRSA colonization were noted in seven eligible studies, they included younger age (OR: 3.54, 95% CI: 2.38-5.26; OR: 2.24, 95% CI: 1.73-2.9), attending day care centers (DCCs) (OR: 1.95, 95% CI: 1.4-2.72; OR: 1.53, 95% CI: 1.2-1.95), flu vaccination (OR:1.73, 95% CI: 1.28-2.35), using antibiotics within the past year (OR: 2.05, 95% CI:1.35-3.11), residing in northern Taiwan (OR: 1.45, 95% CI: 1.19-1.77), regular visits to health care facility (OR: 23.83, 95% CI: 2.72-209.01), household member working in health care facility (OR: 8.98, 95% CI:1.4-55.63), and contact with livestock (OR: 6.31, 95% CI: 3.44-11.57). Moreover, MRSA was found to be highly resistant to penicillin, ampicillin, erythromycin, and clindamycin, with a pooled resistance ratio of 100, 93, 88, and 75%, respectively. However, no resistance were noted to vancomycin. CONCLUSION: The pooled prevalence of MRSA was considerably high in health Chinese population. Additionally, these strains showed extreme resistance to penicillin, ampicillin, erythromycin and clindamycin. Public MRSA protection measures and the surveillance of MRSA should be strengthened to reduce the spread of MRSA among hospitals, communities, and livestock.


Asunto(s)
Portador Sano/epidemiología , Portador Sano/microbiología , Staphylococcus aureus Resistente a Meticilina , Voluntarios Sanos , Humanos , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/genética , Oportunidad Relativa , Vigilancia de la Población , Prevalencia , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología
19.
Ir Med J ; 112(8): 988, 2019 09 12.
Artículo en Inglés | MEDLINE | ID: mdl-31650818

RESUMEN

Aims To define the burden of wound complications in patients with infra-inguinal bypass surgery. Methods A retrospective review of 50 consecutive patients from January 2012 to July 2017. Data collected included patient demographics, operative details, length of stay (LOS) and postoperative complications. Results The average age was 64 years (range 25-88 years) and 10 had a body mass index (BMI) ≥25 kg/m2. Pre-operative methicillin-resistant Staphylococcus aureus (MRSA) screening was performed in 17 patients (n=4 positive). Surgical antimicrobial prophylaxis (SAP) continued longer than 24 hours in 25. Surgical site infection (SSI) was the most common complication (n=10) and associated with female gender (p= 0.039), high BMI (p=0.017), shorter preoperative (p=0.039) and longer postoperative LOS (p=0.022). Three of 46 patients and four of 38 had graft occlusion at 30 days and one year respectively. Conclusion Pre-operative co-morbidity (e.g., BMI reduction), and MRSA screening optimization and SAP are areas identified for improvement.


Asunto(s)
Profilaxis Antibiótica/estadística & datos numéricos , Arteria Femoral/cirugía , Sobrepeso/epidemiología , Enfermedad Arterial Periférica/cirugía , Arteria Poplítea/cirugía , Infección de la Herida Quirúrgica/epidemiología , Injerto Vascular , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Portador Sano/diagnóstico , Portador Sano/tratamiento farmacológico , Portador Sano/epidemiología , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Staphylococcus aureus Resistente a Meticilina , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Hemorragia Posoperatoria/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Seroma/epidemiología , Factores Sexuales , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Procedimientos Quirúrgicos Vasculares
20.
Arch Pediatr ; 26(8): 453-458, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31645292

RESUMEN

OBJECTIVES: In Morocco, 13-valent pneumococcal conjugated vaccine (PCV) was introduced in the childhood immunization program in October 2010 and changed to PCV-10 in July 2012. The purpose of this study was firstly to determine the prevalence of pneumococcus carriage in a population of febrile infants in Marrakesh and secondly, to investigate the risk factors for carriage and the distribution of circulating serotypes. MATERIAL AND METHODS: This prospective study was conducted from February to June 2017, in the pediatric emergency department of the Mother and Child Hospital of Mohammed VI University Hospital Centre (UHC) in Marrakesh. At total of 183febrile infants, aged 2-18months, were enrolled in this study and were swabbed for nasopharyngeal carriage. Pneumococci were cultured, identified, serotyped, and tested for penicillin susceptibility. Demographic data and risk factors for carriage were collected. The statistical analyses performed were the following: the analysis of the risk factors using logistic regression, the estimation of serotype diversity with the Simpson index, and the Chi2 test to compare serotype distribution in the prevaccination (a cohort of 660 healthy children, less than 2years old, in the Marrakesh region, in 2008-2009) and postvaccination periods. RESULTS: The prevalence of Streptococcus pneumoniae carriage was 68.3%. Of the 183infants enrolled in this study, 111 had received at least one dose of PCV-10. Colonization by vaccine serotype among febrile children was related to incomplete vaccination status. In total, vaccine serotypes accounted for 6.4% (n=8): 19F (n=2), 1 (n=2) and one strain for each of the following serotypes: 14, 23F, 6B, and 9V. Non-vaccine and nontypeable strains presented 63.2% and 23.2%, respectively, with dominance of serotypes 6A (6.4%), 15A/15F (5.6%), 20, 22F/22A, 23B, and 11A/11D with a prevalence of 3.2%. The rate of pneumococcus strains with reduced susceptibility to penicillin was 33.6%, of which 90.2% were non-vaccine serotypes and nontypeable strains. Serotype diversity increased in the postvaccination period and the effectiveness of PCV-10 against vaccine serotypes was estimated at 89.6%. CONCLUSION: An important change in the distribution of vaccine and non-vaccine serotypes was observed after the introduction of the PCVs. In fact, the prevalence of vaccine serotypes decreased significantly while non-vaccine serotypes emerged. These results underscore the importance of maintaining close and prolonged surveillance of serotype distribution to monitor the dynamics of nasopharyngeal pneumococcal carriage.


Asunto(s)
Portador Sano/epidemiología , Portador Sano/microbiología , Fiebre/microbiología , Inmunización , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Vacunas Neumococicas , Streptococcus pneumoniae/aislamiento & purificación , Urgencias Médicas , Femenino , Hospitales Universitarios , Humanos , Lactante , Masculino , Marruecos , Infecciones Neumocócicas/prevención & control , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Serogrupo , Streptococcus pneumoniae/clasificación
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