Bacteriologic profile and drug resistance in children with respiratory infection from 2016 to 2018 / 中国当代儿科杂志

OBJECTIVE@#To study the bacteriologic profile and drug resistance of respiratory infection in children, and to provide a basis for etiological diagnosis and rational use of antimicrobial agents.@*METHODS@#A retrospective analysis was performed for 15 047 children who attended the hospital due to respiratory infection from January 2016 to December 2018. Their sputum samples were collected, and the Phoenix-100 automatic microbial identification system was used for the identification and drug sensitivity analysis of the isolated pathogenic bacteria.@*RESULTS@#Of all 17 174 sputum samples detected, there were 2 395 positive samples, with a positive rate of 13.95%; a total of 2 584 strains of pathogenic bacteria were isolated, among which there were 1 577 (61.03%) Gram-negative strains, 967 (37.42%) Gram-positive strains, and 40 (1.55%) fungal strains. The most common pathogen was Haemophilus influenzae (33.90%), followed by Streptococcus pneumoniae (33.55%), Moraxella catarrhalis (19.20%), and Staphylococcus aureus (3.64%). Among the 2 331 children with positive infection, 251 had mixed infection, most commonly with Haemophilus influenzae and Streptococcus pneumoniae. The detection rate of pathogenic bacteria was higher in winter and spring and lower in summer and autumn. There was a significant difference in the detection rate of pathogenic bacteria between different age groups (P<0.05), with the highest detection rate in infants aged 1 month to <1 year. Streptococcus pneumoniae and Staphylococcus aureus had a sensitivity rate of 100% to vancomycin, linezolid, and teicoplanin, and Haemophilus influenzae had a lower sensitivity rate to ampicillin, compound sulfamethoxazole and cefuroxime and a higher sensitivity rate to other drugs.@*CONCLUSIONS@#Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis are the main pathogenic bacteria of respiratory infection in children, and mixed infection is the most common type of infection. The detection rate of pathogenic bacteria varies across seasons and ages. Different pathogenic bacteria have different features of drug resistance, and antibiotics should be selected based on drug sensitivity results.

Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia / Infecção por Streptococcus pneumoniae em crianças com ou sem pneumonia radiologicamente confirmada

Abstract Objective: Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. Methods: The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n = 249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. Results: Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. Conclusions: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.

Resumo Objetivo: Avaliar o papel do raios X de tórax na identificação de casos de pneumonia adquirida na comunidade (PAC) causada por agentes bacterianos. Métodos: A frequência de infecção por Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis em crianças com PAC não hospitalizadas foi comparada com a presença de confirmação radiológica da pneumonia (n = 249 crianças com pneumonia radiologicamente confirmada e 366 crianças com raios X de tórax normal). Infecção por S. pneumoniae foi diagnosticada com base na resposta sorológica a pelo menos uma dentre oito proteínas pneumocócicas investigadas (aumento ≥ 2 vezes nos níveis de IgG em relação a Ply, CbpA, PspA1 e 2, PhtD, StkP-C e PcsB-N ou aumento≥ 1,5 vez em relação aPcpA). Infecção por H. influenzae e M. catarrhalis foi definida por aumento ≥ 2 vezes nos níveis de IgG específica a antígenos de cada agente. Resultados: Crianças com pneumonia radiologicamente confirmada apresentaram maior taxa de infecção pelo pneumococo. Além disso, a presença de infecção pneumocócica foi um fator preditor de pneumonia radiologicamente confirmada, o que aumenta sua chance de detecção em 2,8 vezes (IC 95%: 1,8-4,3). O valor preditivo negativo do raios X normal para a infecção por S. pneumoniae foi 86,3% (IC95%: 82,4%-89,7%). Não houve diferença nas frequências de infecção por H. influenzae e M. catarrhalis entre crianças com PAC com ou sem confirmação radiológica. Conclusão: Crianças com diagnóstico clínico de PAC submetidas a um raios X de tórax que apresentam confirmação radiológica têm maior taxa de infecção por S. pneumoniae comparadas com as crianças com raios X normal.

Prevalence of Moraxella catarrhalis in the nasopharyngeal specimen from 1 082 hospitalized children with respiratory infection and the drug resistance of the isolates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the prevalence of Moraxella catarrhalis in the nasopharyngeal region of children with respiratory infection and the sensitivity of Moraxella catarrhalis isolates to common antimicrobial drugs.</p><p><b>METHODS</b>Nasopharyngeal swabs were collected from 1 082 children with respiratory infection, and Moraxella catarrhalis strains were isolated. The E-test method and disc diffusion test were used to determine the sensitivity of these strains to 11 common antimicrobial drugs. The test results were interpreted with reference to the standards of European Committee on Antimicrobial Susceptibility Testing (EUCAST), Clinical and Laboratory Standards Institute (CLSI), and British Society for Antimicrobial Chemotherapy (BSAC). The nitrocefin disc method was used to detect whether the isolated strains produced β-lactamase.</p><p><b>RESULTS</b>Among the 1 082 children with respiratory infection, 77 (77/1 082, 7.12%) carried Moraxella catarrhalis in the nasopharyngeal region. All the strains produced β-lactamase. With reference to all the three standards, all the strains were sensitive to amoxycillin-clavulanate and had a susceptibility rate of >95% towards ciprofloxacin and tetracycline. According to the EUCAST and CLSI standards, the susceptibility rate of the strains towards sulfamethoxazole-trimethoprim was as high as 98.7%, and more than 80% of all strains were sensitive to the three cephalosporins detected; however, with reference to the BSAC standard, only 2.6% of the strains were sensitive to cefuroxime, with an intermediate rate of 44.2% and a drug resistance rate of 53.2%. The rate of resistance to ampicillin was 81.8%. According to the CLSI standard, the non-susceptibility rate of the strains to erythromycin was 79.2%, and according to the EUCAST or BSAC standards, their non-susceptibility rate reached 90.9%; more than one third of the strains (27/77, 35.1%) had a minimal inhibitory concentration of >256 mg/L.</p><p><b>CONCLUSIONS</b>All of the Moraxella catarrhalis isolates in the nasopharyngeal region of children with respiratory infection produce β-lactamase and are sensitive to amoxycillin-clavulanate. These isolates have high susceptibility rates to the third- and fourth-generation cephalosporins and sulfamethoxazole-trimethoprim, but most of the isolates are resistant to ampicillin, cefuroxime, and erythromycin.</p>

Clinical Characteristics and Microbiology of Acute Otitis Media of Children: Multicenter Studies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute otitis media (AOM) is one of the most common forms of bacterial infection in children. The aim of this study was to investigate the clinical characteristics and the common pathogens of AOM children who visited three different centers. SUBJECTS AND METHOD: We have conducted a retrospective study of 133 children under 15 years with the diagnosis of AOM that had been seen between January 2010 and January 2011. We examined of AOM children's symptoms, signs and culture results. RESULTS: The most common symptoms were in the order of crying or irritability, otalgia and fever. Otorrhea was significantly higher under 2 years old and drum injection was over 2 years old. The most common pathogens were Streptococcus pneumoniae (26.6%), followed by Moraxella catarrhalis (19.0%), Haemophilus influenzae (11.4%) and Staphylococcus aureus (11.4%). Among the total pathogens, about 71% of pathogens were resistant to amoxicillin, 78% to macroride, and 55.2% to clindamycin. About 58.3% of H. influenza and M. catarrhalis were positive to beta-lactamase. CONCLUSION: More than half of pathogens were resistant to standard dose amoxicillin. For the appropriate treatment of AOM, decisions were made based on the common symptoms, signs and antibiotic resistances of pathogens.

Four bacterial studies on children with chronic otitis media with effusion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To research the prevalences of four kinds of bacteria including Alloiococcus otitidis, Streptococcus pneumonia, Haemophilus influenzae, and Moraxella catarrhalis in children with chronic otitis media with effusion (SOM) of the middle ear effusion, and the reproduction of the nasopharynx, so as to explore their meaning for the children with SOM.@*METHOD@#Alloiococcus otitidis, Streptococcus pneumonia, Haemophilus influenza, and Moraxella catarrhal were investigated in the samples obtained from middle ear effusion and nasopharyn- geal swabs, using PCR and conventional bacterial culture methods.@*RESULT@#By bacterial culture, the pathogen detection rate from middle ear effusion was 3.6%,while the nasopharynx was 54.0%, the detection rate of Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis was 10.8%, 27.0%, 4.5%, respectively, the drug susceptibility results for 51 samples of bacterial culture positive showed that 39 cases was sensitivite to the β-lactam antibiotic; By PCR, the number of detecting various kinds of bacteria simultaneously in middle ear effusion or in the nasopharynx were 6 and 34. The bacteria prevalences of S. pneumoniae, H. influenzae, M. catarrhalis, and A. otitidis are 5.4%, 5.4%, 3.6%, and 42.3% in the middle ear effusion, are 25.2%, 27.0%,13.5% and 34.2% in nasopharyngeal, respectively.@*CONCLUSION@#(1) PCR method is more sensitively detecting the bacteria than conventional bacterial culture methods. (2) The chronic SOM of children may be a combination of mixed bacterial infection, A. otitidis may be the most common pathogen of children SOM. (3) For children of SOM, if antibiotics are chosen to be used early in the disease, we suggest using the β-lactam antibiotics.

Concurrent Assay for Four Bacterial Species Including Alloiococcus Otitidis in Middle Ear, Nasopharynx and Tonsils of Children with Otitis Media with Effusion: A Preliminary Report

OBJECTIVES: To detect the prevalences of Alloiococcus otitidis, as well as Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis in children with chronic otitis media with effusion (OME) and to simultaneously investigate the colonization of these bacteria in the nasopharynx and palatine tonsils of these patients. METHODS: The study included 34 pediatric patients with OME, and 15 controls without OME. In the study group, A. otitidis, H. influenzae, S. pneumoniae, and M. catarrhalis were investigated in the samples obtained from middle ear effusions (MEE), nasopharyngeal swabs (NPS) and tonsillar swabs (TS), using multiplex polymerase chain reaction (PCR) and conventional culture methods. Only the samples obtained from NPS and TS were studied with the same techniques in the control group. RESULTS: A. otitidis was isolated only in MEE and only with multiplex PCR method. A. otitidis, S. pneumoniae, M. catarrhalis, H. influenzae were identified in 35%, 8.8%, 8.8%, and 2.9%, respectively, in 34 MEE. A. otitidis was not isolated in NPS or TS of the study and the control groups. CONCLUSION: The prevalence of A.otitidis is high in children with OME and A.otitidis doesn't colonize in the nasopharynx or tonsil.

Nasopharyngeal Colonization of Moraxella catarrhalis in Young Korean Children / 감염과화학요법

BACKGROUND: Nasopharyngeal bacterial flora can cause respiratory tract diseases as well as invasive bacterial diseases. Moraxella catarrhalis colonizing in the nasopharynx is considered an important potential pathogen with an increasing production of beta-lactamase. This study examined the nasopharyngeal colonization rate of M. catarrhalis and the antibiotic susceptibility of M. catarrhalis. MATERIALS AND METHODS: Healthy children who visited one of the three University hospitals in the Republic of Korea or attended a day-care center around the participating hospitals were enrolled in this study. The nasopharyngeal samples were obtained by nasopharyngeal washing with normal saline and M. catarrhalis was isolated. The nasopharyngeal colonization rate of M. catarrhalis was investigated and the minimal inhibitory concentrations (MICs) were measured for commonly used oral antibiotics (amoxicillin, amoxicillin/clavulanate, cefaclor, cefixime, cefdinir, cefditoren, erythromycin and trimethoprim). RESULTS: Three hundred and seventy-nine children aged between 6 months and 5 years were enrolled, and the nasopharyngeal colonization rate of M. catarrhalis was 33% (124 children). All isolated M. catarrhalis produced beta-lactamase. The MIC90 of the antibiotics were as follows: amoxicillin, >16 mg/L; amoxicillin/clavulanate, 0.5 mg/L; cefaclor, 8 mg/L ; cefixime, 0.125 mg/L; cefdinir, 0.25 mg/L; cefditoren, 0.25 mg/L; erythromycin, 0.5 mg/L; and trimethoprim, >16 mg/L. CONCLUSIONS: M. catarrhalis was colonized in 33% of the children aged 6 months to 5 years, and showed low MICs for amoxicillin/clavulanate and oral 2nd and 3rd generation cephalosporins.

In Vitro Activities of Ceftriaxone-Sulbactam against Major Aerobic and Anaerobic Bacteria from Clinical Samples

BACKGROUND: beta-lactam antibiotics are one of the most common antimicrobial agents. However, the increasing of beta-lactamase-producing bacteria makes these agents less useful. Therefore, agents stable for beta-lactamase have been developed. This study was conducted to determine the activities of the combination agent ceftriaxone-sulbactam and to compare its activities with other agents. METHODS: A total of 437 clinical isolates of aerobic and anaerobic bacteria were collected in Severance Hospital from 2007 to 2011. Using 23 antimicrobial agents, antimicrobial susceptibility tests were performed using the Clinical and Laboratory Standards Institute (CLSI) agar dilution method. RESULTS: The minimal inhibitory concentrations (MICs) of ceftriaxone and ceftriaxone-sulbactam were similar to or lower than those of other beta-lactam antibiotics for methicillin-susceptible Staphylococcus aureus (MSSA), Streptococcus pneumoniae, S. pyogenes, and viridans group streptococci. For Moraxella catarrhalis, Neisseria gonorrhoeae, Haemophilus influenzae, and H. parainfluenzae, ceftriaxone and the ceftriaxone-sulbactam combination also show low MIC50 and MIC90. For extended-spectrum beta-lactamase (ESBL)-producing E. coli, the MICs of ceftriaxone-sulbactam were lower than those of other cephalosporins. Among the anaerobes, ceftriaxone-sulbactam showed good activity compared to ceftriaxone alone for the Bacteroides fragilis group, B. thetaiotaomicron, other Bacteroides sp., Prevotella sp., and Porphyromonas sp. CONCLUSIONS: Ceftriaxone-sulbactam showed good antimicrobial activity and thus is useful for the treatment of infections by MSSA, S. pneumoniae, S. pyogenes, viridans group streptococci, M. catarrhalis, N. gonorrhoeae, H. influenzae, H. parainfluenzae, E. coli, and K. pneumoniae, B. fragilis group, B. thetaiotaomicron, other Bacteroides sp., Prevotella sp., and Porphyromonas sp.

Annual Report on External Quality Assessment in Clinical Microbiology Laboratory in Korea (2009) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2009. A total of 16 specimens were distributed. Eight specimens were distributed to 339 laboratories with 322 (95.0%) returns in Trial I, and another eight specimens to 337 laboratories with 327 returns (97.0%) in Trial II. Two slide specimens for mycobacterium stain (AFB) were distributed in both Trial I and II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology. The acceptable percentages of bacterial identification (correct answers to species level) on Sterotrophomonas maltophilia, Staphylococcus aureus, Streptococcus agalactiae, Micrococcus luteus, Vibrio parahemolyticus and Candida glabrata (Trial I) were 94.4%, 98.5%, 92.1%, 62.3%, 92.1% and 71.5%, respectively. The acceptable percentages of bacterial identification on Pseudomonas aeruginosa, Enterococcus faecalis, Candida albicans, Staphylococcus epidermidis, Moraxella catarrhalis and Enterobacter cloacae (Trial II) were 98.5%, 94.1%, 89.2%, 86.2%, 79.6% and 98.5%, respectively. The acceptable percentages for antimicrobial susceptibility tests on S. maltophilia and S. aureus (Trial I), and P. aeruginosa and E. faecalis(Trial II) were relatively good compared to data of the last year, except results using disk method for S. maltophilia. The acceptable percentages for AFB stain in Trial I and II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Moraxella catarrhalis pneumonia in an AIDS patient: a case report.

Moraxella catarrhalis pneumonia, although in the immunocompromised patients is very uncommon for community-acquired pneumonia (CAP). It demonstrates a potential pathogen with high mortality when the presence of heavy numbers of organisms, intracellularly and extracellularly, in the sputum Gram's stained smears confirmed by cultures. In 2007, the authors reported a case of a 28-year-old Thai single male patient with acquired-immunodeficiency syndrome (AIDS) and Moraxella catarrhalis pneumonia who dramatically responded to two weeks of oral Amoxyclav (Amoxycillin trihydrate 500 milligrams + Clavulanic acid (Potassium clavulanate) 125 milligrams) treatment at 625 milligrams every 8 hours and then discharged. The present case report describes clinical and initial chest roentgenographic presentations of Moraxella catarrhalis pneumonia in AIDS patient. The importance of chest roentgenographic pictures, CD4/CD8-T lymphocyte ratio, sputum Gram's stainings, cultures with susceptibility testing in establishing a diagnosis, and protective vaccine are discussed.

Identificación y tipificación de Haemophilus influenzae mediante PCR múltiple / Use of multiplex PCR for detection and identification of Haemophilus influenzae

Se diseñó una estrategia metodológica para la detección simultánea entre Haemophilus influenzae serotipo b (Hib) y no tipificable (HiNT), así como para discriminar entre H. influenzae, Moraxella catarrhalis y Streptococcus pneumoniae. El estudio se realizó en una recolección de 64 cepas, las cuales se sometieron a amplificación por PCR utilizando ADN genómico o directamente el cultivo bacteriano como plantilla. La PCR se realizó en dos fases: 1) PCR triple para discriminar entre H. influenzae y M. catarrhalis empleando oligonucleótidos específicos para los genes del ARNr 16S y de la neumolisina (Ply) para identificar S. pneumoniae; 2) PCR doble para la identificación simultánea de Hib y HiNT, utilizando oligonucleótidos específicos de los genes cap y hmw. Se logró la amplificación del gen ARNr 16S en las 64 cepas de H. influenzae, sin obtenerse amplificación en las cepas control. La secuencia Bex A se amplificó en 29 de 32 cepas de Hib, y la secuencia HMWA se amplificó en 29 de 30 cepas de HiNT. La amplificación con los oligonucleótidos específicos para M. catarrhalis y S. pneumoniae no mostró productos con ninguna cepa de H. influenzae. Estos resultados permiten proponer la aplicación de esta herramienta metodológica para discriminar entre M. catarrhalis y S. pneumoniae, e identificar H. influenzae directamente a partir de muestras clínicas.

Annual Report on External Quality Assessment of Clinical Microbiology Laboratory in Korea (2007) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2007. A total of 14 specimens were distributed. Six specimens were distributed to 317 laboratories with 305 (96.2%) returns in Trial I, and 8 specimens to 320 laboratories with 309 returns (96.5%) in Trial II. For the first time, two slide specimens for mycobacterium stain (AFB) were distributed in Trial II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology. The acceptable percentages of bacterial identification (correct answers to species level) on Streptococcus pyogenes, Branhamella catarrhalis, Escherichia coli, Enterococcus faecalis, Aeromonas hydrophilia and Yersinia enterocolitica (Trial I) were 83.5%, 70.8%, 98.1%, 87.0%, 89.2%, and 97.0%, respectively. The acceptable percentages of bacterial identification on Staphylococcus aureus, Pseudomonas aeruginosa, Candida tropicalis, Listeria monocytogenes, Enterococcus casseliflavus and Klebsiella pneumoniae (Trial II) were 98.1%, 97.7%, 71.6%, 77.4%, 72.4% and 96.2%, respectively. The acceptable percentages for antimicrobial susceptibility tests on E. coli and E. faecalis (Trial I), and S. aureus and P. aeruginosa (Trial II) were relatively good compared to data of recent three years. The acceptable percentages for AFB stain in Trial II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Annual Report on External Quality Assessment of Clinical Microbiology Laboratory in Korea (2007) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2007. A total of 14 specimens were distributed. Six specimens were distributed to 317 laboratories with 305 (96.2%) returns in Trial I, and 8 specimens to 320 laboratories with 309 returns (96.5%) in Trial II. For the first time, two slide specimens for mycobacterium stain (AFB) were distributed in Trial II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology. The acceptable percentages of bacterial identification (correct answers to species level) on Streptococcus pyogenes, Branhamella catarrhalis, Escherichia coli, Enterococcus faecalis, Aeromonas hydrophilia and Yersinia enterocolitica (Trial I) were 83.5%, 70.8%, 98.1%, 87.0%, 89.2%, and 97.0%, respectively. The acceptable percentages of bacterial identification on Staphylococcus aureus, Pseudomonas aeruginosa, Candida tropicalis, Listeria monocytogenes, Enterococcus casseliflavus and Klebsiella pneumoniae (Trial II) were 98.1%, 97.7%, 71.6%, 77.4%, 72.4% and 96.2%, respectively. The acceptable percentages for antimicrobial susceptibility tests on E. coli and E. faecalis (Trial I), and S. aureus and P. aeruginosa (Trial II) were relatively good compared to data of recent three years. The acceptable percentages for AFB stain in Trial II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Isolation of some microorganisms from Iraqi patients with chronic maxillary sinusitis

Maxillary sinusitis is one of the most common infections of humans. Sinusitis can be defined as an inflammation of the membrane lining of any sinus, especially one of the paranasal sinuses. To determine the causative microorganisms of chronic maxillary sinusitis. Forty five chronic sinusitis patients were involved in the present study. Sampling method were sinus specimens [aspiration or injection aspiration]. Haemophilus species, Streptococcus pneumoniae [S.pneumoniae] and Moraxella catarrhalis [M.catarrhalis] were the most frequent isolates; in addition Penicillium and Cladosporium species were isolated from some chronic sinusitis patients. Chronic sinusitis could be caused by either bacterial species or by fungal species; most bacterial isolates were Haemophilus species followed by S.pneumoniae and M.catarrhalis. The incidences of chronic sinusitis were more at patients age [20-29 years] groups

Epidemiology and Etiology of Community-Acquired Pneumonia

Pneumonia is the 12th leading cause of death among Korean population in 2005. In spite of sophisticated diagnostic assessments and treatment techniques, the management of the pneumonia is still challenging. Furthermore, the emergence of antibiotic-resistant microorganisms poses difficulties to the selection of optimal antimicrobial agents. The empirical antibiotic regimen for the community-acquired pneumonia is based on the epidemiologic characteristics of the causative pathogens, for example, Streptococcus pneumoniae, Staphylococcus aureus after influenza outbreak, Klebsiella pneumoniae, Moraxella catarrhalis, and Pseudomonas aeruginosa in patients with chronic obstructive lung diseases. The most important and frequent etiologic organism is S. pneumonia according to a prospective multicenter study by investigators including the author, followed by K. pneumoniae, Chlamydia pneumoniae, P. aeruginosa, S. aureus, and M. pneumoniae in decreasing order. Still we need a nation-wide surveillance system of the community-acquired pneumonia because we are not certain about the etiology in almost half the cases of community-acquired pneumonia.

Outpatient antibiotic therapy as a predisposing factor for bacterial resistance: a rational approach to airway infections

OBJETIVOS: Apresentar as recomendações baseadas em evidência para uso de antibióticos no tratamento das infecções respiratórias agudas (IRA) mais freqüentes e as informações disponíveis sobre a importância desse tipo de conduta. FONTES DOS DADOS: Bases de dados MEDLINE, LILACS, publicações técnicas de organizações internacionais, diretrizes nacionais e internacionais. Foram utilizados os unitermos acute respiratory infection, otitis, sinusitis, tonsillitis, pneumonia, antibiotic, guidelines, bacterial resistance. Artigos citados pelos artigos incluídos foram analisados quanto à apresentação de informação de interesse. SíNTESE DOS DADOS: A resistência bacteriana tem crescido, sendo atualmente reconhecida como problema mundial de saúde pública. As IRA são a causa mais freqüente para uso de antibiótico na comunidade; grande parte desses casos, tanto nas vias aéreas superiores (otite, sinusite, faringoamidalite) como nas inferiores (pneumonia), são decorrente de infecção viral. As recomendações para racionalizar o uso de antibióticos nos pacientes com IRA têm como objetivo comum minimizar o uso desnecessário de antibióticos, visto que a "pressão antibiótica" é um dos fatores desencadeantes da resistência bacteriana. CONCLUSÕES: É de grande importância a distinção, entre os pacientes com IRA, daqueles que podem se beneficiar do uso de antibióticos. O uso das recomendações para a prescrição de antibióticos é uma estratégia para minimizar a freqüência de resistência bacteriana.

OBJECTIVES: To present evidence-based recommendations for the use of antibiotics for the treatment of the most common acute respiratory infections (ARI) and the available information on the importance of this type of management. SOURCES: MEDLINE and LILACS databases, technical publications by international organizations, national and international directives. The search terms acute respiratory infection, otitis, sinusitis, tonsillitis, pneumonia, antibiotic, guidelines and bacterial resistance were used. Articles cited by the articles selected were analyzed for information of interest. SUMMARY OF THE FINDINGS: Bacterial resistance has grown, to the extent that today it is recognized as a global public health problem. ARI are the most common cause of antibiotic usage within the community; yet a large proportion of these cases, compromising the upper (otitis, sinusitis, tonsillitis) or the lower airways (pneumonia), are the result of viral infections. Recommendations to rationalize the use of antibiotics in patients with ARI have the common objective of minimizing unnecessary antibiotic use, since "antibiotic pressure" is one of the factors triggering bacterial resistance. CONCLUSIONS: It is of great importance to differentiate among ARI patients those who will benefit from the use of antibiotics. The establishment of recommendations for the prescription of antibiotics is one strategy for minimizing the frequency of bacterial resistance.

Susceptibilidade de antimicrobiana de Moraxella catarrhalis isolada de infecções do trato respiratório / Antibiotic-susceptibility of Moraxella catarrhalis isolated from respiratory tract infections

Moraxella catarrhalis pode normalmente ser encontrada no trato respiratório superior. Esta bactéria, entretanto, pode causar infecções como otite média aguda, sinusite, conjuntivite, bronquite crônica, pneumonia, endocardite, septicemia e meningite. Haemophilus influenzae, Streptococcus pneumoniae e M.catarrhalis foram os agentes etiológicos principais nas infecções do trato respiratório neste estudo. Os maiores problemas de resistência associados com estas espécies são aqueles associados à resistência aos beta-lactâmicos. A enzima beta-lactamase foi produzida por mais de 80 das cepas de M. Catarrhalis. A susceptibilidade a ampicilina, amoxilina/clavulanato, cefuroxima, eritromicina e ciprofloracin foi testada em 137 cepas de M. catarrhalis. Todas as cepas resistentes a ampicilina produziram beta-lactamase e foram sensíveis a combinação amoxilina/clavulanato. Para M.catarrhalis os antimicrobianos mais ativos foram a cefuroxima (99).

In vitro activity of fluoroquinolones against common respiratory pathogens / La actividad in vitro de las fluorquinolonas contra los patógenos respiratorios

The treatment of respiratory infections is often empiric, necessitating the use of agents with a broad range of antimicrobial activity. The fluoroquinolones, having activity against common respiratory pathogens, fit this description. New fluoroquinolones have been developed in an attempt to improve the in vitro activity against a wide variety of respiratory tract pathogens. The objective of the study is to compare in vitro activity of newest fluoroquinolones, gatifloxacin and moxifloxacin, with levofloxacin and ciprofloxacin using three major respiratory pathogens, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Minimum inhibitory concentrations (MICs) of four fluoroquinolones were tested against 93 S pneumoniae, 62 H influenzae and 60 M catarrhalis, ie 215 isolates by the E-test method. National Committee for Clinical Laboratory Standards (NCCLS)-approved interpretive criteria were used throughout. All isolates were susceptible to the tested fluoro-quinolones. Ninety per cent of S pneumoniae strains were inhibited by ciprofloxacin at concentrations of 2 mg/L. The gatifloxacin and moxifloxacin MICs were lower than the ciprofloxacin and levofloxacin MICs against S pneumoniae. In contrast to S pneumoniae, in vitro activities of gatifloxacin and moxifloxacin offered no apparent advantages over ciprofloxacin and levofloxacin for H influenzae and M catarrhalis.

La terapia de las infecciones respiratorias es a menudo empírica, y exige por ende el uso de agentes con un amplio espectro de actividad antimicrobiana. Por su actividad contra los patógenos respiratorios comunes, las fluorquinolonas se ajustan a esta descripción. Nuevas fluorquinolonas han sido desarrolladas, en un intento por mejorar la actividad in vitro contra una variedad de patógenos de las vías respiratorias. El objetivo de este estudio es comparar la actividad in vitro de las fluorquinolonas más recientes – la gatifloxacina y la moxifloxacina – con la levofloxacina y la ciprofloxacina, usando tres de los más importantes patógenos respiratorios: Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis. Las concentraciones inhibitorias mínimas (CIMs) de las cuatro fluorquinolonas fueron sometidas a prueba contra 93 S pneumoniae, 62 H influenzae y 60 M catarrhalis, para un total de 215 aislados mediante el método de E-test. En todos los casos se aplicaron criterios interpretativos aprobados por el Comité Nacional para Normas del Laboratorio Clínico (NCCLS). Todos los aislados resultaron sensibles a las fluorquinolonas ensayadas. El noventa por ciento de las cepas de S pneumoniae fueron inhibidas por la ciprofloxacina a concentrationes of 2 mg/L. Las CIMs de la gatifloxacina y la moxifloxacina fueron más bajas que las CIMs de la ciprofloxacina y la levofloxacina contra S pneumoniae. En contraste con S pneumoniae, la actividad in vitro de la gatifloxacina y la moxifloxacina no ofrecieron ventajas aparentes por encima de la ciprofloxacina y la levofloxacina frente a H influenzae y M catarrhalis.

Risk of acute otitis media in relation to acute bronchiolitis in children

A prospective study was carried out to evaluate the prevalence and the etiology of acute otitis media [AOM] In children with acute bronchiolitis. Also to determine whether AOM occurring with acute bronchiolitis "Which mainly due to respiratory syncytial virus [RSV]" is accompanied with another pathogens "which usually found in the middle ear aspirate [MEA]" or not. Thirty-six children with acute bronchiolitis aged 3 to 18 months that were admitted to pediatrics department, El-Minia University Hospital during the period from September 2005 to December 2005 were included In this study. In patients with AOM at entry or developed AOM within 14 days, Gram-stained smears, bacterial cultures, and enzyme-linked immunosorbent assay [ELISA] were performed on middle-ear aspirates to detect the presence of bacterial pathogens and RSV respectively. Twenty children [55.6%] with acute bronchiolitis had AOM at entry or developed AOM within 14 days, 9 patients [25%] had developed otitis media with effusion, and only 7 patients [19.4%] remained free of both AOM and otitis media with effusion, throughout the 2-weeks observation period. Of 27 middle-ear aspirates [13 unilateral and 7 bilateral], bacterial pathogens were isolated in 23 [85%] [10 bacteria alone "37%" and 13 mixed bacteria and RSV "48%"], RSV was identified in 15 [55.5%] of middle ear aspirates [mixed with bacteria in 13 and RSV alone in 2 cases [7.5%]], so RSV was identified in 15 of 20 patients [75%] with AOM. Streptococcus pneumoniae was isolated in 11 middle ear aspirates, Haemophilus influenza in 6, Moraxella catarrhalis in 4, Staphylococcus aureus in 2, Streptococcus pyogenes in one aspirate and Pseudomonas aeruginosa in one aspirate only. Of 20 cases of AOM, 15 [75%] responded clinically to usual dose of antibiotic [Amoxicillin and clavulanic acid and/or Cefotaxime]. Finally we concluded that bacterial AOM is a complication In most children with acute bronchiolitis. Streptococcus pneumoniae and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in most cases of acute otitis media [75%] and mixed with bacterial pathogens. Accordingly, in patients with acute bronchiolitis and associated AOM, antimicrobial treatment is indicated