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Santos A, Isidro J, Silva C, Boaventura L, Diogo J, Faustino A, Toscano C, Oleastro M. Molecular and epidemiologic study of Clostridium difficile reveals unusual heterogeneity in clinical strains circulating in different regions in Portugal. Clin Microbiol Infect 2016; 22:695-700. [PMID: 27091093 DOI: 10.1016/j.cmi.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/21/2016] [Accepted: 04/05/2016] [Indexed: 02/04/2023]
Abstract
Clostridium difficile infection (CDI) represents a great healthcare burden in developed countries. The emergence of the epidemic PCR ribotype (RT) 027 and its acquired fluoroquinolones resistance have accentuated the need for an active surveillance of CDI. Here we report the first countrywide study of CDI in Portugal with the characterization of 498 C. difficile clinical isolates from 20 hospitals in four regions in Portugal regarding RT, virulence factors and antimicrobial susceptibility. We identified 96 RTs with marked variations between and within regions, as only six RTs appeared in all four regions. RT027 was the most frequent RT overall (18.5%) and among healthcare facility-associated isolates (19.6%), while RT014 was the most common among community-associated isolates (12%). The north showed a high RT diversity among isolates and a low moxifloxacin (MXF) resistance rate (11.9%), being the only region in which RT027 was not predominant. In contrast, the isolates from the centre presented the highest RT027 frequency, and 53.4% were resistant to MXF. Overall, MXF resistance (33.2%) was associated (p <0.001) with the presence of binary toxin genes and mutations in tcdC regardless of the RT. Both traits appeared in almost 30% of the strains. RT027 showed a reduced susceptibility to metronidazole (p <0.01), and RT126 had higher minimum inhibitory concentrations to vancomycin (p = 0.03) compared to other RTs. The present study highlights an unusual heterogeneity of RTs in Portugal, with a high frequency of hypervirulent RTs and the emergence of virulence factors in non-027 RTs, emphasizing the need for a surveillance system for CDI in Portugal.
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Affiliation(s)
- A Santos
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health, Lisboa, Portugal
| | - J Isidro
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health, Lisboa, Portugal
| | - C Silva
- Innovation and Technology Unit, Human Genetics Department, National Institute of Health, Lisboa, Portugal
| | - L Boaventura
- Service of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Diogo
- Service of Clinical Pathology, Hospital Garcia de Orta, Almada, Portugal
| | - A Faustino
- Service of Clinical Pathology, Hospital de Braga, Braga, Portugal
| | - C Toscano
- Service of Clinical Pathology, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - M Oleastro
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health, Lisboa, Portugal.
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Da Silva G, Simões A, Tavares A, Boaventura L, Vital C, Ribeiro G. P1022 Prevalence and molecular epidemiology of CTX-M extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates in a Portuguese university hospital. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70863-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Puro V, De Carli G, Cicalini S, Soldani F, Balslev U, Begovac J, Boaventura L, Campins Marti M, Hernández Navarrete MJ, Kammerlander R, Larsen C, Lot F, Lunding S, Marcus U, Payne L, Pereira AA, Thomas T, Ippolito G. European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus. Euro Surveill 2005; 10:11-12. [DOI: 10.2807/esm.10.10.00573-en] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up.
Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, >10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted.
Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs >50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs >10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination
The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days).
In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.
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Affiliation(s)
- V Puro
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| | - G De Carli
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| | - S Cicalini
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| | - F Soldani
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| | - U Balslev
- Department of Infectious Diseases, Hvidovre Hospital; Copenhagen, Denmark
| | - J Begovac
- Dr. Fran Mihaljevic University Hospital for Infectious Diseases; Zagreb, Croatia
| | - L Boaventura
- Servicio de Doenças Infecciosas, Hospital de Santa Maria; Lisbon, Portugal
| | - M Campins Marti
- Hospital Vall d’Hebron, Servicio de Medicina Preventiva; Barcelona, Spain
| | | | - R Kammerlander
- Office Fédéral de la Santé Publique, Division Epidémiologie et Maladies Infectieuses, Berne, Switzerland
| | - C Larsen
- Institut de Veille Sanitaire, Département des Maladies Infectieuses, Saint-Maurice, France
| | - F Lot
- Institut de Veille Sanitaire, Département des Maladies Infectieuses, Saint-Maurice, France
| | - S Lunding
- Department of Infectious Diseases, Rigshospitalet; Copenhagen, Denmark
| | - U Marcus
- Robert Koch Institut, Infektionsepidemiologie AIDS/STD; Berlin, Germany
| | - L Payne
- Public Health Laboratory Service, Communicable Disease Surveillance Centre, HIV and STI Division; London, UK
| | - A A Pereira
- Servicio de Doenças Infecciosas, Hospital de Santa Maria; Lisbon, Portugal
| | - T Thomas
- Public Health Laboratory Service, Communicable Disease Surveillance Centre, HIV and STI Division; London, UK
| | - G Ippolito
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
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Puro V, De Carli G, Cicalini S, Soldani F, Balslev U, Begovac J, Boaventura L, Campins Martí M, Hernández Navarrete MJ, Kammerlander R, Larsen C, Lot F, Lunding S, Marcus U, Payne L, Pereira AA, Thomas T, Ippolito G. European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus. Euro Surveill 2005; 10:260-4. [PMID: 16282641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up. Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, >or=10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted. Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs >or=50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs >or=10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days). In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.
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Affiliation(s)
- V Puro
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy
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