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1.
Einstein (Sao Paulo) ; 18: eAO4920, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31826077

RESUMO

OBJECTIVE: To evaluate the prevalence of group B Streptococci in pregnant women of a corporate health program, as well as the epidemiological correlations. METHODS: This retrospective study used medical records of patients who participated of the prenatal care program at a private hospital in the city of São Paulo (SP), Brazil, from 2015 to 2016. Those who abandoned the program or had incomplete data in their medical records were excluded. Quantitative variables were described by means, standard deviations, median, minimal and maximal values. Parity and socioeconomic status were described by absolute frequency and percentages. We used logistic regression models in the software (SPSS) to analyze correlations of variables according to vaginal-rectal culture, considering a 95%CI and p-values. Variables were age, number of pregnancies, weight gain in pregnancy and gestational age at delivery. RESULTS: A total of 347 medical records were included, and after applying the exclusion criteria, 287 medical records composed the final sample. Patients' age ranged between 17 and 44 years. Mean age was 30.6 years, 67 patients had positive result for group B Streptococcus (prevalence of 23.3%; 95%CI: 18.7-28.5). CONCLUSION: Considering the high prevalence of group B Streptococcus in our service, the antibiotic prophylaxis strategy based on rectovaginal culture screening approach seems to be cost-effective.


Assuntos
Complicações Infecciosas na Gravidez/microbiologia , Reto/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Vagina/microbiologia , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Humanos , Idade Materna , Paridade , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal , Prevalência , Estudos Retrospectivos , Fatores Socioeconômicos , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/epidemiologia , Adulto Jovem
2.
Lakartidningen ; 1162019 Dec 13.
Artigo em Sueco | MEDLINE | ID: mdl-31846050

RESUMO

Two minor outbreaks of puerperal sepsis in two different hospitals are presented. In four (out of totally five) cases nosocomial transmission of group A streptococci (GAS) from health care workers to patients was likely to have occurred, based on epidemiological links and microbiological typing results. This is a reminder of the importance of careful adherence to standard precautions, but also illustrates the difficulties in keeping up good results over time.


Assuntos
Infecção Hospitalar , Sepse , Infecções Estreptocócicas , Surtos de Doenças , Humanos , Sepse/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes
3.
BMC Infect Dis ; 19(1): 1062, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852453

RESUMO

BACKGROUND: To investigate the cumulative incidence of and factors associated with mortality among patients with infective endocarditis (IE) at Thailand's largest national tertiary referral center. METHODS: Medical charts of adult patients diagnosed with IE by Duke criteria at Siriraj Hospital during January 2005 to May 2015 were retrospectively reviewed. RESULTS: Of 380 patients, 66.3% had definite IE, and 81.3% had native valve IE (NVE). Cumulative IE incidence was 5.67/1000 admissions. The most common pathogens were viridans group streptococci (VGS) (39.7%), methicillin-sensitive Staphylococcus aureus (MSSA) (13.1%), and beta-hemolytic streptococci (11.5%) in NVE; and, MSSA (20.3%), VGS (20.3%), and Enterococcus spp. (16.9%) in prosthetic valve (PVE) or device-related IE (DRIE). Overall in-hospital mortality was 18.4%. Mortality was significantly higher in PVE/DRIE than in NVE (26.8% vs. 16.5%, p = 0.047). End-stage renal disease (ESRD) (aOR: 9.43, 95% CI: 2.36-37.70), diabetes mellitus (DM) (aOR: 2.81, 95% CI: 1.06-7.49), neurological complication (aOR: 14.16, 95% CI: 5.11-39.22), congestive heart failure (aOR: 4.32, 95% CI: 1.91-9.75), hospital-acquired infection (aOR: 3.78, 95% CI: 1.66-8.57), renal complication (aOR: 3.12, 95%CI: 1.32-7.37), and other complication during admission (aOR: 3.28, 95% CI: 1.41-7.61) were independently associated with mortality. CONCLUSIONS: The incidence of IE, and the mortality rate among those diagnosed with IE are both increasing in Thailand - particularly among those with PVE or DRIE. End-stage renal disease, diabetes mellitus, and development of IE-related complications during admission were found to be independent predictors of mortality.


Assuntos
Endocardite Bacteriana/epidemiologia , Enterococcus/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Infecções Estreptocócicas/epidemiologia , Streptococcus/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/mortalidade , Tailândia/epidemiologia , Estreptococos Viridans/isolamento & purificação , Adulto Jovem
4.
BMC Infect Dis ; 19(1): 1009, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31779587

RESUMO

BACKGROUND: Although Streptococcus agalactiae is the leading causative agent of neonatal sepsis and meningitis, recently it is increasingly isolated from non-pregnant adults. The relation between its presence in the genitourinary tract and manifested clinical symptoms of STD patients remains an open question. In this study, a complex epidemiological investigation of GBS isolates from a venerology clinic was performed. METHODS: Ninety-six GBS isolates were serotyped and their genetic relatedness determined by PFGE. MLST was also performed for a subset of 20 isolates. The antibiotic susceptibility was tested with agar dilution. Surface proteins and the ST-17 hypervirulent clone was detected by PCR. RESULTS: The serotype prevalence was the following: V (29.2%), III (27.1%), Ia (22.9%), IV (10.4%), II (5.2%) and Ib (4.2%). A strong association was demonstrated between surface protein genes and serotypes. All isolates were fully susceptible to penicillin, but erythromycin and clindamycin resistance was high (41.7 and 35.4%, respectively), and 8 phenotypically macrolide sensitive isolates carried the ermB gene. 21.9% of all strains belonged to the hypervirulent ST17 clone, most being of serotype III and all were rib +. We found a few serotype IV isolates belonging to several STs and one serotype V/ST110 strain, containing a 44-bp deletion in the atr allele. CONCLUSIONS: The presence of silent ermB genes is of worry, as their expression upon macrolide exposure could lead to unforeseen therapeutic failure, while clindamycin is used for intrapartum antibiotic prophylaxis, in case of penicillin allergy. The other alarming result is the high prevalence of ST17 among these strains from STD patients, who could be sources of further infections. This is the first report from Hungary providing both serotyping and genotyping data of GBS isolates. These results could be helpful for vaccine production as the major vaccine candidates are capsular antigens or surface proteins.


Assuntos
Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/genética , Adulto , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Humanos , Hungria/epidemiologia , Macrolídeos/farmacologia , Testes de Sensibilidade Microbiana , Fenótipo , Prevalência , Sorogrupo , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/efeitos dos fármacos , Streptococcus agalactiae/isolamento & purificação , Streptococcus agalactiae/patogenicidade , Virulência/genética
5.
PLoS Negl Trop Dis ; 13(10): e0007801, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31609963

RESUMO

BACKGROUND: Scabies is a WHO neglected tropical disease common in children in low- and middle-income countries. Excoriation of scabies lesions can lead to secondary pyoderma infection, most commonly by Staphyloccocus aureus and Streptococcus pyogenes (group A streptococcus, GAS), with the latter linked to acute post-streptococcal glomerulonephritis (APSGN) and potentially rheumatic heart disease (RHD). There is a paucity of data on the prevalence of these skin infections and their bacterial aetiology from Africa. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study, conducted over a four-month period that included the dry and rainy season, was conducted to determine the prevalence of common skin infections in Sukuta, a peri-urban settlement in western Gambia, in children <5 years. Swabs from pyoderma lesions were cultured for S. aureus and GAS. Of 1441 children examined, 15.9% had scabies (95% CI 12.2-20.4), 17.4% had pyoderma (95% CI 10.4-27.7) and 9.7% had fungal infections (95% CI 6.6-14.0). Scabies was significantly associated with pyoderma (aOR 2.74, 95% CI 1.61-4.67). Of 250 pyoderma swabs, 80.8% were culture-positive for S. aureus, and 50.8% for GAS. Participants examined after the first rains were significantly more likely to have pyoderma than those examined before (aRR 2.42, 95% CI 1.38-4.23), whereas no difference in scabies prevalence was seen (aRR 1.08, 95% CI 0.70-1.67). Swab positivity was not affected by the season. CONCLUSIONS/SIGNIFICANCE: High prevalence of scabies and pyoderma were observed. Pyoderma increased significantly during the rainy season. Given the high prevalence of GAS pyoderma among children, further research on the association with RHD in West Africa is warranted.


Assuntos
Clima , Coinfecção/epidemiologia , Pioderma/epidemiologia , Escabiose/epidemiologia , Estações do Ano , Infecções Cutâneas Estafilocócicas/epidemiologia , Algoritmos , Pré-Escolar , Coinfecção/etiologia , Coinfecção/microbiologia , Estudos Transversais , Feminino , Gâmbia/epidemiologia , Glomerulonefrite/etiologia , Glomerulonefrite/microbiologia , Humanos , Lactente , Masculino , Micoses , Razão de Chances , Prevalência , Pioderma/complicações , Pioderma/microbiologia , Cardiopatia Reumática/etiologia , Cardiopatia Reumática/microbiologia , Fatores de Risco , Escabiose/complicações , Escabiose/microbiologia , Infecções Cutâneas Estafilocócicas/microbiologia , Staphylococcus aureus , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes
6.
J Dairy Sci ; 102(12): 11384-11400, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31606215

RESUMO

Objectives of this study were to (1) describe the intramammary infection (IMI) prevalence and pathogen profiles in quarters of cows approaching dry-off in US dairy herds, (2) compare IMI prevalence in quarters of cows exposed to different bedding material types, and (3) identify associations between bedding bacteria count and IMI in cows approaching dry-off. Eighty herds using 1 of 4 common bedding materials (manure solids, organic non-manure, new sand, and recycled sand) were recruited in a multi-site cross-sectional study. Each herd was visited twice for sampling. At each visit, aseptic quarter-milk samples were collected from 20 cows approaching dry-off (>180 d pregnant). Samples of unused and used bedding were also collected. Aerobic culture was used to determine the IMI status of 10,448 quarters and to enumerate counts (log10 cfu/mL) of all bacteria, Staphylococcus spp., Streptococcus spp. and Streptococcus-like organisms (SSLO), coliforms, Klebsiella spp., noncoliform gram-negatives, Bacillus spp., and Prototheca spp. in unused (n = 148) and used (n = 150) bedding. The association between bedding bacteria count and IMI was determined using multivariable logistic regression with mixed effects. Quarter-level prevalence of IMI was 21.1%, which was primarily caused by non-aureus Staphylococcus spp. (11.4%) and SSLO (5.6%). Only modest differences in IMI prevalence were observed between the 4 common bedding material types. Counts of all bacteria in unused bedding was positively associated with odds of IMI caused by any pathogen [ALL-IMI; odds ratio (OR) = 1.08]. A positive association was also observed for counts of SSLO in unused bedding and SSLO-IMI (OR = 1.09). These patterns of association were generally consistent across the 4 common bedding materials. In contrast, the association between counts of all bacteria in used bedding and ALL-IMI varied by bedding type, with positive associations observed in quarters exposed to manure solids (OR = 2.29) and organic non-manure (OR = 1.51) and a negative association in quarters exposed to new sand (OR = 0.47). Findings from this study suggest that quarter-level IMI prevalence in late-lactation cows is low in US dairy herds. Furthermore, bedding material type may not be an important risk factor for IMI in late lactation. Higher levels of bacteria in bedding may increase IMI prevalence at dry-off in general, but this relationship is likely to vary according to bedding material type.


Assuntos
Infecções por Klebsiella/veterinária , Mastite Bovina/microbiologia , Leite/microbiologia , Infecções Estafilocócicas/veterinária , Infecções Estreptocócicas/veterinária , Animais , Carga Bacteriana/veterinária , Roupas de Cama, Mesa e Banho/microbiologia , Roupas de Cama, Mesa e Banho/veterinária , Bovinos , Estudos Transversais , Feminino , Klebsiella/isolamento & purificação , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Lactação , Modelos Logísticos , Glândulas Mamárias Animais/microbiologia , Esterco/microbiologia , Mastite Bovina/epidemiologia , Prevalência , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus/isolamento & purificação , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação
7.
J Dairy Sci ; 102(12): 11401-11413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31606221

RESUMO

Because cloth udder towels (CUT) may function as a fomite for mastitis-causing pathogens, most udder health laboratories offer towel culture services as a tool to monitor towel hygiene. However, no studies have investigated if an association exists between bacteria levels in CUT and udder health outcomes. The objectives of this cross-sectional study were to (1) describe associations between herd-level measures of towel bacteria count (ToBC) and quarter-level intramammary infection (IMI) status in late-lactation cows, (2) establish pathogen-specific target levels of bacteria in CUT to aid the interpretation of towel culture reports, and (3) identify laundering-related risk factors for high ToBC. The study was conducted in 67 herds from 10 dairy states in the United States that used CUT. These 67 herds were originally recruited as part of a larger (80 herd) cross-sectional study of bedding management. Each herd was visited once during December 2017 to April 2018 and quarter-milk samples (n = 4,656) were collected from late-gestation (>180 d pregnant) cows (n = 1,313). Two recently laundered CUT were collected and a questionnaire was used to collect information about pre-milking teat preparation and CUT management practices. Quarter-level IMI status was determined using standard bacteriologic methods. In addition, colony-forming units of all bacteria (total bacteria), Staphylococcus spp., Streptococcus spp. or Streptococcus-like organisms (SSLO), coliforms, noncoliform gram-negatives, and Bacillus spp. were determined for each pair of CUT (log10 cfu/cm2). The association between ToBC and IMI was determined using multivariable logistic regression with mixed effects. After dichotomizing ToBC into high and low categories, associations between towel management practices and ToBC category were determined using unconditional logistic regression. The quarter-level prevalence of IMI was 19.6%, which was predominantly caused by non-aureus Staphylococcus spp. (NAS; 10.2%) and SSLO (5.1%). The predominant bacteria in CUT were Bacillus spp. (median = 3.13 log10 cfu/cm2). Total bacteria count was not associated with odds of IMI (odds ratio = 1.06), likely due to the predominance of Bacillus spp. in CUT and low number of IMI caused by Bacillus spp. In contrast, counts of Staphylococcus spp. and SSLO were positively associated with odds of IMI caused by NAS (odds ratio = 1.33) and SSLO (odds ratio = 1.45), respectively. Of 12 CUT management practices evaluated, only the failure to use a dryer was identified as a clear predictor of risk for a high ToBC (risk ratio of high coliform count = 8.17). Our study findings suggest that CUT may act as a fomite for NAS and SSLO. We recommend that herds aim to keep counts of Staphylococcus spp. and SSLO in CUT below 32 cfu/cm2 (or 5 cfu/in2), and that laundered towels be completely dried in a hot air dryer.


Assuntos
Infecções por Klebsiella/veterinária , Mastite Bovina/microbiologia , Leite/microbiologia , Infecções Estafilocócicas/veterinária , Infecções Estreptocócicas/veterinária , Animais , Carga Bacteriana/veterinária , Bovinos , Estudos Transversais , Feminino , Klebsiella/isolamento & purificação , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Lactação , Modelos Logísticos , Glândulas Mamárias Animais/microbiologia , Esterco/microbiologia , Mastite Bovina/epidemiologia , Gravidez , Prevalência , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus/isolamento & purificação , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação
8.
BMC Infect Dis ; 19(1): 812, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533652

RESUMO

BACKGROUND: Invasive group B Streptococcus (GBS) disease in Chinese infants has gradually gained attention in recent years, but the molecular epidemiology of the pathogen is still not well known. METHODS: This multicenter study retrospectively investigated distribution of capsular serotypes, sequence types (STs), and hypervirulent GBS adhesin gene (hvgA) in clinical GBS isolates that caused invasive disease in infants aged < 3 months of age in southern mainland China between January 2013 and June 2016. Genes for antibiotic resistance to tetracycline, erythromycin, and clindamycin were also examined. RESULTS: From a total of 93 GBS isolates taken from 34 early-onset disease (EOD, 0-6 days after birth) and 59 late-onset disease (LOD, 7-89 days after birth) cases, four serotypes were identified: serotypes III (79.6%), Ib (12.9%), Ia (4.3%), and V (3.2%). Serotype III accounted for 73.5% of EOD and 83.1% of LOD and was responsible for 75.5% of cases involving meningitis. Fifteen STs were found, with the majority being ST17 (61.3%), ST12 (7.5%), ST19 (7.5%), and others (23.7%). 96.8% of STs belonged to only five clonal complexes (CCs): CC17 (64.5%), CC10 (12.9%), CC19 (9.7%), CC23 (6.5%), and CC1 (3.2%). The hvgA gene was detected in 66.7% of GBS isolates and 95% of CC17 isolates, all of which were serotype III except one serotype Ib/CC17 isolate. A large proportion of GBS isolates were found to be resistant to tetracycline (93.5%), clindamycin (65.5%), and erythromycin (60.2%). Genes of tetO (74.7%) and tetM (46.0%) were found in tetracycline resistant isolates, linB (24.6%) in clindamycin resistant isolates, and ermB (87.5%) and mefA (3.6%) in erythromycin resistant isolates. CONCLUSION: Our results reveal higher prevalence of serotype III, ST17, CC17, hvgA expressing, and antibiotic resistant GBS isolates than previously reported in southern mainland China. This study provides guidance for appropriate measures of prevention and control to be taken in the future.


Assuntos
Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/isolamento & purificação , Adesinas Bacterianas/genética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , China/epidemiologia , DNA Bacteriano/química , DNA Bacteriano/metabolismo , Farmacorresistência Bacteriana/efeitos dos fármacos , Humanos , Lactente , Recém-Nascido , Tipagem de Sequências Multilocus , Prevalência , Estudos Retrospectivos , Sorogrupo , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/patologia , Streptococcus agalactiae/genética
9.
J Med Microbiol ; 68(10): 1540-1543, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31483245

RESUMO

Four group A streptococcus (GAS) bacteraemia occurred in a small burn unit within 2 weeks. The GAS patient isolates, characterized as emm89, shared the same PFGE pulsotype with two other strains isolated 2 months later. The outbreak investigation revealed that a nurse was the most likely source of GAS transmission, as she was confirmed to carry the same outbreak strain in her throat and had direct and regular contact with the six outbreak patients in the unit. The outbreak was controlled after the nurse had undergone eradication treatment. This report highlights the emergence of the emm89 clone and its capacity to elicit invasive GAS outbreaks.


Assuntos
Unidades de Queimados/estatística & dados numéricos , Infecção Hospitalar/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/isolamento & purificação , Adulto , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Proteínas da Membrana Bacteriana Externa/genética , Proteínas da Membrana Bacteriana Externa/metabolismo , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Feminino , Humanos , Pessoa de Meia-Idade , Epidemiologia Molecular , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/classificação , Streptococcus pyogenes/genética , Tunísia , Adulto Jovem
10.
Eur J Clin Microbiol Infect Dis ; 38(12): 2253-2258, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31392445

RESUMO

The clinical characteristics and outcomes of Streptococcus dysgalactiae subspecies equisimilis (SDSE) bacteremia cases have not been adequately evaluated. We retrospectively enrolled consecutive adult patients with SDSE or S. agalactiae (group B streptococci, GBS) bacteremia at a tertiary care hospital (Republic of Korea) from August 2012 to December 2016. We compared the incidence, seasonality, clinical characteristics, and outcomes of 52 SDSE bacteremia cases with 151 GBS bacteremia cases. The incidence of SDSE and GBS bacteremia in these patients was 1.28/100,000 and 4.22/100,000 person-days, respectively. Most SDSE bacteremia cases were of community-onset infection (SDSE 94.2% vs GBS 83.4%; p = 0.052). Lancefield group G was the most common bacteria type among SDSE isolates (43/47; 91.5%). Patients with SDSE bacteremia were older (median, 68.0 years vs 61.0 years; p = 0.03). In both groups, solid tumor was the most common underlying disease, and more than half of the patients were immunocompromised (51.9% vs 54.3%; p = 0.77). Chronic kidney disease was more common in the SDSE group (19.2% vs 5.3%; p < 0.01). Cellulitis was the most common clinical syndrome of SDSE bacteremia and was more common in the SDSE group (59.6% vs 29.1%; p < 0.01). SDSE bacteremia cases occurred more frequently in the warm season compared with GBS bacteremia cases (65.4% vs 37.1%; p < 0.01); in-hospital mortalities were not significantly different between the groups (3.8% vs 10.6%; p = 0.17). In conclusion, SDSE bacteremia is commonly associated with cellulitis, especially in older and immunocompromised patients during the warm season.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Streptococcus/isolamento & purificação , Idoso , Antibacterianos/farmacologia , Bacteriemia/patologia , Feminino , Humanos , Incidência , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/patologia , Streptococcus/classificação , Streptococcus/efeitos dos fármacos , Streptococcus agalactiae/classificação , Streptococcus agalactiae/efeitos dos fármacos , Centros de Atenção Terciária
11.
J Med Microbiol ; 68(10): 1526-1533, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31418669

RESUMO

Introduction. Among beta-haemolytic streptococci, Streptococcus pyogenes (GAS) is the prototype agent of bacterial pharyngitis and causes other human infections. Streptococcus dysgalactiae subsp. equisimilis (SDSE) causes GAS-like infections, while Streptococcus agalactiae (GBS) is a common neonate pathogen that is rarely associated with pharyngitis.Aim. To determine the prevalence and persistence of beta-haemolytic streptococci throat carriage and type the bacterial population.Methods. Throat swabs were collected from 121 children and 127 young adult volunteers and cultured. Colonized volunteers were screened quarterly, for up to 1 year, while beta-haemolytic streptococci could be detected. Isolates were identified and submitted to antimicrobial susceptibility testing and epidemiological typing.Results. Carriage was detected in 34 (13.7 %) volunteers. Seventeen children carried GAS (14 %), while 17 young adults carried SDSE (8, 6.3 %), GBS (4, 3.1 %), GAS (3, 2.4 %) and the Streptococcus anginosus group (2, 1.6 %). Persistent carriage was detected for up to 6 months in two children and for up to 1 year in three young adults. Three new emm subtypes were found, emm87.16 and emm90.9 (GAS) and stC36.11 (SDSE). While the GAS population among children was unexpectedly clonal, substantial genetic diversity was found among the isolates recovered from young adults. Resistance to erythromycin, clindamycin and tetracycline was detected in GAS, GBS and SDSE recovered from young adults.Conclusions. Prevalence was slightly greater among children, but persistent carriage was greater among young adults, with SDSE being the species most associated with persistence. Few sources seemed to disseminate GAS among children, since only two clonal types were found. The volunteers hosted pathogenic streptococci persistently, including macrolide-resistant strains.


Assuntos
Portador Sadio/microbiologia , Faringe/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Adolescente , Adulto , Antibacterianos/farmacologia , Brasil/epidemiologia , Portador Sadio/epidemiologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Humanos , Macrolídeos/farmacologia , Masculino , Faringite/epidemiologia , Faringite/microbiologia , Estudos Prospectivos , Infecções Estreptocócicas/epidemiologia , Streptococcus/classificação , Streptococcus/efeitos dos fármacos , Streptococcus/genética , Tetraciclina/farmacologia , Adulto Jovem
12.
Eur J Clin Microbiol Infect Dis ; 38(12): 2305-2310, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31440914

RESUMO

The objective of this study was to examine the clinical presentation of community-acquired beta-haemolytic streptococcal (BHS) meningitis in adults. This is a nationwide population-based cohort study of adults (≥ 16 years) with BHS meningitis verified by culture or polymerase chain reaction of the cerebrospinal fluid (CSF) from 1993 to 2005. We retrospectively evaluated clinical and laboratory features and assessed outcome by Glasgow Outcome Scale (GOS). We identified 54 adults (58% female) with a median age of 65 years (IQR 55-73). Mean incidence rate was 0.7 cases per 1,000,000 person-years. Alcohol abuse was noted among 11 (20%) patients. Group A streptococci (GAS) were found in 17 (32%) patients, group B (GBS) in 18 (34%), group C (GCS) in four (8%) and group G (GGS) in 14 (26%). Patients with GAS meningitis often had concomitant otitis media (47%) and mastoiditis (30%). Among patients with GBS, GCS or GGS meningitis, the most frequent concomitant focal infections were bone and soft tissue infections (19%) and endocarditis (16%). In-hospital mortality was 31% (95% CI 19-45), and 63% (95% CI 49-76) had an unfavourable outcome at discharge (GOS < 5). BHS meningitis in adults is primarily observed among the elderly and has a poor prognosis. GAS meningitis is primarily associated with concomitant ear-nose-throat infection.


Assuntos
Meningite/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus/isolamento & purificação , Idoso , Líquido Cefalorraquidiano/microbiologia , Infecções Comunitárias Adquiridas , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Meningite/microbiologia , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/microbiologia , Streptococcus/classificação , Streptococcus/genética
13.
Braz J Microbiol ; 50(4): 943-952, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432465

RESUMO

Brazilian data for maternal GBS colonization shows different prevalence rates. This conflicting data may be related to the absence of an official recommendation from the Federal Brazilian Health Authorities describing guidelines and protocols to perform GBS screening in pregnant women, in both public and private clinics. In the present review, we evaluated published reports addressing the prevalence of GBS in different regions of the country, methods used, and, when available, information regarding antibiotic resistance and serological typing of clinical isolates. According to this review, GBS prevalence in pregnant women in Brazil ranged from 4.2 to 28.4%, in the last 10 years. Serotype Ia was the most prevalent. The highest antibiotic resistance rates were found for tetarcycline, although its use to treat GBS infections is not common. Our results also show high resistance rates to clindamycin and erythromycin, which are commonly used as an alternative to penicillin in GBS infecctions. The increased antibiotic resistance, variations in serotype distribution, and high GBS prevalences need to be further investigated. Based on the present situation, recommendations regarding GBS surveillance in the country were raised and may improve our strategies for preventing neonatal infections.


Assuntos
Farmacorresistência Bacteriana , Complicações Infecciosas na Gravidez/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Antibacterianos/farmacologia , Brasil/epidemiologia , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Sorogrupo , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/classificação , Streptococcus agalactiae/efeitos dos fármacos , Streptococcus agalactiae/genética
14.
Eur J Obstet Gynecol Reprod Biol ; 241: 24-29, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31437621

RESUMO

OBJECTIVE: To compare the detection rates of vaginal-perineal cultures for group B streptococci (GBS) with the standard vaginal and rectal cultures and evaluate the diagnostic yield of vaginal-perineal vs. rectal swabs for extended spectrum ß-lactamase producing Enterobacterales (ESBL-E) during the third trimester of pregnancy. STUDY DESIGN: Vagino-perineal and rectal swabs were collected cross-sectionally from pregnant women between 35-37 weeks gestation and tested for the presence of GBS and ESBL-E. Accuracy of the vagino-perineal swab was compared to the combined vagino-perineal/rectal swab. Risk factors for ESBL carriage were examined. Degrees of pain, discomfort and stress related to the rectal swab were analyzed on visual analogue scales. RESULTS: 48 out of 250 participants (19.2%) were GBS positive. The vagino-perineal swab was positive in 44 of 48 women (91.7%) yielding a negative predictive value of 98.1%. Agreement (kappa) between the two methods was 0.95. Six out of 190 women with additional ESBL-E screening (3.2%) tested positive by rectal swab. Of these, only two had also a positive vagino-perineal swab. The rectal swab caused overall little subjective discomfort, pain or stress, as indicated by low scores indicated on the visual scales. CONCLUSIONS: The GBS detection rate of the vagino-perineal swab was lower compared to the reference standard. However, agreement between the two screening methods was high and there were no cases of GBS neonatal sepsis in the recruited population, supporting this less invasive screening strategy. In contrast, the vaginal-perineal swab was inferior to the rectal swab for detecting ESBL-E, indicating that this less invasive method for detecting antibiotic resistant bacteria that may be potentially transferred to the neonate during labor and delivery would be inappropriate for ESBL-E screening in pregnant women. The low ESBL-E carriage rate among pregnant women likely reflects the prevalence in the general population.


Assuntos
Infecções por Enterobacteriaceae/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Manejo de Espécimes/métodos , Infecções Estreptocócicas/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Prevalência , Infecções Estreptocócicas/epidemiologia , Suíça/epidemiologia
15.
J Hosp Infect ; 103(1): 21-26, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31283948

RESUMO

BACKGROUND: Whole genome sequencing (WGS) of Streptococcus pyogenes linked to invasive disease has been used to identify and investigate outbreaks. The clinical application of WGS in real-time for outbreak control is seldom employed. AIMS: A fatal case of bacteraemia at a national orthopaedic hospital prompted an outbreak investigation to identify carriers and halt transmission using real-time WGS. METHODS: Retrospective surveillance was conducted to identify patients with Streptococcus pyogenes infections in the last year. Upon contact tracing, four patients and 179 staff were screened for Streptococcus pyogenes carriage. All isolates identified were emm-typed. WGS was performed in real-time on a subset of isolates. FINDINGS: Twelve isolates of Streptococcus pyogenes from the index case, two patients and eight staff were identified. Six isolates were emm 1.0, including the index case and five staff isolates. The remaining isolates belonged to distinct emm types. WGS analysis was undertaken on the six emm 1.0 isolates. Five were indistinguishable by single nucleotide polymorphism (SNP) analysis, with 0 SNP distance, and one had one SNP difference, supporting the hypothesis of recent local transmission. All screen-positive healthcare workers were offered treatment with penicillin or clindamycin. No further cases were identified. CONCLUSION: The increased molecular discrimination of WGS confirmed the clustering of these cases and the outbreak was contained. This demonstrates the clinical utility of WGS in managing outbreaks of invasive Streptococcus pyogenes in real-time and we recommend its implementation as a routine clinical service.


Assuntos
Bacteriemia/epidemiologia , Portador Sadio/epidemiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/classificação , Sequenciamento Completo do Genoma/métodos , Bacteriemia/microbiologia , Portador Sadio/microbiologia , Portador Sadio/transmissão , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Hospitais , Humanos , Epidemiologia Molecular/métodos , Tipagem Molecular/métodos , Estudos Retrospectivos , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Streptococcus pyogenes/genética , Streptococcus pyogenes/isolamento & purificação
16.
Can J Vet Res ; 83(3): 168-176, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31308588

RESUMO

The primary objective of this study was to explore the variability of Streptococcus uberis (S. uberis) isolates by extracting multilocus sequence typing (MLST) data from whole-genome sequencing. The secondary objective was to determine the distribution of the phenotypic antimicrobial resistance (AMR) and the associated AMR genes as well as the virulence gene profiles among sequence types (STs). Sixty-two isolates were recovered from 16 herds in 3 Canadian Maritime Provinces: New Brunswick (14.5%), Nova Scotia (48.3%), and Prince Edward Island (37.1%). Of these, 9, 30, and 23 were recovered from post-calving, lactational samples, and post-mastitis samples, respectively. These 62 S. uberis isolates belonged to 34 STs; 11 isolates were typed to 9 known STs and 51 isolates were classified as one of 25 new STs. Thirteen isolates were part of major clonal complexes (CCs). Post-mastitis isolates contained 10 unique STs, lactational isolates contained 11 unique STs, and post-calving isolates had 3 STs. Each farm had only 1 isolate that was a unique ST except for STs 233, 851, 855, 857, 864, and 866, which were found in multiple cows per herd on more than one farm. ST851 and ST857 were found in each of the 3 sample types, with ST857 found in cows from all 3 Maritime provinces. These results indicate that S. uberis is a diverse non-clonal pathogen with specific STs residing in clonal clusters, carrying multiple AMR genes and virulence, with a diverse phenotypic AMR.


Assuntos
Variação Genética , Mastite Bovina/microbiologia , Infecções Estreptocócicas/veterinária , Streptococcus/genética , Animais , Canadá/epidemiologia , Bovinos , Feminino , Mastite Bovina/epidemiologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia
17.
Eur J Obstet Gynecol Reprod Biol ; 240: 178-181, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301553

RESUMO

OBJECTIVES: To estimate the prevalence of group B streptococcus at onset of labor and to compare the accuracy of intrapartum antibiotic prophylaxis based on a risk factor strategy versus an intrapartum screening. STUDY DESIGN: In this cross-sectional study, 700 women referred for intended vaginal delivery were tested for group B streptococcus at onset of labor by gold standard culture in vaginal and rectal swabs. The results were blinded, and intrapartum antibiotic prophylaxis was given to women with risk factors for group B streptococcus infection: previous neonatal group B streptococcus infection, group B streptococcus in urine and/or vagina in current pregnancy, gestational age <36 + 0 weeks, temperature ≥38.0 °C or rupture of membranes ≥18 h. RESULTS: Of 642 women, who delivered within three days of specimen collection, 170 (26.5%) received benzylpenicillin as intrapartum antibiotic prophylaxis based on risk factors. The prevalence of group B streptococcus at onset of labor was 17.8% (114/642), with 62 women positive for group B streptococcus in both the vagina and rectum, 12 in the vagina only and 40 in rectum only. Intrapartum antibiotic prophylaxis was administered correctly in 31.6% (36/114) of GBS positive women at time of delivery and 78.8% (134/170) of women who received antibiotics were actually GBS negative. The positive predictive value of intrapartum antibiotic prophylaxis based on risk factors was 21.2%. The sensitivity was 31.6% and the specificity was 74.6%. CONCLUSION: The accuracy of predicting maternal group B streptococcus infection from risk factors is low. Intrapartum group B streptococcus diagnostics is more precise and will not increase the overall use of intrapartum antibiotic prophylaxis.


Assuntos
Antibacterianos/uso terapêutico , Complicações Infecciosas na Gravidez/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/isolamento & purificação , Adulto , Antibioticoprofilaxia , Estudos Transversais , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Prevalência , Fatores de Risco , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Adulto Jovem
18.
Rev Esp Quimioter ; 32(4): 333-364, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31345005

RESUMO

The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial. The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table.


Assuntos
Vacinas Bacterianas/administração & dosagem , Controle de Doenças Transmissíveis , Controle de Infecções , Cobertura Vacinal/estatística & dados numéricos , Vacinas Virais/administração & dosagem , Adulto , Previsões , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/prevenção & controle , Haemophilus influenzae tipo b , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Humanos , Incidência , Influenza Humana/prevenção & controle , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Neisseria meningitidis , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Espanha/epidemiologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/prevenção & controle , Streptococcus pneumoniae , Infecção pelo Vírus da Varicela-Zoster/epidemiologia , Infecção pelo Vírus da Varicela-Zoster/prevenção & controle
19.
PLoS Negl Trop Dis ; 13(7): e0007511, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31269021

RESUMO

The prevalence of rheumatic heart disease (RHD) in the Aboriginal population of the Australian Northern Territory is high, and Streptococcus pyogenes skin infections likely contribute to this. A promising candidate S. pyogenes "30mer" vaccine is composed of 30 pharyngitis associated type-specific antigens from the S. pyogenes M protein. Cross opsonisation experiments suggest that 30mer vaccine protection may extend to non-cognate emm types. A new "emm cluster" scheme for classifying M protein is based on the full-length coding sequence, and correlates with functional and immunological properties, and anatomical tropism. Twenty-seven years of research in the Northern Territory has yielded 1810 S. pyogenes isolates with clinical and emm type data. The primary aim was to analyse these data with reference to the emm cluster scheme and cross opsonisation information, to inform estimation of 30mer vaccine efficacy in the Northern Territory. The isolates encompass 101 emm types. Variants of cluster A-C were enriched in throat isolates, and variants of emm cluster D enriched in skin isolates. Throat isolates were enriched for 30mer vaccine cognate emm types in comparison with skin isolates of which only 25% were vaccine emm types. While cross opsonisation data indicates potential for enhancing 30mer vaccine coverage, more than one third of skin isolates were within 38 emm types untested for cross opsonisation. Emm cluster D variants, in particular emm cluster D4, were not only all non-cognate with the vaccine, but were abundant and diverse, and less likely to be cross-opsonisation positive than other emm clusters. Long term persistence of many emm types in the study area was revealed. It was concluded that the 30mer vaccine efficacy in the Northern Territory will likely require both cross protection, and additional measures to elicit immunity against variants of emm cluster D.


Assuntos
Antígenos de Bactérias/imunologia , Proteínas da Membrana Bacteriana Externa/imunologia , Proteínas de Transporte/imunologia , Cardiopatia Reumática/microbiologia , Infecções Estreptocócicas/prevenção & controle , Vacinas Estreptocócicas/uso terapêutico , Streptococcus pyogenes , Humanos , Northern Territory/epidemiologia , Faringite/epidemiologia , Faringite/microbiologia , Prevalência , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/prevenção & controle , Pele/microbiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/epidemiologia , Vacinas Estreptocócicas/imunologia
20.
PLoS One ; 14(6): e0218668, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220158

RESUMO

BACKGROUND: Necrotizing fasciitis (NF) is a serious skin and soft tissue infection causing high mortality. Investigating region specific epidemiologic factors associated with NF is important for establishing appropriate treatment strategies. This multicenter study was done to provide an update of the microbial etiology, clinical characteristics, and outcomes of NF in Korea. MATERIALS AND METHODS: A retrospective cohort of adult patients with NF was established using patient data from 13 general hospitals between January 2012 and December 2015 in Korea. We evaluated microbial etiology and clinical characteristics to identify risk factors associated with in-hospital mortality; analyses were performed using binary logistic regression models. RESULTS: A total of 161 patients with NF were included. The most common underlying disease was diabetes mellitus (66 cases, 41.0%). A total of 148 organisms were isolated from 119 (73.9%) patients. Enteric Gram-negative organisms (36 patients) were the most common pathogen, followed by Staphylococcus aureus (30 patients) and streptococci (28 patients). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 6.2% (10/161) of patients. Of 37 enteric Gram-negative isolates tested, 26 (70.3%) isolates were susceptible to ceftriaxone. The in-hospital mortality rate was 22.4%. Intensive care unit admission, septic shock, and Gram-negative organism infections were significantly associated with in-hospital mortality, and surgery was not a favorable prognostic factor. CONCLUSIONS: As initial empirical antibiotics, glycopeptides against MRSA and broad-spectrum antibiotics against third-generation cephalosporin-resistant organisms should be considered for patients with community-onset NF in Korea.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/etiologia , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/etiologia , Adulto , Idoso , Estudos de Coortes , Infecções Comunitárias Adquiridas/diagnóstico , Fasciite Necrosante/diagnóstico , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prognóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/epidemiologia
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