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Puig C, Calatayud L, Martí S, Tubau F, Garcia-Vidal C, Carratalà J, Liñares J, Ardanuy C. Molecular epidemiology of nontypeable Haemophilus influenzae causing community-acquired pneumonia in adults. PLoS One 2013; 8:e82515. [PMID: 24349303 PMCID: PMC3862678 DOI: 10.1371/journal.pone.0082515] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) is an opportunistic pathogen which causes a variety of respiratory infections. The objectives of the study were to determine its antimicrobial susceptibility, to characterize the β-lactam resistance, and to establish a genetic characterization of NTHi isolates. Ninety-five NTHi isolates were analyzed by pulsed field gel electrophoresis (PFGE) and multi locus sequence typing (MLST). Antimicrobial susceptibility was determined by microdilution, and the ftsI gene (encoding penicillin-binding protein 3, PBP3) was PCR amplified and sequenced. Thirty (31.6%) isolates were non-susceptible to ampicillin (MIC ≥ 2 mg/L), with 10 of them producing β-lactamase type TEM-1 as a resistance mechanism. After ftsI sequencing, 39 (41.1%) isolates showed amino acid substitutions in PBP3, with Asn526 → Lys being the most common (69.2%). Eighty-four patients were successfully treated with amoxicillin/clavulanic acid, ceftriaxone and levofloxacin. Eight patients died due either to aspiration or complication of their comorbidities. In conclusion, NTHi causing CAP in adults shows high genetic diversity and is associated with a high rate of reduced susceptibility to ampicillin due to alterations in PBP3. The analysis of treatment and outcomes demonstrated that NTHi strains with mutations in the ftsI gene could be successfully treated with ceftriaxone or fluoroquinolones.
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Affiliation(s)
- Carmen Puig
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, Universitat de Barcelona, Barcelona, Spain
| | - Laura Calatayud
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
| | - Sara Martí
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
| | - Fe Tubau
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
- Spanish Network for Research on Infectious Diseases (REIPI), ISCIII, Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
- Spanish Network for Research on Infectious Diseases (REIPI), ISCIII, Madrid, Spain
| | - Josefina Liñares
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Ardanuy
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
- * E-mail:
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DE Gaudio M, Chiappini E, Galli L, DE Martino M. Therapeutic management of bacterial meningitis in children: a systematic review and comparison of published guidelines from a European perspective. J Chemother 2010; 22:226-37. [PMID: 20685625 DOI: 10.1179/joc.2010.22.4.226] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Bacterial meningitis is an infectious disease emergency that can cause substantial morbidity and mortality. We compared the most recent international guidelines and recommendations on bacterial meningitis management in infants and children in developed countries, in terms of initial management approach, empirical antimicrobial therapy, timing, dosages, and duration of antimicrobial therapy, and possible adjunctive treatment with dexamethasone. Secondly, epidemiological data on bacterial resistance in several european countries were analyzed and discussed in relation to the therapies currently recommended for bacterial meningitis. The comparative analysis of the selected guidelines highlighted significant differences in the therapeutic management of bacterial meningitis. Differences among guidelines have important consequences for daily practice. An agreed protocol for early, evidence-based, and effective therapeutic management of bacterial meningitis is essential for the best outcome. further studies and expert consensus are required to establish the best management of bacterial meningitis in the european setting based on the most recent epidemiological data on resistance rates.
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Affiliation(s)
- M DE Gaudio
- Department of Pediatrics, University of Florence, Florence, Italy
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Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 2008; 35:9-29. [DOI: 10.1007/s00134-008-1336-9] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 10/06/2008] [Indexed: 01/15/2023]
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Lode HM. Rational antibiotic therapy and the position of ampicillin/sulbactam. Int J Antimicrob Agents 2008; 32:10-28. [PMID: 18539004 DOI: 10.1016/j.ijantimicag.2008.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 02/04/2008] [Indexed: 01/22/2023]
Abstract
In the current context of increasing antimicrobial resistance, it is important to use antibiotics rationally and to re-assess regularly the clinical usefulness of commonly used agents. This review focuses on the efficacy of the beta-lactam ampicillin co-administered with the beta-lactamase inhibitor sulbactam, either parenterally (ampicillin/sulbactam) or orally (sultamicillin), for the treatment of bacterial infections. Clinical findings from the past decade confirm the results of numerous older studies and together provide good evidence to support the continued use of ampicillin/sulbactam and sultamicillin in hospital- and community-acquired infections both in adults and children. This is also recognised in recent published national and international guidelines, many of which recommend ampicillin/sulbactam as first-line therapy for various respiratory and skin infections.
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Affiliation(s)
- Hartmut M Lode
- Research Centre for Medical Studies, Institute of Clinical Pharmacology, Charité Universitätsmedizin Berlin, Hohenzollerndamm 2, Berlin, Germany.
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Takahata S, Kato Y, Sanbongi Y, Maebashi K, Ida T. Comparison of the efficacies of oral beta-lactams in selection of Haemophilus influenzae transformants with mutated ftsI genes. Antimicrob Agents Chemother 2008; 52:1880-3. [PMID: 18347113 PMCID: PMC2346623 DOI: 10.1128/aac.00936-07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 10/14/2007] [Accepted: 03/05/2008] [Indexed: 11/20/2022] Open
Abstract
Horizontal transfer of the mutated ftsI gene from beta-lactamase-nonproducing ampicillin-resistant (BLNAR) Haemophilus influenzae to a susceptible strain was examined in vitro under selection with nine oral beta-lactams (ampicillin, amoxicillin, cefprozil, cefuroxime, cefpodoxime, cefdinir, cefcapene, cefditoren, and tebipenem). Compared to the penicillins and the carbapenem, the cephalosporins showed a wide selection window for the genetic transfer.
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Affiliation(s)
- Sho Takahata
- Pharmaceutical Research Center, Meiji Seika Kaisha, Ltd., 760 Morooka-cho, Kohoku-ku, Yokohama 222-8567, Japan.
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Wang A, Yu S, Yao K, Zhang W, Yuan L, Wang Y, Wei J, Shen X, Yang Y. Antimicrobial susceptibility of Haemophilus influenzae strains and antibiotics usage patterns in pediatric outpatients: results from a children's hospital in China (2000-2004). Pediatr Pulmonol 2008; 43:457-62. [PMID: 18360841 DOI: 10.1002/ppul.20789] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the nasopharyngeal carriage and antimicrobial susceptibility of H. influenzae among children younger than 5 years old and to assess antibiotics usage patterns in the outpatient department of Beijing Children's Hospital from 2000 to 2004. MATERIALS AND METHODS From 2000 to 2004, At least 100 strains of H. influenzae were isolated from the pediatric patients who were younger than 5 years and who presented with symptoms of acute upper respiratory tract infections during February to May in each of the study years. Antimicrobial susceptibilities were determined; and antibiotics usage was expressed as defined daily dose (DDD)/100 patient days. RESULTS The overall nasopharyngeal carriage rate of H. influenzae is 26.3% (562/2,137) in children younger than 5 years old with acute upper respiratory tract infection. The percentage of ampicillin-resistant isolates ranges from 4.0% (4/100) to 14.3% (17/119) from 2000 to 2004. All the ampicillin-resistant isolates are beta-lactamase producers. More than 80% of the isolates are susceptible to amoxicillin, cefaclor, and chloramphenicol; whereas, almost all (99-100%) of the isolates are sensitive to amoxicillin/clavulanic acid, ceftriaxone, and cefuroxime. For antibiotics utilization, macrolides are the predominantly used antibiotics, followed by cephalosporins and penicillins among pediatric patients in the outpatient department during the study period. CONCLUSION All amoxicillin-resistant isolates of H. influenzae are producing beta-Lactamase; and the rates of amoxicillin-resistant isolates are increasing over time. Amoxicillin/clavulanic acid and cephalosporins are highly sensitive to H. influenzae isolated from Chinese pediatric patients. Macrolides are the most used antibiotics in the outpatient department during the study period.
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Affiliation(s)
- Aihua Wang
- Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Daoud Z, Cocozaki A, Hakime N. Antimicrobial susceptibility patterns of Haemophilus influenzae and Streptococcus pneumoniae isolates in a Beirut general university hospital between 2000 and 2004. Clin Microbiol Infect 2006; 12:86-90. [PMID: 16460553 DOI: 10.1111/j.1469-0691.2005.01303.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Susceptibility patterns of Streptococcus pneumoniae and Haemophilus influenzae collected over a 5-year period in a Beirut general university hospital were studied. Only 40.6-50% of S. pneumoniae isolates were susceptible to penicillin G. Susceptibility to clindamycin and erythromycin decreased from 94.1% and 89.7%, respectively, in 2000 to 75% and 71.9%, respectively, in 2004. All isolates were susceptible to ceftriaxone, ciprofloxacin and vancomycin. For H. influenzae, no resistance was observed to amoxycillin-clavulanate, ceftriaxone, ciprofloxacin and rifampicin, with >92% of isolates showing susceptibility to cefuroxime, chloramphenicol, erythromycin and tetracycline. The proportion of beta-lactamase-positive isolates varied between 22.7 and 30.8%.
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Affiliation(s)
- Z Daoud
- University of Balamand and Clinical Microbiology Laboratory of the Saint George University Hospital, Beirut, Lebanon.
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Cerquetti M, Cardines R, Giufrè M, Mastrantonio P. Antimicrobial susceptibility of Haemophilus influenzae strains isolated from invasive disease in Italy. J Antimicrob Chemother 2004; 54:1139-43. [PMID: 15486078 DOI: 10.1093/jac/dkh467] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Haemophilus influenzae invasive disease is potentially life threatening and requires prompt antibiotic therapy. The aim of this study was to assess the antimicrobial susceptibility of H. influenzae strains isolated from invasive disease in Italy and to investigate ampicillin-resistant isolates by molecular biology techniques. MATERIALS AND METHODS One-hundred and seventy-six invasive H. influenzae isolates, collected during 1998-2003, were analysed for susceptibility to ampicillin, azithromycin, chloramphenicol and ciprofloxacin. Ampicillin-resistant isolates were further tested against cefotaxime and imipenem. MICs were determined by Etest and interpreted according to NCCLS criteria. The ampicillin resistance genes, bla(TEM) and bla(ROB), were searched for by PCR. Genetic relatedness among ampicillin-resistant isolates was investigated by PFGE. RESULTS Overall, ampicillin resistance was 10.2% (all beta-lactamase producer strains). The prevalence of ampicillin-resistant isolates increased from 6.9% in 1998/1999 to 19% in 2002/2003. Resistance to azithromycin and chloramphenicol was 6.8% and 1.7%, respectively. No strains were resistant to ciprofloxacin. Co-resistance between ampicillin and chloramphenicol and between ampicillin and azithromycin was observed in three and one isolates, respectively. All ampicillin-resistant isolates were susceptible to cefotaxime and imipenem and all harboured the bla(TEM) gene. PFGE demonstrated that most of the ampicillin-resistant isolates showed little genetic homology. CONCLUSIONS An upward trend in resistance to ampicillin due to beta-lactamase production was demonstrated In Italy. According to PFGE results, clonal dissemination of ampicillin-resistant isolates does not occur. Imipenem may represent an appropriate alternative for treatment of H. influenzae invasive disease caused by ampicillin-resistant isolates when third-generation cephalosporins cannot be used.
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Affiliation(s)
- Marina Cerquetti
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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Bricks LF, Mendes CMF, Lucarevschi BR, Oplustil CP, Zanella RC, Bori A, Bertoli CJ. Oropharyngeal colonization by Haemophilus influenzae in healthy children from Taubaté (São Paulo), prior to the Haemophilus influenzae type B vaccination program in Brazil. REVISTA DO HOSPITAL DAS CLINICAS 2004; 59:236-43. [PMID: 15543393 DOI: 10.1590/s0041-87812004000500003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Haemophilus influenzae is one of the most important bacterial agents of otitis and sinusitis. H. influenzae type b (Hib) is one of the main causes of meningitis, pneumonia, and septicemia in nonvaccinated children under 6 years of age. The aims of this study were to determine the prevalence of H. influenzae and Hib oropharyngeal colonization prior to the onset of the Hib vaccination program in Brazil in previously healthy children and to assess the susceptibility profile of this microorganism to a selected group of antimicrobials that are used to treat acute respiratory infections. METHOD Cultures of Haemophilus influenzae were made from oropharynx swabs from 987 children under 6 years of age who were enrolled in 29 day-care centers in Taubaté (a city of São Paulo state, Brazil) between July and December 1998. RESULTS The prevalence of H. influenzae carriers was 17.4%, and only 5.5% of the strains were beta-lactamase producers. The prevalence of Hib carriers was high, 7.3% on average (range, 0.0 - 33.3%). CONCLUSIONS The low prevalence of colonization by penicillin-resistant strains indicates that it is not necessary to substitute ampicilin or amoxicilin to effectively treat otitis and sinusitis caused by H. influenzae in Taubaté.
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Affiliation(s)
- Lucia Ferro Bricks
- Department of Pediatrics, Children's Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Lee K, Jang SJ, Lee HJ, Ryoo N, Kim M, Hong SG, Chong Y. Increasing prevalence of vancomycin-resistant Enterococcus faecium, expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae, and imipenem-resistant Pseudomonas aeruginosa in Korea: KONSAR study in 2001. J Korean Med Sci 2004; 19:8-14. [PMID: 14966334 PMCID: PMC2822269 DOI: 10.3346/jkms.2004.19.1.8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The 5th year KONSAR surveillance in 2001 was based on routine test data at 30 participating hospitals. It was of particular interest to find a trend in the resistances of enterococci to vancomycin, of Enterobacteriaceae to the 3rd generation cephalosporin and fluoroquinolone, and of Pseudomonas aeruginosa and acinetobacters to carbapenem. Resistance rates of Gram-positive cocci were: 70% of Staphylococcus aureus to oxacillin; 88% and 16% of Enterococcus faecium to ampicillin and vancomycin, respectively. Seventy-two percent of pneumococci were nonsusceptible to penicillin. The resistance rates of Enterobacteriaceae were: Escherichia coli, 28% to fluoroquinolone; Klebsiella pneumoniae, 27% to ceftazidime, and 20% to cefoxitin; and Enterobacter cloacae, > or =40% to cefotaxime and ceftazidime. The resistance rates of P. aeruginosa were 21% to ceftazidime, 17% to imipenem, and those of the acinetobacters were > or =61% to ceftazidime, aminoglycosides, fluoroquinolone and cotrimoxazole. Thirty-five percent of non-typhoidal salmonellae were ampicillin resistant, and 66% of Haemophilus influenzae were beta-lactamase producers. Notable changes over the 1997-2001 period were: increases in vancomycin-resistant E. faecium, and amikacin- and fluoroquinolone-resistant acinetobacters. With the increasing prevalence of resistant bacteria, nationwide surveillance has become more important for optimal patient management, for the control of nosocomial infection, and for the conservation of the newer antimicrobial agents.
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Affiliation(s)
- Kyungwon Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sook-Jin Jang
- Department of Laboratory Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Hee Joo Lee
- Department of Laboratory Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Namhee Ryoo
- Department of Laboratory Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Geun Hong
- Department of Laboratory Medicine, Pundang CHA General Hospital, Pochon CHA University, Sungnam, Korea
| | - Yunsop Chong
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
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