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1.
BMC Infect Dis ; 20(1): 798, 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33115434

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), the causative agent of the coronavirus disease 19 (COVID-19), is a highly transmittable virus. Since the first person-to-person transmission of SARS-CoV-2 was reported in Italy on February 21st, 2020, the number of people infected with SARS-COV-2 increased rapidly, mainly in northern Italian regions, including Piedmont. A strict lockdown was imposed on March 21st until May 4th when a gradual relaxation of the restrictions started. In this context, computational models and computer simulations are one of the available research tools that epidemiologists can exploit to understand the spread of the diseases and to evaluate social measures to counteract, mitigate or delay the spread of the epidemic. METHODS: This study presents an extended version of the Susceptible-Exposed-Infected-Removed-Susceptible (SEIRS) model accounting for population age structure. The infectious population is divided into three sub-groups: (i) undetected infected individuals, (ii) quarantined infected individuals and (iii) hospitalized infected individuals. Moreover, the strength of the government restriction measures and the related population response to these are explicitly represented in the model. RESULTS: The proposed model allows us to investigate different scenarios of the COVID-19 spread in Piedmont and the implementation of different infection-control measures and testing approaches. The results show that the implemented control measures have proven effective in containing the epidemic, mitigating the potential dangerous impact of a large proportion of undetected cases. We also forecast the optimal combination of individual-level measures and community surveillance to contain the new wave of COVID-19 spread after the re-opening work and social activities. CONCLUSIONS: Our model is an effective tool useful to investigate different scenarios and to inform policy makers about the potential impact of different control strategies. This will be crucial in the upcoming months, when very critical decisions about easing control measures will need to be taken.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Betacoronavirus/isolamento & purificação , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Suscetibilidade a Doenças/diagnóstico , Suscetibilidade a Doenças/epidemiologia , Humanos , Itália/epidemiologia , Modelos Teóricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Quarentena
2.
Infect Dis Poverty ; 9(1): 112, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787916

RESUMO

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) had spread worldwide. Although the world has intensively focused on the epidemic center during this period of time, it is imperative to emphasize that more attention should also be paid to some impoverished areas in China since they are more vulnerable to disease outbreak due to their weak health service capacities. Therefore, this study took Liangshan Yi Autonomous Prefecture as an example to analyze the COVID-19 epidemic in the impoverished area, evaluate the control effect and explore future control strategies. METHODS: In this study, we collected information including age, gender, nationality, occupation, and address of all COVID-19 cases reported from 25 January 2020 to 23 April 2020 in Liangshan Prefecture from the Nationwide Notifiable Infectious Diseases Reporting Information System (NIDRIS), which were used under license and not publicly available. Additionally, we retrieved other information of cases through epidemiological investigation reports reviewing. Data were analyzed using the software Excel 2010 and SPSS 17.0. The geographic distribution of cases was mapped using ArcGIS10.2. RESULTS: By 23 April 2020, a total of 13 COVID-19 cases and two asymptomatic SARS-CoV-2 carriers were reported in Liangshan, in three family clusters. Among the cases, eight cases had a history of sojourning in Hubei Province (61.54%), of which six were related to Wuhan. Cases aged under 44 years accounted for 61.54%, with no child case. The delay of patients' hospital visiting, and the low degree of cooperation in epidemiological investigation are problems. CONCLUSIONS: During the study period, Liangshan was well under control. This was mainly contributed to strict preventive strategies aimed at local culture, inter-sectoral coordination and highly degree of public cooperation. Besides, some possible environmentally and culturally preventive factors (e.g., rapid air flow and family concept) would affect disease prevention and control. In the next step, the health education about COVID-19 should be strengthened and carried out according to the special culture of ethnic minorities to enhance public awareness of timely medical treatment.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Áreas de Pobreza , Adulto , Distribuição por Idade , Idoso , Portador Sadio/epidemiologia , Portador Sadio/transmissão , Portador Sadio/virologia , China/epidemiologia , Análise por Conglomerados , Busca de Comunicante , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Quarentena , Análise Espacial , Fatores de Tempo , Adulto Jovem
3.
Epidemiol Infect ; 148: e132, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32611465

RESUMO

Hubei province in China has had the most confirmed coronavirus disease 2019 (COVID-19) cases and has reported sustained transmission of the disease. Although Lu'an city is adjacent to Hubei province, its community transmission was blocked at the early stage, and the impact of the epidemic was limited. Therefore, we summarised the overall characteristics of the entire epidemic course in Lu'an to help cities with a few imported cases better contain the epidemic. A total of 69 confirmed COVID-19 cases and 11 asymptomatic carriers were identified in Lu'an during the epidemic from 12 January to 21 February 2020. Fifty-two (65.0%) cases were male, and the median age was 40 years. On admission, 56.5% of cases had a fever as the initial symptom, and pneumonia was present in 89.9% of cases. The mean serial interval and the mean duration of hospitalisation were 6.5 days (95% CI: 4.8-8.2) and 18.2 days (95% CI: 16.8-19.5), respectively. A total of 16 clusters involving 60 cases (17 first-generation cases and 43 secondary cases) were reported during the epidemic. We observed that only 18.9% (7/37) index cases resulted in community transmission during the epidemic in Lu'an, indicating that the scale of the epidemic was limited to a low level in Lu'an city. An asymptomatic carrier caused the largest cluster, involving 13 cases. Spread of COVID-19 by asymptomatic carriers represents an enormous challenge for countries responding to the pandemic.


Assuntos
Portador Sadio/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Portador Sadio/epidemiologia , Portador Sadio/transmissão , Criança , Pré-Escolar , China/epidemiologia , Cidades/epidemiologia , Análise por Conglomerados , Infecções por Coronavirus/transmissão , Feminino , Febre , Humanos , Lactente , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/transmissão , Vigilância da População/métodos , Fatores de Tempo , Adulto Jovem
4.
Can J Anaesth ; 67(10): 1424-1430, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32488493

RESUMO

PURPOSE: Risk to healthcare workers treating asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the operating room depends on multiple factors. This review examines the evidence for asymptomatic or pre-symptomatic carriage of SARS-CoV-2, the risk of transmission from asymptomatic patients, and the specific risks associated with aerosol-generating procedures. Protective measures, such as minimization of aerosols and use of personal protective equipment in the setting of treating asymptomatic patients, are also reviewed. SOURCE: We examined the published literature as well as Societal guidelines. PRINCIPAL FINDINGS: There is evidence that a proportion of those infected with SARS-CoV-2 have detectable viral loads prior to exhibiting symptoms, or without ever developing symptoms. The degree of risk of transmission from asymptomatic patients to healthcare providers will depend on the prevalence of disease in the population, which is difficult to assess without widespread population screening. Aerosol-generating procedures increase the odds of viral transmission from infected symptomatic patients to healthcare providers, but transmission from asymptomatic patients has not been reported. Techniques to minimize aerosolization and appropriate personal protective equipment may help reduce the risk to healthcare workers in the operating room. Some societal guidelines recommend the use of airborne precautions during aerosol-generating procedures on asymptomatic patients during the coronavirus disease pandemic, although evidence supporting this practice is limited. CONCLUSION: Viral transmission from patients exhibiting no symptoms in the operating room is plausible and efforts to reduce risk to healthcare providers include reducing aerosolization and wearing appropriate personal protective equipment, the feasibility of which will vary based on geographic risk and equipment availability.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/transmissão , Aerossóis , Betacoronavirus/isolamento & purificação , Portador Sadio/epidemiologia , Portador Sadio/virologia , Infecções por Coronavirus/epidemiologia , Pessoal de Saúde , Humanos , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-32574282

RESUMO

To investigate the early epidemic of COVID-19, a total of 176 confirmed COVID-19 cases in Shiyan city, Hubei province, China were surveyed. Our data indicated that the rate of emergence of early confirmed COVID-19 cases in Hubei province outside Wuhan was dependent on migration population, and the second-generation of patients were family clusters originating from Wuhan travelers. Epidemiological investigation indicated that the reproductive number (R0) under containment strategies was 1.81, and asymptomatic SARS-CoV-2 carriers were contagious with a transmission rate of 10.7%. Among the 176 patients, 53 were admitted to the Renmin Hospital of Hubei University of Medicine. The clinical characteristics of these 53 patients were collected and compared based on a positive RT-PCR test and presence of pneumonia. Clinical data showed that 47.2% (25/53) of COVID-19 patients were co-infected with Mycoplasma pneumoniae, and COVID-19 patients coinfected with M. pneumoniae had a higher percentage of monocytes (P < 0.0044) and a lower neutrophils percentage (P < 0.0264). Therefore, it is important to assess the transmissibility of infected asymptomatic individuals for SARS-CoV-2 transmission; moreover, clinicians should be alert to the high incidence of co-infection with M. pneumoniae in COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Assintomáticas/epidemiologia , Contagem de Células Sanguíneas , Portador Sadio/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Coinfecção/epidemiologia , Busca de Comunicante , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Feminino , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia por Mycoplasma/complicações , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Tomografia Computadorizada por Raios X , Viagem , Adulto Jovem
6.
Int J Infect Dis ; 98: 113-120, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32562849

RESUMO

BACKGROUND: Streptococcus pneumoniae remains a major contributor to childhood infections and deaths globally. In Cameroon, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in July 2011, using a 3-dose Expanded programme on immunization (EPI) schedule administered to infants at 6, 10 and 14 weeks of age. To evaluate PCV13 effects, we assessed pneumococcal nasopharyngeal colonization and serotype distribution among Cameroonian children after PCV13 introduction. METHODS: Nasopharyngeal (NP) swabs were collected from eligible children aged 24-36 months in two cross-sectional surveys conducted from March to July: in 2013 (PCV13-unvaccinated), and in 2015 (PCV13-vaccinated). Using a systematic World Health Organization (WHO) cluster coverage sampling technique in 40 communities, NP swabs collected were processed following WHO recommendations. Standard bacterial culture techniques were used for the isolation of S. pneumoniae from gentamicin-blood agar plates and identification using optochin susceptibility testing. Serotyping was performed using sequential multiplex polymerase chain reaction, supplemented with Quellung test. RESULTS: Among the PCV13-vaccinated children, overall pneumococcal carriage prevalence was 61.8% (426/689) and PCV13 vaccine-type carriage prevalence was 18.0% (123/689). Eleven out of the 13 vaccine serotypes were detected in the vaccinated children. The most common serotypes were 19F (4.5%, 31/689) and 15B/C (7.3%, 50/689). CONCLUSION: In Cameroon, four years after infant vaccination nearly all of the PCV13-serotypes continued to circulate in the population. This suggests that the direct and indirect effects of the vaccination programme have not resulted in expected low levels of vaccine-type transmission. Continuous monitoring is needed to assess the long term effects of the PCV13 on nasopharyngeal carriage and disease.


Assuntos
Nasofaringe/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/imunologia , Camarões/epidemiologia , Portador Sadio/epidemiologia , Portador Sadio/imunologia , Portador Sadio/microbiologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Programas de Imunização , Esquemas de Imunização , Masculino , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas/imunologia , Prevalência , Sorogrupo , Sorotipagem , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/crescimento & desenvolvimento , Streptococcus pneumoniae/isolamento & purificação , Vacinação
7.
PLoS One ; 15(4): e0232456, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353071

RESUMO

Since its emergence in the early 2000s, livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398 (LA-MRSA CC398) has led to an increasing number of human infections in Denmark and other European countries with industrial pig production. LA-MRSA CC398 is primarily associated with skin infections among pig farm workers but is also increasingly recognized as a cause of life-threatening disease among elderly and immunocompromised people. Pig farm workers may serve as vehicles for the spread of LA-MRSA CC398 and other farm-origin bacteria between farms and into the general population. Yet, little is known about the bacterial community dynamics in pig farm workers and other persons with long- and short-term exposure to the pig farm environment. To gain insight into this, we investigated the nasal microbiomes in pig farm workers during a workweek on four LA-MRSA CC398-positive pig farms, as well as in short-term visitors two hours before, immediately after, and 48 hours after a 1-hour visit to another LA-MRSA CC398-positive pig farm. S. aureus and LA-MRSA CC398 carriage was quantified by means of culture, and the composition of the bacterial communities was investigated through sequencing of the 16S rRNA gene. Pig farm workers often carried LA-MRSA CC398 and other bacteria from the pig farm environment, both at work and at home, although at lower levels at home. In contrast, short-term visitors were subject to a less dramatic and rapidly reversible change in the nasal bacterial community composition. These results suggest that pig farm workers may be an important source of LA-MRSA CC398 and perhaps other pathogens of human and veterinary relevance.


Assuntos
Portador Sadio/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Exposição Ocupacional/efeitos adversos , Infecções Estafilocócicas/epidemiologia , Suínos/microbiologia , Adulto , Animais , Portador Sadio/microbiologia , Portador Sadio/transmissão , DNA Bacteriano/isolamento & purificação , Fazendas/estatística & dados numéricos , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Microbiota/genética , Pessoa de Meia-Idade , Nariz/microbiologia , RNA Ribossômico 16S/genética , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/transmissão , Fatores de Tempo , Adulto Jovem
8.
Am J Trop Med Hyg ; 103(2): 684-688, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32458778

RESUMO

Increasing antibiotic consumption has been shown to lead to increased antibiotic resistance selection. We evaluated the prevalence of antibiotic resistance in Streptococcus pneumoniae to commonly used antibiotic classes as well as correlations between resistance and antibiotic consumption at the individual and community levels in children aged 0-59 months in Nouna district, Burkina Faso. A population-based sample of 300 children aged 0-59 months was randomly selected from the most recent census in 18 communities in the Nouna Health and Demographic Surveillance Site. Caregivers were interviewed about children's recent antibiotic use, and a nasopharyngeal swab was collected from each child. Nasopharyngeal swabs were processed using standard microbiological methods to determine pneumococcal carriage and resistance. Community-level antibiotic consumption was determined by record review from primary healthcare facilities, which routinely collect prescription data for children aged 0-59 months. Streptococcus pneumoniae was isolated from 101 (35.7%) nasopharyngeal samples. Among positive isolates, co-trimoxazole (75.6%) and tetracycline (69.3%) resistance was the most common, followed by oxacillin (26.7%) and azithromycin (9.9%). Recent antibiotic use was associated with decreased pneumococcal carriage (odds ratio 0.56, 95% CI: 0.33-0.93) at the individual level. There was no statistically significant relationship between antibiotic use and antibiotic resistance at the individual or community levels, although CIs were generally wide. The prevalence of antibiotic resistance to commonly used antibiotics was high in the study area. Expanding antimicrobial resistance surveillance in areas with little population-based data will be important for informing policy related to antibiotic use.


Assuntos
Antibacterianos/uso terapêutico , Portador Sadio/microbiologia , Farmacorresistência Bacteriana/fisiologia , Streptococcus pneumoniae/fisiologia , Azitromicina , Burkina Faso/epidemiologia , Portador Sadio/epidemiologia , Pré-Escolar , Clindamicina , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Nasofaringe/microbiologia , Oxacilina , Fatores de Risco , Streptococcus pneumoniae/isolamento & purificação , Tetraciclina , Resistência a Tetraciclina/fisiologia , Combinação Trimetoprima e Sulfametoxazol
9.
BMC Infect Dis ; 20(1): 358, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434569

RESUMO

BACKGROUND: Globally, in 2012, about 1.2 million estimated cases were reported with ~ 135,000 deaths annually. In Ethiopia, specifically in our study area, limited information is found on the oropharyngeal carriage, antimicrobial resistance pattern, and associated risk factors for N. meningitidis among school children. So, the aim of this study was to assess oropharyngeal carriage rate of N. meningitidis, antibiotic susceptibility pattern and associated risk factors among primary school children in Gondar town, Northwest Ethiopia. METHODS: A cross sectional study was conducted from January to April, 2019 in Gondar town. Multi stage simple random sampling technique was used. A total of 524 oropharyngeal swabs were collected using sterile plastic cotton swabs. Modified Thayer Martin media was used for primary isolation. Antimicrobial susceptibility pattern was done based on Kirby-Bauer method on Muller-Hinton agar supplemented with 5% sheep blood. Multidrug resistance was defined as resistance of an isolate to two or more antimicrobial classes tested. Logistic regression model was used to see the association between dependent variables (Carriage rate of Neisseria meningitidis, Serogroups of Neisseria meningitidis and Antimicrobial susceptibility patterns) and independent variables (Socio-demographic data and risk factors). Variables with a P- value ≤0.2 during bivariable analysis was taken to multivariable analysis to check significant association of meningococcal carriage with risk factors. Finally, a P-value < 0.05 was considered as statistically significant. Data was summarized using numbers, percentages and tables. RESULTS: A total of 53(10.1%) (CI: 7.6-12.8) N. meningitidis isolates were identified. Serogroup A 13 (24.5%) was the most prevalent followed by Y/W135 11(20.7%) whereas serogroup B 4(7.6%) was the least identified serotype. Meningococcal isolates were resistant to ciprofloxacin (45.3%) and trimethoprim-sulfamethoxazole (73.6%). Overall, most of meningococcal isolates showed about 32(60.4%) multidrug resistance. Meningococcal carriage rate was significantly associated with family size, tonsillectomy, passive smoking, number of students per class, sharing utensils, history of visiting healthcare institutions, and indoor kitchen. CONCLUSION: This study highlights the need for reinforcement of case-based, laboratory confirmed surveillance of N. meningitidis carriage in Ethiopian elementary school students to enable mapping of distribution of serotypes of the causative organisms across the country and determine the current potential necessity of vaccination.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/efeitos dos fármacos , Adolescente , Portador Sadio/epidemiologia , Criança , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Infecções Meningocócicas/epidemiologia , Testes de Sensibilidade Microbiana , Neisseria meningitidis/isolamento & purificação , Orofaringe/microbiologia , Prevalência , Fatores de Risco , Instituições Acadêmicas/estatística & dados numéricos , Sorogrupo
10.
BMC Infect Dis ; 20(1): 279, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293324

RESUMO

BACKGROUND: The 13-valent Pneumococcal Conjugate Vaccine (PCV-13) was introduced in the National Immunization Programme (NIP) schedule in Russia in March 2014. Previously, the 7-valent Pneumococcal Conjugate Vaccine (PCV-7) was marketed in Russia in 2009 but has never been offered for mass vaccination. A carriage study was performed among children in Arkhangelsk in 2006. The objective was to determine the prevalence of carriage, serotype distribution, antimicrobial susceptibility and the molecular structure of Streptococcus pneumoniae strains before marketing and introduction of PCV-13. METHODS: A cross-sectional study was conducted on a cluster-randomized sample of children and a self-administrated questionnaire for parents/guardians.  Nasopharyngeal samples were collected from 438 children younger than 7 years attending nurseries and kindergartens in the Arkhangelsk region, Russia. Detailed demographic data, as well as information about the child's health, traveling, exposure to antimicrobials within the last 3 months and anthropometric measurements were collected for all study subjects. Variables extracted from the questionnaire were analysed using statistic regression models to estimate the risk of carriage. All pneumococcal  isolates were examined with susceptibility testing, serotyping and multilocus sequence typing. RESULTS: The overall prevalence of asymptomatic carriage was high and peaking at 36 months with a rate of 57%. PCV-13 covered 67.3% of the detected strains. High rates of non-susceptibility to penicillin, macrolides and multidrug resistance were associated with specific vaccine serotypes, pandemic clones, and local sequence types. Nine percent of isolates represented three globally disseminated disease-associated pandemic clones; penicillin- and macrolide-resistant clones NorwayNT-42 and Poland6B-20, as well as penicillin- and macrolide-susceptible clone Netherlands3-31. A high level of antimicrobial consumption was noted by the study. According to the parent's reports, 89.5% of the children used at least one antimicrobial regime since birth. None of the hypothesised predictors of S. pneumoniae carriage were statistically significant in univariable and multivariable logistic models. CONCLUSIONS: The study identified a high coverage of the PCV-13-vaccine, but serotype replacement and expansion of globally disseminated disease-associated clones with non-vaccine serotypes may be expected. Further surveillance of antimicrobial resistance and serotype distribution is therefore required.


Assuntos
Portador Sadio/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/imunologia , Vacinas Conjugadas/imunologia , Antibacterianos/uso terapêutico , Portador Sadio/microbiologia , Criança , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Lactente , Macrolídeos/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Nasofaringe/microbiologia , Penicilinas/uso terapêutico , Infecções Pneumocócicas/tratamento farmacológico , Prevalência , Federação Russa/epidemiologia , Sorogrupo , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação
11.
PLoS One ; 15(4): e0231041, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236150

RESUMO

This study describes predictors of pneumococcal nasopharyngeal carriage and density in Fiji. We used data from four annual (2012-2015) cross-sectional surveys, pre- and post-introduction of ten-valent pneumococcal conjugate vaccine (PCV10) in October 2012. Infants (5-8 weeks), toddlers (12-23 months), children (2-6 years), and their caregivers participated. Pneumococci were detected and quantified using lytA qPCR, with molecular serotyping by microarray. Logistic and quantile regression were used to determine predictors of pneumococcal carriage and density, respectively. There were 8,109 participants. Pneumococcal carriage was negatively associated with years post-PCV10 introduction (global P<0.001), and positively associated with indigenous iTaukei ethnicity (aOR 2.74 [95% CI 2.17-3.45] P<0.001); young age (infant, toddler, and child compared with caregiver participant groups) (global P<0.001); urban residence (aOR 1.45 [95% CI 1.30-2.57] P<0.001); living with ≥2 children <5 years of age (aOR 1.42 [95% CI 1.27-1.59] P<0.001); low family income (aOR 1.44 [95% CI 1.28-1.62] P<0.001); and upper respiratory tract infection (URTI) symptoms (aOR 1.77 [95% CI 1.57-2.01] P<0.001). Predictors were similar for PCV10 and non-PCV10 carriage, except PCV10 carriage was negatively associated with PCV10 vaccination (0.58 [95% CI 0.41-0.82] P = 0.002) and positively associated with exposure to household cigarette smoke (aOR 1.21 [95% CI 1.02-1.43] P = 0.031), while there was no association between years post-PCV10 introduction and non-PCV10 carriage. Pneumococcal density was positively associated with URTI symptoms (adjusted median difference 0.28 [95% CI 0.16, 0.40] P<0.001) and toddler and child, compared with caregiver, participant groups (global P = 0.008). Predictors were similar for PCV10 and non-PCV10 density, except infant, toddler, and child participant groups were not associated with PCV10 density. PCV10 introduction was associated with reduced the odds of overall and PCV10 pneumococcal carriage in Fiji. However, after adjustment iTaukei ethnicity was positively associated with pneumococcal carriage compared with Fijians of Indian Descent, despite similar PCV10 coverage rates.


Assuntos
Portador Sadio/epidemiologia , Infecções Pneumocócicas/epidemiologia , Adolescente , Adulto , Fatores Etários , Portador Sadio/microbiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Fiji/epidemiologia , Humanos , Lactente , Modelos Logísticos , Masculino , Infecções Pneumocócicas/etiologia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Fatores de Risco , Adulto Jovem
12.
Niger Postgrad Med J ; 27(2): 136-142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32295946

RESUMO

Context: Bowel carriage has been identified as the main reservoir of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and hospital-acquired infections. There are gaps in the knowledge of trends of these rates, which need to be filled for the development and implementation of hospital surveillance systems and antibiotic stewardship programmes in Nigeria. Aim: This study investigated the carriage rates of ESBL-PE among 273 children admitted to the paediatric wards of a university teaching hospital, Nigeria, using a prospective cohort study design over a 6-month period. Settings and Design: The study explored the role of new and transferred patients in introducing resistant strains of ESBLs into paediatric wards and how quickly paediatric patients that were previously free of resistant strains acquired these within the hospital environment. Materials and Methods: E-swabs (Copan Diagnostics, Italy) were used to obtain rectal samples from participants. Positive colonies were Gram stained and subcultured onto purity plates for further identification, and antibiotic susceptibility pattern of identified ESBL-PE was obtained using a range of antibiotics. Statistical Analysis Used: Data were analysed using SPSS statistics 20 (IBM SPSS Statistics, version 20). Statistical significance was determined using the Chi-square test and Fisher's exact test. A logistic regression analysis was also conducted to identify independent risk factors for colonisation. Results: The findings showed that transferred patients contributed to the introduction of ESBLs into the hospital. Independent multivariate risk factors for colonisation of ESBL-PE were age >10-14 years, instrumentation (odds ratio [OR]: 0.2 [P < 0.05]) and sharing of thermometers (OR: 0.11 [P < 0.05]). Conclusions: The carriage rate of ESBL-PE is high (25.3%) among children, and none-carriers may become colonised within 14 days of hospitalisation.


Assuntos
Antibacterianos/uso terapêutico , Portador Sadio/epidemiologia , Infecção Hospitalar/microbiologia , Infecções por Enterobacteriaceae/diagnóstico , Enterobacteriaceae/isolamento & purificação , Hospitalização/estatística & dados numéricos , beta-Lactamases/biossíntese , Adolescente , Antibacterianos/farmacologia , Portador Sadio/microbiologia , Criança , Infecção Hospitalar/epidemiologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Hospitais de Ensino , Humanos , Nigéria/epidemiologia , Prevalência , Estudos Prospectivos , Fatores de Risco
13.
Epidemiol Infect ; 148: e80, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32228726

RESUMO

Teenagers have a higher risk of invasive meningococcal disease (IMD) than the general population. This cross-sectional study aimed to characterise strains of Neisseria meningitidis circulating among Norwegian teenagers and to assess risk factors for meningococcal carriage. Oropharyngeal swabs were collected from secondary-school students in southeastern Norway in 2018-2019. Meningococcal isolates were characterised using whole genome sequencing. Risk factors for meningococcal carriage were assessed from questionnaire data. Samples were obtained from 2296 12-24-year-olds (majority 13-19-year-olds). N. meningitidis was identified in 167 (7.3%) individuals. The highest carriage rate was found among 18-year-olds (16.4%). Most carriage isolates were capsule null (40.1%) or genogroup Y (33.5%). Clonal complexes cc23 (35.9%) and cc198 (32.3%) dominated and 38.9% of carriage strains were similar to invasive strains currently causing IMD in Norway. Use of Swedish snus (smokeless tobacco) (OR 1.56, 95% CI 1.07-2.27), kissing >two persons/month (OR 2.76, 95% CI 1.49-5.10) and partying >10 times/3months (OR 3.50, 95% CI 1.45-8.48) were associated with carriage, while age, cigarette smoking, sharing of drinking bottles and meningococcal vaccination were not. The high meningococcal carriage rate among 18-year-olds is probably due to risk-related behaviour. Use of Swedish snus is possibly a new risk factor for meningococcal carriage. Almost 40% of circulating carriage strains have invasive potential.


Assuntos
Portador Sadio/epidemiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Portador Sadio/microbiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Noruega/epidemiologia , Filogenia , Fatores de Risco , Adulto Jovem
14.
Am J Trop Med Hyg ; 103(1): 508-514, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32314689

RESUMO

Intensive care unit-acquired bloodstream infections (ICU-BSI) are frequent and are associated with high morbidity and mortality rates. We conducted this study to describe the epidemiology and the prognosis of ICU-BSI in our ICU and to search for factors associated with mortality at 28 days. For this, we retrospectively studied ICU-BSI in the ICU of the Cayenne General Hospital, from January 2013 to June 2019. Intensive care unit-acquired bloodstream infections were diagnosed in 9.5% of admissions (10.3 ICU-BSI/1,000 days). The median delay to the first ICU-BSI was 9 days. The ICU-BSI was primitive in 44% of cases and secondary to ventilator-acquired pneumonia in 25% of cases. The main isolated microorganisms were Enterobacteriaceae in 67.7% of patients. They were extended-spectrum beta-lactamase (ESBL) producers in 27.6% of cases. Initial antibiotic therapy was appropriate in 65.1% of cases. Factors independently associated with ESBL-producing Enterobacteriaceae (ESBL-PE) as the causative microorganism of ICU-BSI were ESBL-PE carriage before ICU-BSI (odds ratio [OR]: 7.273; 95% CI: 2.876-18.392; P < 0.000) and prior exposure to fluoroquinolones (OR: 4.327; 95% CI: 1.120-16.728; P = 0.034). The sensitivity of ESBL-PE carriage to predict ESBL-PE as the causative microorganism of ICU-BSI was 64.9% and specificity was 81.2%. Mortality at 28 days was 20.6% in the general population. Factors independently associated with mortality at day 28 from the occurrence of ICU-BSI were traumatic category of admission (OR: 0.346; 95% CI: 0.134-0.894; P = 0.028) and septic shock on the day of ICU-BSI (OR: 3.317; 95% CI: 1.561-7.050; P = 0.002). Mortality rate was independent of the causative organism.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/terapia , Candidemia/epidemiologia , Candidemia/mortalidade , Candidemia/terapia , Portador Sadio/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Infecções Relacionadas a Cateter/terapia , Cateterismo Venoso Central/estatística & dados numéricos , Cateterismo Periférico/estatística & dados numéricos , Coma/epidemiologia , Comorbidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/terapia , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Guiana Francesa/epidemiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Prognóstico , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Choque/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/terapia , Ferimentos e Lesões/epidemiologia
15.
R I Med J (2013) ; 103(2): 18-20, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122094

RESUMO

Hospital antibiograms, because they are typically derived from samples obtained from hospitalized patients, may overestimate the prevalence of methicillin resistance in S. aureus in individuals presenting to the hospital for surgery. Because hospital antibiograms are commonly used to justify empiric perioperative prophylactic antibiotic selection prior to surgery, this may lead to unnecessary treatment with broad-spectrum antibiotics such as vancomycin. In a single-institution study, we observed that in our hospital antibiogram the proportion of S. aureus that are methicillin-resistant (MRSA) was significantly higher (45%) than isolates in preoperative nasal cultures obtained at the same hospital in outpatients prior to their lower extremity joint replacement surgery (13%): mean difference 0.32, [95% CI 0.25, 0.39], p <0.0001. These data suggest that hospital antibiograms may overstate the true prevalence of MRSA in those at risk for MRSA surgical site infections who present from the outpatient setting.


Assuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Cavidade Nasal/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Portador Sadio/epidemiologia , Feminino , Humanos , Masculino , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Período Pré-Operatório , Prevalência , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Staphylococcus aureus/efeitos dos fármacos
16.
PLoS One ; 15(3): e0230332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182260

RESUMO

BACKGROUND: Penicillin non-susceptible (PNSP) and multi-resistant pneumococci have been prevalent in Iceland since early nineties, mainly causing problems in treatment of acute otitis media. The 10-valent protein conjugated pneumococcal vaccine (PHiD-CV) was introduced into the childhood vaccination program in 2011. The aim of the study was to investigate the changes in antimicrobial susceptibility and serotype distribution of penicillin non-susceptible pneumococci (PNSP) in Iceland 2011-2017. METHODS AND FINDINGS: All pneumococcal isolates identified at the Landspítali University Hospital in 2011-2017, excluding isolates from the nasopharynx and throat were studied. Susceptibility testing was done according to the EUCAST guidelines using disk diffusion with chloramphenicol, erythromycin, clindamycin, tetracycline, trimethoprim/sulfamethoxazole and oxacillin for PNSP screening. Penicillin and ceftriaxone minimum inhibitory concentrations (MIC) were measured for oxacillin resistant isolates using the E-test. Serotyping was done using latex agglutination and/or multiplex PCR. The total number of pneumococcal isolates that met the study criteria was 1,706, of which 516 (30.2%) were PNSP, and declining with time. PNSP isolates of PHiD-CV vaccine serotypes (VT) were 362/516 (70.2%) declining with time, 132/143 (92.3%) in 2011 and 17/54 (31.5%) in 2017. PNSP were most commonly of serotype 19F, 317/516 isolates declining with time, 124/143 in 2011 and 15/54 in 2017. Their number decreased in all age groups, but mainly in the youngest children. PNSP isolates of non PHiD-CV vaccine serotypes (NVT) were 154/516, increasing with time, 11/14, in 2011 and 37/54 in 2017. The most common emerging NVTs in 2011 and 2017 were 6C, 1/143 and 10/54 respectively. CONCLUSIONS: PNSP of VTs have virtually disappeared from children with pneumococcal diseases after the initiation of pneumococcal vaccination in Iceland and a clear herd effect was observed. This was mainly driven by a decrease of PNSP isolates belonging to a serotype 19F multi-resistant lineage. However, emerging multi-resistant NVT isolates are of concern.


Assuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/uso terapêutico , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Pré-Escolar , Farmacorresistência Bacteriana Múltipla , Feminino , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Islândia/epidemiologia , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Otite Média , Resistência às Penicilinas , Faringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Avaliação de Programas e Projetos de Saúde , Sorotipagem/estatística & dados numéricos , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/imunologia
17.
Euro Surveill ; 25(5)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32046817

RESUMO

BackgroundThe current carriage study was set up to reinforce surveillance during/after the PCV13-to-PCVC10 switch in Belgium.AimThis observational study monitored carriage of Streptococcus pneumoniae (Sp) serotypes, particularly those no longer covered (3, 6A, 19A), as well as Haemophilus influenzae (Hi), because PCV10 contains the non-typeable Hi protein D.MethodsA total of 2,615 nasopharyngeal swabs from children (6-30 months old) attending day care were collected in three periods over 2016-2018. Children's demographic and clinical characteristics and vaccination status were obtained through a questionnaire. Sp and Hi were identified by culture and PCR. Pneumococcal strains were tested for antimicrobial (non-)susceptibility by disc diffusion and serotyped by Quellung-reaction (Quellung-reaction and PCR for serotypes 3, 6A, 19A).ResultsThe carriage prevalence of Sp (> 75%) remained stable over the successive periods but that of Hi increased (87.4%, 664 Hi-carriers/760 in 2016 vs 93.9%, 895/953 in 2017-2018). The proportion of non-PCV13 vaccine serotypes decreased (94.6%, 438 isolates/463 in 2016 vs 89.7%, 599/668 in 2017-2018) while that of PCV13-non-PCV10 vaccine serotypes (3 + 6A + 19A) increased (0.9%, 4 isolates/463 in 2016 vs 7.8%, 52/668 in 2017-2018), with serotype 19A most frequently identified (87.9%, 58/66 isolates). Non-susceptibility of pneumococci against any of the tested antibiotics was stable over the study period (> 44%).ConclusionsDuring and after the PCV13-to-PCV10 vaccine switch, the proportion of non-PCV13 serotypes decreased, mainly due to a serotype 19A carriage prevalence increase. These results complement invasive pneumococcal disease surveillance data, providing further basis for pneumococcal vaccination programme policy making.


Assuntos
Portador Sadio/microbiologia , Haemophilus influenzae/isolamento & purificação , Nasofaringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/farmacologia , Bélgica/epidemiologia , Portador Sadio/epidemiologia , Portador Sadio/imunologia , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Haemophilus influenzae/efeitos dos fármacos , Haemophilus influenzae/imunologia , Humanos , Programas de Imunização/estatística & dados numéricos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/prevenção & controle , Prevalência , Sorogrupo , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/imunologia , Vacinação
18.
Clin Lab ; 66(1)2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013354

RESUMO

BACKGROUND: Considering the physiological changes in serum procalcitonin (PCT) levels in newborns due to age, we recently established an age-specific percentile-based reference curve for serum PCT level. The present study aimed to determine the best cutoff percentile line using this reference curve for the differentiation between infected and colonized preterm infants. METHODS: A total of 52 preterm infants with positive bacterial culture (9 with bacterial infection, 43 with colonization) were enrolled within the study period. The 97.5th, 95.0th, 92.5th, 90.0th, 80.0th, 70.0th, 60.0th, and 50.0th percentile lines were drawn in the reference curve. PCT levels in infected or colonized infants were used, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The best cutoff percentile line was determined in the receiver operating characteristic curve analysis. RESULTS: Of the 52 preterm infants, 9 were infected (5 and 4 infants with an onset of < 7 days and ≥ 7 days after birth, respectively), whereas 43 were colonized (6 and 37 infants with an onset of < 7 days and ≥ 7 days after birth, respectively). The best cutoff percentile lines were the 90.0th percentile (sensitivity, 0.800; specificity, 0.833; PPV, 0.800; NPV, 0.833) and 97.5th percentile (sensitivity, 1.00; specificity, 0.973; PPV, 0.800; NPV, 1.00) in infants with an onset of < 7 days and ≥ 7 days after birth, respectively. CONCLUSIONS: The age-specific percentile-based reference curve for serum PCT level is clinically applicable as a new tool for diagnosing infections in preterm infants with positive culture results, particularly at ≥ 7 days after birth.


Assuntos
Infecções Bacterianas/diagnóstico , Recém-Nascido Prematuro , Pró-Calcitonina/sangue , Fatores Etários , Infecções Bacterianas/epidemiologia , Biomarcadores/sangue , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Sepse Neonatal/diagnóstico , Sepse Neonatal/epidemiologia , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos
19.
Malar J ; 19(1): 64, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041620

RESUMO

BACKGROUND: Asymptomatic carriage of Plasmodium falciparum is widespread in adults and children living in malaria-endemic countries. This study identified the prevalence of malaria parasites and the corresponding levels of naturally acquired anti-parasite antibody levels in afebrile adults living in two communities in the Greater Accra Region of Ghana. METHODS: Two cross-sectional studies conducted in January and February 2016 and repeated in July and August 2016 recruited subjects aged between 6 and 75 years from high parasite prevalence (Obom) and low parasite prevalence (Asutsuare) communities. Whole blood (5 ml) was collected from each volunteer, plasma was aliquoted and frozen until needed. An aliquot (10 µl) of the blood was used to prepare thick and thin blood smears, 100 µl was preserved in Trizol and the rest was separated into plasma and blood cells and each stored at - 20 °C until needed. Anti-MSP3 and Pfs230 antibody levels were measured using ELISA. RESULTS: Asexual parasite and gametocyte prevalence were higher in Obom than Asutsuare. Antibody (IgG, IgG1, IgG3, IgM) responses against the asexual parasite antigen MSP3 and gametocyte antigen Pfs230 were higher in Obom during the course of the study except for IgM responses against Pfs230, which was higher in Asutsuare than in Obom during the rainy season. Antibody responses in Asutsuare were more significantly associated with age than the responses measured in Obom. CONCLUSION: The pattern of antibody responses measured in people living in the high and low malaria transmission setting was similar. All antibody responses measured against the asexual antigen MSP3 increased, however, IgG and IgG1 responses against gametocyte antigen Pfs230 decreased in moving from the dry to the peak season in both sites. Whilst asexual and gametocyte prevalence was similar between the seasons in the low transmission setting, in the high transmission setting asexual parasite prevalence increased but gametocyte prevalence decreased in the rainy season relative to the dry season.


Assuntos
Portador Sadio/epidemiologia , Malária Falciparum/epidemiologia , Plasmodium falciparum/imunologia , Adolescente , Adulto , Fatores Etários , Idoso , Anticorpos Antiprotozoários/sangue , Infecções Assintomáticas/epidemiologia , Portador Sadio/imunologia , Portador Sadio/parasitologia , Criança , Ensaio de Imunoadsorção Enzimática , Gana/epidemiologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Modelos Lineares , Malária Falciparum/imunologia , Malária Falciparum/parasitologia , Pessoa de Meia-Idade , Plasmodium falciparum/crescimento & desenvolvimento , Prevalência , RNA de Protozoário/sangue , Chuva , Reação em Cadeia da Polimerase em Tempo Real , Estações do Ano , Adulto Jovem
20.
PLoS One ; 15(2): e0229021, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32032364

RESUMO

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


Assuntos
Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Haemophilus influenzae , Moraxella catarrhalis , Nasofaringe/microbiologia , Staphylococcus aureus , Streptococcus pneumoniae , Adolescente , Fatores Etários , Antibacterianos/farmacologia , Criança , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/microbiologia , Feminino , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/classificação , Haemophilus influenzae/efeitos dos fármacos , Haemophilus influenzae/genética , Haemophilus influenzae/isolamento & purificação , Humanos , Hungria/epidemiologia , Lactente , Masculino , Testes de Sensibilidade Microbiana , Moraxella catarrhalis/classificação , Moraxella catarrhalis/efeitos dos fármacos , Moraxella catarrhalis/genética , Moraxella catarrhalis/isolamento & purificação , Infecções por Moraxellaceae/epidemiologia , Infecções por Moraxellaceae/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Vigilância em Saúde Pública , Fatores de Risco , Sorogrupo , Staphylococcus aureus/classificação , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificação
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