Clinical analysis of different types of neonatal sepsis: a multi-center retrospective study / 中国新生儿科杂志

Objective:To study the clinical characteristics of different types of neonatal sepsis.Methods:From January 2012 to December 2019, neonates with confirmed sepsis from 5 neonatal centers of central-south China were reviewed. The neonates were assigned into early-onset sepsis (EOS) and late-onset sepsis (LOS) group, and the latter was further subgrouped into hospital-acquired LOS (hLOS) group and community-acquired LOS (cLOS) group. The etiological and clinical characteristics were analyzed. SPSS 26.0 was used for statistical analysis.Results:A total of 580 neonates were enrolled, including 286 (49.3%) in the EOS group and 294 (50.7%) in the LOS group. In LOS group, 147 were in hLOS group and 147 were in cLOS group. The gestational age and birth weight of hLOS group were significantly lower than the other two groups [(32.7±3.6) weeks vs. (37.1±3.7) weeks and (37.7±3.0) weeks, (1 810±717) g vs. (2 837±865) g and (3 024±710) g] ( P<0.05). The common pathogens in EOS and cLOS groups were coagulase-negative staphylococci and Escherichia coli, while Klebsiella pneumoniae was common in hLOS group. Carbapenems usage in the hLOS group was significantly higher than the other two groups [62.6% vs. 28.7% and 16.2%] ( P<0.05). Antibiotics duration in the hLOS group was longer than the other two groups [19 (14, 27) d vs. 15 (12, 20) d and 14 (12, 19) d] ( P<0.05). Conclusions:The clinical characteristics of neonatal sepsis vary among different types of infections, and it is necessary to establish appropriate prevention, control, diagnosis and treatment protocols.

Changing Escherichia coli susceptibility and increasing antimicrobial resistance in community urinary tract infections

Introducción: Las infecciones del tracto urinario causadas por bacterias gramnegativas resistentes a los antibióticos son una preocupación creciente debido a las limitadas opciones terapéuticas. Objetivo: Analizar la tendencia de resistencia a los antibióticos en Escherichia coli resistente a la ciprofloxacina aislada de la infección del tracto urinario adquirida en la comunidad. Métodos: Estudio de series de tiempo que analiza registros de urocultivos positivos para E. coli resistente a ciprofloxacina en personas de ≥18 años de 2011 a 2017. Las tendencias en los patrones de resistencia a los antibióticos se obtuvieron mediante la regresión lineal generalizada de Prais-Winsten. El cambio porcentual anual (APC) y el intervalo de confianza del 95 por ciento (IC 95 por ciento) se calcularon a partir del coeficiente de análisis de regresión β1 y el error estándar (SE). Los valores de p < 0,05 se consideraron estadísticamente significativos. Resultados: De los datos analizados, 3363 (26,1 por ciento) fueron positivos para E. coli resistente a la ciprofloxacina. El aumento de E. coli resistente a la ciprofloxacina fue del 45,3 por ciento. Las mujeres sufrieron más infección por E. coli sensible a la ciprofloxacina (75,5 por ciento), pero los hombres tuvieron una mayor probabilidad de infectarse con E. coli resistente a la ciprofloxacina [2,132 (1,891-2,402)]. El aumento de la resistencia fue mayor para la nitrofurantoína (<0,001) y la ceftriaxona (<0,001). La prevalencia de resistencia fue alta para nitrofurantoína, norfloxacina, ácido nalidíxico, amoxicilina/clavulanato, ceftriaxona y tobramicina. A excepción de la gentamicina, que presentó una tendencia a la baja en la resistencia, los otros antimicrobianos analizados no mostraron tendencias en la resistencia a los antibióticos. Conclusiones: Hubo un aumento promedio en la resistencia a los principales antibióticos utilizados para tratar la infecciones del tracto urinario adquirida en la comunidad. Entre los antibióticos probados, solo la gentamicina mostró una tendencia a la baja en la resistencia. Estos resultados son importantes para dirigir la elección de los antimicrobianos para el tratamiento empírico de la infección urinaria adquirida en la comunidad(AU)

Introduction: Urinary tract infections caused by antibiotic-resistant Gram-negative bacteria are a growing concern due to limited therapeutic options. Objective: To analyze the antibiotic resistance trend in ciprofloxacin-resistant Escherichia coli isolated from community-acquired urinary tract infection. Methods: Time series study analyzing records of urine cultures positive for ciprofloxacin-resistant E. coli in persons aged ≥18 years from 2011 to 2017. The trends in antibiotic resistance patterns were obtained using the Prais-Winsten generalized linear regression. Annual percent change (APC) and 95 percent confidence interval (CI 95 percent) were calculated from the regression analysis coefficient β1 and standard error (SE). Values of p<0.05 were considered statistically significant. Results: From the analyzed data, 3 363 (26.1 percent) were positive for ciprofloxacin-resistant E. coli. The increase in ciprofloxacin-resistant E. coli was 45.3 percent. Females suffered more infection by ciprofloxacin-sensitive E. coli (75.5 percent), but males had a higher chance of being infected with ciprofloxacin-resistant E. coli. [2.132 (1.891- 2.402)]. Increase in resistance was highest for nitrofurantoin (<0.001) and ceftriaxone (<0.001). Prevalence of resistance was high for nitrofurantoin, norfloxacin, nalidixic acid, amoxicillin/clavulanate, ceftriaxone, and tobramycin. Except for gentamicin, which presented a downward trend in resistance, the other antimicrobials analyzed displayed no trends in antibiotic resistance. Conclusions: There was an average increase in resistance to the main antibiotics used to treat community-acquired UTI. Among the antibiotics tested, only gentamicin displayed a downward trend in resistance. These results are important to direct the choice of antimicrobials for the empirical treatment of community-acquired UTI(AU)

Ubicación intrahospitalaria y tratamiento antimicrobiano inicial en pacientes con neumonía adquirida en la comunidad y su relación con la frecuencia y calidad del proceso de estratificación / Intrahospitalary location and antimicrobial initial treatment in patients with acquired pneumonia in the community and their relationship with the frequency and quality of the stratification process

La importancia de la evaluación inicial de la gravedad del paciente con neumonía es una acción diagnóstica de importancia bien establecida. El objetivo del trabajo fue evaluar la relación entre la frecuencia y calidad del proceso de estratificación de pacientes con neumonía, y el cumplimiento de las sugerencias de ubicación intrahospitalaria y de tratamiento antimicrobiano inicial de un instrumento de estratificación. Se realizó un estudio descriptivo sobre una población de 1,809 pacientes hospitalizados durante 10 años. Se analizó el comportamiento de los índices de ubicación intrahospitalaria y tratamiento antimicrobiano inicial acorde a la sugerencia de un instrumento de estratificación utilizado; en el análisis estadístico se utilizó el Odds ratio y el estadígrafo X2, con un nivel de significación de 95%. En los resultados se destacan que la ubicación intrahospitalaria estuvo acorde a la sugerencia del instrumento en el 96%, con el valor más bajo en los pacientes con neumonía grave y altas probabilidades de recuperación (82%, p<,05). Se constató mayor frecuencia de ubicación intrahospitalaria acorde a la sugerencia del instrumento en los pacientes bien estratificados (p<,05), fundamentalmente en los pacientes con neumonía grave y altas probabilidades de recuperación. La correspondencia del tratamiento antimicrobiano inicial con la propuesta del instrumento fue del 61%; el estrato IIIA mostró el valor más elevado (80%, p<,05). Como conclusiones del estudio se constató un elevado desempeño en el cumplimiento de la sugerencia de ubicación intrahospitalaria del instrumento de estratificación, no así en el cumplimiento de la sugerencia de tratamiento antimicrobiano inicial. Se demostró la existencia de una relación entre el proceso de estratificación y el cumplimiento de la ubicación intrahospitalaria sugerida por el instrumento empleado.

The initial evaluation of the patient's condition with pneumonia is a very important assistance action. The objective was evaluate the relationship between the frequency and quality of the stratification process of the patient with pneumonia, and the execution of suggestions of intrahospitalary location and the initial antimicrobial treatment of stratification instrument. A descriptive study was done on a population of 1,809 patients hospitalized during 10 years. The indexes of intrahospitalary location and of antimicrobian initial treatment were analized according to the suggestions of the instrument; in the statistical analysis it was used the odds ratio and the statistician X2, with a significant level of 95%. The intrahospitalary location was in agreement with the suggestion of the instrument in 96% of the cases, with the lowest value in patients with serious pneumonia and high recovery probabilities (82%, p <,05). The frequency of intrahospitalary location was bigger and veryfied with the suggestion of the instrument in the termed well stratified patients (p <,05), fundamentally in the patients with serious pneumonia and high recovery probabilities. The correspondence of the initial antimicrobial treatment with the proposal of the instrument was of 61%; the stratum IIIA showed the highest value (80%, p <,05). As conclusions, a high performance in the execution of the suggestion of the intrahospitalary location has been one of the characteristics of the process, although as a negative element it stands out the frequent non-fulfillment of the suggestion of the initial antimicrobial treatment. There was a relationship between the stratification process and the execution of the suggestion of the intrahospitalary location.

Perfil microbiologico y de resistencia antimicrobiana en infecciones adquiridas en la comunidad. Hospital Universitario San José de Popayán / Microbiological profile and resistance spectrum of the community acquired bacterial infection of the San Jose Universitary Hospital in Popayan

Resumen Objetivo. Describir el perfil microbiológico y de resistencia bacteriana de los aislamientos en adultos con infecciones adquiridas en comunidad en el Hospital Universitario San José de junio 2016 a diciembre 2019. Metodología. Se realizó un estudio descriptivo de corte transversal, análisis retrospectivo de los aislamientos microbiológicos en adultos desde junio 2016 a diciembre 2019, basado en la data institucional. Se analizó la información con STATA15,0. Se obtuvo la aprobación del comité de ética del hospital. Resultados. Se incluyeron 5121 aislamientos microbiológicos, el 61% en el servicio de urgencias. El urocultivo fue la muestra más frecuente. Escherichia coli fue el germen más común tanto a nivel general como en urocultivos, hemocultivos y cultivos de líquido peritoneal. La resistencia a ampicilina y amp/sul fue elevada, hasta del 68% para E. coli. El 20% de los Staphylococcus aureus fueron resistentes a meticilina. Se observó una resistencia inusual a carbapenémicos por parte de Pseudomonas aeruginosa. Discusión. El perfil microbiológico concuerda con la literatura mundial y nacional, sin embargo, el HUSJ tiene un comportamiento microbiológico que debe ser estudiado a profundidad. Conclusión. Los porcentajes de resistencia a antibióticos de uso frecuente son elevados. Se requiere ajustes de las guías de manejo institucionales y nacionales.

Abstract Objetive. To describe the microbiological profile and resistance spectrum of the community acquired bacterial infection of the San Jose university hospital from june 2016 to december 2019 Methodology. A retrospective transverse descriptive study of microbial organisms found in adults in the institution from June 2016 to December 2019, the study is based in the hospital data. The analysis of the information was made with SATA 15.0. Results. 5121 samples were included, 61% from the emergency department. Urine culture was the most frequent sample taken. Escherichia coli was the most frequent isolated bacterial, in all samples, urine culture, blood culture, and peritoneal culture. Ampiciline r and ampiciline/sulbactam was high up to 68% of the E. Coli cultures. 20% of Staphylococcus aureus were methicillin resistant. Unusual carbapenemic resistance was found in the Pseudomona aeruginosa isolates.. Discussion. The data of the bacterial resistance spectrum Concord which was is found in the general medical literature, nevertheless the HUSJ, has a microbial behaviour that must be studied thoroughly. Conclusion. The antibiotic bacterial resistance to common used antibiotics is high. Adjustments are required in the instucional and national management guidelines

Resistencia inducible a clindamicina en Staphylococcus aureus resistentes a meticilina aislados de pacientes pediátricos en Paraguay / Inducible resistance to clindamycin in methicillin-resistant Staphylococcus aureus isolated from Paraguayan children

Resumen Introducción: El método de difusión de doble disco se presenta como una alternativa diagnóstica que permite identificar aislados de Staphylococcus aureus susceptibles a clindamicina, ante el aumento de resistencia a meticilina, reduciendo así la posibilidad de fallo en el tratamiento. Objetivo: Determinar la frecuencia de resistencia a clindamicina inducida por eritromicina en S. aureus resistentes a meticilina (SARM) aislados de niños paraguayos. Materiales y Métodos: Estudio observacional, descriptivo, de corte transversal. Se colectaron 145 aislados S. aureus que causaron infecciones de piel y tejidos blandos y osteo-articulares en pacientes pediátricos del Hospital Central del Instituto de Previsión Social en el período de diciembre-2012 a noviembre-2013. La resistencia a clindamicina se determinó por métodos automatizados y de difusión de doble disco. Se realizó reacción de polimerasa en cadena para genes ermA, ermB, ermC y msrA de aislados representativos. Resultados: La resistencia global a meticilina y clindamicina fue de 67 y 13%, respectivamente (11% atribuible al mecanismo de resistencia a clindamicina inducible). Los genes ermC y msrA fueron detectados individualmente en 25 y 17% de los aislados, respectivamente, mientras que un aislado presentó ambos genes en simultáneo. Discusión: La frecuencia de mecanismo de resistencia inducible a clindamicina señala la importancia de los métodos de difusión de doble disco en la práctica microbiológica, así como se encuentran en los límites de puntos de cortes considerados como aceptables para el uso de este antimicrobiano para infecciones cutáneas y osteo-articulares causadas por SARM.

Background: The double disc diffusion method is an alternative diagnostic that allows the identification of Staphylococcus aureus isolates apparently susceptible to clindamycin but that may develop resistance due to an induction phenomena, mainly asociated to the increase in resistance to methicillin, thus increasing the possibility of failure in the treatment. Aim: To determine the frequency of induced clindamycin resistance in methicillin-resistant S. aureus (MRSA) isolated from Paraguayan children. Materials and Methods: In this cross sectional study, we collected 145 S. aureus isolates that caused skin and soft tissue and osteoarticular infections in pediatric patients of the Central Hospital I.P.S. in the period from December-2012 to November-2013. Resistance to clindamycin was determined by automated methods and double disc diffusion. PCR was performed for ermA, ermB, ermC and msrA genes from representative isolates. Results: The global resistance to methicillin and clindamycin was 67 and 13%, respectively (11% attributable to the inducible mechanism). The ermC and msrA genes were detected individually in 25 and 17% of the isolates respectively while an isolate presented both genes simultaneously. Discussion: The frequency of inducible resistance to clindamycin indicates the importance of double disc diffusion methods in microbiological practice, as well as being within the cut off points considered acceptable for the use of this antibiotic for skin infections. and osteoarticular caused by MRSA.

Clinical characteristics and pathogen profile in 193 cases of community acquired bloodstream infection / 中国感染与化疗杂志

Objective To understand the clinical and pathogen characteristics of community acquired bloodstream infection(CABSI)for improving empirical antimicrobial therapy. Methods The clinical and laboratory findings of 193 CABSI cases in the Fifth Affiliated(Zhuhai)Hospital of Zunyi Medical College from 2013 to 2017 were retrospectively analyzed. Results Of the193 CABSI cases, 97.9％(189/193)had underlying diseases and/or risk factors. Primary site of infection was identified in 81.3％(157/193)of the patients. The top three primary site of infection was urinary tract(39.5％, 62/157), hepatobiliary system(22.9％, 36/157)and lower respiratory tract(20.4％, 32/157). The top pathogens included Escherichia coli(47.2％), Klebsiella pneumoniae(15.0％), coagulase-negative Staphylococcus(10.4％), and Streptococcus spp.(7.8％). All the E. coli and K. pneumoniae strains were susceptible to carbapenems. More than 90％ of the E. coli and K. pneumoniae strains were susceptible to piperacillin-tazobactam and amikacin. About 54.9％(50/91)of the E. coli and 27.6％(8/29)of the K. pneumoniae strains produced extended-spectrum β-lactamases(ESBLs). No vancomycin-resistant gram-positive bacteria were detected. The prevalence of MRCNS and MRSA was 35.0％ and 0, respectively. Conclusions Most CABSI cases had underlying diseases and/or risk factors. The common primary site of infection associated with secondary bloodstream infection is urinary tract, hepatobiliary system, and lower respirtaory tract. Enterobacteriaceae strains are the main pathogen of CABSI.

Healthcare-associated infection and community-acquired infection: Cross-sectional survey of 37 hospitals in Tangshan / 实用医学杂志

Objective To understand the status and the risk factors of healthcare-associated infection (HAI) and community-acquired infection (CAI) , and to provide guidance and basis for prevention and control of nosocomial infections. Methods We investigated and analyzed HAI and CAI of 37 hospitals by the cross-sectional survey method. Results 16 650 patients were investigated, the HAI occurred in 171 and 267 ases with the prevalence rate of 1.54％ and 5.24％ in the second-class and the third-class hospitals. The CAI occurred in 1 889 and 831 cases with the prevalence rate of 17.04％ and 16.31％. HAI prevalence rate in the third-class hospitals was higher than the second-class hospitals, while there was no difference in the rate of CAI. There was statistical significance in constituent of infection sites in different levels of hospitals. There was no difference in community infection. A total of 148 pathogens were isolated from patients with HAI, and the top four bacteria were Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumonia, Acinetobacter baumannii. The detection rate of multidrug-resistant bacteria were 26.32％ and 31.82％ respectively in the second-class and the third-class hospitals. The utilization rates of antimicrobial agents in the second-class and the third-class hospitals were 42.97％ and 31.82％ respectively. Pathogen detection rate in third-class hospitals was higher than that of the second-class hospitals (47.10％, 32.76％) , and the difference was statistically significant. The survey was found that the use of catheters, urinary tract catheters, ventilators and immunosuppressive agents were risk factors in hospital infection. Conclusion Hospitals should strengthen the monitoring of hospital infection and take various measures to control the rate of hospital infection.

Clostridium difficile contamination in retail meat products in Brazil

ABSTRACT Introduction Clostridium difficile is an important cause of diarrhoea, particularly in patients receiving antibiotic therapy. Recent studies have shown that a substantial proportion of C. difficile infections are acquired in the community, as a zoonotic disease. Brazil is a large exporter of meat and so far no study has evaluated meat contamination with C. difficile spores. Methods Here we analysed 80 retail meat products purchased from local supermarkets in a Brazilian metropolis (Porto Alegre, Southern Brazil). Samples from these products were grown in anaerobic conditions, and tested with a real time polymerase chain reaction test. Results Contamination with C. difficile spores was not found in the study. Bacteria isolated from meat included Streptococcus gallolyticus, Lactobacillus plantarum, Enterococcus gallinarum and Pediococcus acidilactici. Discussion Close vigilance is required in order to guarantee the quality of Brazilian retail meat in the long term.

Antimicrobial Susceptibilities of Enterobacteriaceae in Community-Acquired Urinary Tract Infections during a 5-year Period: A Single Hospital Study in Korea

BACKGROUND: Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients over the age of 19 years who visited a hospital in Seoul between January 2012 and December 2016 for a CA-UTI. Urine cultures were used to identify causative organisms. We investigated extended-spectrum β-lactamase (ESBL) production and the antimicrobial susceptibility of Enterobactereiaceae. We evaluated recommended empirical antibiotics numerically by calculating the syndrome-specific likelihood of inadequate therapy (LIT) for the last 2 years (interpretation of the LIT A value: 1 out of A people is likely to receive inadequate empirical antibiotics). RESULTS: Urine cultures were performed in 1,605 out of 2,208 patients who were diagnosed with CA-UTI, and causative pathogens were identified in 1,134 (70.7%) cases. There were 998 (88.0%) cases of Enterobacteriaceae and Escherichia coli was the most common pathogen, accounting for 80.3% of cases (911 cases). The overall resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolones, and cefotaxime were 31.7%, 23.2%, and 13.5%, respectively. There were 128 (10.8%) cases of ESBL-producing Entererobacteriaceae with an increasing but non-significant trend (P = 0.255). The LIT for CA-UTI in the past two years was highest for ertapenem and imipenem. Fluoroquinolones ranked 11th, with a LIT of 8.2, and cefotaxime ranked higher, at 10.5. In ESBL-producing Enterobacteriaceae, except for carbapenems, amikacin and piperacillin-tazobactam showed the highest susceptibility rates at 99.2% and 94.3%, respectively. CONCLUSION: Empiric treatment with fluoroquinolones in CA-UTI should be carefully considered, given the high resistance rate. The proportion of ESBL-producing Entererobacteriaceae in CA-UTI has increased to a high level in Korea. Amikacin and piperacillin-tazobactam could be considered for empiric treatment in patients at risk for ESBL-producing Entererobacteriaceae when considering alternatives to carbapenems.

Índices de oxigenación como predictores de ventilación mecánica en neumonía a 2600 metros de altitud / Oxygen indexes as predictors of mechanical ventilation in pneumonia at 2600 meters above sea level

Resumen Antecedentes: los valores de la diferencia alveolo arterial de oxígeno D(A-a)O2 y de la relación presión alveolar de oxígeno y fracción inspirada de oxígeno (PaO2/FiO2), son pobremente conocidos a gran altitud para predecir ventilación mecánica (VM) en pacientes con neumonía adquirida en comunidad (NAC) mayores de 65 años. Objetivo: conocer los valores de D(A-a)O2 y PaO2/FiO2 en pacientes con NAC que requirieron soporte ventilatorio. Métodos: estudio de cohorte prospectivo donde se obtuvo la D(A-a)O2 y PaO2/FiO2 de los gases arteriales de ingreso a urgencias, con cálculo de sensibilidad (S), especificidad (E), valor predictivo positivo (VPP), valor predictivo negativo VPN) y área bajo la curva ROC para el requerimiento de VM en las primeras 72 horas. Resultados: se siguieron 247 pacientes, 37 (15%) requirieron VM, no se encontraron diferencias en edad, género, y comorbilidades entre los grupos de VM y no VM. El área bajo la curva ROC para D(A-a) O2 como predictor de VM fue de 0.84 (IC95%:0.77-0.92), para la PaO2/FiO2 de 0.85 (IC 5%: 0.78-0.92) (p<0.0001). Para una D(A-a)O2 en 55 se obtuvo una sensibilidad para predecir VM en 70.27%, especificidad 86.19%, VPP: 47%, VPN: 94%, razón de verosimilitud positiva (LR+): 5.1, razón de verosimilitud negativa (LR-): 0.3. Una PaO2/FiO2 de 180 tiene una sensibilidad para predecir VM de: 86.65%, especificidad: 70.27%, VPP: 34%, VPN: 97%, LR+: 2.9, LR-: 0.2. La mortalidad global fue 3.2%. Conclusión: los valores de D(A-a)O2 y PaO2/FiO2 se relacionan con el requerimiento de VM en pacientes mayores de 65 años con NAC. (Acta Med Colomb 2016; 41: 169-175).

Abstract Background: the values of the difference of alveolar arterial oxygen D(A-a)O2 and ratio of the alveolar oxygen pressure and fraction of inspired oxygen (PaO2/FiO2) are poorly known at high altitude to predict mechanical ventilation (MV) in patients over 65 years with community-acquired pneumonia (CAP). Objective: to know the values of D(A-a)O2 and PaO2/FiO2 in CAP patients requiring ventilatory support. Methods: prospective cohort study where D(A-a)O2 y PaO2/FiO2 were obtained from arterial blood gases at entrance to the emergency room, with calculation of sensitivity (S), specificity (E), positive predictive value (PPV), negative predictive value (NPP) and area under the ROC curve for MV requirement within the first 72 hours. Results: 247 patients were followed; 37 (15%) required MV. No differences were found in age, gender and comorbidities between the groups of MV and no MV. The area under the ROC curve for D(A-a) O2 as a predictor of MV was 0.84 (95% CI: 0.77 to 0.92), for the la PaO2/FiO2 of 0.85 (95% CI: 0.78 to 0.92) (p <0.0001). For a D(A-a)O2 in 55 patients was obtained a sensibility to predict MV in 70.27%, specificity 86.19%, PPV 47%, NPV 94%, positive likelihood ratio (LR +): 5.1, negative likelihood ratio (LR -): 0.3. A PaO2/FiO2 of 180 has a sensitivity to predict MV of 86.65%, specificity: 70.27%, PPV 34%, NPV 97%, LR +: 2.9, LR: 0.2. Overall mortality was 3.2%. Conclusion: the values of D(A-a)O2 and PaO2/FiO2 relate to the requirement of MV in patients older than 65 with CAP. (Acta Med Colomb 2016; 41: 169-175).

Increase of Clostridium difficile in Community; Another Worrisome Burden for Public Health / 대한임상미생물학회지

BACKGROUND: Increasing rates of Clostridium difficile infection (CDI) have been reported mainly in Europe and North America; however, only limited reports have originated in Korea. The current epidemiology of CDI in the community could help to understand the outpatient healthcare environment and to extend infection control measures to outpatient settings. METHODS: C. difficile isolates in NHIS Ilsan Hospital from 2012 to 2014 were included in this study. Clinical characteristics, acquisition types, and previous antimicrobial therapy were obtained via Electronic Medical Records. C. difficile culture was performed only in unformed stool. Toxin was positive by enzyme-linked fluorescent immunoassay (ELFA) in 247 specimens. In addition, toxin B and binary toxin gene were detected by PCR in 57 specimens. CDI was defined by toxigenic C. difficile isolation in unformed stool. RESULTS: In the previous 3 years, 251 unduplicated C. difficile cases have been detected; 168 healthcare facility- associated hospital onset (HCFA-HO), 45 healthcare facility-associated community onset (HCFA-CO), and 38 community-associated (CA). Toxin positive rates by ELFA for toxin A&B were HCFA-HO 50.6% (84/166), HCFA-CO 41.9% (18/43), and CA 42.1% (16/38). Toxin positive rate by PCR for tcdB were HCFA-HO 62.9% (22/35), HCFA-CO 69.2% (9/13), and CA 100% (9/9). No binary toxin (cdtA/cdtB) was detected in 57 cases. CONCLUSION: Community-associated CDI may be underestimated in Goyang province, Korea, especially by commonly used ELFA toxin assay. The spread of community-associated CDI should be recognized as an increasing burden of public health.

Meta-analysis on epidemiology of iatrogenic-borne methicillin-resistant Staphylococcus aureus / 中华流行病学杂志

Objective To study the molecular-biologic characteristics and epidemiological status of iatrogenic related Community-acquired methicillin-resistant Staphylococcus (S.) aureus (CA-MRSA) in China through Meta-analysis.Methods Data through systematic searching for peer-reviewed articles published before December 3rd,2015 from 4 main electronic databases including China National Knowledge Infrastructure (CNKI),Wanfang Data,PubMed and Web of Science Core Collection was collected,for this Meta-analysis.PRISMA guidelines were followed and the proportion of MRSA,CA-MRSA,hospital-acquired MRSA (HA-MRSA) and panton-valentine leucocidin (PVL) gene in certain populations were quantitatively analyzed by Stata 13.0 software.Results Average proportion of CA-MRSA from S.aureus was 12％ (95％CI:8％-16％).CA-MRSA in MRSA was 18％ (95％CI:12％-24％).42.1％ (95％CI:20.4％-63.7％) of the CA-MRSA carried a PVL gene,and the number was higher than general MRSA (t =-2.99,P=0.011).Conclusion CA-MRSA was in lower proportion than HA-MRSA,both seen in general MRSA and in S.aureu.s,but under higher proportion of carrying the PVL gene.Transmission of CA-MRSA could be prevented within the general population through conducting effective surveillances and preventive programs.

Meta-analysis on epidemiology of iatrogenic-borne methicillin-resistant Staphylococcus aureus / 中华流行病学杂志

Objective To study the molecular-biologic characteristics and epidemiological status of iatrogenic related Community-acquired methicillin-resistant Staphylococcus (S.) aureus (CA-MRSA) in China through Meta-analysis.Methods Data through systematic searching for peer-reviewed articles published before December 3rd,2015 from 4 main electronic databases including China National Knowledge Infrastructure (CNKI),Wanfang Data,PubMed and Web of Science Core Collection was collected,for this Meta-analysis.PRISMA guidelines were followed and the proportion of MRSA,CA-MRSA,hospital-acquired MRSA (HA-MRSA) and panton-valentine leucocidin (PVL) gene in certain populations were quantitatively analyzed by Stata 13.0 software.Results Average proportion of CA-MRSA from S.aureus was 12％ (95％CI:8％-16％).CA-MRSA in MRSA was 18％ (95％CI:12％-24％).42.1％ (95％CI:20.4％-63.7％) of the CA-MRSA carried a PVL gene,and the number was higher than general MRSA (t =-2.99,P=0.011).Conclusion CA-MRSA was in lower proportion than HA-MRSA,both seen in general MRSA and in S.aureu.s,but under higher proportion of carrying the PVL gene.Transmission of CA-MRSA could be prevented within the general population through conducting effective surveillances and preventive programs.

Neumonía adquirida en la comunidad por pseudomonas aeruginosa asociada a tuberculosis pulmonar: descripción de un caso / Community-acquired pneumonia due to pseudomonas aeruginosa associated to lung tuberculosis: a case report

La Pseudomonas aeruginosa es causa poco frecuente de neumonía adquirida en la comunidad, generalmente está relacionada con factores de riesgo y es aún menos usual que coexista asociada a tuberculosis pulmonar. Se describe el caso de una mujer de 19 años con neumonía por estas dos entidades, con cuadro clínico de tos, expectoración verde, disnea en reposo, fiebre, dolor hemitórax izquierdo, radiografía con opacidad alveolar de todo el pulmón izquierdo y neumonía segmentaria multilobar derecha. Se realizó el diagnóstico por lavado broncoalveolar, con cultivo y recuento de colonias 105 de Pseudomonas a. y baciloscopía directa y cultivo para Micobacterium tuberculosis positivo.Con respuesta favorable al tratamiento.

The Pseudomonas aeruginosa is not very frequent cause of community-acquired pneumonia, they are generally related with factors of risk and it is even less usual that coexists associated to lung tuberculosis. We report a 19 year-old woman with pneumonia by these two entities, with clinical symptoms of cough, green expectoration, dyspnea at rest, fever, left chest pain, chest radiographs revealed alveolar opacity of the whole left lung and right multilobar pneumonia, diagnosis was performed by bronchoalveolar lavage, with cultivation and colony count 105 of Pseudomonas a. and staining samples for an acid-fast bacillus and cultivate for Mycobacterium tuberculosis was positive. With favorable response to the treatment.

Neumonía adquirida en comunidad: Adherencia a las guías terapéuticas, importante eslabón en el desenlace clínico del paciente / Community acquired pneumonia: Compliance to guidelines, important link in the patient outcome

La Neumonía Adquirida en la Comunidad (NAC) es una infección respiratoria frecuente a nivel mundial, presentándose principalmente en edades extremas de la vida. Es causada por una gran variedad de microorganismos, entre los más frecuentes están el Streptococcus pneumoniae, Haemophilus influenzae y Mycoplasma pneumoniae. Esta patología presenta un cuadro clínico amplio que va desde asintomático hasta muy sintomático, dificultando en algunas circunstancias su diagnóstico. Existen diferentes escalas que clasifican a los pacientes según la severidad como el CURB-65 y SMART-COP; con base en esta clasificación se tienen indicaciones pre-establecidas a seguir con cada paciente. En muchas ocasiones el desenlace clínico del paciente puede verse ligado al cumplimiento del médico con lo estipulado en las guías clínicas pre-establecidas, ya que las directrices que allí se contienen están basadas en la mejor evidencia científica y la adherencia a estas en la mayoría de ocasiones favorece un buen pronóstico y desenlace clínico del paciente.

The community acquired pneumonia (CAP) is a common worldwide respiratory infection, occurring mainly in extreme ages of life. It is caused by a variety of microorganisms, in which the most common are Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae. This disease presents a wide clinical manifestation from asymptomatic until very symptomatic, difficulting in some circumstances its diagnosis. There are differents scales as the CURB-65 and SMART-COP which classify patients according to severity; based on this classification there are preset indications to follow with each patient. In many cases the patient outcome may be linked to medical compliance with the pre established in clinical guidelines, because the recommendations in guidelines are based on the best scientific evidence and compliance to these in most cases favors a good prognosis and patient outcome.

Microbiologic profile of hospitalized healthcare workers / Perfil microbiológico de profissionais de saúde com internação hospitalar

Objective: according to the epidemiologic and antimicrobial resistance profile, infections are usually classified as community-acquired or nosocomial. Reports on patients without the classic criteria for nosocomial infection with multidrug-resistant germs are increasing. There is a particular concern regarding which microbiological profile must be addressed in case of infections in healthcare workers. This study was carried out with the purpose of identifying the prevalence of infection by multidrug-resistant germs in healthcare workers exposed to occupational contact with such germs at work. Methods: observational and retrospective study. In a 7-year period, healthcare worker hospitalizations were identified and the cultures results were assessed in order to identify the prevalence of infection by multidrug-resistant pathogens. Results: 1,487 healthcare workers hospitalizations were identified. In 105 of these hospitalizations, cultures were collected on the first 5 days after admission, and in 22 patients, 24 germs were identified. Multidrug-resistant pathogens were not found. Conclusion: in our sample, composed of workers from a tertiary public hospital who were hospitalized, none of the individuals presented MDR colonization or infection. These results suggest that when healthcare workers present infections, they must receive antibiotic therapy directed to community-acquired pathogens. In light of the limitations of this study, further larger and multicenter studies must be developed to enlighten such issue. .

Objetivo: conforme perfil epidemiológico e resistência antimicrobiana, as infecções costumam ser divididas entre comunitárias e nosocomiais. É crescente o relato de pacientes sem critérios clássicos para infecções nosocomiais com infecções por germes multirresistentes (GMR). Há particular preocupação perante qual perfil microbiológico deve ser coberto na presença de infecções em profissionais de saúde. Realizamos este trabalho com intuito de identificar a prevalência de infecção por GMR em profissionais de saúde expostos a contato laboral com tais germes. Métodos: estudo observacional, retrospectivo. Em um período de 7 anos, foram identificadas internações hospitalares de profissionais de saúde e aferidos resultados de culturas visando a identificar prevalência de infecção por GMR. Resultados: identificamos 1.487 internações de profissionais de saúde. Em 105 internações, foram solicitadas culturas nos primeiros 5 dias de internação. Em 22 internações, foram identificados 24 germes. Não houve isolamento de GMR. Conclusão: na amostra, composta por funcionários de um hospital público de nível terciário que apresentaram internação hospitalar, nenhum funcionário apresentou colonização ou infecção por GMR. O resultado sugere que trabalhadores da área de saúde, ao apresentar infecções, devem receber antibioticoterapia voltada para patógenos comunitários. Tendo em vista as limitações deste estudo, são necessários estudos maiores e multicêntricos para elucidar essa questão. .

Actualización en bacteriemia por Staphylococcus Aureus / Update on Staphylococcus aureus bacteremia / Atualização em bacteriémia por Staphylococcus aureus

El Staphylococcus aureus es un patógeno bacteriano de distribución mundial y es el principal responsable de las bacteriemias en numerosas áreas geográficas. Las tasas de resistencia a antibióticos han aumentado exponencialmente y diversos estudios han demostrado que las cepas resistentes ya no se limitan al ámbito hospitalario, con un aumento significativo de las infecciones adquiridas en la comunidad por bacterias meticilino-resistentes. La epidemiología de la infección es cambiante, lo que ha dificultado el enfoque inicial de los pacientes con bacteriemia por S. aureus, sumado a la cantidad de antibióticos relativamente limitada para su tratamiento. A pesar de los avances médicos y científicos, la mortalidad atribuible a esta infección ha permanecido estable durante los últimos años, por lo que se ha convertido en un problema para los sistemas de salud con un aumento considerable en los costos de atención. Es necesario realizar una actualización en este tópico para facilitar un tratamiento clínico adecuado de las bacteriemias por S. aureus.

Staphylococcus aureus is a bacterial pathogen that is distributed worldwide and is the main cause of bacteremia in numerous geographical regions. The rates of resistance to antibiotics have increased exponentially and various studies have demonstrated that the resistant strains are no longer limited to the hospital environment, as there has been a significant increase in community-acquired methicillin-resistant bacteria. The epidemiology of this infection is changing, which has made the initial management of patients with S. aureus bacteremia more complicated, as well as the relatively limited amount of antibiotics for treatment. Despite medical and scientific progress, mortality attributed to this infection has remained the same over the past years. Thus, it is becoming a problem for health systems that implies increased healthcare costs. It is necessary to update this topic in order to offer adequate clinical treatment for S. aureus bacteremia.

O Staphylococcus aureus é um patógeno bacteriano de distribuição mundial e é o principal responsável das bacteriémias em numerosas áreas geográficas. As taxas de resistência a antibióticos aumentaram exponencialmente e diversos estudos demostraram que as cepas resistentes já não se limitam ao âmbito hospitalário, com um aumento significativo das infecções adquiridas na comunidade por bactérias meticilino-resistentes. A epidemiologia da infecção é cambiante, o que há dificultado o enfoque inicial dos pacientes com bacteriémia por S. aureus, somado à quantidade de antibióticos relativamente limitada para seu tratamento. A pesar dos avanços médicos e científicos, a mortalidade atribuível a esta infecção há permanecido estável durante os últimos anos, pelo que se há convertido num problema para os sistemas de saúde com um aumento considerável nos custos de atenção. É necessário realizar uma atualização neste tópico para facilitar um tratamento clínico adequado das bacteriémias por S. aureus.

Prevalence rate of healthcare-associated infection in a hospital in 2014 / 中国感染控制杂志

Objective To investigate the basic status of healthcare-associated infection(HAI)in a hospital,and provide evidence for strengthening HAI management.Methods A cross-sectional study was conducted to investi-gate the prevalence rates of HAI in all hospitalized patients at 0 ∶00 -24∶00 of May 7,2014.Results A total of 2 262 patients were supposed to be investigated,while 2 253 (99.60%)patients were actually investigated,586 of whom (26.01%)came from pulmonary hospital(specialized in tuberculosis)affiliated to the general hospital.53 patients devel-oped 58 times of HAI,prevalence rate and case prevalence rate was 2.35% and 2.57% respectively;1 073 patients devel-oped 1 265 times of community-acquired infection (CAI),prevalence rate and case prevalence rate was 47.63% and 56.15% respectively.Rates of HAI and CAI were high in intensive care unit(ICU,21.28%)and pulmonary hospital (99.49%)respectively;the main infection site was lower respiratory tract,which accounting for 46.55%(n =27)and 69.72%(n=882)respectively.The major pathogens causing HAI were gram-negative bacteria(n = 19),and the major pathogens causing CAI were Mycobacteria(n=141)and fungi (n=89).The rate of antimicrobial usage and etiological ex-amination was 34.80%(n=784 )and 81.48%(n=550 )respectively.Conclusion In order to prevent cross infection of tuberculosis and reduce the incidence of HAI,lower respiratory tract and ICU should be one of the key infection sites and departments of HAI surveillance,treatment and management of patients with tuberculosis should be stand-ardized,professional precaution of health care workers should be enhanced.

Methicillin-resistant and methicillin-susceptible community-acquired Staphylococcus aureus infection among children

Methicillin-resistant Staphylococcus aureus has emerged as a pathogen associated with community-acquired infections worldwide. We report the spectrum of community-acquired S. aureus infections and compare the patients infected with methicillin-susceptible or methicillin-resistant strains among patients aged <20 years. Overall, 90 cases of community acquired S. aureus were detected in an 11-year period. Clinical and microbiological data were registered. Fifty-nine (66%) patients were male and the median age was two years. The majority (87%) of the patients were hospitalized and chronic underlying illnesses were detected in 27 (30%) cases. Overall, 34 (37.8%) patients had skin/soft tissue infections and 56 (62.2%) patients had deep-seated infection. Four (5.1%) patients were transferred to the intensive care unit and two (2.6%) died. Complications were detected in 17 (18.9%) cases, such as pleural effusion (41.2%), osteomyelitis (23.5%), and sepsis (17.6%). Six (6.7%) methicillin-resistant strains were detected. Patients infected with methicillin-susceptible or methicillin-resistant strains had similar baseline characteristics and treatment outcomes. Approximately 93% of the cases received systemic antibiotics, out of which 59 (65.5%) used oxacillin or cefalotin. Both methicillin-susceptible and methicillin-resistant S. aureus strains resulted in morbidity and death among children in this setting where methicillin-resistant strains are infrequent.

The Prognostic Value of Alveolar-arterial Oxygen Gradient for Community-Acquired Pneumonia in the ED

PURPOSE: The purpose of this study was to investigate the value of the alveolar-arterial (A-a) oxygen gradient for patients with community-acquired pneumonia (CAP) in the emergency department (ED). METHODS: A prospective study of patients with CAP in the ED was performed. Patients with clinical and a radiographic diagnosis of CAP were enrolled. Inflammatory biomarkers, such as WBC (white blood cell) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and A-a oxygen gradient were measured. The severity of CAP was assessed by three prediction rules: The Pneumonia Severity Index (PSI), CURB65 (confusion, blood urea nitrogen, respiratory rate, blood pressure and age> or =65 yrs), and the Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) rules. The value of each biomarker (WBC, CRP, ESR) and A-a oxygen gradient for the prediction of mortality and CAP severity were assessed. RESULTS: A total of 126 patients with CAP were included. Sixteen patients, older and in the high-risk group, died within 30 days. Non-survivors had a significantly increased A-a oxygen gradient compared to survivors (91.20 vs. 46.71 mmHg, respectively; p<.01) and a high-sensitivity to C-reactive protein (158.57 vs. 91.28 mg/dL, respectively; p<.01). The median A-a oxygen gradient was significantly higher with severe disease based on the three prediction rules. In regression logistic analyses, the area under the receiver operating characteristic curve of the alveolar-arterial oxygen gradient was 0.807(95% confidence interval, 0.727-0.872). The addition of A-a oxygen gradient to the three prediction rules significantly increased the area under the receiver operating characteristic curve. CONCLUSION: These results suggest that A-a oxygen gradient is useful for the prediction of mortality and disease severity among CAP patients in the ED. The A-a oxygen gradient, as an adjunct to CAP prediction rules, may be worth while for the assessment of prognosis and severity.