RESUMO
OBJECTIVES: Among patients with preterm labor and intact membranes (PTL), those with intra-amniotic infection (IAI) present the highest risk of adverse perinatal outcomes. Current identification of IAI, based on microbiological cultures and/or polymerase chain reaction amplification of the 16S ribosomal RNA gene, delay diagnosis and, consequently, antenatal management. The aim to of the study was to assess the performance of a multivariable prediction model for diagnosing IAI in patients with PTL below 34.0 weeks using clinical, sonographic and biochemical biomarkers. METHODS: From 2019 to 2022, we prospectively included pregnant patients admitted below 34.0 weeks with diagnosis of PTL and had undergone amniocentesis to rule in/out IAI. The main outcome was IAI, defined by a positive culture and/or 16S ribosomal RNA gene in amniotic fluid. Based on the date of admission, the sample (n=98) was divided into a derivation (2019-2020, n=49) and validation cohort (2021-2022, n=49). Logistic regression models were developed for the outcomes evaluated. As predictive variables we explored ultrasound cervical length measurement at admission, maternal C-reactive protein, gestational age, and amniotic fluid glucose and matrix metalloproteinase-8 (MMP-8) levels. The model was developed in the derivation cohort and applied to the validation cohort and diagnostic performance was evaluated. Clinical management was blinded to the model results. RESULTS: During the study period, we included 98 patients admitted with a diagnosis of PTL. Of these, 10â¯% had IAI. The final model included MMP-8 and amniotic fluid glucose levels and showed an area under the receiver operating characteristic curve to predict the risk of IAI of 0.961 (95â¯% confidence interval: 0.860-0.995) with a sensitivity of 75â¯%, specificity of 93.3â¯%, positive likelihood ratio (LR) of 11.3 and negative LR of 0.27 in the validation cohort. CONCLUSIONS: In patients with PTL, a multivariable prediction model including amniotic fluid MMP-8 and glucose levels might help in the clinical management of patients undergoing amniocentesis to rule in/out IAI, providing results within a few minutes.
Assuntos
Corioamnionite , Trabalho de Parto Prematuro , Humanos , Recém-Nascido , Gravidez , Feminino , Líquido Amniótico/metabolismo , Metaloproteinase 8 da Matriz , Corioamnionite/microbiologia , Sistemas Automatizados de Assistência Junto ao Leito , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/metabolismo , Idade Gestacional , Glucose/metabolismoRESUMO
Aetiological diagnosis of gastrointestinal infections is challenging since a wide range of bacteria, parasites and viruses can be causal agents and derived clinical manifestations appear quite similar. Our aim was to evaluate contribution of the novel QIAstat-DxGastrointestinal Panel (GIP) to aetiological diagnosis of gastrointestinal infections and rational antimicrobial prescription in a reference paediatric hospital. Evaluation included comparison of diagnostic yield and agreement of results of QIAstat-Dx GIP and conventional microbiological methods. Parallel testing was performed on stool samples collected prospectively from children admitted to Sant Joan de Deu Barcelona Hospital (Spain) during the period February-March 2019. Influence of the panel test use on antimicrobial prescription was assessed using a pre-post study design. Eighty-six (68.8%) out of 125 specimens were positive by QIAstat-Dx GIP versus 44 (35.2%) positive by a composite of conventional methods (p<0.001). Global agreement of panel test results with rotavirus-adenovirus antigen detection (92.8%) and a two-step antigen/toxin and PCR-based algorithm for toxigenic Clostridioides difficile detection (87.5%) was greater than that with bacterial culture (76.0%) and parasite microscopic identification (64.3%). Panel test results orientated antimicrobial prescription changes in 18 (14.4%) patients, including antimicrobial start in 11 cases initially untreated, targeted antimicrobial prescription in 5 and discontinuation in 2 cases empirically treated. Results showed that QIAstat-Dx GIP significantly expanded aetiological diagnosis of gastrointestinal infections compared to conventional microbiological methods while orientating a more judicious use of antimicrobial drugs in hospitalised children.
Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Gastroenteropatias/microbiologia , Técnicas de Diagnóstico Molecular/métodos , Bactérias/classificação , Bactérias/genética , Infecções Bacterianas/diagnóstico , Criança , Pré-Escolar , Feminino , Gastroenteropatias/diagnóstico , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Técnicas de Diagnóstico Molecular/instrumentação , Estudos Prospectivos , EspanhaRESUMO
AIM: The rate of paediatric occult bacteraemia after the introduction of the 13-valent pneumococcal conjugated vaccine is relatively unknown. We determined the rate, and identified isolated pathogens, in children aged three to 36 months who presented to a paediatric emergency department with fever, but otherwise appeared well. We also analysed the yield of laboratory parameters traditionally considered risk factors for occult bacteraemia. METHODS: Children aged three to 36 months who were febrile, but otherwise appeared well, were included if they had blood tests in the paediatric emergency department between April 2010 and September 2012. RESULTS: Of the 591 patients, only six (1.0%) had a true bacterial pathogen and three of those were Streptococcus pneumoniae (0.5%). None of the children with pneumococcal bacteraemia had been immunised. The contaminant rate was 2.7%, and an elevated band count was the best predictor of occult bacteraemia, with positive and negative likelihood ratios of 10 and 0.4, respectively. The yield of the other laboratory parameters was very limited. CONCLUSION: In the era of the 13-valent pneumococcal conjugated vaccine, occult bacteraemia is an uncommon event in febrile children aged three to 36 who otherwise appear well and close follow-up should replace blood analysis in such cases.
Assuntos
Bacteriemia/epidemiologia , Febre/epidemiologia , Febre/microbiologia , Bacteriemia/sangue , Bacteriemia/complicações , Bacteriemia/microbiologia , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Febre/sangue , Humanos , Lactente , Masculino , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
OBJECTIVE: To conduct a retrospective multicenter study to assess the ability of a predictive algorithm to differentiate between children with Kingella kingae infection of the hip and those with transient synovitis. STUDY DESIGN: Medical charts of 25 Israeli and 9 Spanish children aged 6-27 months with culture-proven K kingae arthritis of the hip were reviewed, and information on the 4 variables included in the commonly used Kocher prediction algorithm (body temperature, refusal to bear weight, leukocytosis, and erythrocyte sedimentation rate) was gathered. RESULTS: Patients with K kingae arthritis usually presented with mildly abnormal clinical picture and normal serum levels of or near-normal acute-phase reactants. Data on all 4 variables were available for 28 (82%) children, of whom 1 child had none, 6 children had 1, 13 children had 2, 5 had 3, and only 3 children had 4 predictors, implying ≤ 40% probability of infectious arthritis in 20 (71%) children. CONCLUSIONS: Because of the overlapping features of K kingae arthritis of the hip and transient synovitis in children younger than 3 years of age, Kocher predictive algorithm is not sensitive enough for differentiating between these 2 conditions. To exclude K kingae arthritis, blood cultures and nucleic acid amplification assay should be performed in young children presenting with irritation of the hip, even in the absence of fever, leukocytosis, or a high Kocher score.
Assuntos
Artrite Infecciosa/diagnóstico , Articulação do Quadril/patologia , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/diagnóstico , Sinovite/diagnóstico , Algoritmos , Artrite Infecciosa/microbiologia , Sedimentação Sanguínea , Temperatura Corporal , Pré-Escolar , Diagnóstico Diferencial , Feminino , Articulação do Quadril/microbiologia , Humanos , Lactente , Contagem de Leucócitos , Masculino , Infecções por Neisseriaceae/microbiologia , Probabilidade , Estudos Retrospectivos , Sinovite/microbiologiaRESUMO
The use of intensive chemotherapy and central devices has improved patients survival, but it is associated with catheter-related blood-stream infections (CRBSI). An educational program was instituted for preventing CRBSI occurrence in acute leukemia pediatric patients having totally implanted central devices. The Centers of Disease Control and Prevention criteria were used as definition for CRBSI. Data collected were age, sex, diagnosis, chemotherapy, inpatient versus outpatient, microbiological data, risk factors, social risk score, and treatment performed. CRBSI rate decreased from 6.7 to 3.7/1000 catheter-days with preventive measures (P=0.05). A further decrease to 1.5/1000 catheter-days was reached after the intensification of the educational program (P=0.01). Severe neutropenia at the time of catheter insertion was related to CRBSI and to infection recurrence (P<0.05). Most of the episodes occurred during induction chemotherapy. Thirty-six CRBSI episodes occurred in 25 of 73 patients. The most frequent microorganism isolated was Staphylococcus spp. Antibiotherapy was successful in 83.3% of episodes. Six patients needed a central venous access device replacement. Our intervention program was successful to decrease the CRBSI rates and its intensification allowed a further decrease, approaching reported rates in this setting. Severe neutropenia at the time of central venous access device insertion was related to CRBSI occurrence and recurrence.
Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Controle de Infecções/métodos , Leucemia/tratamento farmacológico , Antineoplásicos/administração & dosagem , Bacteriemia/prevenção & controle , Bacteriemia/transmissão , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Lactente , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Enfermeiras e Enfermeiros , Médicos , Estudos ProspectivosRESUMO
Background: It has been suggested that Mycobacterium avium, Mycobacterium intracellulare, and M. chimaera have differential drug susceptibility patterns. We prospectively analyzed and compared the drug susceptibility patterns among these species over an 8.5-year period. Methods: A microdilution method (Slomyco®) was performed for drug susceptibility testing of 402 M. avium, 273 M. intracellulare, and 139 M. chimaera clinical isolates. Results: M. avium showed significantly higher resistance to moxifloxacin, ciprofloxacin, rifampicin, ethambutol, streptomycin, linezolid, cotrimoxazole, and clarithromycin. M. avium also showed higher minimum inhibitory concentrations (MIC) than M. intracellulare and M. chimaera against all drugs except ethionamide, to which M. intracellulare and M. chimaera showed greater resistance. Conclusions: Our series demonstrated differential drug resistance patterns among the most frequent M. avium complex species. M. avium was more resistant than M. intracellulare and M. chimaera versus eight antibiotics and showed greater MIC values to most of the antibiotics studied. These data suggest that knowledge of the local distribution and susceptibility profiles of these pathogens is essential for adequate clinical management.
RESUMO
BACKGROUND: We aimed to evaluate diagnostic performance of the cobas® Liat® Cdiff test, a novel single-step automated polymerase chain reaction (PCR) assay for rapid diagnosis of toxigenic Clostridioides difficile infection (CDI) in stool samples from children with clinical symptoms of CDI. METHODS: Assessment of cobas Liat Cdiff diagnostic yield, time of analytical process and agreement of results with those of a 2-step diagnostic algorithm. The sequential algorithm combined an enzyme immunoassay (EIA) targeting antigen glutamate dehydrogenase (GDH), enterotoxin-A and cytotoxin-B, and a confirmatory PCR in EIA GDH-positive and toxin-negative samples. Fresh stool samples were collected prospectively from patients 2-18 years of age that were attended in Hospital Sant Joan de Deu (Barcelona, Spain) during December 2018-August 2019. RESULTS: A total of 122 specimens were collected from 91 children (mean age, 8 years; 69.7% male). cobas Liat Cdiff identified 24 (19.7%) positive samples. EIA yielded 97 (79.5%) GDH- and toxin-negative results, 11 (9.0%) GDH- and toxin-positive results, and 14 (11.5%) GDH-positive and toxin-negative results, of which 11 (9.0%) were positive for the toxin by the confirmatory PCR. Overall, GDH- and toxin-positive samples detected by the sequential algorithm were 22 (18.0%). Comparatively, the new test reduced time of the analytical process significantly (20 vs. 35.4 minutes, P < 0.001). CONCLUSION: Use of cobas Liat Cdiff showed similar detection yield compared with a 2-step diagnostic algorithm that combined an EIA and a confirmatory PCR while decreasing the time of the analytical process markedly in stool samples from children suspected of CDI.
Assuntos
Clostridioides difficile/genética , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Técnicas Imunoenzimáticas/métodos , Reação em Cadeia da Polimerase/métodos , Algoritmos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Adolescents may present with adult-type pulmonary tuberculosis (TB), including cavity disease in upper lobes and smear-positive sputum, which involves a significant transmission risk for social and family contacts. PATIENTS AND METHODS: A retrospective (2007-2012) observational study of a case series of TB was conducted in children and adolescents (<18 years) in a paediatric referral centre in Barcelona. Patients aged≤12 and>12 years at diagnosis are compared. RESULTS: The series consisted of 124 patients (56.5% males, median age: 4.0 years). In half of the cases, the patient was of immigrant origina and TB was diagnosed after clinical-radiological suspicion, intra-thoracic disease being the most common (91.9%). Cultures yielded positive results in one third of cases (37.9%) and isolates were sensitive to oral first-line anti-TB agents in 100%. Median (interquartile range) duration of treatment was 6 (6-9) months, directly observed therapy was needed in 10 patients, and there was a satisfactory outcome after treatment in 98.4%. Among adolescents, TB was more prevalent in females (63.2%) and immigrant patients (68.4%), comorbidity at diagnosis and lung cavity forms were more common, and the source case was identified only in 21.1% of the patients. CONCLUSION: Adult-type pulmonary TB is common among adolescents, may be associated with underlying medical conditions, and is often diagnosed late, posing a significant transmission risk to the community.
Assuntos
Tuberculose/prevenção & controle , Tuberculose/transmissão , Adolescente , Feminino , Humanos , Masculino , Saúde Pública , Estudos Retrospectivos , EspanhaRESUMO
BACKGROUND: Candida spp. are increasingly important hospital-acquired pathogens in neonatal intensive care units (NICU) and cause considerable mortality in preterm infants. Most studies have been limited to a single institution. The aim of this study was to determine the epidemiology of candidemia in all Barcelona NICUs. METHODS: We conducted prospective population-based surveillance for candidemia in Barcelona, Spain, during 2002-2003. This report focuses on the results from 5 participating hospitals with NICUs. RESULTS: We detected 24 cases, resulting in an annual incidence of 32.6 cases per 100,000 live births and 1.1 cases per 100 NICU discharges. Median gestational age was 27.5 weeks (range, 24-40.5), and there were 21 cases among very low birth weight infants. Among the 20 (83%) cases evaluated for the presence of end organ infection, endophthalmitis occurred in 2 cases, and endocarditis, meningitis and peritonitis occurred in 1 case each. Candida parapsilosis was the most frequent species isolated (67%). All isolates were fluconazole-susceptible. Crude mortality was 21%. CONCLUSIONS: The preponderance of C. parapsilosis candidemias observed in Barcelona NICUs is similar to reports from the literature. Morbidity and mortality associated with neonatal candidemia remain high.
Assuntos
Candidíase/epidemiologia , Fungemia/epidemiologia , Doenças do Prematuro/epidemiologia , Unidades de Terapia Intensiva Neonatal , Vigilância da População , Candida/classificação , Candida/isolamento & purificação , Candidíase/microbiologia , Candidíase/mortalidade , Fungemia/microbiologia , Fungemia/mortalidade , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/microbiologia , Doenças do Prematuro/mortalidade , Fatores de Risco , Espanha/epidemiologiaRESUMO
BACKGROUND: Blood cultures (BCs) are commonly performed on children admitted to hospital for skin and soft tissue infections (SSTIs). In recent years, this practice has been questioned in patients with uncomplicated SSTIs because of its low yield. At the same time, however, an increase in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has been described; its influence on rates of bacteremia in patients with SSTIs is unclear. The aims of the study were to describe the performance and the yield of BC in immunocompetent patients with uncomplicated SSTIs and to determine the prevalence of CA-MRSA as a causative agent in our area. METHODS: Retrospective study: immunocompetent patients younger than 18 years evaluated in the emergency department and admitted for uncomplicated SSTIs (cellulitis, abscess, impetigo or erysipelas) from July 1, 2010 to June 31, 2014 were included. Patients referred from other hospitals who were receiving parenteral antibiotics and patients with complicated SSTIs (surgical or traumatic wound infection, need for surgical intervention and infected ulcers or burns) were excluded. RESULTS: We included 445 cases: 348 (78.2%) cellulitis, 78 (17.5%) abscess and 19 (4.3%) impetigo. BCs were performed on 353 (79.3%) patients. Two (0.6%; 95% confidence interval: 0.2-2.0%) were positive and 10 (2.8%; 95% confidence interval: 1.5-5.1%) contaminated. The positive BCs grew S. aureus and Streptococcus pyogenes. Wound cultures were performed on 148 (33.3%) patients; 98 (66.2%) were positive. In 22 (22.4%) patients CA-MRSA grew, accounting for 14.9% of overall wound cultures. CONCLUSIONS: BCs are not useful in the management of immunocompetent patients admitted to the hospital with uncomplicated SSTIs. The prevalence of CA-MRSA is low in our area, but continuing careful surveillance is needed.
Assuntos
Sangue/microbiologia , Técnicas Microbiológicas/métodos , Dermatopatias Bacterianas/diagnóstico , Infecções dos Tecidos Moles/diagnóstico , Manejo de Espécimes/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estudos Retrospectivos , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
Osteoarticular infection and occult bacteremia are the 2 invasive infectious pathologies most frequently associated in childhood with Kingella kingae. We report a series of 11 patients in whom osteomyelitis predominates over septic arthritis, which is the reverse of other series, probably as a consequence of inoculation of samples during surgery on agar media, used in combination with or as an alternative to inoculation into blood culture bottles. Although K. kingae infections usually follow a benign clinical course, we noted 2 patients with mild orthopedic sequelae.
Assuntos
Artrite Infecciosa/microbiologia , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/diagnóstico , Osteomielite/microbiologia , Antibacterianos , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/epidemiologia , Pré-Escolar , Quimioterapia Combinada/uso terapêutico , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Infecções por Neisseriaceae/tratamento farmacológico , Infecções por Neisseriaceae/epidemiologia , Osteomielite/tratamento farmacológico , Osteomielite/epidemiologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVES: Blood culture (BC) is one of the most commonly used microbiological tests in the paediatric emergency department (PED) despite its lack of immediate diagnostic utility. Our objectives were to uncover the reasons for BC in the PED, to review adherence to the current protocol for this technique, and to analyse the diagnostic yield (DY) of BC in localized bacterial infections. PATIENTS AND METHODS: Retrospective study including patients younger than 18 years with a BC obtained in the PED of a tertiary care hospital in 2011. Patients with bacteraemia risk factors (immunosuppressant condition, long-term vascular catheter, prosthetic valve or ventriculoperitoneal shunt, and hospitalization or aggressive diagnostic or therapeutic procedure in the previous week) were excluded. RESULTS: Two thousand and sixty-two BCs were included. Fever without source (FWS) (34.3%) and pneumonia (10.1%) were the main indications for BC. Twenty-five per cent of BCs did not adhere to protocol: FWS (115 cases), mononucleosic syndrome (83 cases) and acute gastroenteritis (78 cases) represented half of these. The global DY by BC was 2.0%. Streptococcus pneumoniae was the main isolated microorganism (41.4%) and pneumonia was the main associated pathology (22%). All of the BCs with non-adhered-to protocol were negative. All of the BCs obtained for noncomplicated bacterial skin and soft tissue infection were negative. CONCLUSION: FWS is the main reason for BC in the PED. One-quarter of the BCs were not indicated, with the DY null in these cases. Due to the low DY in certain localized bacterial infections, a strict individualized ordering of BC in these cases should be considered.
Assuntos
Bacteriemia/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Bacteriemia/sangue , Bacteriemia/microbiologia , Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Sangue/microbiologia , Pré-Escolar , Protocolos Clínicos , Feminino , Febre/diagnóstico , Febre/microbiologia , Humanos , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: There is scarce information about changes in serotypes and clonal types of Streptococcus pneumoniae causing acute otitis media (AOM) in recent years, particularly in European countries. METHODS: Pneumococcal serotypes and clones from S. pneumoniae strains isolated from children with AOM who were attended at Hospital Sant Joan de Déu, Barcelona (1992 to 2011), were studied. Heptavalent pneumococcal conjugate vaccine (PCV7) was introduced in June 2001. We defined 3 periods: prevaccine period 1992 to 2001, early vaccine period 2002 to 2006 and late vaccine period 2007 to 2011. RESULTS: There were 376 pneumococcal strains causing AOM, and 373 (99.2%) of them were serotyped. AOM caused by PCV7 serotypes declined significantly: 161 of 245 (65.7%) episodes in 1992 to 2001 versus 22 of 67 (32.8%) in 2002 to 2006 versus 8 of 61 (13.1%) in 2007 to 2011 P < 0.001. In the last period (2007 to 2011), the potential serotype coverage for the PCV10 was 16.4% and for the PCV13 was 68.9% (P < 0.001). Serotype 19A increased from 5.7% in 1992 to 2001 to 42.6% in 2007 to 2011 (P < 0.001). Among strains with penicillin minimal inhibitory concentration ≥0.12 µg/mL (n = 241), serotype 19A rose from 2.3% in the first period to 57.9 % in the last period (P < 0.001). The clonal-type ST320 was initially detected in 2005, and in the period 2007 to 2011, the ST320 was found in 72.7% of nonsusceptible serotype 19A isolates. CONCLUSIONS: Among children with AOM, a rapid expansion of the multiresistant clone ST320 expressing serotype 19A has been observed in Barcelona. The implementation of PCV13, which includes this serotype, may decrease the prevalence of AOM and reduce antimicrobial resistance.
Assuntos
Farmacorresistência Bacteriana Múltipla , Tipagem Molecular , Otite Média/epidemiologia , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Antibacterianos/farmacologia , Criança , Pré-Escolar , Feminino , Vacina Pneumocócica Conjugada Heptavalente , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Otite Média/microbiologia , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas/administração & dosagem , Prevalência , Sorotipagem , Espanha/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Vacinação/estatística & dados numéricosRESUMO
Between April 2004 and March 2006 an oropharyngeal swab was obtained from 502 asymptomatic children, aged 6 months to 6 years, at a tertiary children's hospital outpatient department to assess the pneumococcal colonisation rate, risk factors, serotype distribution and antimicrobial susceptibility. Only 126 (25.3%) children had received ≥ 1 dose of PCV7. The pneumococcal carriage rate was 23.5%. Carrier rates were significantly higher in children aged ≥ 24 months and children attending daycare center. Thirty six (31.0%) of the isolates were contained in PCV7, 39 (33.6%) in PCV10 and 62 (53.4%) in PCV13. Forty-four strains (37.9%) were resistant to penicillin. Vaccine serotype (VT) strains were more likely to be penicillin-nonsusceptible S. pneumoniae than non-PCV7 serotype (NVT) strains (66.7% vs. 21.6%; P < 0.001). In our pediatric population, NVT were predominant among pneumococcal carriers whereas antibiotic resistance was significantly associated with VT. PCV13 can substantially increase the serotype coverage of S.pneumoniae in healthy carriers.
Assuntos
Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/farmacologia , Criança , Pré-Escolar , Feminino , Vacina Pneumocócica Conjugada Heptavalente , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Orofaringe/microbiologia , Ambulatório Hospitalar , Resistência às Penicilinas , Vacinas Pneumocócicas/imunologia , Prevalência , Sorotipagem , Espanha/epidemiologia , Streptococcus pneumoniae/classificaçãoRESUMO
We developed a real-time polymerase chain reaction specific for Streptococcus pneumoniae to be applied directly from blood culture bottles without previous DNA extraction step. For the 128 blood culture bottles tested, the assay had 94% and 98.4% sensitivity and specificity, respectively. This assay provides rapid and accurate identification of this pathogen.
Assuntos
Bacteriemia/diagnóstico , Sangue/microbiologia , Técnicas de Laboratório Clínico/métodos , Infecções Pneumocócicas/diagnóstico , Reação em Cadeia da Polimerase/métodos , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Bacteriemia/microbiologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: In recent years an increase in the incidence and severity of parapneumonic pleural effusion (PPE) in pediatric populations has been observed. Streptococcus pneumoniae remains the main causal agent. New molecular and antigen techniques have increased the microbiological diagnosis of this pathology. OBJECTIVES: To describe the epidemiology and clinical characteristics of PPE in our population. PATIENTS AND METHODS: Prospective study of patients under the age of 18 years admitted for PPE in a tertiary-care pediatric hospital in Barcelona (Spain) between September 2003 and December 2006. RESULTS: One hundred ninety cases of PPE were diagnosed. The annual incidence of PPE in the population under 18 years of age increased from 19.9 cases per 100,000 in 2004 to 35.2 per 100,000 in 2006. S. pneumoniae was the main causal agent identified: 82.9% of the 21.6% patients with positive culture. Non-vaccine serotypes (NVS) predominated (81.5%), and serotype 1 was responsible for 38.5% of cases. The use of polymerase chain reaction (PCR) test to detect S. pneumoniae increased etiological diagnosis from 21.6% to 42.1%. Antigen assays used to detect pneumococcus in pleural fluid demonstrated 87.9% sensitivity and 100% specificity when PCR was used as the gold standard. CONCLUSIONS: There has been an increase in the incidence of PPE that parallels the increase in CAP. S. pneumoniae remains the principal causal agent, and NVS clearly predominate. The use of PCR to detect S. pneumoniae substantially increases etiologic diagnosis. The use of antigen assays to detect pneumococcus in pleural fluid is a quick and sensitive diagnostic method, and thus a valid alternative to PCR.
Assuntos
Derrame Pleural/microbiologia , Pneumonia/complicações , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Derrame Pleural/epidemiologia , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To describe the epidemiology of invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae serotype 19A. METHODS: We studied all children and adolescents with IPD caused by serotype 19A who were admitted to a Children's Hospital in Barcelona (1997-2007). Serotyping, antibiotic susceptibility and clonal analysis were performed. RESULTS: Comparing the pre-vaccine period (1997-2001) with the early vaccine period (2002-2004) and the late vaccine period (2005-2007) there was an increase of IPD caused by serotype 19A: 1 of 58 episodes (1.7%) vs. 8 of 54 episodes (14.8%) vs. 27 of 123 episodes (21.9%), respectively (P = 0.002). All S. pneumoniae serotype 19A isolated in the pre-vaccine and early vaccine periods (n = 9) were penicillin susceptible, while in the late vaccine period, 12 of 27 (44%) were penicillin nonsusceptible (P = 0.01). A clonal analysis revealed 15 different sequence types (STs) expressing serotype 19A. 10 of them were preexisting STs associated with serotype 19A including the multidrug-resistant ST320 and ST276. CONCLUSION: There was an increase of IPD caused by S. pneumoniae serotype 19A which was mainly related with the emergence of preexisting clones several of them closely related with international multidrug-resistant clones. These results should be considered when selecting the new conjugate pneumococcal vaccines.
Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Adolescente , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , Análise por Conglomerados , Impressões Digitais de DNA , DNA Bacteriano/química , DNA Bacteriano/genética , Feminino , Genótipo , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Análise de Sequência de DNA , Sorotipagem , Espanha/epidemiologia , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
A prospective study was performed including all children younger than 18 years with the clinical diagnosis of invasive meningococcal disease (IMD) hospitalized at the University Hospital Sant Joan de Déu in Barcelona, Spain, from January 2001 to December 2006. During the study period, 168 meningococcal disease cases were reported. Microbiologic confirmation was obtained in 118 cases. Forty-six (38.9%) of 118 cases were only detected by polymerase chain reaction (PCR); 6 patients were culture positive and PCR negative (5%). Serogroup B predominated in the 6-year period with 83.1% of the strains. A significant decrease in serogroup C was observed in the last 3 years of the study (P=0.029), and less common serogroups, such as serogroup A and W135, emerged. Serogroup distribution of patient diagnoses only by real-time PCR showed a similar distribution: serogroup B, 85.7%; serogroup C, 7.1%; and nontypeable serogroups, 7.1%. In conclusion, real-time PCR is more rapid and sensitive than culture for diagnosis and serogrouping of IMD.
Assuntos
Infecções Meningocócicas/diagnóstico , Neisseria meningitidis/classificação , Reação em Cadeia da Polimerase/métodos , Sorotipagem/métodos , Adolescente , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Primers do DNA , Feminino , Humanos , Lactente , Masculino , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Neisseria meningitidis/isolamento & purificação , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: The genetic mechanisms and changes in resistance of Streptococcus pyogenes to clarithromycin and clindamycin were studied in 480 strains from a children's hospital in Barcelona (1996-2003). RESULTS: There was a progressive increase of strains with the MLSB phenotype (55.6% of resistant strains in 2002) and a relative decrease in the M phenotype. The overall rate of macrolide resistance was 29.8%, with an increase from 27.4% in the 1996-2001 period to 35.8% in the 2002-2003 period. The MefA gene was detected in M phenotype strains, the ermB gene in constitutive MLSB strains and the ermTR gene in some inducible MLSB strains. CONCLUSION: The increase of the resistance and the changes in the implied mechanisms reduce the effectiveness of macrolides and clindamycin as an alternative treatment.