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1.
Orv Hetil ; 160(41): 1623-1632, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31587580

RESUMO

Introduction: Previous data showed bacterial infections among diabetic patients to be more serious and frequent, with higher mortality rates in comparison with non-diabetics. Recent investigations, however, are contradictory. Aim: The goal of our prospective, observational study was to compare patients hospitalized on a general medical ward due to community-acquired bacterial infections with type 2 diabetes mellitus (T2DM) to those of non-diabetics (K) by 1) infection localization, 2) spectrum of pathogens, 3) three-month mortality rates. Method: Patients were consecutively involved (T2DM: n = 205, K: n = 202). We characterized the infections, clinical parameters, mortalities of the two groups, and matched them to international data. Results: No difference regarding clinical details of the groups were found except for glycemic parameters and BMI. In the T2DM group the skin- and soft tissue- (37.1%), in the K patients respiratory infections (37.1%) were the most common, followed by urinary ones (31.2% and 31.7%, respectively). Skin- and soft tissue infection incidence among T2DM subjects were higher compared to international results (37.1% vs. 16%). Co-presence of Gram positive and Gram negative bacteria in the skin- and soft tissue infections (23/76 vs. 5/46, p = 0.0149), and polymicrobial origin in the urinary tract infections (34.0% vs. 15.1%, p = 0.0335) were found to be more frequent in T2DM than in K. No difference regarding mortality rates were detected. In T2DM the skin- and soft tissue while in the K group the respiratory infections had the most death counts. Conclusions: We found higher rates of skin- and soft tissue infections among T2DM patients hospitalized on a general medical ward compared to international data. In total we did not find difference regarding three-month mortality between the groups. Our results highlight the importance of primary prevention and shows its inadequacy concerning skin and soft tissue infections among type 2 diabetics in Hungary. Orv Hetil. 2019; 160(41): 1623-1632.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Diabetes Mellitus Tipo 2/complicações , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Infecções dos Tecidos Moles/microbiologia , Infecções Urinárias/microbiologia , Adulto , Idoso , Infecções Bacterianas/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Diabetes Mellitus Tipo 2/microbiologia , Feminino , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções dos Tecidos Moles/epidemiologia , Infecções Urinárias/epidemiologia
2.
Pneumologie ; 73(10): 605-616, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31622999

RESUMO

Pneumonia belongs to the most frequent and most deadly infectious diseases worldwide. It represents an increasing problem for the aging population. The incidence and mortality rises with every decade. The clinical presentation of pneumonia differs between elderly and younger patients. Multiple factors including functional status (self-dependency and immobilization), comorbidities, immunosenescence, nutritional status, swallowing disorders have to be accounted for. Pneumonia in the elderly has to be differentiated from nursing home acquired pneumonia. Diagnosis of pneumonia of the elderly demands special attention as the diagnostic value of common biomarkers and prognostic scores is different.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Estado Nutricional , Pneumonia/diagnóstico
3.
Artigo em Inglês | MEDLINE | ID: mdl-31522665

RESUMO

From 1 January to 31 December 2017, 36 institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2017 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin and to characterise the molecular epidemiology of the methicillin-resistant isolates. A total of 2,515 S. aureus bacteraemia episodes were reported, of which 77% were community-onset. Approximately one in five S. aureus (19.0%) were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 18.7% which was significantly higher than the 14.0% mortality associated with methicillin-susceptible SAB. With the exception of the ß-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However in addition to the ß-lactams approximately 42% of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin and ciprofloxacin and approximately 14% resistant to co-trimoxazole, tetracycline and gentamicin. When applying the EUCAST breakpoints teicoplanin resistance was detected in five S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). ST22-IV [2B] (EMRSA-15) is the predominant healthcare-associated clone in Australia. Seventy-five percent of methicillin-resistant SAB were due to community-associated clones. Although polyclonal approximately 74% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5] and ST1-IV [2B]. CA-MRSA, in particular the ST45-VT [5C2&5] clone has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. ST45-VT [5C2&5] accounted for 12.8% of CA-MRSA. As CA-MRSA is well established in the Australian community it is important antimicrobial resistance patterns in community- and healthcare-associated SAB is monitored as this information will guide therapeutic practices in treating S. aureus sepsis.


Assuntos
Anti-Infecciosos/farmacologia , Bacteriemia/epidemiologia , Farmacorresistência Bacteriana Múltipla , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Pessoa de Meia-Idade , Epidemiologia Molecular , Infecções Estafilocócicas/microbiologia , Adulto Jovem
4.
Artigo em Inglês | MEDLINE | ID: mdl-31315314

RESUMO

Flutracking participation continued to grow, with a total of 33,947 participants in 2017 (a 9.5% increase from 2016). The majority of participants completed their survey within 24 hours of the email being sent (average 72.5% responses received in 24 hours). Overall, the rate of influenza-like illness (ILI) in 2017 was higher and remained elevated for a longer period compared to previous years except for the 2009 pandemic. Flutracking placed the severity and magnitude of the influenza season into historical context. Following the highest number of laboratory-notified influenza cases on record (2.8-fold increase from 2016), Flutracking data demonstrated a large increase in the percent of participants with fever and cough that were tested for influenza (2.9% to 5.0% for 2016 and 2017 respectively) and thus determined it was increased laboratory testing that contributed to the substantial increase in influenza notifications. Flutracking participants with fever and cough that were tested for influenza have increased each year from 2013 to 2017 at the national level, with a large increase from 2016 (2.9%) to 2017 (5.0%). The peak weekly fever and cough attack rate occurred in mid-August, with 4.1% ILI in the unvaccinated, compared to 3.1% in vaccinated Flutrackers. In the peak four weeks of ILI, 12.3% of participants experienced an episode of fever and cough. Divergence between the vaccinated and unvaccinated participants' ILI percentages was highest during the week ending 6 August 2017 (4.1% in the unvaccinated group and 2.7% in the vaccinated group). The timing of the ILI peak amongst Flutracking participants was consistent with peak notifications of laboratory-confirmed influenza.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Influenza Humana/epidemiologia , Sistemas On-Line , Vigilância da População , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Criança , Pré-Escolar , Tosse/epidemiologia , Notificação de Doenças , Feminino , Febre/epidemiologia , Humanos , Incidência , Lactente , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Faringite/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
5.
J Med Microbiol ; 68(9): 1367-1372, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31329093

RESUMO

Methicillin-resistant Staphylococcus lugdunensis (MRSL) is increasingly recognized in healthcare and community settings. To obtain a better understanding of the emergence of MRSL, this study characterized the structure and content of the SCCmec elements harboured by 36 MRSL isolates obtained from diverse sources in Hong Kong from 2008 to 2017. The isolates were investigated by whole-genome sequencing. SCCmec types and subtypes were assigned according to the guidelines from the International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements. The sequence type (ST)-SCCmec combinations in the 36 MRSL isolates were as follows: ST3-SCCmec IV (n=2), ST3-SCCmec V (n=28), ST27-SCCmec V (n=5) and ST42-SCCmec V (n=1). The two SCCmec IV elements were highly similar to the SCCmec IV element harboured by the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain, JCSC6668. The J3-mec complex-J2 regions in the SCCmec V elements were highly similar to the corresponding regions in the CA-MRSA strains PM1 (n=13) or WIS (n=21). Based on the J1 to J3 sequences, the SCCmec V elements can be categorized into nine different subtypes. Our findings highlight the diversified structures of SCCmec elements among MRSL strains and their close relationship with SCCmec elements harboured by CA-MRSA.


Assuntos
Cromossomos Bacterianos/genética , Infecções Comunitárias Adquiridas/microbiologia , Genes Bacterianos/genética , Staphylococcus aureus Resistente à Meticilina/genética , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/genética , Antibacterianos/farmacologia , Infecções Comunitárias Adquiridas/epidemiologia , DNA Bacteriano/genética , Genoma Bacteriano/genética , Hong Kong/epidemiologia , Humanos , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Análise de Sequência de DNA , Infecções Estafilocócicas/epidemiologia , Estudantes de Medicina
6.
BMC Public Health ; 19(1): 914, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288765

RESUMO

BACKGROUND: The first Canadian outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was identified in 2004 in Calgary, Alberta. Using a novel model of MRSA population-based surveillance, sociodemographic risk associations, yearly geospatial dissemination and prevalence of CA-MRSA infections over an 11 year period was identified in an urban healthcare jurisdiction of Calgary. METHODS: Positive MRSA case records, patient demographics and laboratory data were obtained from a centralized Laboratory Information System of Calgary Laboratory Services in Calgary, Alberta, Canada between 2004 and 2014. Public census data was obtained from Statistics Canada, which was used to match with laboratory data and mapped using Geographic Information Systems. RESULTS: During the study period, 52.5% of positive MRSA infections in Calgary were CA-MRSA cases. The majority were CMRSA10 (USA300) clones (94.1%; n = 4255), while the remaining case (n = 266) were CMRSA7 (USA400) clones. Period prevalence of CMRSA10 increased from 3.6 cases/100000 population in 2004, to 41.3 cases/100000 population in 2014. Geospatial analysis demonstrated wide dissemination of CMRSA10 annually in the city. Those who are English speaking (RR = 0.05, p <  0.0001), identify as visible minority Chinese (RR = 0.09, p = 0.0023) or visible minority South Asian (RR = 0.25, p = 0.015), and have a high median household income (RR = 0.27, p <  0.0001) have a significantly decreased relative risk of CMRSA10 infections. CONCLUSIONS: CMRSA10 prevalence increased between 2004 and 2007, followed by a stabilization of cases by 2014. Certain sociodemographic factors were protective from CMRSA10 infections. The model of MRSA population-surveillance and geomap outbreak events can be used to track the epidemiology of MRSA in any jurisdiction.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Vigilância da População , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Adulto , Alberta/epidemiologia , Feminino , Sistemas de Informação Geográfica , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Análise Espacial
7.
Int J Infect Dis ; 85: 195-202, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31226404

RESUMO

OBJECTIVES: Invasive pneumococcal disease (IPD) usually has its onset in the community (CO-IPD), but it can commence following hospitalization (HO-IPD). This study compared HO-IPD and CO-IPD cases during the implementation of the pneumococcal conjugate vaccine (PCV) program for children in Israel. METHODS: This was a nationwide retrospective cohort study of adult (age >18 years) IPD patients covering the period from the implementation of the PCV7/13 program in 2009/2010 through 2015. HO-IPD and CO-IPD were defined as IPD with onset ≥4 and ≤2 days from admission, respectively. Patient characteristics, outcome measures, serotypes, and antimicrobial susceptibility were compared for the entire cohort, followed by a matched case-control analysis. RESULTS: The study included 114 patients with HO-IPD and 2180 with CO-IPD. After matching HO-IPD to CO-IPD patients by age, sex, and comorbidities, the mortality rate and discharge to long-term care facility rate were significantly higher for HO-IPD patients than for CO-IPD patients (44.6% vs. 26.3% and 26.5% vs. 8.2%, respectively). HO-IPD isolates were less often covered by PCV13 (39.6% vs. 49.0%) and pneumococcal polysaccharide vaccine PPSV23 (56.6% vs. 71.3%) and more often resistant to penicillin (9.3% vs. 3.6%), ceftriaxone (3.8% vs. 0.75%), and levofloxacin (9.3% vs. 0.8%). CONCLUSIONS: HO-IPD was associated with higher morbidity and mortality than CO-IPD and was more often caused by non-vaccine serotypes (primarily non-PCV13 types) and antibiotic-resistant strains.


Assuntos
Infecção Hospitalar/microbiologia , Infecções Pneumocócicas/microbiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana , Feminino , Vacina Pneumocócica Conjugada Heptavalente , Hospitalização , Hospitais , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Morbidade , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/mortalidade , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Estudos Retrospectivos , Sorogrupo , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação
8.
Comp Immunol Microbiol Infect Dis ; 64: 153-158, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174691

RESUMO

PURPOSE: The etiology of community-acquired pneumonia (CAP) in hospital patients is often ambiguous due to the limited pathogen detection. Lack of a microbiological diagnosis impairs precision treatment in CAP. METHODS: Specimens collected from the lower respiratory tract of 195 CAP patients, viruses were measured by the Single-plex real-time PCR assay and the conventional culture method was exploited for bacteria. RESULTS: Among the 195 patients, there were 46 (23.59%) pure bacterial infections, 20 (10.26%) yeast infections, 32 (16.41%) pure viral infections, 8 (4.10%) viral-yeast co-infections, and 17 (8.72%) viral-bacterial co-infections. The two most abundant bacteria were Acinetobacter baumannii and klebsiella pneumoniae, whereas the most common virus was influenza A. CONCLUSIONS: Non-influenza respiratory microorganisms frequently co-circulated during the epidemic peaks of influenza, which easily being ignored in CAP therapy. In patients with bacterial and viral co-infections, identifying the etiologic agent is crucial for patient's therapy.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Influenza Humana/epidemiologia , Pneumonia/epidemiologia , Pneumonia/microbiologia , Infecções por Acinetobacter/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Influenza Humana/microbiologia , Infecções por Klebsiella/epidemiologia , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Adulto Jovem
9.
J Hand Surg Asian Pac Vol ; 24(2): 129-137, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31035877

RESUMO

Background: Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) rates have been increasing worldwide and contribute to a growing "global health security threat" as reported by the WHO. Our group previously reported an overall rate of 7% in CA-MRSA upper extremity infections between 2004-2009 at the Auckland Regional Hand Unit. This fell below the Center for Disease Control (CDC) recommendation for empiric antimicrobial cover once local rates exceed 10-15%. We examined prevalence and characteristics of CA-MRSA upper extremity infections in our region over a subsequent 5-year period. Methods: One thousand two hundred and fifty-two patients with upper extremity infections requiring operative management between 2011 and 2015 inclusive were included in this study. Associated clinical characteristics were recorded including ethnicity, cultured organisms, antibiotic sensitivities, infection rate, and treatment practice. Results: One hundred and fifty (12%) of patients had culture positive CA-MRSA upper extremity infections. There was an increasing annual trend. Of note, rates of CA-MRSA in the Maori and Pacific Island ethnic subpopulations exceeded 15% in 2014 and 2015. Susceptibilities, associated factors and patient demographics are reported. Conclusions: Our unit enjoys significantly lower rates of CA-MRSA upper extremity infections than has been reported internationally. However, trends are increasing relative to our prior 6-year report, and the threshold for empiric treatment has been met within the Maori and Pacific Island ethnic subpopulations. This evolving threat is also highlighted by increasing cases of multi-drug resistant CA-MRSA. Evolving regional guidelines for empiric coverage of CA-MRSA among high-risk ethnic subpopulations identified by this study are underway.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/epidemiologia , Extremidade Superior/microbiologia , Adulto , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Prevalência , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Infecciosas/microbiologia , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/microbiologia
11.
J Med Microbiol ; 68(5): 720-727, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30994438

RESUMO

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) can be classified into hospital-acquired MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA), based on the associated epidemiological risk factors and their SCCmec types. We therefore studied the diversity and distribution of SCCmec elements among MRSA isolates in our region and also evaluated SCCmec typing as a tool for the classification of MRSA. METHODOLOGY: Two hundred isolates of MRSA obtained from various clinical specimens were included. The clinical and demographic details of the patients and the epidemiological risk factors for MRSA acquisition were documented. Multiplex PCR was optimized for all the major SCCmec types (I to V). Subtyping of SCCmec type IV (IVb, IVc, IVd, IVh) was carried out by simplex PCR. RESULTS: Based on epidemiological criteria, CA-MRSA constituted 57  % (114/200) of the the test isolates and HA-MRSA made up 43  % (86/200). The predominant SCCmec type found in our study was type III (62%), followed by type V (52.5%) and type I (47.5%), while type II was carried by a single isolate. Of the 200 isolates, 118 carried multiple SCCmec types and 3 were non-typable. CONCLUSION: The existence of multiple SCCmec types in individual MRSA isolates resulted in our inability to categorize many of these isolates as either CA-MRSA or HA-MRSA as defined by the SCCmec type criterion. LIMITATION: The major limitation of the study was that the SCC mec element of MRSA isolates exhibiting multiple types was not sequenced and hence this finding could not be confirmed.


Assuntos
Elementos de DNA Transponíveis , Staphylococcus aureus Resistente à Meticilina/classificação , Infecções Estafilocócicas/epidemiologia , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/microbiologia , DNA Bacteriano/genética , Genótipo , Humanos , Índia/epidemiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Proteínas de Ligação às Penicilinas/genética , Reação em Cadeia da Polimerase
12.
New Microbiol ; 41(4): 81-87, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30994177

RESUMO

The epidemiology of community-acquired bacterial meningitis (CABM) in adults has changed significantly in the past several years. Despite substantial improvement in patient care, CABM remains a major cause of morbidity and mortality. Thus, new prognostic factors could help improve patient stratification. We conducted a multicenter retrospective study to determine the clinical pattern of CABM in an urban area of Western Europe and to identify potential predictors of unfavorable prognosis and complicated course. Over a period of 6-8 years, 79 adult CABM cases were treated at three tertiary hospitals. A Glasgow Outcome Scale (GOS) score of ≤4 was defined as unfavorable outcome. Predictors of unfavorable prognosis or complicated course were identified through logistic-regression analysis. S. pneumoniae was the most frequent pathogen (34%). 82% of patients exhibited at least two of five signs, including fever, neck stiffness, altered mental status, headache and nausea. Almost 50% presented focal neurological deficits; the overall mortality rate was 15%. In the multivariate analysis, risk factors for an unfavorable outcome included a GCS score of ≤13, female sex, and etiology by L. monocytogenes and gram-negative bacilli. However, risk factors for systemic complications were a GCS score of ≤13 and reduced platelet count, whereas C-Reactive Protein (CRP) increase was associated with a higher rate of neurological complications. Patients with non-pneumococcal CABM were more prone to an unfavorable outcome, probably because of underutilization of empiric ampicillin in patients at risk of listeriosis and because the suspicion of pneumococcal infection was facilitated by the existence of otitis and the higher yield of Gram's stain. Patients presenting a GCS of ≤13, thrombocytopenia and/or increased CRP, may benefit from more aggressive care to avoid in-hospital complications and neurological sequelae.


Assuntos
Infecções Comunitárias Adquiridas , Meningites Bacterianas , Adulto , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/patologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
13.
Biomed Res Int ; 2019: 7168949, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31008110

RESUMO

Background: Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP). This cross-sectional study aimed to determine the prevalence of macrolide-resistant M. pneumoniae strains in a convenience series of 234 adult hospitalised and nonhospitalised subjects with a diagnosis of CAP in January 2013 to April 2015 in South Italy. Methods: Respiratory samples were subjected to real-time PCR. In M. pneumoniae-positive samples, domain V of 23S rRNA was sequenced to detect resistance-conferring point mutations. P1 major adhesion protein typing and multiple loci variable-number tandem repeat analysis (MLVA) were also performed. Results: Of the 234 samples, 15 (6.4%) were positive for M. pneumoniae. Three of these had a macrolide-resistant genotype: two and one had A2063G and A2064G mutations, respectively. Fourteen of the 15 strains were subtyped: half had subtype 1 and half had subtype 2. Eight strains underwent MLVA profiling: one each had the J, A, and Z type. The remainder was unclassifiable. Conclusions: This novel discovery of macrolide-resistant M. pneumoniae strains in adults with CAP in Italy suggests that there may be increasing circulation of these strains in the population. To facilitate rapid optimization of the antibiotic strategy in Italy, macrolide resistance should be monitored by a surveillance system that is based on molecular methods.


Assuntos
Infecções Comunitárias Adquiridas/tratamento farmacológico , Farmacorresistência Bacteriana/genética , Macrolídeos/uso terapêutico , Pneumonia por Mycoplasma/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/genética , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Genótipo , Humanos , Itália/epidemiologia , Macrolídeos/efeitos adversos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Repetições Minissatélites/genética , Mutação , Mycoplasma pneumoniae/efeitos dos fármacos , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/patogenicidade , Pneumonia por Mycoplasma/epidemiologia , Pneumonia por Mycoplasma/genética , Pneumonia por Mycoplasma/microbiologia , Adulto Jovem
14.
Eur J Clin Microbiol Infect Dis ; 38(5): 927-936, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30904995

RESUMO

The prevalence of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) has increased in many countries, including Ireland. This study aimed to investigate the molecular epidemiology of MSSA causing BSIs in Irish hospitals between 2006 and 2017, when MSSA BSIs increased, to identify any potential patient or pathogen contributing factors. A total of 252 MSSA isolates from patients in Irish hospitals in 2006/2007, 2011 and 2017 underwent spa typing and DNA microarray profiling. Each patient's gender, age, 14-day mortality and epidemiological context of infection were recorded. Significant increases in community-onset (CO) MSSA BSIs and the average patient's age and decreases in hospital-onset (HO) MSSA were identified. Although, extensive genetic diversity was detected amongst the isolates, i.e. 24 multilocus sequence type clonal complexes (CCs)/sequence types and 124 spa types, three CCs (CC30, CC45, CC5) dominated, albeit in different proportions, during the study periods. CC30 declined significantly, in particular spa type t021, and was more common amongst HO-MSSA and CC45 and CC8 increased, particularly spa types t015 and t008, respectively, and were more common amongst CO-MSSA. Five of the seven most frequent spa types were more common amongst CO-MSSA. Although overall multidrug resistance decreased, the prevalence of erm(C) increased significantly and virulence genes decreased, mostly notably egc, tst, scn, sep and fnbB. This study highlights the threat posed by the increasing prevalence of CO-MSSA BSIs and suggests an association with the increasing prevalence of CC45 CO-MSSA, decreasing prevalence of CC30 HO-MSSA, an ageing population and an overall decrease in virulence and resistance genes.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Distribuição por Idade , Proteínas de Bactérias/genética , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , DNA Bacteriano/genética , Farmacorresistência Bacteriana Múltipla/genética , Feminino , Genótipo , Humanos , Irlanda/epidemiologia , Masculino , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Prevalência , Staphylococcus aureus/classificação , Fatores de Virulência/genética
15.
Int J Infect Dis ; 83: 26-31, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30926541

RESUMO

BACKGROUND: Analysis of the molecular characteristics of isolates is very important for clinical and epidemiological study of community-acquired pneumonia (CAP) caused by Mycoplasma pneumoniae. METHODS: Between 2010 and 2012, an epidemic period, M. pneumoniae was isolated from oropharyngeal swabs of consecutive CAP patients. Minimum inhibitory concentrations of macrolides, 23S rRNA gene sequencing, P1 gene and multilocus variable-number tandem-repeat analysis (MLVA) genotyping was conducted. RESULTS: 88.3% (181/205) of the isolates were macrolide-resistant M. pneumoniae (MRMP) and all harbored an A2063 G mutation. The strains were clustered into 7 MLVA types, and P1 type 1 and type 2 lineages were co-circulated (86.3% and 13.7%). Compared with adults, no specific MLVA type contributed to higher M. pneumoniae infection in children (p = 0.14). Similar macrolide profile and genotypes of M. pneumoniae was found between outpatients and inpatients. Significant differences in proportion of P1 types and two main MLVA types 4/5/7/2 and 3/5/6/2 were observed between MRMP and macrolide-sensitive M. pneumoniae (MSMP) (p < 0.001). CONCLUSIONS: This study demonstrates a comprehensive profile of M. pneumoniae molecular characterization among CAP patients of all age, and provides more evidences on a correlation between MLVA type 4/5/7/2 and macrolide resistance in the setting of high incidence of MRMP.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Epidemias , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/epidemiologia , Adulto , Idoso , Criança , Pré-Escolar , China/epidemiologia , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Macrolídeos/farmacologia , Masculino , Pessoa de Meia-Idade , Mycoplasma pneumoniae/efeitos dos fármacos , Adulto Jovem
16.
Emerg Microbes Infect ; 8(1): 471-478, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30924398

RESUMO

A consistently decreasing prevalence of MRSA infections in China has been reported, however, the underlying mechanism of molecular processes responsible for this decline in MRSA infections has been poorly understood. We conducted an epidemiologic investigation to determine the dynamic changes of Staphylococcus aureus infections. A total of 3695 S. aureus isolates was recovered from 2008 to 2017, and subsequently characterized by infection types, resistance profile, and clone types. The frequency of respiratory infection decreased over the study period from 76% to 52%. The proportion of MRSA remarkably decreased (from 83.5% to 54.2%, 2008-2017) (p < .0001). The prevalence of predominant healthcare-associated MRSA (HA-MRSA) clones, ST239-t030 and ST239-t037, significantly decreased (from 20.3% to 1% and 18.4% to 0.5%, 2008-2017, respectively); both of them were replaced by the continually growing ST5-t2460 clone (from 0% to 17.3%, 2008-2017). Epidemic community-acquired MRSA (CA-MRSA) ST59 and ST398 clones also increased (from 1.0% to 5.8% and 1.8% to 10.5%, 2008-2017, respectively). These results demonstrated a significant decrease in the previously dominant HA-MRSA ST239 clones, leading to a marked decrease in the prevalence of MRSA over the past decade, and shed new light on the complex competition of S. aureus clones predominating within the health-care environment.


Assuntos
Genótipo , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Prevalência , Adulto Jovem
17.
BMC Infect Dis ; 19(1): 245, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30866828

RESUMO

BACKGROUND: Increased resistance to third-generation cephalosporin (3GC) is a serious concern for community-onset Escherichia coli infection because this resistance easily delays effective treatment. This study surveyed the current antimicrobial resistance pattern among E. coli isolates that cause community-onset bacteremia, with a special focus on the prevalence of and the risk factors for 3GC resistance, and determined factors for poor outcomes among patients with community-onset E. coli bacteremia. METHODS: This retrospective study was conducted at a tertiary-care teaching hospital in Taiwan. All adult patients with community-onset E. coli bacteremia between January 1, 2015, and December 31, 2015 were enrolled and were divided into two groups depending on whether the E. coli isolate was susceptible to 3GCs. Risk factors for 3GC resistance, 14-day all-cause mortality, and length of hospital stay were analyzed. RESULTS: The overall rate of 3GC resistance among E. coli isolates causing community-onset bacteremia was 19.7%, whereas it was 9.6% if only isolates causing community-acquired bacteremia were considered. Independent risk factors for 3GC-resistant community-onset E. coli bacteremia were hospitalization within the past 1 year (odds ratio: 2.4, 95% confidence interval: 1.6-3.7, P < 0.001), exposure to antibiotics within the past 15 days (2.6, 1.4-4.9, P = 0.002), residence in nursing home or long-term care facility (3.6, 1.0-12.3, P = 0.044), presence of underlying genitourinary disease (1.9, 1.2-2.9, P = 0.005), and presence of indwelling implantable intravenous port (2.2, 1.1-4.1, P = 0.021). 3GC resistance was independently associated with increased length of hospital stays (P < 0.001). CONCLUSION: In this study, the prevalence of 3GC resistance was high among both patients with community-onset and those with community-acquired E. coli bacteremia. 3GC resistance is a strong independent risk factor for length of hospital stay. The effectiveness of empirical antibiotic treatment would partially explain the impact of 3GC resistance, but more evidence is needed. The choice of appropriate empirical antibiotics for community-onset E. coli bacteremia might impact outcomes in terms of the length of hospital stay and need to be individualized according to the patient-specific risk for acquiring drug-resistant pathogens.


Assuntos
Antibacterianos/farmacologia , Bacteriemia , Cefalosporinas/farmacologia , Farmacorresistência Bacteriana , Infecções por Escherichia coli , Escherichia coli , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/patogenicidade , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Hospitais , Humanos , Prevalência , Fatores de Risco
18.
Cent Eur J Public Health ; 27(1): 58-63, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30927399

RESUMO

OBJECTIVES: Staphylococcus aureus (SA) represents one of the most important microorganism that is part of the normal microflora of humans, but in certain conditions can cause very serious infections. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for a wide spectrum of nosocomial and community associated infections worldwide. The aim of this study was to determine community acquired MRSA (CA-MRSA), as well as the frequency of Panton-Valentine leukocidin (PVL) genes and staphylococcal cassette chromosome mec (SCCmec) types in isolates obtained from outpatients in the region of 700,000 people (Canton Sarajevo, Bosnia and Herzegovina) Methods: Our investigation included phenotypic and genotypic markers such as antimicrobial resistance, pulsed-field gel electrophoresis (PFGE), SCC typing, and PVL detection. RESULTS: Antimicrobial susceptibility: all MRSA isolates were resistant to the ß-lactam antibiotics tested, and all isolates were susceptible to trimethoprim sulphamethoxazole, rifampicin, fusidic acid, linezolid, and vancomycin. After the PFGE analysis, the isolates were grouped into five similarity groups: A-E. The largest number of isolates belonged to one of two groups: C - 60% and D - 27%. In both groups C and D, SCCmec type IV was predominant (60% and 88.8%, respectively). A total of 24% of the isolates had positive expression of PVL genes, while 76% showed a statistically significantly greater negative expression of PVL genes. CONCLUSIONS: Using combination techniques, we were able to investigate the origin and genetic background of the strains. PFGE analysis revealed two large, genetically related groups of strains consisting of 87 isolates. Our results suggest failure to apply the screening policy, and a lack of knowledge about multiresistant MRSA strains. This study showed the local epidemiological situation which should be the basis of antimicrobial empiric therapy for non-hospitalized patients.


Assuntos
Antibacterianos/uso terapêutico , Toxinas Bacterianas/genética , Exotoxinas/genética , Leucocidinas/genética , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Proteínas de Bactérias , Bósnia e Herzegóvina/epidemiologia , Cromossomos , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Humanos , Meticilina , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Proteínas de Ligação às Penicilinas , Infecções Estafilocócicas/epidemiologia
19.
Medicine (Baltimore) ; 98(13): e14636, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921179

RESUMO

BACKGROUND: The systemic use of corticosteroids for patients in severe community-acquired pneumonia (CAP) remains disputed in clinical practice. We undertook a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with severe CAP. METHODS: We searched MEDLINE (1946 to June 2018), EMBASE (1966 to June 2018), and the Cochrane Library database for randomized controlled trials (RCTs) conducted for severe CAP. The endpoints of the study included total mortality, length of intensive care unit (ICU) stay and mechanical ventilation. RESULTS: Nine trials which contained 914 patients were included for final meta-analysis. Of the 488 patients in the corticosteroid group, there were 37 deaths (7.58%) and 56 deaths occurred in 426 patients in the control group (13.1%). Corticosteroid therapy was associated with a lower rate of all-cause mortality compared to control (odd ratio [OR] 0.63, 95% confidence interval [CI] 0.42-0.95, P = .03). Subgroup analysis was conducted to show that the drug type modified the effect of steroids for mortality rate: prednisolone or methylprednisolone therapy (OR 0.37, 95% CI 0.19-0.72) reduced total mortality, whereas hydrocortisone use did not (OR 0.90, 95% CI 0.54-1.49). We found the length of ICU stay was significantly shorter in the steroid group compared to control (MD -2.52 days, 95% CI -4.88 to -0.15; P = .04). And there was a reduction trend in the need for mechanical ventilation in corticosteroid group (OR 0.53, 95% CI 0.28-1.02; P = .06). There was no trend towards more adverse events in the corticosteroid arm compared to control (OR 0.92, 95% CI 0.58-1.47; P = .74). CONCLUSION: Overall, adjunctive systemic corticosteroids therapy was effective and safe for patients with severe CAP. In addition, the effects of mortality may differ according to the type of corticosteroids.


Assuntos
Corticosteroides/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Hidrocortisona/uso terapêutico , Metilprednisolona/uso terapêutico , Pneumonia/tratamento farmacológico , Prednisolona/uso terapêutico , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Idoso , Infecções Comunitárias Adquiridas/epidemiologia , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/efeitos adversos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Mortalidade/tendências , Pneumonia/mortalidade , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento
20.
BMC Infect Dis ; 19(1): 163, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764770

RESUMO

BACKGROUND: Bacterial resistance to first line antibiotics used to treat community-onset urinary tract infections (UTIs) continues to emerge. We sought to determine the association between extended-spectrum cephalosporin resistance (ESC-R) and recurrence among Enterobacteriaceae (EB) UTIs. METHODS: A retrospective cohort study was performed. All patients presenting to the Emergency Departments (EDs) or outpatient practices in a large health system with EB UTIs between 2010 and 2013 were included. Exposed patients had ESC-R EB UTIs. Unexposed patients had ESC-susceptible EB UTIs and were matched to exposed patients 1:1 on study year. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between ESC-R EB UTI and time to recurrent UTI within 12 months. RESULTS: A total of 302 patients with an index community-onset EB UTI were included, with 151 exposed and 151 unexposed. Overall, 163 (54%) patients experienced a recurrent UTI with a median time to recurrence of 69 days (interquartile range 25-183). On multivariable analyses, ESC-resistance was associated with an increased hazard of recurrent UTI (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.01-1.91, P = 0.04). Other variables that were independently associated with recurrence included a history of UTI prior to the index UTI and presence of a urinary catheter at the time of the index UTI. Secondarily, we found that when the treatment for the index UTI was adjusted for, there was no longer a significant association between ESC-R status and time to recurrent UTI (aHR 1.26, 95% CI 0.91-1.76, P = 0.17). CONCLUSIONS: Community-onset UTI due to EB demonstrating ESC-resistance is associated with a significantly increased hazard of recurrent UTI within 12 months compared to ESC-susceptible EB, even after adjusting for baseline factors that predispose patients to UTI recurrence. This association appears to be driven primarily by delayed or inappropriate treatment for the index ESC-R EB UTI.


Assuntos
Resistência às Cefalosporinas , Cefalosporinas/uso terapêutico , Infecções Comunitárias Adquiridas , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Resistência às Cefalosporinas/efeitos dos fármacos , Resistência às Cefalosporinas/genética , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/genética , Infecções por Enterobacteriaceae/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , beta-Lactamases/genética
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