Prevalencia de sepsis neonatal confirmada microbiológicamente en una maternidad de la Ciudad Autó noma de Buenos Aires / Prevalence of microbiologically confirmed neonatal sepsis at a maternity center in the City of Buenos Aires

Introducción. En neonatos internados es frecuente sospechar sepsis neonatal, pero solo en el 25 % al 30 % se confirma con cultivos positivos. La selección del esquema antibiótico basándose en la epidemiología local favorece el uso racional y minimiza sus efectos colaterales. Objetivo primario. Describir la prevalencia de sepsis precoz y tardía con rescate microbiológico y sus características clínicas. Población y método. Estudio transversal retrospectivo, realizado del 1 de enero de 2013 al 31 de diciembre de 2017, en una maternidad pública de Argentina, que incluyó todos los recién nacidos internados en la unidad con diagnóstico de sepsis precoz y tardía con rescate microbiológico, y aquellos reingresados dentro del mes de vida. Resultados. Ingresaron 3322 recién nacidos, 1296 evaluados por sospecha de sepsis precoz, cultivos positivos en 25 (1,9 %; tasa: 0,86 ‰). El 52 % eran menores de 33 semanas de edad gestacional. Microorganismos: Escherichia coli 5, Listeria monocytogenes 4, Streptococcus agalactiae (SGB) 3, Streptococcus pneumoniae 3. Sepsis tardía (tasa 8,73 ‰), el 68 % ocurridas en menores de 33 semanas. Microorganismos intrahospitalarios: Staphylococcus coagulasa negativos 115, Staphylococcus aureus 47, Escherichia coli 30, Cándida spp. 16, Enterococcus faecalis 13, Klebsiella pneumoniae 11 y Streptococcus agalactiae 10. En los reingresos: E. coli 11, S. aureus 12, SGB 3 y Haemophilus influenzae 3. Conclusiones. Se observa en el período estudiado una frecuencia de sepsis precoz similar a los reportes internacionales, con predominio de E. coli y L. monocytogenes. La tasa de sepsis tardía presentó una tendencia descendente en los años analizados, con predominio de los cocos grampositivos

Introduction. Neonatal sepsis is often suspected in hospitalized newborn infants, but only in 25­30% of cases it is confirmed via a positive culture. Selecting the antibiotics based on local epidemiology favors their rational use and minimizes their side effects. Primary objective. To describe the prevalence of early- and late-onset sepsis with microorganism isolation and their clinical characteristics. Population and method. Retrospective, cross-sectional study conducted between 01-01-2013 and 12-31-2017 in a public maternity center of Argentina in all hospitalized newborn infants with a diagnosis of early- and late-onset sepsis with microorganism isolation, and those re-admitted in their first month of life. Results. A total of 3322 newborn infants were admitted; 1296 were assessed for suspected early- onset sepsis; 25 had a positive culture (1.9%; rate: 0.86‰). Of these, 52% were born before 33 weeks of gestation. Microorganisms: Escherichia coli 5, Listeria monocytogenes 4, Streptococcus agalactiae (SGB) 3, Streptococcus pneumoniae 3. Also, 68% of late-onset sepsis cases (rate: 8.73‰) occurred in infants born before 33 weeks of gestation. Hospital-acquired microorganisms: coagulase-negative Staphylococcus 115, Staphylococcus aureus 47, Escherichia coli 30, Candida spp. 16, Enterococcus faecalis 13, Klebsiella pneumoniae 11, and Streptococcus agalactiae 10. In re-admissions: E. coli 11, S. aureus 12, SGB 3, and Haemophilus influenzae 3. Conclusions. During the study period, the frequency of early-onset sepsis was similar to international reports, with a predominance of E. coli and L. monocytogenes. The rate of late-onset sepsis showed a downward trend in the analyzed years, with a predominance of Gram-positive cocci.

Recent research on the epidemiology and preventive strategies of neonatal group B Streptococcus infection in the latest decade / 中国当代儿科杂志

Currently, the main strategy for preventing neonatal group B Streptococcus (GBS) infection is prenatal screening combined with intrapartum antibiotic prophylaxis, which has effectively reduced the incidence of neonatal GBS early-onset disease. However, the burden of GBS infection is still significant. The intrapartum antibiotic prophylaxis strategy has limitations such as inducing antibiotic resistance and inability to effectively prevent GBS late-onset disease. It is crucial to develop and evaluate other prevention strategies, while paying close attention to assessing penicillin allergy in pregnant women and how to prevent GBS infection in neonates with negative maternal GBS screening. In recent years, there has been some progress in GBS vaccines and related immunological research, and the use of specific vaccines is expected to significantly reduce GBS infection in neonates.

Infección tardía por Streptococcus agalactiae asociada a la leche humana: reporte de 3 casos clínicos / Streptococcus agalactiae late onset infection associated with human milk: three cases report

La infección por estreptococo ß-hemolítico del grupo B o Streptococcus agalactiae puede causar morbilidad grave y mortalidad en los recién nacidos, especialmente en prematuros. Las estrategias de prevención actuales han sido eficaces en reducir la frecuencia de sepsis neonatal temprana ocasionada por transmisión vertical. La incidencia de sepsis tardía por dicho microrganismo no se ha modificado y la vía de infección es menos clara. En niños amamantados, la transmisión a través de la leche materna es posible. Se presentan tres casos de infección tardía por estreptococo ß-hemolítico del grupo B en recién nacidos prematuros alimentados con leche materna cuyas madres tenían mastitis. En todos los casos, tanto en el cultivo de la leche materna como en los hemocultivos de los neonatos se desarrolló el mismo microrganismo.

Group B ß-hemolytic Streptococcus or Streptococcus agalactiae is a major cause of morbidity and mortality in neonates, especially in premature infants. Current prevention strategies have been effective in reducing the frequency of early onset neonatal sepsis caused by vertical transmission. The incidence of late onset sepsis due to this microorganism has not changed and the route of infection is less clear. In breastfed infants, transmission through breast milk is possible. We report three cases of late group B ß-hemolytic streptococcal infection in breastfed preterm infants whose mothers had mastitis. In all cases, both the breast milk culture and the blood cultures of the neonates developed the same microorganism.

Adherencia a las recomendaciones de prevención de la sepsis neonatal temprana asociada a la colonización por Streptococcus agalactiae en una institución de referencia en Bogotá, Colombia, 2019 / Adherence to recommendations for preventing early neonatal sepsis associated with Streptococcus agalactiae colonization in a referral center in Bogotá, Colombia, 2019

RESUMEN Objetivos: Evaluar la adherencia a las recomendaciones de tamización para la prevención de la sepsis neonatal, describir la prevalencia de colonización por estreptococo del grupo B y los desenlaces perinatales asociados a la colonización por esta bacteria. Materiales y métodos: Estudio de cohorte retrospectiva que incluyó gestantes a término y sus recién nacidos, en una clínica universitaria privada de alta complejidad en Bogotá, entre el 1 de julio y el 31 de diciembre de 2019. Se evaluó la adherencia a la tamización y a la profilaxis antibiótica intraparto para las gestantes colonizadas con EGB, la prevalencia de colonización y los desenlaces perinatales adversos tempranos. Resultados: Se incluyeron 1.928 mujeres. La adherencia a la tamización fue de 68,0 % (IC 95 %: 66-70,1), a la administración de antibióticos intraparto de 87,9 % (IC 95 %: 87,8 -88), pero hubo uso no indicado de antibióticos en 14,7 % de mujeres para una adherencia final a profilaxis antibiótica de 86,3 %. La prevalencia de colonización por EGB fue 12,5 % (IC 95 %: 10,7-14,3), la incidencia de hospitalización neonatal fue de 27,5 % (IC 95 %: 16,3-33,7); no hubo casos de mortalidad ni sepsis neonatal temprana atribuibles al estado de tamización, colonización o profilaxis antibiótica para EGB. Conclusiones: Se requieren nuevos estudios en otras instituciones para determinar la adherencia a esta guía, en especial en aquellas regiones que atienden usuarias adscritas al régimen subsidiado, con cobertura a la población más vulnerable, así como nuevos estudios poblacionales de prevalencia de EGB y costo-efectividad de la estrategia de tamización universal en comparación con la profilaxis antibiótica basada en factores de riesgo.

ABSTRACT Objectives: To assess adherence to screening recommendations for the prevention of neonatal sepsis, and describe the prevalence of colonization by Group B streptococcus (GBS) as well as the perinatal outcomes associated with colonization by this bacterium. Material and methods: Retrospective cohort study that included pregnant women at term and their newborns, seen at a private high-complexity clinic in Bogota, between July 1 and December 31, 2019. Adherence to screening and intrapartum antibiotic prophylaxis in pregnant women colonized with group B streptococcus, as well as the prevalence of colonization and early adverse perinatal outcomes were assessed. Results: Overall, 1928 women were included. Adherence to screening was 68.0 % (95 % CI: 66-70.1) and 87.9 % to intrapartum antibiotic administration (95 % CI: 87.8-88); non-indicated use of antibiotics occurred in 14.7 % of the women, for 86.3 % final adherence to antibiotic prophylaxis. The prevalence of GBS colonization was 12.5 % (95 % CI: 10.7-14.3); the incidence of neonatal hospitalization was 27.5 % (95 % CI: 16.3-33.7). There were no cases of mortality or early neonatal sepsis attributable to screening status, colonization or prophylactic antibiotics for GBS. Conclusions: Additional studies in other centers are required in order to determine adherence to this guideline, particularly in those that receive users affiliated to the subsidized regime which covers the most vulnerable population. Also, new population studies of GBS prevalence and cost-effectiveness of universal screening compared to risk factor-based antibiotic prophylaxis are needed.

Sepsis precoz, osteoartritis y meningitis: a propósito de un caso clínico / Early sepsis, osteoarthritis and meningitis: a clinical case / Sepse precoce, osteoartrite e meningite: relato de caso

Se expone el caso de un recién nacido que desarrolló sepsis connatal precoz a Streptococcus agalactiae, con meningitis aguda supurada y osteoartritis de rodilla izquierda. Como factor de riesgo la madre no tenía realizado el exudado rectovaginal, pesquisa que detecta la colonización por estreptococo del grupo B (EGB). Se aisló el germen en hemocultivo y en líquido de punción articular. Recibió tratamiento antibiótico adecuado a la sensibilidad del microorganismo y según pauta de sepsis con meningitis, evolucionando favorablemente. En este trabajo se describe la epidemiología de la sepsis neonatal y los cambios ocurridos luego de la implementación de la profilaxis antibiótica en el preparto.

We hereby present the case of a newborn with early connatal sepsis due to Streptococcus agalactiae, with acute suppurative meningitis and left knee osteoarthritis. As a risk factor, the mother had not performed the rectus vaginal exudate screening that detects colonization by Group B Streptococcus (GBS). The germ was isolated in blood culture and in joint puncture fluid. The patient received germ-sensitive antibiotic treatment for meningitis sepsis and evolved favorably. This paper describes the epidemiology of neonatal sepsis and the changes that have occurred after the administration of the antibiotic prophylaxis during pregnancy.

Apresentamos o caso de um recém-nascido com sepse neonatal precoce por Streptococcus agalactiae, com meningite supurativa aguda e osteoartrite de joelho esquerdo. Como fator de risco, a mãe não realizou teste de exsudato vaginal do reto que detecta a colonização por estreptococos do grupo B (SGB). O germe foi isolado em hemocultura e líquido de punção articular. A paciente recebeu tratamento com antibióticos germinativos para padrão meningite sepse e evoluiu favoravelmente. Este artigo descreve a epidemiologia da sepse neonatal e as mudanças ocorridas após a administração da profilaxia antibiótica durante a gravidez.

Hiperplasia sebácea ectópica en mucosa oral de neonatos: reporte de tres casos / Ectopic sebaceous gland hyperplasia in neonates oral mucosa: 3 case studies / Hiperplasia sebácea ectópica na mucosa oral de recém-nascidos: relato de 3 casos

La hiperplasia de glándulas sebáceas es un hallazgo benigno y transitorio, común en el período neonatal. Secundariamente al estímulo hormonal androgénico se produce un hipercrecimiento de las glándulas, con mayor frecuencia en nariz y mejillas, donde existen en mayor densidad. La hiperplasia de glándulas en una localización ectópica, llamada gránulos de Fordyce (GF), es excepcional en el período neonatal. Se han reportado en aproximadamente 1% de los recién nacidos, y con frecuencia se localizan en la mucosa oral. Los GF se describen como lesiones papulares de aspecto vesiculoso blanco amarillentas de 1-3 mm2, que podrían confundir al neonatólogo o al pediatra con entidades infecciosas, dando lugar a pruebas invasivas y tratamientos innecesarios. Se describen tres casos clínicos de neonatos con diagnóstico de hiperplasia sebácea ectópica localizada en mucosa oral, con el objetivo de revisar la etiología, las características clínicas, los diagnósticos diferenciales y la evolución de esta entidad benigna. Conclusiones: la hiperplasia sebácea ectópica en mucosa oral de neonatos es un hallazgo benigno autolimitado que se presenta con baja frecuencia. El reconocimiento clínico de esta entidad es importante para evitar diagnósticos incorrectos y tratamientos innecesarios.

Sebaceous gland hyperplasia is a common transient and benign finding in neonates. After androgenic hormonal stimulation, there is a gland overgrowth mainly in the nose and cheeks where there is a greater density of glands. Ectopic sebaceous gland hyperplasia, called Fordyce's Granules (FG), is exceptional in neonates and it is reported in approximately 1% of newborns and frequently located in the oral mucosa. FGs are described as 1-3mm2 yellowish-white papular and vesicular lesions. Neonatologists or pediatricians may confuse these clinical features with infectious diseases, leading to invasive tests and unnecessary treatment. We describe three clinical cases of neonates with diagnosis of ectopic sebaceous gland hyperplasia located in the oral mucosa, with the aim of reviewing the etiology, clinical characteristics, differential diagnoses and evolution of this benign entity. Conclusions: ectopic sebaceous gland hyperplasia of the lips is a self-limited benign finding occurring infrequently in newborns. The clinical recognition of this entity is important to avoid inaccurate diagnoses or unnecessary treatment.

A hiperplasia das glândulas sebáceas é um achado benigno e transitório comum nos neonatos. Secundário ao estímulo hormonal androgênico, há um hipercrescimento das glândulas com mais frequência no nariz e nas bochechas onde há uma maior densidade das glândulas. A hiperplasia das glândulas num local ectópico, chamado Fordyce Granules (FG), é excepcional no período neonatal, e ela é relatada em aproximadamente 1% dos recém-nascidos e muitas vezes está localizada na mucosa oral. Os FGs são descritos como lesões vesiculares brancas amareladas de 1-3mm2, o que poderia confundir o neonatologista ou pediatra com entidades infecciosas, levando a testes invasivos e tratamentos desnecessários. Descrevemos três relatos clínicos de recém-nascidos com diagnóstico de hiperplasia sebácea ectópica localizada na mucosa oral, com o objetivo de rever a etiologia, características clínicas, diagnósticos diferenciais e evolução desta entidade benigna. Conclusões: hiperplasia sebácea ectópica na mucosa oral de recém-nascidos é um achado benigno autolimitante que ocorre com baixa frequência. O reconhecimento clínico desta entidade é importante para evitar diagnósticos incorretos e tratamentos desnecessários.

Bacterias aisladas en hemocultivos positivos en lactantes bajo 90 días de edad ingresados por fiebre al Hospital Exequiel González Cortés entre 2014 y 2016 / Positive blood cultured isolated bacteria in children under 90 days old admitted for fever in Hospital Exequiel González Cortés between 2014 and 2016

INTRODUCCIÓN: En neonatos y lactantes bajo 90 días de vida la fiebre constituye un signo clínico relevante ya que puede corresponder a una infección bacteriana grave, por lo que se toman hemocultivos de forma rutinaria y el paciente es hospitalizado. Aún no existe una recomendación respecto al tiempo de observación necesario una vez internado el paciente. OBJETIVO: Describir las bacterias aisladas en hemocultivos de lactantes bajo 90 días de vida hospitalizados por fiebre y el tiempo de detección de crecimiento microbiano en los mismos. ¨MÉTODO: Estudio descriptivo, retrospectivo. Se revisaron hemocultivos positivos tomados entre 2014 y 2016 en neonatos y lactantes < 90 días de edad. Se obtuvieron las identificaciones, tiempo de positividad de las bacterias, así como datos clínicos, de laboratorio y demográficos. RESULTADOS: Se identificaron 172 hemocultivos positivos, 51 cumplían los criterios de inclusión. De éstos, 21 microorganismos fueron patógenos (Escherichia coli: 10, Streptococcus agalactiae: 3, Streptococcus pyogenes: 3, otros: 5) y 30 se consideraron contaminación, principalmente Staphylococcus coagulasa negativa. En relación al total de la muestra, la mediana del tiempo de positividad fue de 10 h. A las 24 h de cultivo se detectó crecimiento bacteriano en 94% de la muestra. CONCLUSIÓN: Las bacterias patógenas aisladas en los hemocultivos de pacientes < 90 días de edad, que ingresaron con fiebre, corresponden principalmente a bacilos gramnegativos y estreptococos. Todos los patógenos aislados fueron detectados antes de 24 h de incubación.

BACKGROUND: Fever in infants younger than 90 days may reflect a serious bacterial infection, so blood cultures (BC) are taken routinely and the patient is hospitalized. The observation time to detect occult bacteremia is not well established. AIM: To describe type and positivity time of isolated bacteria in blood cultures in infants under 90 days admitted for fever. METHODS: Retrospective, descriptive study. Positive blood cultures taken between 2014-2016 in young infants admitted for fever were included. Identification and time of positivity of each bacteria, clinical, laboratory and demographic data were recorded. Demographic variables and the clinical outcome was obtained. RESULTS: There were 172 positive blood cultures, only 51 met inclusion criteria. Of these, 21 microorganisms were pathogenic (Escherichia coli: 10, Streptococcus agalactiae: 3, Streptococcus pyogenes: 3, others: 5) and 30 were considered contamination, mainly coagulase negative Staphylococcus. In relation to the total sample, the median time of positivity was 10 hrs. At 24 hours of culture, bacterial growth was detected in 94% of the sample. CONCLUSION: The pathogenic bacteria isolated in the blood cultures of patients younger than 90 days who were admitted with fever correspond mainly to Gram negative bacilli and streptococci. All isolated pathogens were detected before 24 h of incubation.

Avaliação de colonização por Streptococcus agalactiae em gestantes atendidas em um laboratório de análises clínicas da Serra Gaúcha / Rio Grande do Sul / Assessment of Streptococcus agalactiae colonization in pregnant women attending a clinical laboratory in southern Brazil

Introdução: O Streptococcus agalactiae é uma bactéria Gram-positiva, cocoide, disposta em cadeias ou aos pares e coloniza o trato gastrointestinal e geniturinário, podendo se tornar um agente causador de patologias. Recém-nascidos são os mais afetados pela colonização do S. agalactiae, com manifestações clínicas de pneumonia, meningite a sepse, porém gestantes também são suscetíveis a infecção por esta bactéria.Métodos: A coleta de dados foi realizada através do sistema informatizado do laboratório coparticipante. Foi selecionado o período de 01 de janeiro de 2016 a 31 de dezembro de 2020, exame Pesquisa de Streptococcus B (PEB) com coleta por swab em região vaginal e anorretal e idade das gestantes. Após obtenção dos dados, os resultados foram tabulados em planilhas do Excel 2016 para posterior análise.Resultados: O percentual de positividade de colonização por S. agalactiae entre as gestantes foi de 18,6% de um total de 1385 gestantes. O ano de 2016 apresentou os menores índices de colonização com 14,5% (32/220) e o ano de 2020, os maiores, com 26,3% (84/319). A idade das participantes variou de 13 a 54 anos, com média de 29,08 anos e mediana de 29 anos.Conclusão: O presente estudo pôde evidenciar um alto índice de colonização por S. agalactiae entre as gestantes atendidas pelo laboratório coparticipante durante os anos pesquisados. Como também demonstrar a importância da pesquisa de colonização por S. agalactiae em gestantes durante o pré-natal, pois assim se torna possível a correta profilaxia para evitar futuras complicações nos recém-nascidos como também nas mães.

Introduction:Streptococcus agalactiae is a gram-positive bacterium, coccoid bacterium, arranged in chains or pairs that colonizes the gastrointestinal and genitourinary tracts, and may become a causative agent of diseases. Newborns are the most affected by S. agalactiae colonization, with clinical manifestations of pneumonia, meningitis and sepsis, but pregnant women are also susceptible to infection caused by this bacterium.Methods: Data were collected using the computerized system of the co-participating laboratory. The following variables were select: period from January 1, 2016 to December 31, 2020, Streptococcus B screening with collection of vaginal an anorectal swabs and age of the pregnant women. After data were obtained, the results were tabulated in Excel 2016 spreadsheets for further analysis.Results: The percentage of positive S. agalactiae colonizacion in pregnant women was 18.6% of a total of 1,385 pregnant women. The year 2016 had the lowest colonization rate with 14.5% (32/220), and the year 2020 had the highest rate with 26.3% (84/319). The age of the participants ranged from 13 to 54 years, with a mean of 29.08 years and a median of 29 years.Conclusion: The present study showed a high rate of S. agalactiae colonization among pregnant women attending the co-participating laboratory during the study period. It also demonstrated the importance of S. agalactiae colonization screening in pregnant women during prenatal care, as this allows to correct prophylaxis to avoid future complications in both newborns and mothers.

Effect of intrapartum antibiotic prophylaxis of group B streptococcus infection on the incidence and bacteriological profile of early-onset neonatal sepsis / 中国当代儿科杂志

OBJECTIVES@#To study the effect of intrapartum antibiotic prophylaxis (IAP) of group B streptococcus (GBS) infection on the incidence and bacteriological profile of early-onset neonatal sepsis (EONS).@*METHODS@#A retrospective analysis was performed on the medical data of 494 pregnant women with positive GBS screening results and 526 neonates born by these women. According to whether the pregnant woman received IAP, the neonates were divided into two groups: IAP (n=304) and control (n=222). The two groups were compared in terms of clinical indices, incidence rate of EONS, and distribution of pathogenic bacteria in blood culture.@*RESULTS@#Compared with the control group, the IAP group had a significantly lower proportion of children with abnormal clinical manifestations (P<0.001) and a significantly lower incidence rate of EONS (P=0.022). In the IAP group, Escherichia coli (2.3%) was the most common type of pathogenic bacteria in blood culture of the neonates with EONS, while GBS (3.2%) was the most common type of pathogenic bacteria in the control group. The IAP group had a significantly higher detection rate of ampicillin-resistant Escherichia coli than the control group (P=0.029).@*CONCLUSIONS@#Although IAP can significantly reduce the incidence rate of EONS in neonates born to pregnant women with positive GBS screening results, the infection rate of ampicillin-resistant Escherichia coli may increase after IAP treatment. Therefore, it is needed to enhance the monitoring of blood culture results of neonates with EONS and timely adjust treatment plan according to drug susceptibility test results.

Caracterización molecular de genes de virulencia (lmb, bca y rib) y de resistencia a macrólidos (ermB, ermTR y mefA) en aislamientos clínicos de Streptococcus agalactiae / Molecular characterization of virulence (lmb, bca and rib) and macrolid resistance genes (ermB, ermTR and mefA) in clinical isolates of Streptococcus agalactiae

RESUMEN El objetivo del estudio fue identificar molecularmente los genes de virulencia y resistencia a macrólidos en aislamientos clínicos de Streptococcus agalactiae (EGB), recuperados en 2019 a partir de secreción vaginal (n=9) y orina (n=22), en dos establecimientos de salud de Lima. La identificación y susceptibilidad antimicrobiana se determinaron por el sistema automatizado Vitek® 2, se confirmó la identificación fenotípicamente; la resistencia a macrólidos por el método D-test; la identificación de genes de virulencia (lmb, bca y rib) y de resistencia a macrólidos (ermB, ermTR y mefA) por reacción en cadena de la polimerasa (PCR). El fenotipo y genotipo de resistencia a macrólidos predominante fue cMLSb (12/31) y ermB (11/31), y el gen de virulencia más frecuente fue lmb (23/31). Todos fueron sensibles a penicilina, ampicilina y vancomicina. Estos hallazgos muestran la necesidad de implementar estudios de epidemiología molecular que permitan un adecuado conocimiento y seguimiento de EGB en el Perú.

ABSTRACT The aim of the study was to molecularly identify virulence and macrolide resistance genes in clinical isolates of Streptococcus agalactiae (GBS), recovered in 2019 from vaginal discharge (n=9) and urine (n=22), from two health facilities in Lima. Identification and antimicrobial susceptibility were determined by the Vitek® 2 automated system, identification was confirmed phenotypically; macrolide resistance was determined by the D-test method. Identification of virulence genes (lmb, bca and rib) and macrolide resistance genes (ermB, ermTR and mefA) was carried out by polymerase chain reaction (PCR). The predominant macrolide resistance phenotype and genotype were cMLSb (12/31) and ermB (11/31); the most frequent virulence gene was lmb (23/31). All were sensitive to penicillin, ampicillin and vancomycin. These findings show the need to implement molecular epidemiology studies that allow adequate knowledge and follow-up of GBS in Peru.

Incidência de Streptococcus ß-Hemolítico em Gestantes do Município de Campinas, São Paulo / ß-hemolytic Streptococcus incidence in pregnant women of Campinas Municipality, São Paulo

Objetivo: O objetivo deste estudo foi avaliar a incidência de Streptococcus ß-hemolítico em gestantes e a suscetibilidade aos antimicrobianos das pacientes colonizadas. Métodos: Para isso, foram analisadas 4.380 amostras de secreções vaginais e anais de gestantes, a partir de 35 semanas de gestação, atendidas em laboratório particular na cidade de Campinas, para detecção da presença de Streptococcus ß-hemolítico. Resultados: Foi encontrada uma prevalência de colonização nas gestantes analisadas de 12% (504/4380), sendo 293 (13%) vaginais e 211 (10%) anais. Das positivas, foi realizado o perfil de resistência bacteriana em 60 amostras, sendo 20% das amostras anais resistentes à clindamicina e 22% à eritromicina e das amostras vaginais 25% resistentes à clindamicina e 33% à eritromicina, não havendo resistência à penicilina e ampicilina. Conclusão: Diante da incidência apresentada, ressalta-se a importância da realização do rastreio da colonização transitória de estreptococos ß-hemolíticos em gestantes durante o pré-natal, associado à adequada profilaxia intraparto, para minimizar os riscos de ocorrência de sepse nos neonatos.

Objective: The aim of this study was evaluate the incidence of ß-hemolytic Streptococcus in pregnant women and antimicrobial susceptibility of colonized patients. Methods: For this, a cohort of 4,380 of pregnant women, from 35 weeks of gestation, were analyzed, samples of vaginal and anal secretion were collected in a private laboratory in the city of Campinas. Result: The prevalence of colonization was of 12% (504/4380) in pregnant women was evidenced, being 293 (13%) vaginal and 211 (10%) anal. From the positives, the bacterial resistance profile was performed in 60 samples, 20% of the clinical samples resistant to Clindamycin and 22% of Erythromycin and 25% of the vaginal samples resistant to Clindamycin and 33% to Erythromycin, without resistance to Penicillin and Ampicillin. Conclusion: We conclude that the emphasize the importance of performing the screening of ß-hemolytic Streptococcus in pregnant women during the prenatal period, associated with adequate intrapartum prophylaxis is needed.

Sensibilidad disminuida a los antibóticos Beta-Lactamicos en estreptococos Beta-Hemolíticos / Decreased sensitivity to beta-lactam antibiotics in beta-hemolytic streptococci

Últimamente, se están detectando mutaciones en las proteínas ligadoras de penicilina (PBP) de los estreptococos beta-hemolíticos que corresponden a sitios que en Streptococcus pneumoniae han determinado sensibilidad disminuida a los antibióticos beta-lactámicos. Primero, se describieron cepas con sensibilidad intermedia a penicilina en Streptococcus agalactiae (estreptococos del grupo B), luego en Streptococcus dysgalactiae subsp. equisimilis (mayormente grupos C y G) y, más recientemente, cepas con sensibilidad disminuida a aminopenicilinas y cefalosporinas de tercera generación en Streptococcus pyogenes (grupo A). El costo biológico de estas modificaciones nos permite pensar que los niveles de resistencia no han de ser tan elevados como para comprometer por ahora la efectividad clínica de los beta-lactámicos (AU)

Recently, mutations in penicillin-binding proteins (PBPs) of beta-hemolytic streptococci have been detected corresponding to sites that in Streptococcus pneumoniae have been determined to have decreased sensitivity to beta-lactam antibiotics. First, strains with intermediate sensitivity to penicillin were described in Streptococcus agalactiae (group B streptococci), subsequently in Streptococcus dysgalactiae subsp. equisimilis (mainly groups C and G) and, more recently, strains with decreased sensitivity to third-generation aminopenicillins and cephalosporins were found in Streptococcus pyogenes (group A). The biological cost of these modifications suggests that, for now, resistance levels are not high enough to compromise the clinical effectiveness of beta-lactams (AU)

Antimicrobial properties of heterocyclic compounds against clinical mastitis isolates / Propriedades antimicrobianas de compostos heterocíclicos contra isolados de mastite clínica

Mastitis causes significant economic losses to the dairy cattle industry. The present study aimed to evaluate the antibacterial properties of 39 heterocyclic derivatives (1,3-thiazoles and 4-thiazolidinones) against clinical mastitis isolates from dairy cows. Milk samples were collected from cows with clinical mastitis and the bacterial species were identified by PCR. Antibacterial activity was assessed using the broth microdilution method. First, 39 heterocyclic compounds were tested against four bacterial isolates (Staphylococcus aureus, Streptococcus agalactiae, Corynebacterium bovis and Escherichia coli) randomly chosen from those recovered from the milk samples (Study 1). Subsequently, the compounds with the strongest antibacterial activity were tested against all the bacterial isolates recovered from the milk samples (Study 2). 1,3-thiazoles showed the strongest antibacterial activity, specially compounds 30 and 38, which also showed bactericidal properties according to their minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) values. Corynebacterium spp. and Enterobacteriaceae isolates were the most susceptible to compounds 30 and 38. Compounds 30 and 38 are promising targets for new antimicrobial agents.(AU)

A mastite causa significativas perdas econômicas à indústria leiteira bovina. O presente estudo teve como objetivo avaliar as propriedades antibacterianas de 39 derivados heterocíclicos (1,3-tiazóis e 4-tiazolidinonas) contra isolados clínicos de mastite em vacas leiteiras. Amostras de leite foram coletadas de vacas com mastite clínica e as espécies bacterianas isoladas foram identificadas por PCR. A atividade antibacteriana foi avaliada pelo método de microdiluição em caldo. Primeiramente, os 39 compostos heterocíclicos foram testados contra quatro isolados bacterianos (Staphylococcus aureus, Streptococcus agalactiae, Corynebacterium bovis e Escherichia coli) escolhidos aleatoriamente dentre os recuperados das amostras de leite (Estudo 1). Posteriormente, compostos com atividade antibacteriana mais forte foram testados contra todos os isolados bacterianos recuperados das amostras de leite (Estudo 2). Os compostos 1,3-tiazóis apresentaram a maior atividade antibacteriana, principalmente os compostos 30 e 38, que também apresentaram propriedades bactericidas de acordo com seus valores de concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM). Os isolados Corynebacterium spp. e Enterobacteriaceae foram os mais suscetíveis aos compostos 30 e 38. Os compostos 30 e 38 mostraram-se promissores como novos agentes antimicrobianos.(AU)

Antimicrobial susceptibility profile of Streptococcus agalactiaestrains isolated from bovine mastitis / Perfil de susceptibilidade a antimicrobianos em Streptococcus agalactiae isolados de mastite bovina

Bovine mastitis is the most important disease of dairy herds worldwide. Its main etiologic agents are bacteria, including Streptococcus agalactiae. The importance of this agent in bovine mastitis is because it is highly contagious and has a high impact on the occurrence of clinical mastitis cases and in the increase of the bulk milk somatic cell counts. The dry cow therapy and the treatment of the clinical mastitis cases stand out among the measures to control intramammary infections in cows. However, these strategies require knowledge about the antimicrobial susceptibility of the causal microorganisms. Thus, this study aimed to evaluate the antimicrobial susceptibility of 89 S. agalactiae strains isolated from bovine mastitis between the years 2004 and 2008 in dairy herds from Campo das Vertentes region, Minas Gerais State, Brazil. The disc diffusion technique was used and the antimicrobials currently used in mastitis therapy were tested. The isolates tested showed 100% susceptibility to chloramphenicol, ceftiofur, cefotaxime, enrofloxacin, and cefquinome. High frequencies of susceptibility (>95%) were also observed for the beta-lactams (penicillin G, ampicillin, and oxacillin), cephalosporins (cephalotin, ceftiofur, cefotaxime, cefoperazone, and cefquinome), florfenicol, gentamicin, lincomycin, nitrofurantoin, and sulfamethoprim. The strains showed high frequencies of resistance to neomycin (15.74%), and tetracycline (21.35%). Multidrug resistance was detected in 2.25% of the tested isolates. The results pointed to variations in the antimicrobial susceptibility profiles of the studied strains and the importance of the use of the susceptibility tests to determine the correct antimicrobial to be applied in the treatment of bovine mastitis caused by S. agalactiae. The high frequencies of resistance observed to some antimicrobials, such as neomycin and tetracycline, commonly used in the treatment of mastitis and other pathologies, highlighted the need for more judicious use of antimicrobials on dairy farms.(AU)

A mastite é a principal doença de bovinos leiteiros em todo o mundo e tem como principais agentes as bactérias, entre as quais Streptococcus agalactiae. Esse agente se destaca por ser altamente contagioso e pelos reflexos que causa na incidência de casos clínicos e no incremento da contagem de células somáticas do leite do tanque. Para o controle desta enfermidade, destacam-se a terapia de vacas secas e o tratamento de casos clínicos, medidas que requerem o conhecimento do perfil de sensibilidade dos agentes causais aos antimicrobianos. Este estudo teve como objetivo avaliar os perfis de suscetibilidade a antimicrobianos em 89 amostras de S. agalactiae isoladas de casos de mastite bovina em rebanhos da região de Campo das Vertentes, Minas Gerais, no período de 2004 a 2008. A técnica de difusão em discos foi utilizada e os antimicrobianos correntemente empregados na terapia da mastite foram testados. Os testes de suscetibilidade antimicrobiana apontaram 100% de susceptibilidade para cloranfenicol, ceftiofur, cefotaxima, enrofloxacina e cefquimona. Níveis elevados de susceptibilidade (>95%) foram observados para os betalactâmicos, florfenicol, gentamicina, lincomicina, nitrofurantoína e sulfametoprim. Altas frequências de resistência foram observadas para neomicina (15,74%) e tetraciclina (21,35%). Dois isolados multirresistentes (2,25%) foram encontrados. Os resultados apontaram variações nos perfis se suscetibilidade aos antimicrobianos na população analisada, indicando a importância do uso do antibiograma para a escolha mais criteriosa dos antibacterianos a serem utilizados para o tratamento da mastite bovina causada por S. agalactiae. As altas frequências de resistência detectadas para alguns dos antimicrobianos comumente utilizados para o tratamento de mastite e outras patologias, tais como a neomicina e a tetraciclina, salientam a necessidade de monitoramento permanente do perfil de suscetibilidade aos antimicrobianos e do uso mais criterioso dos mesmos nos rebanhos leiteiros.(AU)

Capsular genotype distribution of Group B Streptococcus colonization among at-risk pregnant women in Sao Paulo, Brazil

ABSTRACT Background: Vaccines in development against Group B Streptococcus (GBS) should contain the most prevalent capsular genotypes screened in the target population. In low- and middle-income countries epidemiological data on GBS carriage among pregnant women, a prerequisite condition for GBS neonatal sepsis, is needed to inform vaccine strategies. Objective: To investigate the prevalence of different GBS capsular genotypes that colonizes at-risk pregnant women in a private maternity hospital in São Paulo, Brazil. Methods: GBS strains isolated in routine maternity procedures from at-risk pregnant women from 2014 to 2018 were confirmed by mass spectrometry (MALDI-TOF) with subsequent DNA extraction for identification of capsular genotype through polymerase chain reaction (PCR). Demographic and gestational data were analyzed. Results: A total of 820 Todd-Hewitt broths positive for GBS were selected for streptococcal growth. Recovery and confirmation of GBS by MALDI-TOF were possible in 352. Strains were processed for determination of capsular genotype by PCR. From the total of 352 GBS isolates, 125 strains (35.5%) were genotyped as Ia; 23 (6.5%) as Ib; 41 (11.6%) as II; 36 (10.2%) as III; 4 (1.1%) as IV; 120 (34.1%) as V and 1 strain (0.3%) as VIII. Two isolates (0.7%) were not genotyped by used methodology. No statistically significant correlation between gestational risk factors, demographic data and distribution of capsular genotypes were found. Conclusions: GBS capsular genotypes Ia, Ib, II, III, and V were the most prevalent isolates colonizing at risk pregnant women in the present study. The inclusion of capsular genotypes Ia and V in the composition of future vaccines would cover 69.6% of capsular genotypes in the studied population. No statistically significant differences were observed between capsular genotype and gestational and demographic data and risk factors.

Una neumonía complicada por un germen inusual: Reporte de caso / A pneumonia complicated by an unusual germ: Case report

Resumen El Streptococcus pseudoporcinus es un germen de la clasificación Beta hemolítico, con similitud a Streptococcus agalactiae, con baja incidencia en producción de infección pero principalmente aislado en tracto genitourinario de mujeres embarazadas y relacionado con complicaciones materno-fetales. Reportes en la literatura como infección fuera de este sitio son inusuales, por lo cual presentamos un caso de un hombre de 48 años con infección de tracto respiratorio bajo, compatible con colección neumónica y un derrame paraneumonico complicado, con requerimiento de manejo antibiótico y drenaje por toracostomia. Al realizar el estudio microbiológico se reportó aislamiento de un Streptococcus pseudoporcinus. No hay reportes previos en la literatura como causa de infección en este sitio anatómico.

Abstract Streptococcus pseudoporcinus in a germ of the Beta hemolytic group, similar to Streptococcus agalactiae, with low incidence in the production of infection, and isolated in most of cases from the genitourinary tract of pregnant women and related to maternal and fetal complications; the reports in the literature as infection outside this site are unusual. We describe a case of one 48-year-old man with a low respiratory tract infection with a pneumonic collection and a complicated parapneumonic effusion, requiring antibiotic management and thoracostomy drainage. Isolation of a Streptococcus pseudoporcinus. There is no report in the literatura as a cause of infection in this anatomical site.

Streptococcus agalactiae: causa de artritis séptica inusual a partir de los 3 meses de edad. Caso clínico / Streptococcus agalactiae: an unusual cause of septic arthritis beyond 3 months of age. Case report

La artritis séptica es una patología poco frecuente, pero con una alta morbilidad, debido a las importantes secuelas que puede originar. La etiología varía según la edad, y Staphylococcus aureus es el microorganismo más frecuente en todas ellas. Streptococcus agalactiae odel grupo B es una causa infrecuente de infección fuera del período neonatal; se asocia, a partir de los 3 meses de edad, con infecciones graves en pacientes inmunocomprometidos. El tratamiento de elección es penicilina G o ampicilina.Aquí se describe el caso de un niño de cuatro meses y medio de edad que desarrolló una artritis séptica por Streptococcus agalactiae odel grupo B, con inicio insidioso de la clínica. El diagnóstico etiológico obligó a descartar meningitis y una inmunodeficiencia asociada. La frecuencia extremadamente baja de dicha artritis a esta edad y la importancia de descartar una enfermedad diseminada son importantes puntos de aprendizaje en este caso.

Septic arthritis is not a very frequent disease, but with a high morbidity due to the important sequelae that it can cause. The etiology is age-specific, with Staphylococcus aureus being the most frequent microorganism in all ages. Streptococcus agalactiae or group B Streptococcus is an uncommon cause of infection outside the neonatal period. Beyond 3 months of age, infections by this pathogen are associated with serious infections in immunocompromised patients. The treatment of choice is penicillin G or ampicillin. A 4.5-month-old child who developed a group B Streptococcus septic arthritis is reported. The onset was insidious, and the etiological diagnosis prompted us to rule out meningitis and associated immunodeficiency. The extremely low frequency of group B Streptococcus septic arthritis at this age and the importance of ruling out a disseminated disease are crucial learning points in this case

Prevalence of rectovaginal colonization by group B Streptococcus in pregnant women seen at prenatal care program of a health organization / Prevalência de colonização retovaginal por estreptococo do grupo B em gestantes de programa de atendimento pré-natal de instituição de saúde

ABSTRACT Objective To evaluate the prevalence of group B Streptococci in pregnant women of a corporate health program, as well as the epidemiological correlations. Methods This retrospective study used medical records of patients who participated of the prenatal care program at a private hospital in the city of São Paulo (SP), Brazil, from 2015 to 2016. Those who abandoned the program or had incomplete data in their medical records were excluded. Quantitative variables were described by means, standard deviations, median, minimal and maximal values. Parity and socioeconomic status were described by absolute frequency and percentages. We used logistic regression models in the software (SPSS) to analyze correlations of variables according to vaginal-rectal culture, considering a 95%CI and p-values. Variables were age, number of pregnancies, weight gain in pregnancy and gestational age at delivery. Results A total of 347 medical records were included, and after applying the exclusion criteria, 287 medical records composed the final sample. Patients' age ranged between 17 and 44 years. Mean age was 30.6 years, 67 patients had positive result for group B Streptococcus (prevalence of 23.3%; 95%CI: 18.7-28.5). Conclusion Considering the high prevalence of group B Streptococcus in our service, the antibiotic prophylaxis strategy based on rectovaginal culture screening approach seems to be cost-effective.

RESUMO Objetivo Identificar a prevalência de estreptococo do grupo B entre gestantes que frequentaram um programa de saúde corporativa, bem como as correlações com a colonização positiva. Métodos Estudo retrospectivo dos prontuários do pré-natal de um hospital privado em São Paulo, no período de 2015 a 2016. Foram excluídas as mulheres que abandonaram o programa ou apresentavam dados incompletos nos prontuários. As variáveis quantitativas foram descritas por média, desvios padrão, mediana, valores mínimos e máximos. A paridade e a condição socioeconômica foram descritos por frequência absoluta e percentagens. Utilizamos modelos de regressão logística no programa (SPSS) para analisar as correlações de variáveis de acordo com a cultura retovaginal, considerando IC95% e valores de p. As variáveis foram idade, número de gestações, peso ganho na gestação e idade gestacional no parto. Resultados Foram incluídos 347 prontuários e, após a aplicação dos critérios de exclusão, 287 prontuários compuseram a amostra final. A idade dos pacientes variou entre 17 e 44 anos. A média de idade foi de 30,6 anos, e 67 pacientes tiveram resultado positivo para o estreptococo do grupo B (prevalência de 23,3%; IC95%: 18,7-28,5). Conclusão Considerando a alta prevalência de estreptococos do grupo B em nosso serviço, existem evidências de que a estratégia de antibiótico profilaxia baseada na cultura retovaginal é custo-efetiva.

Antibiotic susceptibility patterns and prevalence of streptococcus agalactiae rectovaginal colonization among pregnant women in iran

Abstract Objective Streptococcus agalactiae is an important pathogen in neonates and pregnant women. Neonatal invasive infections due to S. agalactiae are life-threatening and preventive strategies for this challenge of human have become a concern. The aim of the present study was to determine the prevalence of rectovaginal colonization, related risk factors and antibiotic resistance pattern of S. agalactiae among pregnant women in Iran. Methods The present study was performed on 240 pregnant women. Vaginal and rectal swabs were obtained from all of the women and then were transferred to the laboratory. The isolation and identification of S. agalactiae was performed by standard microbiological tests and polymerase chain reaction (PCR) assay. The antimicrobial susceptibility patterns of the isolates were determined by the Kirby-Bauer disk diffusion. Polymerase chain reaction was used to detect ermB and mefA genes in erythromycin-nonsusceptible isolates. Results Out of 240 pregnant women, 16 cases (6.7%) were colonized by S. agalactiae. There is no significant association between demographic-obstetric factors and maternal S. agalactiae colonization in the pregnant women. Linezolid, vancomycin and ampicillin were the most effective antibiotics against S. agalactiae. The ermB gene was present in 6 (35.29%) S. agalactiae isolates. However, the mefA gene was not detected in any of the isolates. Conclusion Given the relatively significant prevalence of S. agalactiae colonization in the pregnant women in the present study and the risk of serious neonatal infections, the screening of pregnant mothers for the bacteria seems necessary. Our findings highlight the importance of appropriate antibiotic prophylaxis during pregnancy for the prevention of early onset S. agalactiae-neonatal infection and comorbidity.