Following an outbreak of meningococcal disease in three schoolchildren in a small community in northern Norway, DNA fingerprinting, serotyping with monoclonal antibodies, serogrouping, and sulfonamide sensitivity testing were applied for characterization and tracing of the causative agent. The three case isolates were genomically indistinguishable, sulfonamide-resistant, serogroup B, serotype 15 meningococci. Throat specimens were collected from 552 healthy contacts, including all children below age 17 and their parents. Among the 36 carrier isolates (carrier rate, 6.5%) 13 showed DNA fingerprints identical, or almost identical, to the index pattern. All of these 13 isolates were sulfonamide resistant, 12 were of serotype 15, and 8 were of polysaccharide serogroup B (5 were nongroupable). These closely related isolates were almost exclusively recovered from schoolchildren of 2 of 15 small villages, one of which included the homes of two of the patients. The remaining 23 carrier isolates were nonresistant, non-type 15 meningococci of widely differing DNA restriction patterns. Our results confirm that DNA fingerprinting has potential as an efficient tool in practical meningococcal epidemiology.
A collection of 178 pneumococcal isolates found in Norway during the period 1987-1994 were tested for their susceptibility to benzylpenicillin, macrolides (azithromycin, clarithromycin, dirithromycin, erythromycin, roxithromycin, spiramycin), fluoroquinolones (ciprofloxacin, sparfloxacin), imipenem, chloramphenicol, and vancomycin by a standard agar dilution procedure. To benzylpenicillin, two strains (1%) showed resistance and 14 strains (8%) intermediate susceptibility. Towards erythromycin, eight strains (4%) showed resistance and four strains (2%) intermediate susceptibility. Cross-resistance was demonstrated among the macrolides. Among the fluoroquinolones, intermediate susceptibility occurred with 42% of the isolates for sparfioxacin and 90% for ciprofloxacin; to the latter 5.1% proved resistant. The sum of intermediate and highly resistant isolates was 53% for chloramphenicol. Both penicillin-resistant strains were isolated during the last 2 years of collection and came from patients of non-Norwegian ethnic background. Imported strains appeared over represented among the strains resistant to penicillin and macrolides. Only imipenem and vancomycin showed full susceptibility for all pneumococci tested. An over representation of serogroup 6 strains was apparent among the strains with intermediate susceptibility and high resistance to benzylpenicillin. It is apparent that high-level resistance has, not so far, become a difficult problem in Norway. Nevertheless, the situation requires monitoring of the resistance level, particularly in meningitis and septic patients, and certainly in patients who cntail a higher than usual possibility of acquiring pneumococci from pools of resistant strains outside Norway (visitors, immigrants and recent returness from abroad).
Blood culture results obtained in a single tertiary neonatal intensive care unit are reviewed. In 4416 admissions occurring over 6 y we identified 206 positive cultures (4.7/100 admissions) growing 234 bacterial and fungal isolates in 182 infants. Very early and early onset positive cultures comprised 17% and 22% each. Gram-positive bacteria dominated in very early (61%), early (91%) and late onset (78%) cultures with coagulase-negative staphylococci (CONS) as the most frequent isolate in all groups (22%, 46% and 55%, respectively). The 3 most frequent isolates following CONS were in very early onset cultures Escherichia coli (19%), anaerobic bacteria (17%) and group B streptococci (GBS) (14%), in early onset cultures Staphylococcus aureus (28%), Enterococci (7%), E. coli (6%) and Viridans streptococci (6%) and in late onset cultures S. aureus (15%), Candida species (8%) and E. coli (5%). Infants
The prevalence of resistant enterococci varies geographically. In the present study we looked at the carrier rate of resistant enterococci in the hematology and gastrointestinal surgery units of a tertiary care hospital in Norway. Anal swabs were taken from all 82 hospitalized patients on 4 different dates, at least 4 weeks apart, in 1995. 51% had positive cultures for enterococci. 6% of all patients carried enterococci resistant to ampicillin. 7% carried enterococci with high-level gentamicin resistance. Two strains resistant to vancomycin were found, including the first vanA Enterococcus faecium isolated in a Norwegian hospital. There was a correlation between use of antibiotics and being a carrier of enterococci per se, but the correlation with resistant enterococci did not reach statistical significance owing to the small number of isolates. The carrier rates both for presence of enterococci and for resistant enterococci were generally lower than those found in other studies.
ment of Paediatrics, Oslo University Hospital Institute of Clinical Medicine, University of Oslo Division of Infectious Disease Control, Norwegian Institute of Public Health Unit of Biostatistics and Epidemiology, Oslo University Hospital Department of Microbiology, Oslo University Hospital, Oslo, Norway.
Clin Microbiol Infect ABSTRACT: A longitudinal, prospective study was conducted intermittently in Norway, from 1999 to 2008, to investigate the Candida colonization rates and species distributions in the tonsillopharyngeal and faecal flora in: (i) children with cancer; (ii) children with cystic fibrosis (CF); and (iii) healthy children. The effect of antibiotic treatment on Candida colonization was also studied, and we looked for changes in antifungal susceptibility over time within each child and between the different groups of children. In total, 566 tonsillopharyngeal swabs and 545 faecal samples were collected from 45 children with cancer, 37 children with CF, and 71 healthy, age-matched controls. The overall colonization rate with Candida was not significantly higher in the two groups of children undergoing extensive treatment with broad-spectrum antibiotics than in healthy controls. Approximately one-third of the cancer patients had a total lack of Candida colonization or had only one Candida-positive sample, despite multiple samples being taken, treatment with broad-spectrum antibiotics, long hospital stays, and periods with neutropenia. Children with CF had the highest prevalence of Candida albicans. Amoxycillin, azithromycin, third-generation cephalosporins and oral vancomycin resulted in a significantly increased Candida colonization rate. Phenoxymethylpenicillin, second-generation cephalosporins, metronidazole, trimethoprim-sulphamethoxazole, ciprofloxacin, penicillinase-resistant penicillins and inhaled tobramycin or colistin showed minimal effects on the Candida colonization rate. We found no evidence of development of antifungal resistance over time.
Since 1991 information on yeast isolates from blood cultures has been recorded prospectively from all microbiological laboratories (5 university and 16 county or local hospital laboratories) in Norway (population, 4.3 million). From 1991 to 1996 a total of 571 episodes of fungemia in 552 patients occurred (1991, 109 episodes; 1992, 81 episodes; 1993, 93 episodes; 1994, 89 episodes; 1995, 98 episodes; and 1996, 101 episodes). The fungemia rates per 10,000 patient days were 0.29 in 1991 and 0.27 in 1996. The average rates for the years 1991 to 1996 were 0.37 for the university laboratories and 0.20 for the other laboratories. These rates are low compared to the rate (0. 76) in five Dutch university hospitals in 1995 and the rate (2.0) in Iowa in 1991. The four most frequently isolated species were Candida albicans (66%), Candida glabrata (12.5%), Candida parapsilosis (7.6%), and Candida tropicalis (6.4%). The incidences of both C. albicans (range, 63 to 73%) and C. glabrata (range, 8.4 to 15.7%) varied somewhat throughout this period, but no significant increase or decrease was noted. MICs of amphotericin B, flucytosine, and fluconazole were determined for 89% of the isolates. All were susceptible to amphotericin B, and only 29 (5.6%) strains had decreased susceptibility to flucytosine. All C. albicans isolates were susceptible to fluconazole. The percentage of yeast isolates with decreased susceptibility to fluconazole (MICs, >/=16 microgram/ml) did increase, from 9.6% in 1991 and 1992 to 12.2% in 1994, 16.1% in 1995, and 18.6% in 1996. This was largely due to increases in the percentages of resistant C. glabrata and Candida krusei strains in the last 2 years. Compared to the incidence in other countries, it is remarkable that Norway has such a low and constant incidence of fungemia. A possible reason for this difference might be a restricted antibiotic use policy in Norway.
Following an outbreak of Candida septicemia in our intensive care nursery we reviewed our routines for diagnosis and treatment of neonatal infections. The revision resulted in a set of written guidelines for septic work-ups, initiation and discontinuation of antibiotic therapy, and choice of antibiotics. In this article we present the guidelines for dealing with bacterial and fungal infections, along with relevant comments.
Viral and protozoal infections are often suspected as causes of neonatal illness or congenital anomalies. The TORCH titer has traditionally been the foremost diagnostic tool in this context, but it is now becoming increasingly clear that this tool is inadequate, partly for conceptual reasons, but also because of the often uncritical way in which it is used. During a recent critical review of our routines and practices for diagnosis and treatment of neonatal infections we also revised our approach to the diagnosis and treatment of suspected pre- or perinatally acquired viral, spirochetal, and protozoal illnesses. The resulting guidelines, originally intended for our house staff, are presented here.
Comment In: Tidsskr Nor Laegeforen. 1993 Aug 10;113(18):22838362399
Our aim was to investigate the use of DNA amplification with the ligase chain reaction (LCR) for detection of the Mycobacterium tuberculosis complex directly in human clinical specimens. The LCR assay employed was the Abbott LCx MTB Assay, which uses the gene encoding protein antigen b as the target template. Four hundred eighty-two samples from 457 patients in one clinical microbiology laboratory in Norway were processed by routine culture analysis (BACTEC culture), direct microscopy (Ziehl-Neelsen staining) and LCR. Of the 118 specimens containing cultivable M. tuberculosis, 106 (90.6%) were detected by LCR. Among the 364 culture-negative specimens, 356 samples were negative also by LCR and 8 (1.6%) were positive by LCR. In five of the eight LCR-positive and culture-negative samples, another sample from the same patient was M. tuberculosis culture positive and/or the patient had symptoms of tuberculosis. In comparison with culture, the sensitivity of LCR was 96.7% for smear-positive samples and 72.0% for smear-negative samples, respectively. For all samples combined, the sensitivity, specificity, and positive and negative predictive values were 90.2, 99.2, 97.4, and 96.7%, respectively. Challenging the M. tuberculosis LCR test with DNAs and cultures from strains of Mycobacterium ulcerans and Mycobacterium marinum, which are the mycobacterial species most closely related to the M. tuberculosis complex, resulted in all-negative test results. The sensitivity, specificity, and positive and negative predictive values of BACTEC culture in comparison with the LCR test and clinical criteria were 95.9, 100, 100, and 98.6%, respectively. A certain prioritization of samples subjected to the LCR assay should be based on clinical indications and risks with regard to infection transmission and patient isolation policy. More automation and lower expenses are generally desired for nucleic acid amplification kits. However, this M. tuberculosis LCR assay represents a valuable tool in routine mycobacterial diagnostics.
The article briefly surveys the epidemiology of Streptococcus pyogenes caused disease in Norway during the last 15 years based on notification data, with emphasis on the nation-wide outbreak in 1987-88 caused by mucoid M-1 organisms. During the season S. pyogenes infections was 60% higher than expected. The number of bacteraemia cases, many with fulminant septicaemia, showed an almost threefold increase compared with earlier years. Unusual clinical manifestations such as necrotising fasciitis, pneumonia with empyema, primary peritonitis and meningitis also occurred. We briefly review the known virulence factors of S. pyogenes in an attempt to improve our understanding of the shift in clinical manifestations and occurrence of the disease.