European Journal of Clinical Microbiology Infectious Diseases

Hau,

doi: 10.1007/s10096-002-0753-xpmid: 12172739

The vast majority of community-acquired skin and soft tissue infections (SSTIs) are caused by gram-positive cocci or are polymicrobial in nature. Hospital-acquired SSTIs are caused by gram-positive cocci in more than 50% of patients. Multidrug-resistant gram-positive cocci are rarely associated with community-acquired SSTIs but are frequently found in hospital-acquired SSTIs. Linezolid is the first member of a new class of antibiotics, the oxazolidinones. These antimicrobial agents have a unique mechanism of action and exhibit excellent activity against a variety of gram-positive organisms, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Linezolid is 100% orally absorbed, allowing for easy intravenous-to-oral continuation therapy. There is considerable clinical experience with the use of linezolid in SSTIs in phase II and III clinical trials. In comparative trials, linezolid was as effective as oxacillin-dicloxacillin or flucloxacillin in patients with complicated SSTIs caused by gram-positive organisms. Linezolid was also associated with significantly earlier hospital discharge than comparator agents among patients with SSTIs. It was equally effective as vancomycin in patients with SSTIs caused by methicillin-resistant Staphylococcus aureus and has also demonstrated efficacy in patients with SSTIs caused by vancomycin-resistant enterococci. Linezolid is well tolerated: the most common adverse events (gastrointestinal effects, headache) are reported in frequencies similar to those reported for comparator agents. Myelosuppression has been reported after prolonged administration but is reversible after discontinuation of the drug. Overall, linezolid has favorable efficacy and safety profiles and will be an increasingly useful option for the treatment of SSTIs, particularly those due to multidrug-resistant, gram-positive organisms.

Madhi, S.; Ramasamy, N.; Petersen, K.; Madhi, A.; Klugman, K.

doi: 10.1007/s10096-002-0754-9pmid: 12172740

. The aim of this study was to compare the clinical course of severe lower respiratory tract infections associated with human parainfluenza virus types 1–3 (HPIV 1–3) in hospitalised children infected with the human immunodeficiency virus type 1 (HIV-1) versus that in hospitalised children not infected with HIV-1. Children were enrolled prospectively as part of a broader study that evaluated the aetiology of lower respiratory tract infections in HIV-1-infected and -noninfected children from March 1997 through March 1999. HPIV types 1–3 were isolated from nasopharyngeal aspirate samples that were analysed using immunofluorescein monoclonal antibody assays. Thirty percent (24 of 80) of the children from whom HPIV was isolated were infected with HIV-1. Sixty-six percent (47of 62) and 22% (14 of 62) of the HPIV isolates that were typed were subtypes 3 and 1, respectively. The clinical presentation of severe lower respiratory tract infection was similar in both HIV-1-infected and -noninfected children, except that the former were less likely to have wheezing (4.2% vs. 28.6%, P=0.01). Furthermore, the duration of hospitalisation was longer in HIV-1-infected children than in HIV-1-noninfected children (median 11.5 days [range 1–15 days] vs. median 7.5 days [range 1–22 days]; P=0.02), and mortality was higher (5 of 24 [20.8%] infected children vs. 0 of 56 noninfected children; P=0.001). Importantly, four of five (80%) of the HIV-1-infected children who died had other concurrent illnesses or predisposing factors for severe HPIV-associated disease. HPIV-associated lower respiratory tract infection causes greater morbidity and mortality in HIV-1-infected children than in HIV-1-noninfected children; however, this may be due to other concurrent illnesses in HIV-1-infected children.

Jensen, ; Berthelsen, ; Lind, ; Fussing, ; Sørensen, ; Schønheyder,

doi: 10.1007/s10096-002-0755-8pmid: 12172741

In a recent 20-year Danish survey, Neisseria meningitidis phenotypes B:15:P1.7,16 and C:2a:P1.2,5 were associated with an increased case-fatality rate of meningococcal disease – 15% and 23% – compared to the case-fatality rate of 8% for any other strain. The aim of the present study was to investigate (i) the mutual genetic relatedness of strains with phenotype B:15:P1.7,16, phenotype C:2a:P1.2,5 or serologically related phenotypes; (ii) the changes in the prevalence of distinctive clone complexes over time; and (iii) whether distinctive clone complexes are associated with an increased case-fatality rate. During the period 1980–1999, 181 of a total of 315 invasive strains obtained in North Jutland County, Denmark, were chosen on the basis of serological characteristics for characterization by multilocus enzyme electrophoresis and ribotyping. Two major complexes were identified on the basis of electrophoretic type (ET): the ET-4/23 complex (n=111), which included all B:15:P1.7,16 strains (n=100), and the ET-15/25 complex (n=44), which included all C:2a:P1.2,5 strains (n=31). Two ribotype complexes were identified within the ET-4/23 complex and one within the ET-15/25 complex, all of which were designated clone complexes. All three clone complexes were associated with an increased case-fatality rate (13–20%). The results show that, among invasive Neisseria meningitidis B:15:P1.7,16, C:2a:P1.2,5 and phenotypically related strains, three distinctive clone complexes are more virulent than any other ET/ribotype combination.

van Duynhoven, ; de Jager, ; Heuvelink, ; van der Zwaluw, ; Maas, ; van Pelt, ; Wannet,

doi: 10.1007/s10096-002-0756-7pmid: 12172742

The aim of this study was to analyse the results of a programme in the Netherlands for enhanced surveillance of Shiga-toxin-producing Escherichia coli (STEC) O157. In this programme, implemented in January 1999, all laboratories report positive cases to the public health services and submit isolates for typing to the reference laboratory. Public health services collect clinical and risk factor information of patients, using a standardised questionnaire. Results were analysed for the first two and a half years of the programme. In February 2000, a questionnaire was sent to all laboratories to assess (i) the criteria for testing faecal samples for STEC O157, (ii) the diagnostic tools used, and (iii) the level of participation in the surveillance programme. Between January 1999 and June 2001, 93 cases of symptomatic STEC O157 infection were reported, 25% of which occurred in children aged 0–4 years. Serotyping for O, H and stx types showed that two types dominated, O157:H7, stx2 positive (48%) and O157:H–, stx1 and stx2 positive (24%). Analysis of the 93 isolates by pulsed-field gel electrophoresis showed 17 clusters of isolates with at least 95% fragments in common, including isolates with unknown epidemiological links. Of the patients for whom questionnaire information was reported, 38% were hospitalised, 15% developed haemolytic uraemic syndrome, and 52% reported a known risk factor, such as contact with farm animals or manure, consumption of raw or undercooked beef, consumption of raw milk or cheese made from raw milk, or contact with a symptomatic individual. Response to the laboratory survey was high (97%). Only 6% of the laboratories carried out testing for non-O157 STEC, although 95% performed testing for STEC O157. The majority (88%) used culture on sorbitol MacConkey agar or sorbitol MacConkey agar with cefixime and tellurite as the method of detection of STEC O157. The identity of the strains was confirmed primarily with commercially available latex agglutination assays (95% of laboratories) and biochemical characterisation with the API 20E test (bioMérieux, France) (42% of laboratories). Most laboratories (92%) used selection criteria for testing, especially bloody diarrhoea and other clinical information (81% of laboratories) and young age (10%). It is concluded that STEC O157 is a limited public health problem in the Netherlands, although the selective testing policy and the low sensitivity of the culture techniques used probably caused the incidence of STEC O157 infection to be underestimated.

Roblot, ; Godet, ; Le Moal, ; Garo, ; Faouzi Souala, ; Dary, ; de Gentile, ; Gandji, ; Guimard, ; Lacroix, ; Roblot, ; Becq-Giraudon,

doi: 10.1007/s10096-002-0758-5

Monpoeho, S.; Coste-Burel, M.; Costa-Mattioli, M.; Besse, B.; Chomel, J.; Billaudel, S.; Ferré, V.

doi: 10.1007/s10096-002-0766-5pmid: 12172744

. A quantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) method based on TaqMan technology was developed to determine the presence and amount of enterovirus RNA. In order to prevent false-negative results, a one-step multiplex RT-PCR was optimized. It contains two dual-labelled fluorogenic probes to quantify the 5′ noncoding region of enterovirus and detect an internal positive control. In the present study, 104 cerebrospinal fluid samples collected during an outbreak of enteroviral meningitis were analyzed using this method. Amplification of the internal positive control was effective in all but two specimens, confirming the absence of PCR inhibitors and allowing the results of amplification to be validated. The sensitivity of the RT-PCR was 96.8%, while that of cell culture was 34.9%. Genomic viral loads found ranged between 3.3 and 5.9 log10 copies per milliliter of cerebrospinal fluid (mean, 4.8 log10 copies/ml). This fluorogenic enterovirus RT-PCR allows large numbers of samples to be screened rapidly. Moreover, its sensitivity and reproducibility make it highly reliable. With these characteristics, the enterovirus RT-PCR can be a useful tool that may offer considerable benefit in the clinical management of patients with enteroviral infections.

Torres, ; Escobar, ; López, ; Marco, ; Pobo,

doi: 10.1007/s10096-002-0767-4pmid: 12172745

Vibrio vulnificus is a gram-negative rod that can cause septicaemia and skin lesions, usually in patients with underlying illnesses such as chronic liver disease or diabetes mellitus. Infections caused by this bacterium are unusual in Spain. A case of skin infection due to Vibrio vulnificus is reported in a patient whose abraded skin on his left leg came into contact with seawater. The patient died suddenly, probably due to septicaemia or bacteraemia caused by this organism. Vibrio vulnificus infection must be considered in the differential diagnosis of septicaemia, skin lesions and wound infections, particularly when a patient reports a history of contact with seawater.

Kunin, ; Salamon, ; Weinberger, ; Genkin, ; Sagie, ; Tur-Kaspa,

doi: 10.1007/s10096-002-0763-8pmid: 12172746

Described here is the case of a patient with infective endocarditis in a prosthetic valve due to a Mycobacterium fortuitum-group organism. The patient was treated medically and had a favorable clinical response. This is only the second report of survival after Mycobacterium fortuitum-group endocarditis, and the first of survival without surgical intervention. The duration of treatment is not well defined for this patient, but life-long suppressive therapy will likely be required.

Samra, ; Bishara, ; Ashkenazi, ; Pitlik, ; Weinberger, ; Lapidoth, ; Yardeni, ; Levy,

doi: 10.1007/s10096-002-0764-7pmid: 12172747

To determine if the prevalence of non-albicans Candida spp. has increased at two institutions in Israel, the distribution of 6,954 Candida isolates obtained from sterile and nonsterile sites during the periods 1995–1996 and 1999–2000 were compared. In the latter period, a slight decrease was observed in the prevalence of non-albicans Candida spp. isolated from sterile sites (from 39% to 37%) and nonsterile sites (from 38% to 35%). Specifically, the prevalence of Candida glabrata increased significantly in sterile sites, from 26% to 35% (P=0.0095), and in nonsterile sites, from 18% to 27% (P<0.0001), and the prevalence of Candida krusei increased significantly in sterile sites, from 2% to 7% (P=0.0072). The prevalence of Candida parapsilosis decreased significantly in nonsterile sites, from 31% to 23% (P=0.0002). Continuous surveys of the distribution of Candida spp. and analysis of the clinical significance of changes are warranted.

Bange, ; Böttger,

doi: 10.1007/s10096-002-0760-ypmid: 12172748

In order to improve the recovery of mycobacteria from patients with cystic fibrosis, the present study evaluated a two-step decontamination procedure for clinical specimens. A total of 920 specimens obtained from 239 patients with cystic fibrosis were treated initially with N-acetyl-L-cysteine/sodium hydroxide. Of these specimens, 31 (3.3%) showed mycobacterial growth and 415 (45.1%) remained contaminated. Contaminated specimens were then subjected to a second round of decontamination, using a combination of N-acetyl-L-cysteine/sodium hydroxide and oxalic acid. Following this second decontamination, the number of specimens overgrown by microorganisms other than mycobacteria was reduced to 7.3%, and an additional 10 specimens positive for mycobacteria were found. The results suggest this two-step protocol could improve the recovery of mycobacteria from heavily contaminated specimens.