Influenza-associated paediatric respiratory hospitalizations in China, 1996–2012: a systematic analysis

Background@#The World Health Organization recommends that children aged ≥6 months be vaccinated against influenza. Influenza vaccination policies depend on the evidence of the burden of influenza, yet few national data on influenza-associated severe outcomes among children exist in China.@*Methods@#We conducted a systematic review of articles published from 1996 to 2012 on laboratory-confirmed, influenza-associated paediatric respiratory hospitalizations in China. We extracted data and stratified the percentage of samples testing positive for influenza by age group (<2, <5 and <18 years old); case definition; test methods; and geographic location. The pooled percentage of samples testing positive for influenza was estimated with a random effects regression model.@*Results@#Influenza was associated with 8.8% of respiratory hospitalizations among children aged <18 years, ranging from 7.0% (95% confidence interval: 4.2–9.8%) in children aged <2 years to 8.9% (95% confidence interval: 6.8–11%) in children aged <5 years. The percentage of samples testing positive for influenza was consistently higher among studies with data from children aged <5 years and <18 years than those restricted only to children aged <2 years; the percentages were higher in Northern China than Southern China.@*Discussion@#Influenza is an important cause of paediatric respiratory hospitalizations in China. Influenza vaccination of school-aged children could prevent substantial influenza-associated illness, including hospitalizations, in China.

Estimation of hospitalization rate of laboratory confirmed influenza cases in Jingzhou city, Hubei province, 2010-2012 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To estimate the hospitalization rate of severe acute respiratory infection (SARI) cases attributable to influenza in Jingzhou city, Hubei province from 2010 to 2012.</p><p><b>METHODS</b>SARI surveillance was conducted at four hospitals in Jingzhou city, Hubei province from 2010 to 2012. Inpatients meeting the SARI case definition and with informed consent were enrolled to collect their demographic information, clinical features, treatment, and disease outcomes, with their respiratory tract specimens collected for PCR test of influenza virus.</p><p><b>RESULTS</b>From April, 2010 to September, 2012, 19 679 SARI cases enrolled were residents of Jingzhou, and nasopharyngeal swab was collected from 18 412 (93.6%) cases of them to test influenza virus and 13.3% were positive for influenza. During the three consecutive 2010-2012 flu seasons, laboratory-confirmed influenza was associated with 102 per 100 000, 132 per 100 000 and 244 per 100 000, respectively. As for the hospitalization rate attributable to specific type/subtype of influenza virus, 48 per 100 000, 30 per 100 000 and 24 per 100 000 were attributable to A (H3N2), A (H1N1) pdm2009, and influenza B, respectively in 2010-2011 season; 42 per 100 000 [A (H3N2)] and 90 per 100 000 (influenza B) in 2011-2012 season; 90 per 100 000 [A (H3N2)] and one per 100 000 [influenza B] from April, 2010 to September, 2012. SARI hospitalization caused by influenza A or B occurred both mainly among children younger than five years old, with the peak in children aged 0.5 year old.</p><p><b>CONCLUSION</b>Influenza could cause a substantial number of hospitalizations and different viral type/subtype result in different hospitalizations over influenza seasons in Jingzhou city, Hubei province. Children less than five years old should be prioritized for influenza vaccination in China.</p>

High prevalence of CTX-M-15 extended spectrum beta-lactamase-producing bacterial clinical isolates in both community and hospital settings in Egypt

High prevalence of infections caused by extended-spectrum beta-lactamase [ESBL]-producing isolates, notably Escherichia coli, has been suggested in Egypt. As little is known about the genetic background of these isolates, ESBL-positive E. coli isolates obtained among 520 Enterobacteriaceae prospectively collected [May 2007 -August 2008] from inpatients [n=320] and outpatients [n=200] seen at the Theodor Bilharz Research Institute [Cairo], were characterized. Clinical epidemiology, antibiotic susceptibility, and genetic traits including bla gene, phylogenetic group, ERIC-2 PCR profile, multilocus sequence type [ST] were determined. Among the 520 collected Enterobacteriaceae, were 291 [56%] E. coli and 165 [32%] Klebsiella pneumoniae. A total of 16% of all Enterobacteriaceae were ESBL-producers: 19% in E. coli and 14% in K. pneumoniae. Of the E. coli ESBL-producers, 75% [n=41] were isolated from urine. Rates of ESBL producers did not differ significantly between in and outpatients for E. coli [20 vs 17%] but significantly for non E. coli ESBL producers [18.5 vs 1.2 %: p= 0.0001]. CTX-M-15 was identified in all ESBL producers. Of the E. coli ESBL producers, 40% belonged to phylogenetic group A, 32% to D and 26% to B2. The ERIC-2 PCR method showed genetic background diversity with clusters in each group having profiles indistinguishable to that of previously published clones: complex ST10 and ST131. MLST showed that 75% of E. coli group B2 belonged to clone ST131 and 15% to clones previously detected worldwide, ST73 and ST405. This study illustrates the dissemination of different E. coli clones producing CTX-M-15 in Africa, notably in outpatients

Changes in etiologic and antibiotic resistance profiles of bacteria causing spontaneous peritonitis in Egyptian patients with liver cirrhosis

To evaluate the recent changes in bacteria causing spontaneous bacterial peritonitis [SBP] in cirrhotic patients and its clinical significance on treatment, we compared the etiologic agents and their antibiotic resistance profiles over a four year period. In the prospective period of the study, 150 ascitic fluid [AF] samples obtained from SBP patients admitted consecutively to the Hepatology Department of Theodor Bilharz Research Institute during 2006-2007 were examined for polymorphnuclear leukocytes [PMLs] by blood cell counter and by a bedside dipstick test [Multistix SG10, Bayer]. Blood and AF cultures were performed using BACTEC blood culture bottles and purified bacterial isolates were identified with a BBL Crystal Id System and software. Antibiotic sensitivity testing and extended-spectrum beta-lactamase [ESBL]- production were determined by disk diffusion and modified double disk synergy tests [MDDST] respectively. Genes encoding ESBLs were detected by PCR and typed by DNA sequencing. In the retrospective period of the study [2004-2005], the laboratory records of 140 episodes of SBP were examined for the culture positive rate, causes of SBP and their antibiotic resistance patterns recorded. Results showed that the overall culture positivity rate was significantly higher in prospective study period [32%] versus retrospective period [16.4 %] p<0.05 and the main bacterial isolates were E.coli, 47.8% and Klebsiella pneumoniae, 28.1% with no differences in the two study periods. Gram positive bacteria [GPB] were isolated more frequently in the prospective than retrospective period [25% versus 13%]. Two opportunistic bacterial species [Staphylococcus haemolyticus and Pantoea agglomerans] were detected as a cause of SBP in the prospective period. Species identification of Pantoea isolate was confirmed by DNA extraction, sequencing of ribosomal RNA and phylogenetic analysis. ESBLs were detected among 17.6% of E. coli and Klebsiella isolates of the prospective period and all were of the CTX-M15 type. The rate of resistance to cefotaxime significantly increased from 45% to 72 % and to ciprofloxacin from 25% to 47% and treatment failure rate was 65% in recent years. No resistance was detected to imipenem over the entire study period. For the GPB, 50% were resistant to ampicilin/sulbactam, cefotaxime and gentamicin and one S. haemolyticus isolate was methicillin resistant. In conclusion the emergence of multidrug resistant opportunistic pathogens and ESBL-producing E. coli and Klebsiellae as causal agents of SBP, together with an increase in resistance to antibiotics commonly used for the empiric treatment of bacterial peritonitis have serious implications on patient management in our region. Rapid diagnosis of SBP by a bedside dipstick test and identification of the causative organism by culture using blood culture bottles and direct sensitivity testing to establish an effective antibiotic therapy is recommended