RESUMEN
OBJECTIVES: Shiga toxin-producing Escherichia coli (STEC) causes diarrhoeal disease, bloody diarrhoea, and haemolytic uraemic syndrome. The aim of this study was to describe the incidence of STEC and the clinical features of STEC patients from a well-defined Danish population in which all fecal samples of patients with suspected infective gastroenteritis were analysed for STEC. METHODS: In this population-based cohort study, all stool samples referred to two clinical microbiology laboratories were screened for STEC by culture and/or PCR. Epidemiological (n=170) and clinical (n=209) characteristics were analysed using data from local and national registries. RESULTS: Overall, 75,132 samples from 30,073 patients were screened resulting in 217 unique STEC-isolates. The epidemiological analysis showed an incidence of 10.1 cases per 100,000 person-years, which was more than twofold higher than the incidence in the rest of Denmark (3.4 cases per 100,000 person-years, p <0.001). Three groups were associated with a higher incidence: age <5 years (n=28, p <0.001), age ≥65 years (n=38, p 0.045), and foreign ethnicity (n=27, p 0.003). In the clinical analysis, patients with STEC harbouring only the Shiga toxin 1 gene (stx1-only isolates) showed a lower frequency of acute (n=11, p <0.05) and bloody diarrhoea (n=5, p <0.05) and a higher frequency of gastrointestinal symptoms for ≥3 months (n=8, p <0.05) than the other STEC patients. CONCLUSIONS: We report a more than twofold higher incidence in the project area compared with the rest of Denmark, indicating that patients remain undiagnosed when selective STEC screening is used. We found an association between patients with stx1-only isolates and long-term gastrointestinal symptoms.
Asunto(s)
Diarrea/epidemiología , Infecciones por Escherichia coli/epidemiología , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Dinamarca/epidemiología , Diarrea/microbiología , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Toxina Shiga I/genética , Escherichia coli Shiga-Toxigénica/genética , Adulto JovenRESUMEN
OBJECTIVES: Outbreaks of Campylobacter are traditionally considered to be rare; however, rather than being the true nature of the disease, this may reflect our present inability to detect them. The aim of this study was to determine the genetic and epidemiological degree of clustering among Campylobacter jejuni isolates from Danish patients. METHODS: Whole-genome sequencing (WGS) was applied to 245 C. jejuni isolates from patients with domestically acquired infection over a 9-month period in 2015 and 2016. RESULTS: WGS demonstrated that 62 of the 245 isolates (25%) clustered genetically. In total, 21 genetic clusters were identified of which four (18%) consisted of five isolates or more. Seventeen (81%) of the 21 genetic clusters were clustered in space and/or time. Of the 245 isolates, 49 (20%) were part of a temporal and/or geographical cluster. The identified clusters included two outbreaks; one which had not been identified through the existing surveillance system. CONCLUSIONS: Using WGS, we show that Campylobacter case clustering and even outbreaks appear to occur more often than previously assumed, providing important new insight into the relatively poorly understood epidemiology of the most important cause of bacterial gastroenteritis in the industrialized world.
Asunto(s)
Campylobacter jejuni/genética , Genoma Bacteriano/genética , Familia de Multigenes/genética , Secuenciación Completa del Genoma , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/microbiología , Dinamarca/epidemiología , Brotes de Enfermedades , Heces/microbiología , Humanos , Filogenia , Polimorfismo de Nucleótido Simple/genéticaRESUMEN
Reduced susceptibility to metronidazole and vancomycin in Clostridium difficile has been reported, which emphasises the need for simple antimicrobial susceptibility testing methods. The aim of this study was to apply a published disc diffusion method and zone diameter breakpoint correlates to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) epidemiological minimum inhibitory concentration (MIC) cut-off values in a routine setting. Metronidazole and vancomycin zone diameters from 2702 isolates were recorded. Fifteen isolates had a metronidazole zone diameter below the published breakpoint (<23 mm) and five isolates had a vancomycin zone diameter below the published breakpoint (<19 mm), most of which were polymerase chain reaction (PCR) ribotype 027. The total number of PCR ribotype 027 was 29 (1.1 %). Overall, C. difficile PCR ribotype 027 isolates had smaller zone diameters than non-027 isolates. The disc diffusion method is very simple and inexpensive, and the published zone diameter breakpoints will detect C. difficile isolates with reduced susceptibility to metronidazole and vancomycin.
Asunto(s)
Antibacterianos/farmacología , Clostridioides difficile/clasificación , Clostridioides difficile/efectos de los fármacos , Infecciones por Clostridium/microbiología , Metronidazol/farmacología , Ribotipificación , Vancomicina/farmacología , Clostridioides difficile/aislamiento & purificación , Diarrea/microbiología , Pruebas Antimicrobianas de Difusión por Disco , Farmacorresistencia Bacteriana , HumanosRESUMEN
Clostridium difficile infection (CDI) is gradually being recognised as a cause of morbidity in the community. We investigated the incidence and clinical characteristics of CDI in a community setting and characterised the C. difficile strains by toxin gene profiling and polymerase chain reaction (PCR) ribotyping. Patients included in the study had attended general practice, primarily because of diarrhoea; CDI patients (259 patients; 121 <2 years of age) had positive cultures for toxigenic C. difficile and non-CDI patients (455 patients) were culture-negative. Outcome variables included the frequency and duration of diarrhoea, vomiting, stomach ache, fever >38 °C, weight loss and sick leave. Data were analysed by logistic regression. CDI patients <2 and ≥2 years of age with C. difficile as the only enteropathogen in the faecal sample reported slimy stools (65% vs. 62%), stomach ache (60% vs. 75%), weight loss (50% vs. 76%) and duration of diarrhoea >15 days (59% vs. 73%) as the predominant symptoms. CDI patients ≥2 years old reported duration of diarrhoea >15 days more often compared to non-CDI patients (73% vs. 27 %, p < 0.0001). The annual incidence of CDI was 518 and 23/100,000 for patients <2 and ≥2 years of age, respectively, and 46/100,000 in the subgroup of patients ≥60 years of age. CDI was characterised by stomach ache and persistent diarrhoea, often leading to weight loss. This emphasises the importance of diagnosing CDI not only in hospitalised patients, but also in individuals ≥2 years of age attending general practice because of gastrointestinal symptoms, especially in the elderly, where the incidence of CDI is high.
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/patología , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/patología , Diarrea/epidemiología , Diarrea/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Toxinas Bacterianas/genética , Niño , Preescolar , Clostridioides difficile/clasificación , Clostridioides difficile/genética , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Medicina General , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Ribotipificación , Adulto JovenRESUMEN
To identify risk factors for Clostridium difficile infection (CDI) in Danish patients consulting general practice with gastrointestinal symptoms, a prospective matched case-control study was performed; cases (N = 259) had positive cultures for toxigenic C. difficile and controls (N = 455) negative cultures. Data were analysed by conditional logistic regression. In patients aged ⩾2 years (138 cases), hospitalization [odds ratio (OR) 8·4, 95% confidence interval (CI) 3·1-23], consumption of beef (OR 5·5, 95% CI 2·0-15), phenoxymethylpenicillin (OR 15, 95% CI 2·7-82), dicloxacillin (OR 27, 95% CI 3·6-211), and extended spectrum penicillins (OR 9·2, 95% CI 1·9-45) were associated with CDI. In patients aged <2 years none of these were associated with CDI, but in a subgroup analysis contact with animals was associated with CDI (OR 8·1, 95% CI 1·0-64). This study emphasizes narrow-spectrum penicillins, and suggests beef consumption, as risk factors for CDI in adults, and indicates a different epidemiology of CDI in infants.
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos , Estudios de Casos y Controles , Niño , Preescolar , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Dinamarca/epidemiología , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Medicina General/estadística & datos numéricos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Adulto JovenRESUMEN
The occurrence of the two Shewanella species found in clinical specimens, Shewanella algae and Shewanella putrefaciens, correlates with the temperature and salinity of seawater. This means that Shewanella infections occur in warm climates or during especially warm summers in temperate climates. The infections described most commonly involve ears, skin and soft tissue, with or without bacteraemia. Primary bacteraemia with a fulminant course is also seen in immunocompromised patients. Important differential characteristics between the two species include the ability of S. algae to produce mucoid colonies with beta-haemolysis on sheep blood agar, to grow at 42 degrees C and in NaCl 6% w/v, and to reduce nitrite, and an inability to produce acid from maltose, all of which are in contrast to the characteristics of S. putrefaciens. Automated identification systems fail to differentiate between S. algae and S. putrefaciens, as S. algae is not included in the databases of these systems. Presumably for this reason, most Shewanella infections reported during recent years have been attributed to S. putrefaciens. However, when extensive phenotypic characterisation is performed, most human infections are seen to be caused by S. algae. As the two species seem to have different pathogenic potential for humans, correct identification is important, and this is possible in routine clinical microbiology laboratories.
Asunto(s)
Infecciones por Bacterias Gramnegativas , Shewanella , Animales , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Enfermedades del Oído/patología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/patología , Humanos , Pruebas de Sensibilidad Microbiana , Fenotipo , Agua de Mar/microbiología , Shewanella/efectos de los fármacos , Shewanella/aislamiento & purificación , Shewanella/patogenicidad , Shewanella putrefaciens , Enfermedades Cutáneas Bacterianas/patología , TemperaturaRESUMEN
Bactec Plus blood culture bottles were preincubated at 35 degrees C or at room temperature before entry into the Bactec 9240 instrument to determine the influence of preincubation temperature and time. Of 463 positive blood culture sets, 956 bottles were positive, of which the instrument detected 92.1%. Of 76 positive bottles undetected by the instrument, 68 were preincubated at 35 degrees C and eight at room temperature. The median entry delay and instrument detection times were 17.9 and 7.2 h for preincubated bottles, and 16.4 and 13.4 h for bottles held at room temperature. Short entry delay and inspection before entry into the instrument are necessary if preincubation at 35 degrees C is used.
Asunto(s)
Bacteriemia/microbiología , Técnicas Bacteriológicas/instrumentación , Automatización , Bacterias/aislamiento & purificación , Técnicas Bacteriológicas/métodos , Humanos , Temperatura , Factores de Tiempo , Levaduras/aislamiento & purificaciónRESUMEN
Danish isolates of Shewanella algae constituted by whole-cell protein profiling a very homogeneous group, and no clear distinction was seen between strains from the marine environment and strains of clinical origin. Although variation between all strains was observed by ribotyping and random amplified polymorphic DNA analysis, no clonal relationship between infective strains was found. From several patients, clonally identical strains of S. algae were reisolated up to 8 months after the primary isolation, indicating that the same strain may be able to maintain the infection.
Asunto(s)
Enfermedades del Oído/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Shewanella/clasificación , Shewanella/genética , Microbiología del Agua , Proteínas Bacterianas/química , Técnicas de Tipificación Bacteriana , Enzimas de Restricción del ADN/metabolismo , ADN Bacteriano/análisis , ADN Bacteriano/genética , Dinamarca/epidemiología , Enfermedades del Oído/epidemiología , Electroforesis en Gel de Poliacrilamida , Infecciones por Bacterias Gramnegativas/epidemiología , Humanos , Técnica del ADN Polimorfo Amplificado Aleatorio , Agua de Mar , Shewanella/aislamiento & purificaciónRESUMEN
Seventy-eight patients with culture-positive epidural catheters were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had en epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of central nervous system infection of at least 0.7% at Odense University Hospital. The patients with generalized symptoms of infection had been catheterized for a longer time, and were older than patients with only local symptoms of infection. The microorganisms isolated from the epidural catheters were coagulase- negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and other bacteria (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and propose prophylactic and diagnostic guidelines for epidural catheter-related infections.
Asunto(s)
Analgesia Epidural/efectos adversos , Anestesia Epidural/efectos adversos , Cateterismo/efectos adversos , Meningitis Bacterianas/microbiología , Adulto , Anciano , Contaminación de Equipos , Femenino , Humanos , Masculino , Meningitis Bacterianas/diagnóstico , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of central nervous system infection of at least 0.7% at Odense University Hospital. This degree of infection is of the same magnitude as that reported for intravascular devices. We found that the patients with generalized symptoms of infection had been catheterized for a longer time, and were older than patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and suggest a proposal for prophylactic and diagnostic guidelines for epidural catheter-related infections.