The occurrence of beta-lactamase production in Haemophilus influenzae, Branhamella catarrhalis and Moraxella nonliquefaciens was compared in 191 healthy children attending day nurseries in 2 municipalities differing with regard to the prescription rate of beta-lactam antibiotics. A significantly higher frequency of beta-lactamase production was recorded in M. nonliquefaciens isolated in the municipality with the higher prescription rate. A corresponding difference was not recorded for H. influenzae or B. catarrhalis. Approximately 75% of the nasopharyngeal pathogens H. influenzae, B. catarrhalis and Streptococcus pneumoniae, as well as the commensal M. nonliquefaciens, were eliminated and often replaced by other strains of either species over a period of one month. Although none of the children were on antibiotics a substantial proportion of the acquired strains produced beta-lactamase. This suggested that the carrier rate of beta-lactamase producing strains of the respiratory tract is not only related to the effect of recent antibiotic treatment but also to the prevalence of such strains in the population.
A retrospective case-control study was initiated at Uppsala University Hospital in 2006 during a major outbreak caused by a Klebsiella pneumoniae strain producing CTX-M-15. To identify risk factors associated with acquisition of the outbreak strain in the urinary tract, 52 case patients with a urine culture positive for the outbreak strain between 1 May and 31 December 2005 were enrolled. Case patients were matched 1:2 with concurrently hospitalized control patients with significant growth of susceptible Escherichia coli in a urine sample. Conditional logistic regression analyses identified hospital stay >or=9 days (odds ratio (OR) 18.8, 95% confidence interval (CI) 5.74-61.2), nasogastric feeding tube (OR 18.0, 95% CI 2.28-142) and diarrhoea (OR 9.62, 95% CI 3.30-28.1) as risk factors with high ORs. The odds of previous use of cephalosporins were 7.58 (95% CI 3.13-18.4) times higher in case patients compared with the controls. Several multivariable models were evaluated to reduce bias from confounding. These models identified prolonged period of hospitalization, diarrhoea, malignancy and antibiotic use as the most important risk factors for acquisition of the outbreak strain, factors that are often found in elderly patients with a poor functional status.
Chlamydia pneumoniae infections have earlier been described as mycoplasma-like illnesses in young people, and also appear to be associated with community-acquired pneumonia in adults. In this retrospective study, 12.2% (23/188) of patients with pneumonia who required hospitalization during the 3 years 1985-87 had serological evidence of recent C. pneumoniae infection. Many of these patients had symptoms similar to ornithosis. The most interesting finding was that half of the patients with a 4-fold IgG antibody titre rise to C. pneumoniae also had an increased alkaline phosphatase concentration.
The prevalence of urinary tract infections (UTIs) caused by extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae is increasing and the therapeutic options are limited, especially in primary care. Recent indications have suggested pivmecillinam to be a suitable option. Here, we evaluated the clinical and bacteriological effects of pivmecillinam in UTIs caused by ESBL-producing Enterobacteriaceae.
We carried out a prospective follow-up of 39 patients diagnosed with UTI caused by ESBL-producing Enterobacteriaceae, initiated on pivmecillinam. The patients were from general practice (n = 29) or admitted to hospitals (n = 10) in the Copenhagen area, Denmark (n = 30) or Halland, Sweden (n = 9). Both patients and physicians were asked to complete a questionnaire on the pretreatment signs and symptoms. Patients were asked to send in two more urine samples for culture examination, together with questionnaires for clinical effect, 2-6 and 10-20 days, respectively, after end of treatment.
Of the 39 patients included, 30 received a treatment regimen of 400 mg of pivmecillinam three times a day and 9 received 200 mg three times a day. All isolates were susceptible to mecillinam. The bacteriological cure rate was 79% (31/39); 80% (24/30) and 78% (7/9) for 400 and 200 mg three times a day, respectively. Relapse, i.e. ESBL-producing bacteria in the second control urine after previous bacteriological cure, was seen in five patients. Clinical cure was evaluable in 19 patients; 16 had a clinical effect (84%).
Pivmecillinam was proven bacteriologically and clinically effective for treatment of lower UTIs caused by ESBL-producing Enterobacteriaceae.
In Finland, occurrence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has previously been sporadic and related to travel. We describe the first outbreak of colonisation with KPC-KP strain ST512; it affected nine patients in a 137-bed primary care hospital. The index case was detected by chance when a non-prescribed urine culture was taken from an asymptomatic patient with suprapubic urinary catheter in June 2013. Thereafter, all patients on the 38-bed ward were screened until two screening rounds were negative and extensive control measures were performed. Eight additional KPC-KP-carriers were found, and the highest prevalence of carriers on the ward was nine of 38. All other patients hospitalised on the outbreak ward between 1 May and 10 June and 101 former roommates of KPC-KP carriers since January had negative screening results. Two screening rounds on the hospital's other wards were negative. No link to travel abroad was detected. Compared with non-carriers, but without statistical significance, KPC-KP carriers were older (83 vs 76 years) and had more often received antimicrobial treatment within the three months before screening (9/9 vs 90/133). No clinical infections occurred during the six-month follow-up. Early detection, prompt control measures and repetitive screening were crucial in controlling the outbreak.
A plasmid-encoded ClpK protein was recently identified as a predictor of a heat-resistant phenotype in the opportunistic pathogen Klebsiella pneumoniae. This study was undertaken to evaluate the presence of the clpK gene in extended-spectrum ß-lactamase (ESBL)-producing K. pneumoniae and to assess the probable co-transfer of multi-resistance with the heat resistance phenotype. A Danish collection of 80 ESBL-producing K. pneumoniae bloodstream infection isolates was screened for clpK by colony hybridization. Nineteen isolates (24%) were positive for clpK; some of them representing major clones identified in Denmark. Among these, nine isolates belonged to a single K. pneumoniae CTX-M-15 clone with sequence type (ST)16 exhibiting a heat-resistant phenotype. This clone has a multi-hospital occurrence and has also been detected outside Denmark. Horizontal co-transfer of multiple antibiotic resistances, including the CTX-M-15 resistance determinant, and the heat resistance phenotype was observed. Thus, the clpK gene is harbored by different ESBL-producing K. pneumoniae isolates including a clone of ST16 internationally spread. The co-localization of clpK on transferable ESBL-encoding plasmids allowing co-dissemination of multiple drug resistance with bacterial heat resistance is a highly interesting phenomenon that may further complicate the prevention of spreading of certain successful clones of multi-resistant K. pneumoniae.