Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK 99508, USA. zwa8@cdc.gov
BACKGROUND: Previous studies in Alaska have demonstrated elevated proportions of antimicrobial resistance among Helicobacter pylori isolates. MATERIALS AND METHODS: We analyzed H. pylori data from the Centers for Disease Control and Prevention (CDC)'s sentinel surveillance in Alaska from July 1999 to June 2003 to determine the proportion of culture-positive biopsies from Alaska Native persons undergoing routine upper-endoscopy, and the susceptibility of H. pylori isolates to metronidazole [minimum inhibitory concentration (MIC) of > 8 g metronidazole/mL), clarithromycin (MIC > or = 1), tetracycline (MIC > or = 2) and amoxicillin (MIC > or = 1)] using agar dilution. RESULTS: Nine-hundred sixty-four biopsy specimens were obtained from 687 participants; 352 (51%) patients tested culture positive. Mean age of both culture-positive and culture-negative patients was 51 years. Metronidazole resistance was demonstrated in isolates from 155 (44%) persons, clarithromycin resistance from 108 (31%) persons, amoxicillin resistance from 8 (2%) persons, and 0 for tetracycline resistance. Metronidazole and clarithromycin resistance varied by geographic region. Female patients were more likely than male subjects to show metronidazole resistance (p
Escherichia coli was the most commonly isolated pathogen in the Canadian Ward Surveillance Study 2007-2009 (3789 isolates). Susceptibility to cefazolin (34.1%), trimethoprim-sulfamethoxazole (73.8%), ciprofloxacin (78.4%), and levofloxacin (78.8%) was lowest. Susceptibility was above 90% for meropenem (100%), tigecycline (99.9%), piperacillin-tazobactam (97.6%), nitrofurantoin (96.9%), ceftazidime (95.6%), amoxicillin-clavulanate (94.9%), ceftriaxone (94.1%), cefoxitin (92.3%), and gentamicin (90.8%). Over the study period, there was a significant reduction in susceptibility to amoxicillin-clavulanate and trimethoprim-sulfamethoxazole for urinary tract isolates. Inpatient status was associated with greater resistance to nearly all antimicrobials including greater multidrug resistance (MDR). Increasing age was associated with resistance to fluoroquinolones, ceftriaxone, piperacillin-tazobactam, and MDR. Female gender was associated with susceptibility to fluoroquinolones and nitrofurantoin. In conclusion, greater antimicrobial resistance and MDR in E. coli were observed in inpatients, males, and with increasing age. The deterioration of susceptibility to trimethoprim-sulfamethoxazole continues with the greatest reduction in urinary isolates. Significant regional differences in resistance rates were apparent.
BACKGROUND: Rising numbers of bullous impetigo caused by Staphylococcus aureus resistant to fucidic acid have been seen in Norway over the last few years. MATERIAL AND METHODS: We present a population-based cohort study of an epidemic in an island community in western Norway with approximately 4450 people. The district's doctors agreed upon guidelines for regimes of antibiotic treatment; taking specimens for bacteriological examination was made routine procedure. The patients included in the study were identified from all patient files from all consultations with all doctors in the district. Clinical, therapeutical and bacteriological variables were registered. A comparison with the present Norwegian guidelines developed by a conference of experts is made. RESULTS: 108 patients were diagnosed as having bullous impetigo (2.4% of the population). Bacteriological swabs were taken from 95 (88%) patients. Staphylococcus aureuswas the bacteriologic aetiology in 79 (83%) of these and were found to be resistant to fusidic acid in 67 (85%) isolates. DISCUSSION: Our findings support the hypothesis that the rising numbers of impetigo might be caused by a clone of Staphylococcus aureus that is resistant to fusidic acid.
To describe the investigation and management of an outbreak due to multiresistant Acinetobacter baumannii and to determine risk factors for acquisition of the organism.
A 14-bed regional burn unit in a Canadian tertiary-care teaching hospital.
Case-control study with multivariate analysis of potential risk factors using logistic regression analysis. Surveillance cultures were obtained from the hospital environment, from noninfected patients, and from healthcare providers.
A total of 31 (13%) of 247 patients with acute burn injuries acquired multiresistant A. baumannii between December 1998 and March 2000; 18 (58%) of the patients were infected. The organism was recovered from the hospital environment and the hands of healthcare providers. Significant risk factors for acquisition of multiresistant A. baumannii were receipt of blood products (odds ratio [OR], 10.8; 95% confidence interval [CI95], 3.4 to 34.4; P
To investigate an outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit (ICU).
Epidemiologic investigation, environmental assessment, and ambidirectional cohort study.
A secondary-care university hospital with a 10-bed ICU.
All patients admitted to the ICU receiving ventilator treatment from December 1, 1999, to September 1, 2000.
An outbreak in an ICU with multidrug-resistant isolates of P aeruginosa belonging to one amplified fragment-length polymorphism (AFLP)-defined genetic cluster was identified, characterized, and cleared. Molecular typing of bacterial isolates with AFLP made it possible to identify the outbreak and make rational decisions during the outbreak period. The outbreak included 19 patients during the study period. Infection with bacterial isolates belonging to the AFLP cluster was associated with reduced survival (odds ratio, 5.26; 95% confidence interval, 1.14 to 24.26). Enhanced barrier and hygiene precautions, cohorting of patients, and altered antibiotic policy were not sufficient to eliminate the outbreak. At the end of the study period (in July), there was a change in the outbreak pattern from long (December to June) to short (July) incubation times before colonization and from primarily tracheal colonization (December to June) to primarily gastric or enteral July) colonization. In this period, the bacterium was also isolated from water taps.
Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.
The article is based on an analysis of results of complex treatment of 497 patients with pancreatonecrosis at the period from 2010 to 2014. All patients were admitted to the surgical departments of Republican hospital No 2 and Centre of Emergency Medicine of Republic of Sakha (Yakutia). The investigation allowed adaptation and development of antibiotic prophylaxis and therapy management in pancreatonecrosis in multifield surgical hospital. More than 80% of patients avoided a contamination of necrotic destruction zones. The level of lethality was reduced in group of patients with infectious complications of pancreatonecrosis from 45.8% to 37.7%.
Antibiotic resistance was compared in 844 Campylobacter jejuni/coli strains acquired outside Sweden and 575 acquired in Sweden during 1990-2002. There was a clear gradual increase in ciprofloxacin and tetracycline resistance among C. jejuni/coli strains acquired outside Sweden during the 13 y period. This trend was not seen for erythromycin or in domestically acquired strains for any of the 3 antibiotics tested.
The results of the statistical treatment of data on the analyses of 766 children, the residents of Moscow, for dysbacteriosis are presented; of these children, 34 were aged up to 1 month and 732, from 1 month to 1 year. This study revealed that in the fist year of life in children with dysbacteriosis the dominating bacterial species were S. aureus, bacteria of the genus Klebsiella and fungi of the genus Candida. From the intestine of children aged up to 1 month S. aureus and Klebsiella were isolated more often than from children aged up to 1 year. The results of the study of antibioticograms demonstrated that 21.6% of S. aureus strains and 74.4% of Klebsiella strains were multiresistant to antibiotics. Taking into account the fact that multiresistance to antibiotics was characteristic of hospital strains, the suggestion was made that the isolated strains were of hospital origin and such strains could colonize the intestine of children in maternity hospitals.
Staphylococcus aureus has become a frequent coloniser of the intestinal tract of infants, but the health effects of such colonisation are not clear. In this study, the antibiotic resistance patterns of 116 S. aureus strains from the commensal intestinal microflora were determined. The strains were obtained from 81 Swedish infants who had been followed with regular stool samples and registration of antibiotic usage during their first year of life. The faecal population levels of the individual strains and the duration of their persistence in the microflora had been determined previously. The prevalence of antibiotic resistance among the 116 strains was modest: methicillin, 0%; penicillin G, 78%; erythromycin A, 3%; tetracycline, 2%; clindamycin, 0.9%; and fusidic acid, 0.9%. Colonisation by antibiotic-resistant strains was unrelated to antibiotic consumption by individual infants. Antibiotic-resistant strains were as capable of persisting in the intestinal microflora and reaching high faecal population levels as fully susceptible strains. No strain lost or acquired resistance during the colonisation period. Thus, antibiotic-resistant strains of S. aureus seem to be as fit for competition in the large bowel microflora as susceptible strains, even in the absence of selective pressure from antibiotics. This may aggravate the ecological consequences of antibiotic resistance development.
