ABSTRACT
Prolonged outbreaks of multidrug-resistant Streptococcus pneumoniae in health care facilities are uncommon. We found persistent transmission of a fluroquinolone-resistant S. pneumoniae clone during 2006-2011 in a post-acute care facility in Israel, despite mandatory vaccination and fluoroquinolone restriction. Capsular switch and multiple antimicrobial nonsusceptibility mutations occurred within this single clone. The persistent transmission of fluoroquinolone-resistant S. pneumoniae during a 5-year period underscores the importance of long-term care facilities as potential reservoirs of multidrug-resistant streptococci.
Subject(s)
Anti-Bacterial Agents/pharmacology , Biological Evolution , Drug Resistance, Bacterial/genetics , Fluoroquinolones/pharmacology , Pneumococcal Infections/epidemiology , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/genetics , Adult , Aged , Aged, 80 and over , Child , Cross Infection , Disease Outbreaks , Hospitals , Humans , Israel/epidemiology , Microbial Sensitivity Tests , Middle Aged , Pneumococcal Infections/microbiology , Prevalence , Public Health Surveillance , Serotyping , Streptococcus pneumoniae/classification , Young AdultABSTRACT
We aimed to study the prevalence of Streptococcus pneumoniae in respiratory samples from institutionalized patients with chronic tracheostomy. A total of 264 pairs of nasopharyngeal and endotracheal cultures were collected. There was no difference in the proportion of positive cultures between children (21%) and adults (18%). However, the proportion of positive endotracheal cultures was higher than that of nasopharyngeal cultures in adults (18% versus 3%, respectively; P < 0.001) but not in children (17% in both sites).
Subject(s)
Pneumococcal Infections/epidemiology , Streptococcus pneumoniae/isolation & purification , Tracheostomy/adverse effects , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Long-Term Care/methods , Male , Middle Aged , Nasopharynx/microbiology , Pneumococcal Infections/microbiology , Prevalence , Trachea/microbiology , Young AdultABSTRACT
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are important extremely drug-resistant pathogens that have emerged during the past decade. Early identification and isolation of carriers are key components of an effective infection control strategy in healthcare facilities. Very little is known about the natural history of CRE carriage. We aimed to determine the predictors of a positive CRE rectal screen test among patients with known CRE carriage screened at their next hospital encounter. METHODS: A case-control study was conducted. Sixty-six patients who tested positive for CRE carriage were surveyed for CRE rectal carriage at the next hospital encounter; screen-positive patients were compared with screen-negative control patients. Data were extracted from the patients' medical records and from the hospital computerized database. RESULTS: Twenty-three case patients and 43 control patients were identified. Predictors for a positive CRE rectal carriage test were (1) prior fluoroquinolone use (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.10-16.6), (2) admission from an institution or another hospital (OR, 4.04; 95% CI, 1.33-12.37), and (3) time interval less than or equal to 3 months since the first positive CRE test (OR, 3.59; 95% CI, 1.24-10.37). Among patients with no predictor variables, the likelihood of having a positive screen test at the next hospital encounter was 1/7. If they had at least 1 predictor, the likelihood increased to 1/2. CONCLUSIONS: Prior fluoroquinolone use, transfer from another healthcare facility, and admission less than or equal to 3 months since the first CRE isolation are predictors of persistent CRE rectal carriage. These predictors can be used in designing CRE prevention strategies.
