RESUMO
Approximately 20% of Shigella isolates tested in New York City, New York, USA, during 2013-2015 displayed decreased azithromycin susceptibility. Case-patients were older and more frequently male and HIV infected than those with azithromycin-susceptible Shigella infection; 90% identified as men who have sex with men. Clinical interpretation guidelines for azithromycin resistance and outcome studies are needed.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Shigella/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Azitromicina/farmacologia , Criança , Pré-Escolar , Coinfecção , Feminino , Infecções por HIV , Homossexualidade Masculina , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Shigella/isolamento & purificação , Adulto JovemRESUMO
The use of pulsed field gel electrophoresis and neisserial lipoprotein gene sequencing for subtyping Neisseria gonorrhoeae has not been reported in the evaluation of sexually abused children. We report the application and implications of combining pulsed field gel electrophoresis and lipoprotein subtyping in the evaluation of a 3-year-old girl with N. gonorrhoeae infection.
Assuntos
Proteínas da Membrana Bacteriana Externa/genética , Técnicas de Tipagem Bacteriana/métodos , Abuso Sexual na Infância/diagnóstico , Medicina Legal/métodos , Gonorreia/microbiologia , Neisseria gonorrhoeae/classificação , Adolescente , Pré-Escolar , Eletroforese em Gel de Campo Pulsado , Feminino , Genótipo , Humanos , Masculino , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Análise de Sequência de DNARESUMO
OBJECTIVES: To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) among AIDS patients in a long-term-care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain. DESIGN: Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance. SETTING: An 80-bed AIDS-care unit in an LTCF PARTICIPANTS: Staff and residents on the unit. RESULTS: From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n=65) and staff (n=70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolates showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized. CONCLUSIONS: Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.
