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PubMed1996

[Treatment of urinary tract infection in children].

The management of urinary tract infection in children must take into account several factors, namely the type of bacteria, the localization of the infection, the presence of an uropathy and the age of the patient. In acute pyelonephritis, the risk of renal scarring justifies a first line treatment with two antibiotics to be administrated intravenously in newborns and infants. Treatment must be maintained for at least 10 days: double antibiotherapy for 4-5 days, followed by oral monotherapy according to the antibiogram. Cystitis requires an oral monotherapy for 3-7 days. In any case it is important to search for a cause to the infection.

Age Factors↗
PubMed1997

[Bacteriological study of purulent nasopharyngitis in children in Senegal].

BACKGROUND: S pneumoniae, H influenzae and M catarrhalis are the main bacteria isolated from rhinopharynx in Europe. The purpose of this work was to study the frequency of potential pathogenic bacteria isolated from acute purulent rhinopharyngitis among children in Senegal. POPULATION AND METHODS: Ninety-three children from one month to 7-years old suffering from purulent rhinopharyngitis were recruited from April 1 to July 1996. The withdrawal samples were taken from the cavum with a swab which was immediately immersed in an agar shipping medium. Bacteria's grouping and serotyping were made by immunoagglutination. A standard antibiogram was made for all isolates and furthermore the minimal inhibitory concentration (MIC) were determined for S pneumoniae. RESULTS: Two hundred bacterial strains were isolated: S pneumoniae 28% (60% of the children), C group streptococci: 19% (41% of the children), H influenzae: 15.5% (33% of the children), S pyogenes: 9.5% (20% of the children), S aureus: 8% (17% of the children) and M catarrhalis: 6% (13% of the children). The other isolates were: B and D groups streptococci, P aeruginosa and Klebsiella spp. S pnuemoniae strains belonged to serogroups 6, 19 and 23. Only three strains of H influenzae were capsulated (serotype b). Infants aged from 6 to 18 months were the most affected. No resistance to penicillin was observed for S pneumoniae and S pyogenes. Ampicillin (81%) and chloramphenicol (96%) both inhibited the majority of H influenzae strains. CONCLUSIONS: This descriptive bacterial epidemiology study of children's rhinopharynx's flora in Senegal allowed us to identify three major pathogenic germs: S pneumoniae, H influenzae and S pyogenes contributing to a better knowledge of these microorganisms' serotypes, biotypes and antibiotypes.

Acute Disease↗
PubMed1993

Phenotypical characters and ribotyping of Pasteurella aerogenes from different sources.

On the occasion of five Danish human Pasteurella aerogenes from pig bite lesions, a comparison was made between 6 isolates from man and 15 animal isolates, mainly from pigs. The strains originated from 6 different countries (USA, Canada, Czechoslovakia, France, Belgium and Denmark). The 21 isolates were characterized by conventional biochemical tests, antibiogram and the API 20 NE kit; finally ribotyping was carried out by hybridizing EcoRI-digested chromosomal DNA with a probe derived from E. coli ribosomal RNA. By ribotyping, 19 of the 21 strains clustered at a similarity level of 81% or more; both phenotypical tests and ribotyping indicated that the remaining two strains did not belong to the species P. aerogenes. In conclusion, despite minor differences our P. aerogenes isolates constituted a well-defined group and they could not be subdivided on basis of animal or geographical origin.

Animals↗
PubMed1992

Small antibiotic resistance plasmids in Staphylococcus intermedius.

Antibiograms and plasmid profiles were evaluated for 116 Staphylococcus intermedius isolates collected from dogs in Germany and in the USA. Of the 26 S. intermedius isolates from Germany, 9 (34.6%) carried plasmids, while 20 (22.2%) of the 90 S. intermedius isolates from the USA were found to be plasmid-positive. Eight small resistance plasmids were identified and characterized using protoplast transformations and restriction endonuclease analyses. Five plasmids (3.8 and 3.9 kb) encoded for chloramphenicol resistance, 2 plasmids (each 2.5 kb) carried determinants for macrolide-lincosamide resistance, and one plasmid (4.5 kb) conferred resistance to tetracycline. Detailed restriction maps of these plasmids were constructed and served for structural comparisons with other small resistance plasmids found in staphylococci. These comparisons implied marked structural homologies with those prototype plasmids initially characterized in S. aureus of human origin.

Ampicillin Resistance↗
PubMed1997

An apparent outbreak of infection with Acinetobacter calcoaceticus reconsidered after investigation by pyrolysis mass spectrometry.

In a previously reported apparent outbreak of infection due to Acinetobacter calcoaceticus on a Regional Burns Unit in which both clinical and environmental isolates were available for study, investigations of the organisms by electrophoretic typing of surface proteins, plasmid profiling and antibiograms were inconclusive and unable to identify a single epidemic strain of the organism. The same collection of isolates has been analysed for inter-strain comparison by pyrolysis mass spectrometry (PyMS). PyMS analysis suggested that a few isolates were very different from the majority but that most of the collection comprised a group of closely similar but nonetheless distinct isolates. These isolates may well be representatives of a limited variety of strains occupying an ecological niche but not yet a single emergent strain. The ability of PyMS to detect a single epidemic strain of A. calcoaceticus when present in such a collection of isolates was demonstrated by analysis of a "constructed outbreak collection", using some of the original isolates. This study illustrates the versatility of PyMS for inter-strain comparison studies of species not yet amenable to conventional typing methods. The application of rapid, highly discriminatory, high-volume inter-strain comparison methods such as PyMS to apparent outbreaks of nosocomial infection is likely to reveal patterns of organism acquisition other than point-source transmission.

Acinetobacter Infections↗
PubMed2003

An assessment of fructose-1,6-bisphosphate as an antimicrobial and anti-inflammatory agent in sepsis.

Tissue lesion mechanisms provoked by sepsis include the infectious process, inflammation, and cellular energy deficit. We chose to test fructose-1,6-bisphosphate (FBP) because of its possible anti-inflammatory and antimicrobial actions. Wistar rats were used and divided into three experimental groups: a control group (n=10), in which a capsule was introduced into the peritoneum of the animals; a septic group (n=10), in which a capsule containing non-sterile fecal matter was introduced together with Escherichia coli (1.5 x 10(9)CFU); and a septic group treated with FBP 500 mg/kg (n=10). The blood cell tests revealed that levels of leukocytes increased significantly in the septic group when compared to both the septic group treated with FBP and the control group. The blood cultures were 100% positive in both the septic group and the septic group treated with bisphosphorylated sugar. The antibiogram only revealed an inhibitory halo in the case of the antibiotic ampicillin, there was no such indication for FBP. The anti-inflammatory power of FBP remained at 60% for 5 h in the rats that received the carrageenan injection. What is more, the sugar reduced the levels of ionic calcium in relation to the control group. This data proves the validity of using FBP in the treatment of sepsis, possibly due to its anti-inflammatory rather than antimicrobial action.

Animals↗
PubMed2000

Multidrug-resistant strains of Salmonella enterica serotype typhi are genetically homogenous and coexist with antibiotic-sensitive strains as distinct, independent clones.

OBJECTIVE: The goal of this study was to report the molecular analysis of antibiotic-sensitive and multidrug-resistant (MDR) strains of Salmonella typhi, using pulsed-field gel electrophoresis (PFGE), with a particular emphasis on the coexistence of these strains in a typhoid-endemic region of Karachi, Pakistan. METHODS: One hundred isolates of S. typhi in humans (50 MDR and 50 antibiotic-sensitive isolates) from sporadic cases of typhoid fever were analyzed by Vi-phage typing, antibiograms and PFGE. RESULTS: The MDR S. typhi strains were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. Analysis by PFGE showed that 50 MDR isolates of S. typhi had a single, homogenous PFGE profile, which was distinctly different from that of 50 antibiotic-sensitive isolates obtained in the same time frame from the same area. This latter group of isolates showed much greater diversity of PFGE profiles, as has been observed in other endemic regions. CONCLUSIONS: Multidrug-resistant and antibiotic-susceptible strains of S. typhi can coexist in endemic areas as epidemiologically independent pathogens and are not in competition for continued persistence and transmission.

Adolescent↗
PubMed2003

Emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection in Queensland, Australia.

OBJECTIVES: To investigate the incidence and epidemiology of non-multiresistant methicillin-resistant Staphylococcus aureus (nmMRSA) infection in south-east Queensland, Australia. STUDY DESIGN: A retrospective survey was done of hospital records of all patients who had non-multiresistant MRSA isolated at Ipswich Hospital (a 250-bed general hospital, 40 km south-west of Brisbane, Queensland, Australia) between March 2000 and June 2001. Laboratory typing of these isolates was done with antibiogram, pulsed-field gel electrophoresis, bacteriophage typing and coagulase gene typing. RESULTS: There were 44 infections caused by nmMRSA. Seventeen infections (39%) occurred in patients from the south-west Pacific Islands (predominantly Samoa, Tonga and New Zealand). Laboratory typing showed that the isolates in Pacific Islanders were Pacific Island strains, and 16/17 of these infections were community acquired. Twenty-three infections (52%) occurred in Caucasians. Eleven of the isolates from Caucasians (48%) were a new predominantly community-acquired strain that we have termed the 'R' pulsotype, nine (39%) were Pacific Island strains, and three (13%) were health care institution-associated strains. Four infections occurred in patients who were not Caucasians or Pacific Islanders. Overall, 34 of all 44 infections (77%) were community acquired. CONCLUSIONS: Non-multiresistant MRSA infection, relatively frequently observed in Pacific Islanders in south-east Queensland, is now a risk for Caucasians as well, and is usually community acquired. Clinicians should consider taking microbiological specimens for culture and antimicrobial susceptibility testing in patients with suspected staphylococcal infections who are not responding to empirical therapy with beta-lactam antibiotics.

Adult↗
PubMed2001

[Neonatal bacterial infections at the CUH of Dakar].

OBJECTIVES: It's a retrospective study in order to determine the epidemiology of neonatal bacterial infection and to evaluate the efficiency of the antibiotic protocol in University Teaching Hospital in Dakar. MATERIAL AND METHODES: From January 1st 1997 to December 31st 1998 we have registered 7461 live births, samples of blood are taken from 2312 new-born baby and they received antibiotherapy (beta-lactamine + gentamycin) at the first day based on infections risk evaluated by anamnestic criterias. The treatment is seven to one days long, the antibiotic was adapted according to the antibiogram result. RESULTS: The neonatal infection diagnosis is confirmed in 246 cases, about 33 per 1000 live births or 10.6% of newborn babies having on antibiotherapy. Most current risk factors are premature rupture of membranes (85%) and neonatal suffering (87.8%). Isolated gerras are: Klebsiella pneumoniae (61.5%), Enterobacteria (11.5 Staphylococcus (8.7%), colibacille (6%), Streptococcus (5.5%), Enterococcus (4.1%) and Pseudomonas (2.7%). Most of these germs are resistant to antibiotics currently used in first intention (ampicillin, cefotaxim, gentamycin), in particularly 95% of Klebsiella. Most efficient antibiotics are amikacin, colistin, ceftriaxon and ciprofloxacine. Deaths occurs in 48 cases with 36 in early neonatal period, 79% of mortality rate related to infection by Klebsiella. CONCLUSION: First intention antibiotherapy must be always adapted to the bacterial ecology evolution and must be more selective by using major infections risk factors. We promote early infection diagnosis by using biologic markers which reference is represented by C Reactive Protein.

Anti-Bacterial Agents↗
PubMed2006

[Parapneumonic pleural effusion: an 11-year review].

INTRODUCTION: In the last few years, the incidence of parapneumonic effusions in children with community-acquired pneumonia seems to have increased. The aim of this study was to determine the clinical features and incidence of parapneumonic effusions throughout an 11-year period. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients aged < 15 years old with parapneumonic effusions from 1993 to 2003. Annual incidence rates were calculated per 100,000 children < 15 years old from Health Area 5 of Madrid and per 100 children hospitalized in the Infectious Diseases Department of our hospital. The linear association test was used to compare the incidence rates over the previous 11 years. RESULTS: There were 130 patients with parapneumonic pleural effusions. The mean age was 4.7 years. Forty-one percent received antibiotics before diagnosis. The causative organisms were identified in 42 patients (32.3%). The most effective diagnostic method was pleural-fluid culture (18/58, 31%). The most common organisms were Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) and Mycobacterium tuberculosis (2). Thirty-two percent of the patients required pleural drainage and 16% underwent video-assisted thoracoscopic surgery. Of 12 S. pneumoniae antibiograms available, 91.7% showed full susceptibility to penicillin and 75% were susceptible to erythromycin. The annual incidence of parapneumonic effusions rose from 18.1 in 1993 to 42.9 in 2003 (p < 0.001) per 100,000 children and from 0.76 in 1993 to 3.3 in 2003 (p < 0.001) per 100 children hospitalized in our unit. CONCLUSION: The incidence of parapneumonic effusions in children with community-acquired pneumonia showed a statistically significant increase between 1993 and 2003. The most common causal organism was S. pneumoniae, with a low rate of penicillin resistance.

Adolescent↗
PubMed1980

Genetical relationship between R plasmids derived from Salmonella and Escherichia coli obtained from a pig farm, and its epidemiological significance.

A total of 475 Salmonella strains belonging to 5 serovars, isolated from a pig farm which had been heavily contaminated with Salmonella for the past 2 years were tested for antibiotic susceptibility and detection of R plasmids. Thirty-three Escherichia coli isolates from the same farm were also examined in a similar way. Out of 475 strains 348 (73.2%) were resistant to one or more antibiotics such as tetracycline (Tc), streptomycin (Sm), sulfadimethoxine (Su), chloramphenicol (Cm) and kanamycin (Km), and 247 (85.2%) out of 290 strains belonging to 3 serovars examined harboured conjugative R plasmids. There was no change in the pattern of drug resistance during this survey nor any variation in the pattern of resistance of R plasmids, whatever the serovar. The antibiogram pattern Tc Sm Su, mainly S. typhimurium, was common among Salmonella strains. Among the transferred resistance patterns, the thermosensitive R plasmids conferring the Tc marker detected in this study were Fi-, and belonged to incompatibility group H1, whereas the R plasmids conferring Sm Su resistances which coexisted in the same host were Fi+, and compatible with the reference R plasmids tested. The I alpha plasmid conferring Cm resistance alone was isolated from S. anatum and the FII plasmid conferring Sm Km resistances was also isolated from S. typhimurium. In contrast, the 33 E. coli strains examined were resistant to three or five antibiotics and most of the resistance markers were located on conjugative R plasmids. I alpha plasmids conferring Cm resistance alone or FII plasmids conferring Cm or Km markers were common in the E. coli strains. H1 and H2 plasmids conferring multiple resistance markers were also found in them. The genetic properties of R plasmids derived from Salmonella or E. coli strains are compared, and the potential spread of R plasmids between strains of Salmonella and E. coli is discussed.

Animals↗
PubMed1984

Prospective study of Clostridium difficile colonization and paracresol detection in the stools of babies on a special care unit.

Infants' stools were examined for the presence of Clostridium difficile and its cytotoxin in a study performed over a one-year period on a special care baby unit. Overall, 21% of infants were colonized, but the organism was only recovered in a seven-month period during which its weekly prevalence in the group varied from zero to 44%, with a distinct clustering of colonized infants being observed. Tests for the presence of cytotoxin in the stools and in supernatants of broth that had been inoculated with each isolate were negative. The factors predisposing to colonization were a prolonged stay in the unit, low birth weight, younger gestational age and being nursed in an incubator. The organism was recovered only once from an environmental screen. An antibiogram, used in conjunction with toxin production, was helpful in distinguishing these isolates from a collection obtained from other units in the hospital. We conclude that Cl. difficile was acquired by nosocomial spread although we did not establish the precise mechanism involved. The detection of para-cresol by gas-liquid chromatography was found to be specific but insufficiently sensitive as a screening test for the organism's presence in the stools. It could only be demonstrated in infants whose birth-weights were less than 2500 g, and no association was observed between the type of feed and para-cresol presence in stools.

Clostridium↗
PubMed1981

Discrimination by multiple typing of isolates of Shigella sonnei in Dundee (1971-6).

Different strains of Shigella sonnei present in Dundee from 1971 to 1976 were identified by a "multiple typing' method in which resistotyping, used as the main method of differentiation, was supplemented by colicine typing, antibiogram testing and biotyping. At least 19 different "multiple types' (MTs) were identified by combining information from the four typing techniques. The relation of the different types and their possible derivation from each other are discussed. The practical value of multiple typing was demonstrated in a study of 247 isolates, of three distinct MTs, recovered from 178 persons involved in an extended outbreak centred primarily on day nurseries. A few episodes that yielded isolates of different resistotypes were analysed to determine whether the cultures were: isolates of the same strain different in resistotype as a result of in vivo or in vitro variation of resistotype characters, or isolates of distinct strains of different resistotypes. The multiple typing approach clarified the way in which different MTs emerged, persisted, disappeared or co-existed in the community during the 6 years of the study.

Anti-Bacterial Agents↗
PubMedDate not supplied

Clinical and laboratory studies of nosocomial Staphylococcus aureus resistant to methicillin and aminoglycosides.

A methicillin/aminoglycoside-resistant strain of Staphylococcus aureus (MARS) was likely introduced by transfer of a patient from another hospital. Over the next year, 20 other patients were colonized or infected with MARS of the same phage type, although antibiograms varied. Affected patients usually had serious underlying disease and were in intensive care units. Vancomycin therapy was frequently delayed and MARS may have contributed to the death of some patients. The mode of spread was not definitively delineated, but two nurses were found to be colonized. Institution of isolation procedures was difficult, but the problem gradually waned. Susceptibility testing showed vancomycin to be the most active agent. Synergy studies showed no consistent effect of combining methicillin with an aminoglycoside. This experience illustrates the problem of MARS spread between hospitals and wards, the need for institution of effective control measures, and consideration of early empiric use of vancomycin.

Aminoglycosides↗
PubMedDate not supplied

Investigation of an epidemic of multi-drug resistant Pseudomonas aeruginosa.

Inter- and intrahospital epidemics of nosocomial infections due to gram-negative bacilli resistant to many antimicrobials have been well-documented. Prospective studies on the use of isolation along with epidemiologic analysis and appropriate environmental control have been lacking. In the six-month period from November 1978 to April 1979 Pseudomonas aeruginosa (MDR) resistant to all antibiotics except amikacin was isolated from 15 patients. This organism had not previously been seen in our hospital. Epidemiologic assessment of infected patients revealed that nine of 15 patients had contact either with a previously infected case or contaminated area. All strains of P. aeruginosa were identical by pyocin typing and antibiogram. The organism was present in an environmental reservoir, the urine graduated cylinder, and was found in three of eight receptacles (p = 0.002 vs. other environmental cultures). A case control study of patient risk factors showed aminoglycoside use, other antibiotic use, surgery, intravenous lines, Foley catheter use and mechanical ventilation to be no more frequent in cases than controls. The use of aminoglycosides in only 40% of cases suggests that antibiotic pressure was not the sole factor in perpetuating the epidemic.

Aminoglycosides↗
PubMed1984

Serratia marcescens meningitis associated with a contaminated benzalkonium chloride solution.

Serratia marcescens is recognized as an important and potentially hazardous nosocomial pathogen. The organism has been implicated here as the first reported case of S. marcescens meningitis associated with skin disinfection. A quaternary ammonium compound ( QAC --Benzalkonium Chloride), was used to sterilize the skin prior to injection in a physician's office. Epidemiological studies were initiated. Six spray bottles containing disinfectant, the opened stock bottle of QAC , and an unopened bottle of disinfectant were all cultured. S. marcescens was noted growing in the spray bottles as well as in the opened stock bottle. Antibiograms of the patient and epidemiological isolates are essentially the same. It is our contention as well as that of the Centers for Disease Control that an appropriate skin disinfectant such as Tincture of Chlorhexidine, Iodophors , or Tincture of Iodine should be used, and that physicians performing surgical techniques in the office be aware of the potential hazard of contamination. The consequences of nosocomial infection with resistant organisms warrant every precaution by health care professionals.

Benzalkonium Compounds↗
PubMed1985

A comparison of antibiotic susceptibility profiles using single and multiple isolates per patient.

We compared the antibiogram statistics generated by including all clinical isolates to those obtained by tabulating no more than one isolate of a particular organism from a given patient. We found that 48.3% of the isolates presented multiple occurrences in individual patients but found no practical differences in the profiles obtained by the two methods. We also tabulated the occurrence of minimum inhibitory concentration (MIC)-distinct organisms among the sets of multiple isolates of E. coli and of S. aureus and found that only 20.9% of those isolates represented duplicate organisms by MIC profile. This heterogeneity of MIC sensitivity that occurs in multiple isolates from individual patients was not expected but provides an explanation for the lack of difference between the two methods of tabulating antibiotic susceptibility statistics.

Bacterial Infections↗
PubMed1986

Outbreak of staphylococcal infection in two hospital nurseries traced to a single nasal carrier.

In late January and early February 1983, an outbreak of skin infections (7 of 145 infants) caused by a penicillin/erythromycin resistant strain of Staphylococcus aureus (SA), phage type 3A/3C, occurred in our newborn nursery. A week following the first cluster of infections, another nursery outbreak due to SA with the same antibiogram occurred in a nearby community hospital (11 of 114 infants). Subsequently, a second cluster of infections with the same SA was identified at our nursery. The epidemic strain was carried in the anterior nares of a single nurse who worked at both hospital nurseries on alternate weeks. Investigation revealed that the nurse had an upper respiratory tract infection during each of these outbreaks--simulating "a cloud baby." No further infections have occurred since this nurse was treated and her SA nasal carrier state eliminated.

Cross Infection↗