Burkholderia Sepsis in Children as a Hospital-Acquired Infection

PURPOSE: Hospital-acquired Burkholderia cepacia (B. cepacia) infection are not commonly recorded in patients without underlying lung disease, such as cystic fibrosis and chronic granulomatous disease. However, in 2014, B. cepacia appeared more frequently in pediatric blood samples than in any other year. In order to access this situation, we analyzed the clinical characteristics of B. cepacia infections in pediatric patients at our hospital. MATERIALS AND METHODS: We conducted a retrospective study of blood isolates of B. cepacia taken at our hospital between January 2004 and December 2014. Patient clinical data were obtained by retrospective review of electronic medical records. We constructed a dendrogram for B. cepacia isolates from two children and five adult patients. RESULTS: A total of 14 pediatric patients and 69 adult patients were identified as having B. cepacia bacteremia. In 2014, higher rates of B. cepacia bacteremia were observed in children. Most of them required Intensive Care Unit (ICU) care (12/14). In eleven children, sputum cultures were examined, and five of these children had the same strain of B. cepacia that grew out from their blood samples. Antibiotics were administered based on antibiotic sensitivity results. Four children expired despite treatment. Compared to children, there were no demonstrative differences in adults, except for history of ICU care. CONCLUSION: Although there were not many pediatric cases at our hospital, awareness of colonization through hospital-acquired infection and effective therapy for infection of B. cepacia is needed, as it can cause mortality and morbidity.

Diagnostic methods in sepsis: the need of speed

OBJECTIVE: Sepsis is a common condition encountered in hospital environments. There is no effective treatment for sepsis, and it remains an important cause of death at intensive care units. This study aimed to discuss some methods that are available in clinics, and tests that have been recently developed for the diagnosis of sepsis. METHODS: A systematic review was performed through the analysis of the following descriptors: sepsis, diagnostic methods, biological markers, and cytokines. RESULTS: The deleterious effects of sepsis are caused by an imbalance between the invasiveness of the pathogen and the ability of the host to mount an effective immune response. Consequently, the host's immune surveillance fails to eliminate the pathogen, allowing it to spread. Moreover, there is a pro-inflammatory mediator release, inappropriate activation of the coagulation and complement cascades, leading to dysfunction of multiple organs and systems. The difficulty achieve total recovery of the patient is explainable. There is an increased incidence of sepsis worldwide due to factors such as aging population, larger number of surgeries, and number of microorganisms resistant to existing antibiotics. CONCLUSION: The search for new diagnostic markers associated with increased risk of sepsis development and molecules that can be correlated to certain steps of sepsis is becoming necessary. This would allow for earlier diagnosis, facilitate patient prognosis characterization, and prediction of possible evolution of each case. All other markers are regrettably constrained to research units.

A Hospital-Based Serological Survey of Cryptosporidiosis in the Republic of Korea

The seroprevalence of cryptosporidiosis was examined using patients' sera collected from hospitals located in 4 different areas of the Republic of Korea. ELISA was used to measure antibody titers against Cryptosporidium parvum antigens from a total of 2,394 serum samples, which were collected randomly from patients in local hospitals; 1) Chungbuk National University Hospital, 2) Konkuk University Hospital, 3) local hospitals in Chuncheon, Gangwon-do (province), 4) Jeonnam National University Hospital, from 2002 through 2003. Of the 2,394 samples assayed, 34%, 26%, and 56% were positive for C. parvum-specific IgG, IgM, and IgA antibodies, respectively. Positive IgG titers were most common in sera from Jeonnam National University Hospital, Gwangju, Jeollanam-do, and positive IgM titers were most common in sera from Chungbuk National University Hospital, Cheongju, Chuncheongbuk-do. The seropositivity was positively correlated with age for both the IgG and IgA antibodies but was negatively correlated with age for the IgM antibodies. Western blotting revealed that 92%, 83%, and 77% of sera positive for IgG, IgM, and IgA ELISA reacted with 27-kDa antigens, respectively. These results suggested that infection with Cryptosporidium in hospital patients occurs more commonly than previously reported in the Republic of Korea.

A Hospital-Based Serological Survey of Cryptosporidiosis in the Republic of Korea

The seroprevalence of cryptosporidiosis was examined using patients' sera collected from hospitals located in 4 different areas of the Republic of Korea. ELISA was used to measure antibody titers against Cryptosporidium parvum antigens from a total of 2,394 serum samples, which were collected randomly from patients in local hospitals; 1) Chungbuk National University Hospital, 2) Konkuk University Hospital, 3) local hospitals in Chuncheon, Gangwon-do (province), 4) Jeonnam National University Hospital, from 2002 through 2003. Of the 2,394 samples assayed, 34%, 26%, and 56% were positive for C. parvum-specific IgG, IgM, and IgA antibodies, respectively. Positive IgG titers were most common in sera from Jeonnam National University Hospital, Gwangju, Jeollanam-do, and positive IgM titers were most common in sera from Chungbuk National University Hospital, Cheongju, Chuncheongbuk-do. The seropositivity was positively correlated with age for both the IgG and IgA antibodies but was negatively correlated with age for the IgM antibodies. Western blotting revealed that 92%, 83%, and 77% of sera positive for IgG, IgM, and IgA ELISA reacted with 27-kDa antigens, respectively. These results suggested that infection with Cryptosporidium in hospital patients occurs more commonly than previously reported in the Republic of Korea.

Parámetros clínicos y de laboratorio asociados a sepsis neonatal nosocomial / Clinical and laboratory parameters in neonatal nosocomial sepsis

Objetivo: Evaluar la utilidad de signos, síntomas y parámetros laboratoriales para predecir sepsis neonatal nosocomial. Métodos: De marzo de 2002 a junio de 2003 se identificaron 343 recién nacidos con sospecha de sepsis neonatal nosocomial, de los cuales 60 reunieron los criterios de inclusión. Se tomaron dos hemocultivos, biometría hemática, proteína C reactiva (PCR) seriada y un frotis de leucocitos teñidos con naranja de acridina o buffy coat. Los signos clínicos y laboratoriales fueron comparados en neonatos con y sin hemocultivo positivo, mediante χ2. Se calculó sensibilidad, especificidad, valores de predicción y razón de momios. Resultados: En 35/60 (58.3%) recién nacidos se aislaron bacterias patógenas. No se identificaron signos o síntomas asociados a sepsis neonatal nosocomial. Plaquetopenia (χ2=4.8 d.f. 1,p=0.03, RM=3.2, IC 95%=1.1-9.6); PCR positiva inicial (χ2=9.1 d.f. 1, p=0.003, RM=15.1, IC 95%=1.7-130.6) y buffy coat positivo (χ2=6.7 d.f.1,p=0.009, RM=11, IC 95%=1.3-91.9) se asociaron significativamente a sepsis neonatal nosocomial. Staphylococcus epidermidis y Serratia marcescens fueron las bacterias más aisladas. Conclusiones: Nuestros resultados fueron consistentes con otros informes, los signos y síntomas clínicos no son de utilidad para predecir sepsis neonatal nosocomial, mientras que la plaquetopenia, PCR y buffy coat positivos resultaron buenos predictores de esta patología.

OBJECTIVE: Assess if certain clinical and laboratorial data are associated with Neonatal Nosocomial Sepsis (NNS). METHODS: From March to June 2003, 343 premature neonates (PN) with clinical data suggestive of NNS were recruited; 60 fulfilled the inclusion criteria and were studied. Laboratory tests included two blood cultures from different peripheral veins, complete blood count (CBC), serial C reactive protein (CRP), and buffy coat (BC) smear stained with acridine orange. Clinical data and laboratory test results were compared among neonates with and without pathogenic bacteria isolated in the blood culture. Statistical analysis included chi-square tests (chi2), odds ratios (OR), sensitivity, specificity and predictive values. RESULTS: In 35/60 (58.3%) PN, a pathogenic bacteria was isolated in blood cultures. We did not identify signs and symptoms significantly associated with SNN. Thrombocytopenia (chi2 4.8 d.f. 1; p = 0.03; OR: 3.2, C.I. 95% 1.1-9.6); positive CRP (chi2 9.1 d.f. 1; p = 0.003; OR: 15.1 C.I. 95%. 1.7-130.6), and positive buffy coat smear (chi2 6.7 d.f. 1; p = 0.009; OR: 11 C.I. 95% 1.3-91.9) were associated with NNS. Staphylococcus epidermidis and Serratia marcescens were the most frequent isolated bacteria. CONCLUSIONS: The present study did not identify signs and symptoms associated with NNS. Nevertheless, thrombocytopenia, positive CRP and positive buffy coat smear were considered adequate predictive factors.

Genotipificación de Acinetobacter baumannii multi-resistente aislado en el hospital Dr. Domingo Luciani de caracas / Genotypification of multiresistant Acinetobacter baumannii isolated in the Dr. Domingo Luciani Hospital of caracas

Las técnicas de genotipificación tienen un rol fundamental en el estudio de las infecciones nosocomiales. Las infecciones nosocomiales son producidas principalmente por microorganismos que son resistentes a los antimicrobianos, que por lo general han sido seleccionados por el uso inadecuado de la terapia antimicrobiana. Entre las especies que causan frecuentemente este tipo de infecciones se encuentra A. baumannii multi-resistente. En esta investigación se planteó genotipificar mediante las técnicas ERIC-PCR y REP-PCR 19 cepas de A. baumannii multi-resistente aisladas en el hospital Dr. Domingo Luciani de Caracas. La confirmación molecular de la especie A. baumannii se realizó mediante la detección de la oxacilinasa OXA 51 por PCR, el 100% de los aislados incluidos en el estudio resultaron positivos para la detección del gen blaOXA-51-Like. La susceptibilidad antimicrobiana y la detección fenotípica de mecanismos de resistencia se efectuaron de acuerdo a las normas de la CLSI 2009. Se determinó policlonalidad en los 19 aislados de A. baumannii, con el predominio de cuatro clones en la Unidad de Terapia Intensiva de Adultos y el área de Hospitalización del Hospital Dr. Domingo Luciani de Caracas. La correlación de los datos epidemiológicos con las características de la resistencia y la información molecular de cada una de las muestras permitió identificar dos patrones de infección: infecciones de origen endógeno, las cuales se caracterizaron por la diversidad genética de los aislamientos, e infecciones cruzadas, debido al hallazgo de cepas estrechamente relacionadas en espacios cercano o distantes del centro de salud. Se demostró que ERIC-PCR y REP-PCR bajo las condiciones estandarizadas en este estudio son técnicas confiables desde el punto de vista de la estabilidad de los marcadores moleculares y la reproducibilidad para caracterizar brotes ocasionados por A. baumannii, considerándose la técnica REP-PCR más adecuada para estudios de genotipificación...

The genotypification techniques have a fundamental role in the study of nosocomial infections. These infections are produced principally by microorganisms that are antimicrobial resistant, that have benn selected by the inadequate use of antimicrobial therapy. Between the species that frequently cause these type of infections is the A baumannii multi-resistant. In this investigation we established to genotypificate by ERIC-PCR y REP-PCR techniques 19 strains of A baumannii multi-resitant isolated in the Dr. Domingo Luciani Hospital of Caracas. The molecular confirmation of the species was realized by the detection of the oxacilianse OXA 51 by PCR. 100% of the isolates included in the study resulted positive for the gen bla OXA-51-Like. The antimocrobial susceptibility and the phenotypic detection of resistance mechanism were done according the CLSI 2009 normative. We determined policlonality on the 19 isolates of A. baumannii, with the predominance of 4 clones in the Intensive Therapy unit and the hospitalization area of the hospital. The correlation of the epidemiological data with the resistance characteristics and the molecular information of each sample allowed us to identificate two patterns of infections: endogen origin infection, which was charaterized by the genetic diversity of the isolates and cross infections, due to the finding of strains closely related in spaces near o distant ffrom the health center. We demostrated that ERIC-PCR and REP-PCR under standarized conditions in this study are good techiques fron the point of view of the stability of the molecular markers and the reproducibility to characterize outbreaks occasioned by A. baumannii, consideratin the REP-PCR technique, the most adequate for genotypification of this strain.

Acinetobacter baumannii infection in the neonatal intensive care unit

To perform a prospective case control study of blood stream infection to determine the infection rate of Acinetobacter baumannii and the risk factors associated with mortality. From February 2004 to January 2005, 579 consecutive episodes of blood stream infection were obtained at two neonatal intensive care units Al Nasser and Al Shifa hospitals in Gaza City. Forty [6.9%] isolates of A. baumannii were obtained from the neonates under 28 d. Most of the isolates [92%] were from hospitalized patients in the intensive care units. Community acquired infection was 8%. Sixty three percent of the patients were males. The isolates of A. baumannii were resistant to commonly used antibiotics while being sensitive to meropenem [92.5%], imipenem [90%], chloramphenicol [80%], ciprofloxacin [75%], gentamicin [57.5%], ceftriaxone [50%], amikacin [37.5%], cefuroxime and cefotaxime [35%]. Over all crude mortality rate was 20% with much higher crude mortality among patients with nosocomial infection. Based on logistic regression, the following factors were statistically significant: weight < 1500g, age < 7 d, mean of hospitalization equal 20 days, antibiotic use, and mechanical ventilation, when compared to the control group [P< 0.05]. Infection rate of nosocomial blood stream infection was considerable and alarming in neonatal intensive care unit infants and associated with a significant excess length of NICU stay and a significant economic burden

Analysis of Methicillin Resistance among Staphylococcus aureus Blood Isolates in an Emergency Department

The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has become of great concern in both hospital and community settings. To evaluate the prevalence and risk factors for methicillin resistance among Staphylococcus aureus, blood isolates in our Emergency Department (ED) were collected. All patients with S. aureus bacteremia (SAB) who presented to the ED from January 2000 to August 2005 were included, and a retrospective study was performed. A total of 231 patients with SAB were enrolled (median age, 59 yr; M:F, 125:106). Among these patients, methicillin-resistant strains accounted for 27.3% (63 patients). Catheter-related infection was the most frequent primary site of SAB (39.0%), followed by skin and soft tissue infection (16.5%). In multivariate analysis, recent surgery (OR, 3.41; 95% CI, 1.48-7.85), recent hospitalization (2.17; 1.06-4.62), and older age (> or =61 yr) (2.39; 1.25-4.57) were independently associated with the acquisition of methicillin-resistant strains. When antimicrobial therapy is considered for the treatment of a patient with suspected SAB, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage for patients with risk factors: older age, recent hospitalization, and recent surgery.

Epidemiology of coagulase-negative Staphylococci isolated from clinical blood specimens at the University Hospital of the West Indies / Epidemiología de los Estafilococos Coagulasa Negativos Aislados de Especímenes Clínicos de Sangre en el Hospital Universitario de West Indies

The prevalence and significance of coagulase negative staphylococci (CoNS) isolated from blood cultures at the University Hospital of the West Indies (UHWI) during a six-month period were investigated. Standard and automated microbiological procedures were used to process 3001 blood culture specimens received from 2363 patients and 658 (21.9) of the blood cultures yielded 854 bacterial isolates. The highest prevalence of positive blood cultures (60) and the lowest prevalence of blood isolates of CoNS (12) were found in the intensive care unit (ICU). The blood isolates of CoNS were most frequent in the surgical wards (13) and lowest in obstetrics and gynaecology (2). High rates of resistance to methicillin, other anti-staphylococcal penicillins, and cephalosporins used in the treatment of CoNS were observed All blood isolates of CoNS (100) were susceptible to vancomycin. In conclusion, the results show that coagulase-negative staphylococci are the most prevalent bacterial isolates in blood cultures at the UHWI occurring mostly as contaminants. The practice of proper venepuncture and hand-washing techniques by medical staff are recommended to facilitate appropriate antibiotic usage.

Se investigó la prevalencia e importancia de los estafilococos coagulasa negativos (ECoN) aislados de cultivos de sangre en el Hospital Universitario de West Indies (HUWI) por un período de seis meses. Se utilizaron procedimientos microbiológicos estándar y automatizados para procesas 3001 cultivos de sangre recibidos de 2363 pacientes y 658 (21.9%) de los cultivos dieron 854 aislados bacterianos. La más alta prevalencia de cultivos de sangre positivos (60%) y la más baja prevalencia de aislados de ECoN (12%) se encontraron en la Unidad de Cuidados Intensivos (UCI). Los aislados de sangre de ECoN fueron más frecuentes en las salas de cirugía (13%) y más bajos en las de obstetricia y ginecología (2%). Se observaron altas tasas de resistencia a la meticilina, así como a otras penicilinas anti-estafilocócicas y cefalosporinas usadas en el tratamiento de ECoN. Todos los aislados de sangre de ECoN (100%) fueron susceptibles a la vancomicina. En conclusión, los resultados muestran que los estafilococos coagulasa negativos son los aislados bacterianos más prevalentes en cultivos de sangre en el HUWI, presentándose en la mayor parte de los casos como contaminantes. Se recomienda la práctica de técnicas adecuadas de venepuntura y lavado de manos por parte del personal médico a fin de facilitar un uso antibiótico correcto.

Genotipificación de cepas de enterobacterias procedentes de 4 centros de salud del área de Caracas / Genotyping of enterobacterias strains from 4 healthcare centers in Caracas

Las infecciones nosocomiales pueden ser producidas por microorganismos resistentes a la acción de los antimicrobianos que han sido seleccionados por la mal uso ó el uso indiscriminado de los antibióticos en el ámbito hospitalario. En los últimos años se han desarrollado nuevas técnicas moleculares de tipificación basada en la reacción en cadena de la polimerasa (PCR), que han representado un avance importante en el estudio de las enfermedades infecciosas, siendo muy útiles al permitir diferenciar serotipos estrechamente relacionados y grupos de cepas no relacionadas clonalmente, debido a su gran poder discriminatorio. En Venezuela, son pocos los estudios de eepidemiología molecular de las infecciones intrahospitalarias, y por esta razón nos propusimos genotipificar cepas de Escherichia coli y Klebsiella pneumoniae provenientes de aislados nosocomiales de cuatro centros de salud del área metropolitana (Hospital "Dr. José María Vargas", Hospital "Dr. Domingo Luciani", Centro Médico de Caracas y Policlínica Metropolitana) con la finalidad de determinar la relación clonal existente entre estas cepas. El uso de ERIC-PCR permitió relacionar parcialmente las especies de E. coli aisladas en los cuatro centros de salud, sin embargo la técnica de REP-PCR permitió discriminar entre los patrones de bandas similares, mostrando un poder de resolución mayor. El uso de ERIC-PCR y REP-PCR no permitió tipificar la mayoría de las cepas de K. pneumoniae aisladas en los cuatro centros de salud en estudio. En el Centro Médico de Caracas se identificaron dos aislados clonales provenientes de diferentes áreas del hospital, Unidad de Terapia de Adultos y Hospitalización. En la Policlínica Metropolitana se identificaron tres aislados clonales, dos en la unidad de Terapia y uno en Hospitalización. En el Hospital "Dr. Domingo Luciani" y en el Hospital "Dr. José María Vargas" no se identificaron clones. Estos resultados proporcionan un aporte a los programas de vigilancia...

Nosocomial infections can be produced by microorganisms resistand to antimicrobial agents, and they have been selected by the bad use or abuse of antibiotics in the hospital environment. Recently, new molecular typing techniques have been developed, based on polymerase chain reaction (PCR). These techniques represent an important advantage the study of infectious diseases; they are able to discriminate relate closed serovars and groups of nonrelated isolates due to its great power discriminatory. In Venezuela, there is a small number of molecular epidemiology researches. The goal of the present study is genotyping Escherichia coli and Klebsiella pneumoniae isolated of nosocomial infected patients from four healthcare centers in the metropolitan area (Hospital "Dr. José María Vargas", Hospital "Dr. Domingo Luciani", Centro Médico de Caracas, Policlínica Metropolitana) in order to investigate the clonal relationship between the isolates. ERIC-PCR allowed us to correlate E. coli isolates however REP-PCR shows greater greater resolution. The use of both ERIC-PCR and REP-PCR, did not permit us typing K. pneumoniae isolates. Two clonally related isolates from Centro Médico de Caracas were identified. Three clonally related isolates from the Policlínica Metropolitana ere identified. No clones were identified in samples from Hospital "Dr. Domingo Luciani" and the Hospital "José María Vargas". These results contribute to monitoring programs, to improve the control of the bacterial infections, helping to establish efficient procedures and reduce nosocomials infections.

Lipid peroxidation by Pseudomonas aeruginosa in the pathogenesis of nosocomial sepsis.

BACKGROUND: To study whether Pseudomonas aeruginosa may directly trigger peroxidation of polyunsaturated fatty acids, since lipid peroxidation is a mechanism involved in the pathogenesis of sepsis. METHODS: Gamma-linolenic acid (GLA) was administered intravenously at a dose of 25mg/kg in an infusion time of 10 minutes to seven male rabbits. Blood samples were collected from the hepatic veins and from the carotid artery at regular time intervals. One clinical isolate was ex vivo incubated with the serum derived from the latter samples and concentrations of malondialdehyde (MDA) were determined during incubation in the growth medium by the thiobarbiturate assay. RESULTS: Elevated concentrations of MDA compared to their basal levels were found over the first three hours of incubation in the presence of samples collected 30 to 60 minutes after the end of the infusion of GLA. After infusion of GLA concentrations of arachidonic acid in the serum increased to concentrations comparable to those detected in sepsis. CONCLUSION: Direct triggering of lipid peroxidation by nosocomial isolates might be proposed as a pathogenetic mechanism of sepsis.

Possible hospital transmission of leptospiral infection.

Leptospirosis is a major zoonotic disease which affects all domestic and wild animals and also human beings throughout the world. Transmission from animal to man is common, with man being the dead end. In hospital environment there is always a possibility of transmission from patient to hospital staff who handle leptospirosis cases and biological material for laboratory diagnosis. 328 clinically suspected cases recorded during 1991-95 in Govt. General Hospital, Chennai were studied for evidence of leptospiral infection among hospital contacts like nurses and laboratory workers. The results of this study are reported here.

Nosocomial blood stream infection in NICN Mansoura University Hospital

We detected 37.24% nosocomial infection rate [292 infection in 205 infants] among 784 neonates hospitalized for more than 48 hours in Neonatal Intensive Care Unit [NICU] in Mansoura University Hospital during 12 months of surveillance. Blood stream infection [BSI] accounted for24.74%of the total infections. Staphylococcus epidermidis [20.61%], E. coli [16.94%] Staphylococcus aureus [14.43%] and other Gram negative bacilli [32.92%] were the most common organisms isolated. Nosocomial infection rates were significantly higher in infants with low birth weight [<2,500 g]. Nosocomial BSI was more common in neonates with intravenous lines

Molecular typing of Candida albicans strains isolated from nosocomial candidemia

Leveduras do genero Candida tem sido reconhecidas como importantes causadoras de fungemias hospitalares. Foram estudados os DNA cromossomicos de oito cepas de C. albicans, obtidas de oitos pacientes com fungemia hospitalar, por cariotipagem eletroforetica atraves de "pulsed-field gel electrophoresis". As cepas foram obtidas pelo isolamento da levedura em seis hemoculturas e duas infeccoes relacionadas ao uso de cateter intra-venoso central. Foram identificados sete perfis de DNA cromossomico. Dois pacientes mostraram cepas com o mesmo perfil de DNA sugerindo transmissao nosocomial. A cariotipagem eletroforetica revelou excelente capacidade discriminatoria entre os isolados sendo util no estudo das candidemias hospitalares.

Increasing prevalence of antimicrobial resistance among organisms isolated from blood culture in a Singapore hospital.

The blood culture isolates obtained over the period 1985-1990 in a general teaching hospital were reviewed to determine trends in the prevalence of resistance to antimicrobial drugs. The percentages of Staphylococcus aureus isolates resistant to methicillin increased each year. Resistance among coagulase negative staphylococci also increased in prevalence: by 1990 approximately 50% of such isolates were resistant to methicillin, erythromycin, co-trimoxazole and gentamicin, 24% were resistant to clindamycin, 20% to fucidic acid but only 0.5% to vancomycin. Isolates of Enterobacteriaceae, excluding community-acquired salmonellae, showed increasing prevalence of resistance to beta-lactams, as did Acinetobacter spp isolates to gentamicin, co-trimoxazole and ceftriaxone. The isolates of Pseudomonas aeruginosa were exceptional, having no evident increase in the prevalence of resistance during the period. The rapid increases observed in relation to the other pathogens indicate the need for an antibiotic policy based on continuous surveillance of susceptibility patterns in the hospital.

Epidemiological study of Pseudomonas aeruginosa isolated from clinical specimens.

The epidemiology of Pseudomonas aeruginosa infection was studied in Siriraj Hospital. During April 1989-June 1990, P. aeruginosa 436 strains were isolated from clinical specimens of 260 patients, ie blood (19 strains), pus (192 strains), sputum (159 strains) and urine (66 strains). By using a combination of serogroups and pyocin types as epidemiological markers, it was found that there were 10 serogroups and 8 pyocin types which can be differentiated into 33 serogroup/pyocin types or patterns. The most common pattern was E 211111 (26.3%) followed by B 121614 (24.5%), G 373112 (13%) and L 888888 (7.1%), respectively.