Deep, respiratory tract and ear infections caused by Pseudallescheria (Scedosporium) and Microascus (Scopulariopsis) in Finland. A 10-year retrospective multi-center study.

Deep, respiratory tract and ear infections due to Microascaceae (Pseudallescheria, Scedosporium, Microascus or Scopulariopsis) were studied nationwide in Finland during 1993-2002. The data were based on 52,000 fungal cultures that represented about 50% of all such specimens in Finland and included all Finnish cases of profound immunosuppression. There were 39 cases that were re-evaluated as clinically significant, i.e., three pneumonias, two deep pedal infections and five wound infections, 11 sinusitis and 18 ear infections. The pedal infections and most pneumonias occurred in immunocompromised patients. Most cases, except the ear infections, were due to Pseudallescheria boydii. Two patients had lethal P. boydii pneumonia and a deep P. boydii infection of the foot contributed to a third lethal case. Two of the patients with lethal outcomes had received an allogeneic haematopoietic stem cell transplantation (AHSCT). Two patients with haematological malignancies were cured of deep site infections by a prolonged course of itraconazole. Wound, sinus and ear infections were cured or improved by local surgery or topical therapy. There were 0.8-1.7 cases of any type of infection per million inhabitants per year (MY) and 3.4 cases/1000 AHSCT. Mortality associated with Microascaceae in any type of patient was 0.06-0.12 MY.

Antimicrobial resistance in Neisseria gonorrhoeae in Finland, 1976 to 1995. The Finnish Study Group For Antimicrobial Resistance.

BACKGROUND AND OBJECTIVES: The worldwide increase in antimicrobial resistance in Neisseria gonorrhoeae prompted the authors to evaluate the status and course of resistance in gonococci in Finland. GOALS: The minimal inhibitory concentrations (MIC) of penicillin, tetracycline, spectinomycin, ciprofloxacin, ceftriaxone, and cefixime were tested for 337 consecutive clinical N. gonorrhoeae isolates collected in 19 Finnish microbiology laboratories in 1993. STUDY DESIGN: The results were compared with data obtained in three Finnish laboratories in 1986 and contrasted with the development of the incidence of gonorrhea and the prevalence of penicillinase-producing N. gonorrhoeae (PPNG) in Finland, 1976 to 1995. The number of strains with an elevated MIC to ciprofloxacin was assessed by questionnaire. RESULTS: A decrease, from more than 50% in 1986 to 20% in 1993, of strains susceptible to penicillin and tetracycline was observed. The prevalence of PPNG increased from 0% (1976) to 5.7% (1995). In 1995, two strains with a ciprofloxacin MIC of > or = 32 micrograms/ml were reported. No resistance to ceftriaxone or spectinomycin was detected. CONCLUSIONS: In spite of the rarity of gonorrhea and the availability of efficient antimicrobials in Finland, monitoring of the antimicrobial resistance of N. gonorrhoeae remains important.

Epidemiology of invasive Streptococcus pneumoniae infections in adults in Finland.

Laboratory-based surveillance of invasive pneumococcal infections in adults in Finland from 1983 to 1992 identified 862 episodes of pneumococcal bacteraemia and 97 episodes of meningitis. The overall incidence of invasive pneumococcal infections was 9.1 per 100,000 for all adults per year, but 27.1, 35.8, and 44.5 per 100,000 in those aged 65 years or over, 75 years or over, and 85 years or over, respectively. Most (99.7%) of the pneumococcal strains were sensitive to penicillin. Ninety-five percent of the strains belonged to serogroups/types present in the 23-valent pneumococcal polysaccharide vaccine. Group/type distribution was different in patients aged 16-64 years compared to those 65 years or over (P < 0.001), in bacteraemia compared to meningitis (P < 0.001), and in the years 1983-7 compared to 1988-92 (P < 0.05).

Development of beta-lactamase-mediated resistance to penicillin in middle-ear isolates of Moraxella catarrhalis in Finnish children, 1978-1993.

The frequency of beta-lactamase production was analyzed in a study of 1,452 strains of Moraxella catarrhalis and 2,738 strains of Haemophilus influenzae isolated from middle-ear fluid of children < 6 years of age at Tampere University Hospital in Tampere, Finland, between 1978 and 1993. In addition, 401 isolates of M. catarrhalis from similar samples collected in different parts of Finland in 1988-1990 were tested for beta-lactamase production; minimal inhibitory concentrations of ampicillin, cefaclor, cephalothin, erythromycin, tetracycline, and trimethoprim-sulfamethoxazole for these strains were determined. These data were compared with figures for the annual consumption of beta-lactam antimicrobials in the community in 1978-1993. A bimodal increase in the proportion of strains of M. catarrhalis producing beta-lactamase was detected: from 0 to 60% in 1978-1983 and from 60% to 80% in 1988-1990. Concurrently with the second increase, the consumption of cephalosporins increased substantially in the community. The frequency of beta-lactamase-producing strains of H. influenzae did not increase between 1978 and 1993.

Antimicrobial resistance of Streptococcus pneumoniae in Finland, 1987-1990.

A nationwide survey of the prevalence of antimicrobial resistance among Streptococcus pneumoniae isolates from the middle ear fluid of children with acute otitis media (639 strains) and from throat-swab samples of healthy children (149 strains) was conducted in Finland during 1987-1990. The MICs of penicillin, cephalothin, cefaclor, erythromycin, trimethoprim, and co-trimoxazole were determined by the agar dilution method. Low-level resistance to penicillin (MIC, 0.1-1 microgram/mL) was found in 1.7% of the otitis-related and 1.3% of the healthy-carrier strains. No highly penicillin-resistant strains (MIC, > or = 2 micrograms/mL) were found. Six multiresistant strains were detected, three of them possibly belonging to a previously identified clone present in Finland since 1985. Eighty-five percent of the resistant otitis-related strains, including 9 of the 11 moderately penicillin-resistant strains (4 of which were multiresistant), belonged to the three most common serogroups (6, 19, and 23).

Antimicrobial resistance in Haemophilus influenzae isolated from blood, cerebrospinal fluid, middle ear fluid and throat samples of children. A nationwide study in Finland in 1988-1990.

A nation-wide survey of the prevalence of antimicrobial resistance in Haemophilus influenzae was conducted on isolates collected in 1988-90 from middle ear fluid (MEF), blood, or cerebrospinal fluid (CSF) in infected children or throat samples of healthy children. Altogether 885 strains were examined regarding capsular type b, beta-lactamase production and the minimal inhibitory concentration (MIC) of ampicillin, cefaclor, erythromycin, tetracycline, chloramphenicol, trimethoprim and trimethoprim-sulfamethoxazole for these strains was determined by the agar dilution method. 99% (578/585) of MEF isolates, 93% (112/121) of throat isolates, but only 6% (10/179) of blood/CSF isolates were not of type b (Hib). The rate of beta-lactamase production was 11.4% among Hib strains, 8.0% among non-type b MEF isolates, and 4.5% among non-type b throat isolates. No increase in the prevalence of beta-lactamase production in H. influenzae has taken place in Finland since the early 1980s. Resistance to ampicillin among strains that lacked beta-lactamase activity was rare (0.2%). Of the non-type b MEF and throat isolates, 5.9% and 2.7%, respectively, were resistant to trimethoprim and 3.6% and 2.7%, respectively, to trimethoprim-sulfamethoxazole. Resistance to other drugs was rare (< 2%) in all isolate groups.