Epidemiological analysis of Klebsiella infections at a neonate department.

At the Department of Obstetrics and Gynaecology of a Brno hospital, 133 Klebsiella strains were isolated from 23 mothers and 58 neonates during a period of increased incidence of Klebsiella and 73 strains were examined in the laboratory. The control group was comprised by 78 Klebsiella strains isolated at three other Brno hospitals. Four prevailing Klebsiella types were identified using bacteriocinotyping and phagotyping. Different bacteriocinotypes and phagotypes were found to prevail at certain intervals both at the examined clinic and in control patients from Brno hospitals. The findings suggest circulation of certain Klebsiella types and their introduction to hospitals. Most infants (37 out of 45, i.e. 82%) were colonized by Klebsiella, their mothers remaining without colonization. The factors influencing the onset and transmission of nosocomial infections in infants are discussed.     

Antilactoferrin activity of microorganisms

The detection rate of the antilactoferrin sign and the level of its manifestation in 165 strains of different microbial species, isolated from patients with inflammatory diseases and intestinal dysbacteriosis, were analyzed. The detection rate of antilactoferrin activity was 43 - 90% for Escherichia coli strains, 20 - 86% for Staphylococcus aureus, 60 - 100% for Klebsiella pneumoniae, 76 - 78% for Candida albicans, isolated from different biotopes of man. Most frequently and with high levels of manifestation this sign was registered in strains isolated from the reproductive tract of women. The detection rate of this sign and the level of its manifestation in bacteria of the vaginal and cervical microbiocenosis, isolated from patients, were higher in comparison with healthy persons. The inverse dependence between the level of the antilactoferrin activity of microflora and the content of lactoferrin during the inflammatory process in women was established.     

Occurrence of Staphylococcus aureus enterotoxigenic strains isolated from pregnant women with pathology

137 S. aureus strains, isolated from the larynx of pregnant women in cases of pathology, were studied for the formation of staphylococcal enterotoxins of types A and B (SEA and SEB) by the indirect hemagglutination test. The study revealed that SEA was produced by 35.0% and SEB, by 56.6% of the strains under study. The proportion of SEA and SEB producers among staphylococci isolated from mothers and children was, respectively, 18.4% and 20.0%, 89.41% and 67.5%. The number of enterotoxigenic staphylococci in the upper respiratory tract of newborn infants and mothers practically coincided with that in mothers. The occurrence of SEA- and SEB-producing enterotoxigenic strains in the medical personnel was 25.5% and 62.7% respectively.     

Antibiotic resistance and putative origin of Staphylococcus aureus and Klebsiella strains isolated from the children with intestinal dysbacteriosis

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.     

A trial of the use of mupirocin in the nasal carriage of Staphylococcus aureus in medical personnel]

Many hospital-acquired purulent diseases and wound infections are due to multiresistant hospital strains of Staphylococcus aureus. The role of S. aureus nasal carriage in development of wound infections due to autoinfection is confirmed. Not only inpatients but also hospital staff can be highly colonized with coagulase positive staphylococci. The S. aureus persistence in hospital personnel results in distribution of the microorganisms in the environment. Therefore, detection of S. aureus carriers without signs of the infection among the hospital personnel and eradication of the pathogen make it possible to control outbreaks of S. aureus infection in hospitals. Clinical efficacy of nasal ointment of mupirocin in the treatment of S. aureus carriers among the intensive care personnel of the N. N.Blokhin Cancer Research Center was evaluated. S. aureus nasal carriage was diagnosed in 17 (26 per cent) out of 65 persons. All the isolates were susceptible to oxacillin. 5-7 days after discontinuation of the mupirocin nasal ointment use eradication of S. aureus was stated in 100 per cent of the cases. The effect was still observed in 94 per cent of the cases in 1 month, in 76 per cent of the cases in 5-6 months and in 60 per cent of the cases in 8-9 months. It is believed that mupirocin nasal ointment (Bactroban) is convenient to use, low toxic and highly active in the treatment of persons with S. aureus nasal carriage.     

Sensitivity to antibiotics and the disinfectant chloramine of Staphylococci isolated from healthy and sick persons

Five hundred and twenty seven strains of Staphylococcus aureus with massive contamination of at least 10(3) when estimated quantitatively were tested for their sensitivity to antibiotics and chloramine B. The staphylococcal strains were isolated from patients, air and stock of rooms in medical institutions, from medical personnel and healthy persons having no long-term contacts with hospital media i. e. from pregnant women and workers of confectionery plants. Among the isolates there were strains simultaneously sensitive to antibiotics and chloramine B (16.6 per cent), sensitive to antibiotics but resistant to chloramine B (5.5 per cent), resistant to antibiotics but sensitive to chloramine B (63.1 per cent) and resistant to antibiotics and chloramine B (15.3 per cent). Staphylococci resistant simultaneously to antibiotics and chloramine B were isolated from the persons of all the groups and from the air and stock of the rooms in the medical institutions. This showed the necessity of controlling sensitivity or staphylococci circulating in hospital media not only to antibiotics but also to disinfectants for providing more efficient prophylaxis of intrahospital infections.     

Adhesive properties and antibiotic resistance of Klebsiella strains isolated from gastrointestinal tracts of children hospitalised in Wroclaw nad Opole

Gram negative Klebsiella bacilli present many pathogenic properties, which determine their ability to survive and rapid spreading in hospital environment. There are many factors responsible for the pathogenicity of Klebsiella strains: capsule, fimbriae, nonfimbrial adhesins, lipopolysaccharide of the cell wall and extracellular secreted exotoxins. Klebsiella strains are etiological agents of different nosocomial infections but also colonized gastrointestinal and respiratory tracts. The aim of our work were adhesive properties and antibiotic resistance of Klebsiella strains isolated from stool of hospitalized children, according to source of potential nosocomial infections--100 Klebsiella strains from Wroclaw and 76 strains from Opole, isolated in cases of diarrhea. The resistance of this strains to different group of antibiotics, the expression of ESBL enzymes, the activity in hemagglutination and their ability to adherence to different cell lines were tested. The highest resistance of all strains to aminopenicillins was observed. The production of ESBL was highest in strains from Opole (51% strains) then in Wroclaw (9%). In both hospital units, ESBL+ strains were resistant to aminoglicosides and cotrimoxazol but sensitive to ciprofloxacine. Using hemagglutination method the types of fimbriae were defined. Above 90% investigated Klebsiella strains showed the presence of fimbriae (in Wroc?aw more strains simultaneously expressed fimbriae type 1 and 3, in Opole mainly fimbriae type 3). Over 70% strains demonstrated the high level of adherence to cell lines. Only several strains showed the low level or the lack of adhesion. These results suggested that among Klebsiella strains in gastrointestinal tract were presented multiresistant strains with high ability to adherence, which may be potential source of nosocomial infections.     

Microbial colonization and succession on the faucial mucosa in newborn infants rooming in with their mothers in a maternity hospital]

The formation of microflora on the laryngeal mucosa in newborn infants during the first 5 days of their life was studied in one of the maternity hospitals of Moscow. In this work modern methods of the isolation and identification of aerobic and anaerobic microorganisms were used, and the results thus obtained were computer-processed. In the maternity hospital of the "mother-child" type the microbial colonization of the laryngeal mucosa by normal and opportunistic microorganisms was noted in newborn infants. A wave-like course of the formation of laryngeal microflora, indicative of microbial succession occurring in the child, was revealed. The attempt to establish the cases of microbial interference between the species colonizing the laryngeal mucosa revealed that it was very rarely observed in 5-day-old newborns. This feature was seemingly the cause of low resistance of the larynx to colonization in newborn infants, which determined frequent colonization of their laryngeal mucosa with Staphylococcus aureus and Klebsiella.     

Staphylococcus cohnii--resident of hospital environment: cell-surface features and resistance to antibiotics

Staphylococcus cohnii strains dominated in the environment of investigated hospitals. We isolated 420 strains of the species mainly from hospitals environments, but also from infants--Intensive Care Units patients, its medical staff and non-hospital environments. S. cohnii subspecies cohnii was seen to dominate (361 strains). Seventy seven percent of these strains expressed cell-surface hydrofobicity, most of them were slime producers (61%) and this feature was correlated with their methicillin resistance. Among S. cohnii ssp. cohnii strains isolated from ICU environment 90% were resistant to methicillin, 43% expressed high-level resistance to mupirocin and high percentages were resistant to many other antibiotics. These strains may constitute a dangerous reservoir of resistance genes in a hospital.     

Characteristics of gram-negative microflora on environmental objects in puerperal wards and their resistance to antibacterial preparations and disinfectants

The species composition of gram-negative opportunistic bacteria isolated from different objects at three puerperal wards of a maternity clinic was studied. Escherichia coli and Acinetobacter were found to have a fairly wide circulation. The objects most contaminated by these bacteria were determined. The study showed that up to 33.3% of the isolated hospital strains of gram-negative bacteria were characterized by multiple resistance to antibiotics used in medical practice and to sulfathiazole. The strains showed the highest sensitivity to gentamicin and kanamycin. Most of the hospital strains were sensitive to chloramine and nirtan, but 4-13% of Klebsiella and Pseudomonas aeruginosa strains showed enhanced resistance to 0.1% chloramine solution.     

社区与医院感染中肺炎克雷伯杆菌和大肠埃希菌耐药性分析

目的探讨社区和医院感染中肺炎克雷伯杆菌和大肠埃希菌产ESBLs的情况及耐药特性。方法采用体外扩散确证试验检测ESBLs,同时用Micro scan wat RA way-40系统全自动细菌鉴定/药敏分析仪及K-B琼脂扩散法进行细菌鉴定和体外药敏试验。结果社区感染标本中分离出肺炎克雷伯杆菌79株,产ESBLs20株,阳性率为25.3%,大肠埃希菌177株,产ESBLs27株,阳性率为15.3%;医院感染标本中分离出肺炎克雷伯杆菌82株,产ES-BLs33株,阳性率为40.2%,大肠埃希菌135株,产ESBLs42株,阳性率为31.1%,社区与医院感染菌株产ESBLs比较差异均有统计学意义(P均<0.05);ESBLs阳性菌株对多种抗生素耐药,其耐药性明显高于ESBLs阴性菌株。结论肺炎克雷伯杆菌和大肠埃希菌产ESBLs菌株在临床分离率较高,医院感染标本要显著高于社区感染标本,并且对多种抗生素具有高度耐药性,产ESBLs菌株耐药性显著高于不产ESBLs菌株,临床上应加强对ESBLs的控制,以防感染流行。     

Circulation of methicillin-resistant staphylococci in hospitals with different profiles

Analysis of prevalence of methicillin-resistant staphylococci in hospitals with different specializations was performed. 2584 strains were isolated. Methicillin-resistant (MR) strains were present in different profile hospitals and their total prevalence between isolated strains was 12.3% while significantly varied in different hospitals (from 8% to 37%). Along with MRSA (methicillin-resistant Staphylococcus aureus), MRSE (methicillin-resistant Staphylococcus epidermidis) and MRSS (methicillin-resistant Staphylococcus saprophyticus) were presented in all studied hospitals. The prevalence of MR strains was highest among strains isolated from flame burn wounds (37%), while in samples from newborns in maternity hospital resistant strains represented 12% of isolates, and in general clinical hospital--not more than 9% of isolates. Relationship between rates of isolation of methicillin-resistant staphylococci and specialization of hospital unit was noted. For example, prevalence of MR staphylococci in isolates from newborns in ICU (47.5%) differed from the same one in maternity hospital (11.6%).     

Isolation of mycoplasmas from house musk shrews (Suncus murinus)

Mycoplasmas were isolated from various sites of experimental and wild house musk shrews (Suncus murinus). The oral cavity was the most prominent site to harbor mycoplasmas (15/18; 83%), followed by the nasal cavity (9/18; 50%). All of the isolated strains required serum for their growth and all fermented glucose. They were found to be serologically homogeneous by growth inhibition test but did not cross-react with several type strains of mycoplasma or reference strains of murine, feline, canine, porcine, bovine and equine origins.     

Streptococcus group B in a maternity home with a decentralized system of newborn infant care (of the mother-child type)

In a maternity hospital with the decentralized system of infant care the presence of the group B streptococcal colonization of puerperants (13.0 +/- 4.5%), newborn infants (25.0 +/- 4.4%) and medical staff (16.9 +/- 3.2%) was established. The strains isolated in this hospital belonged to 13 different serotypes and antigenic combinations with type 1 a/c dominating among them (28.7 +/- 4.8%). Group B streptococci were found to be transmitted by the vertical way in one out of two colonized mother-child pairs, in all other cases the nosocomial spread of streptococci occurred.     

79例重症监护病房患者院内感染病原菌分布分析

目的了解重症监护病房（ICU）院内感染情况,更好地指导有针对性的用药和治疗。方法医院感染管理人员根据病历报告进行回顾性分析,菌种鉴定遵循美国临床和实验室标准化研究所（CLSI）2007年制定的标准,应用SPSS 12.0软件建立数据库并进行统计分析。结果 ICU的院内感染发生率为23.0%,原发疾病集中于脑血管意外和多发复合伤,院内感染患者感染部以下呼吸道和泌尿系感染比例最高,医院感染病例病原菌送检率44.5%,分离出的病原菌以革兰阴性菌为主55.4%,占,其次为革兰阳性菌占35.9%,真菌占8.7%,分离率居前5位的病原菌依次为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌和肠球菌。结论 ICU院内感染情况严重,应加强预防。     

Identification of species and capsular types of Klebsiella clinical isolates, with special reference to Klebsiella planticola

In the 77 reference strains for Klebsiella K types, there are 17 strains (22.1%) of Klebsiella planticola, 6 strains (7.8%) of Klebsiella oxytoca, 1 strain (1.3%) of Klebsiella terrigena, and 53 strains (68.8%) of Klebsiella pneumoniae. The species K. planticola, which was originally isolated from botanical and aquatic environments and hence thus named, was also identified at high incidence (81 strains, 18.5%) among the 439 recent clinical isolates of Klebsiella species. Among these K. planticola strains of hospital origin, 52 (64%) were isolated from sputum, 17 (21%) from urine, and the remaining 12 (15%) from other sources. The capsular types of these isolates were determined by the gel precipitation reaction. Seventy of 81 K. planticola isolates (86.4%) were typable by antisera to Klebsiella reference strains for K types and the K types of the clinical isolates distributed to 35 kinds of K types. The proportion of typable strains among clinical isolates of K. planticola was very similar to those in K. pneumoniae (87.5%) and K. oxytoca (86.0%).     

Epidemiological analysis of Staphylococcus aureus strains from nasal carriers in a teaching hospital

The present study was conducted to assess the epidemiological relation of Staphylococcus aureus isolates from nasal carriers of hospital staff. Nasal swabs were taken from each of 327 personnel. After culturing on blood agar for overnight, probable staphylococcal isolates were identified and subjected to tube coagulase test. After a two-week interval, second nasal swabs were taken from the subjects whose first cultures were positive for S. aureus. Nasal carriage was defined in 58 (17.7%) personnel with positive culture for both sampling time. Antibiogram typing and arbitrarily-primed polymerase chain reaction (AP-PCR) with M13 primer were used for typing of the strains. Antibiotyping distinguished seven types and three subtypes, and 85% of the isolates were clustered in one group. AP-PCR, in contrast, identified 12 distinct patterns with 13 variants. A specific profile was not found among the isolates obtained from the personnel in a particular clinic. These results indicate that antibiotyping has poor discrimination power and heterogeneity among the nasal S. aureus strains in the hospital personnel screened is high.     

The results and characteristics of the mupirocin (Bactroban) sanative treatment of intranasal Staphylococcus carriers in a large hospital]

The action of mupirocin as a nasal ointment (Bactroban) was studied on intranasal carriers of the hospital staphylococcal strains. The study included 37 medical workers from different and mainly problem units of the large general hospital. The tolerability of the ointment was good. After the Bactroban use no complications of the patients were recorded. The efficacy of Bacroban by the microbiological criteria in total amounted to 100 per cent. The eradication of methicillin resistant Staphylococcus aureus (MRSA) was observed in 93 per cent of the cases. A decrease of the level of the nasal passages dissemination by MRSA and methicillin resistant coagulase-negative staphylococci (MRSC) up to such low titers as 100 and 90 per cent was stated. No difference in the action of Bactroban on MRSA, MSSA and MRSC was noted. The bacteriological monitoring for 3 to 4 months revealed a change of the staphylococcal strains in 94 per cent of the cases, recolonization by the same staphylococcal strain in 19 per cent, recolonization by some another staphylococcal strains in 33 per cent and no recolonization in 14 per cent. A stable decrease of staphylococcal strains was possible with simultaneous Bactroban sanitation of all the bacterial carriers of the hospital or its isolated unit.     

Microbial ecology and a retrospective assessment of the possibility of predicting an outbreak of suppurative meningitis caused by a Serratia marcescens strain in a hospital for the nursing care of premature infants]

An outbreak of purulent meningitides in a hospital ward for preterm babies, caused by Serratia marcescens strain of serovar 05/13 with multiple resistance, is described. Data on the results of the long-term observation of the ward showed that during three months preceding the outbreak the consecutive spread of the infective strain and its colonization of the intestine of children occurred. At the moment of the outbreak S. marcescens 05/13 was the dominating intestinal microflora in 37% of children in the ward and constituted 30% of the total aerobic flora in the intestine of the examined children. No S. marcescens strains were isolated from the feces and urine of the medical personnel and mothers. The importance of the observation of microflora colonizing newborn infants in the ward for the evaluation and prognostication of the epidemiological situation is discussed.     

HIV感染患者口咽、鼻腔内真菌分离率的调查

目的了解HIV感染者口咽及鼻腔内真菌分离阳性率。方法用无菌拭子采集口咽腔溃疡、白斑、口角炎等和咽颊区黏膜分泌物,鼻腔取下鼻甲黏膜或中鼻道黏膜分泌物,直接接种于1 mL沙堡弱液体培养基中。取该离心沉淀物作真菌直接镜检,并接种于科玛嘉念珠菌显色培养基置37℃培养48 h后鉴定。如为丝状真菌,转种于察氏琼脂。25℃培养1周后根据菌落形态结合镜下结构鉴定菌种。结果 94例HIV感染者在口咽腔中真菌培养阳性62例(66%),分离出65株真菌,在鼻腔中真菌培养阳性48例(51%),分离出57株真菌。结论 HIV感染者免疫功能低下,易继发真菌机会性感染,口咽及鼻腔真菌的高寄居率是HIV侵袭性真菌感染的先兆症状,真菌菌种以白念珠菌比例为最高,口咽及鼻腔分别61%和33%。