ANTIBIOTIC RESISTANT STAPHYLOCOCCI—Familial Infections Caused by Exposure of Babies in Hospital Nurseries

An antibiotic resistant staphylococcus with bacteriophage pattern 52/42B/80/81^* is frequently responsible for infectious outbreaks in the newborn nursery. Some time after an outbreak had occurred in the University of California''s hospital nursery, family members of the infants were found to be infected with this strain. Two families were studied in detail. In one of them, infection developed in six of the seven members within eight months after the infant''s arrival. In the other, half of the family members had recurrent infections during a 13-month period.Infants who left the nursery as asymptomatic carriers were found as likely to transmit the infectious strain as those with clinical infection. Considerable time sometimes elapsed before infection developed in either the infant or the family members. In one instance the first familial infection occurred six months after the infant had left the nursery as an asymptomatic carrier.Newborn infants are quite likely to disseminate antibiotic resistant staphylococci which they may acquire from a hospital nursery. Infections developing among persons in contact with a young infant must be treated with the possibility of a resistant hospital staphylococcus in mind.     

Nursery Outbreak of Pseudomonas aeruginosa: Epidemiological Conclusions from Five Different Typing Methods

In April 1971, nine cases of Pseudomonas aeruginosa septicemia occurred in a high-risk nursery. The epidemiology of the outbreak was studied by pyocin production, pyocin sensitivity, serological typing, antibiotic susceptibility, and phenotypic properties such as colonial morphology, pigment, and hemolysis. Ten isolates of P. aeruginosa were recovered from 9 newborn infants and from 13 environmental sources. Twenty-one of the 23 isolates had identical pyocin production patterns against 60 different indicator strains and were of the same serotype. These 21 isolates were designated as the "outbreak strain"; the other 2 isolates had no epidemiological significance. The results of pyocin sensitivity, antibiotic susceptibility tests, and phenotypic properties were dissimilar. They would yield incorrect epidemiological conclusions if used alone. The outbreak strain dissociated in vitro and these phenotypic changes accounted for the variable results by the latter three typing methods. Although the precise mode of introduction of the organism into the nursery could not be determined in retrospect, the epidemiological data strongly suggested that one infant contracted a P. aeruginosa infection, and this strain spread throughout the nursery by means of contaminated resuscitation equipment.     

Breast-feeding protects against infection in Indian infants.

A retrospective study was undertaken at two isolated Manitoba Indian communities to determine whether the type of infant feeding was related to infection during the first year of life. Of 158 infants 28 were fully breast-fed, 58 initially breast-fed and then changed to bottle-feeding and 72 fully bottle-fed. Fully bottle-fed infants were hospitalized with infectious diseases 10 times more often and spent 10 times more days in hospital during the first year of life than fully breast-fed infants. Diagnoses were mainly lower respiratory tract infection and gastroenteritis. Gastroenteritis occurred in only one breast-fed infant. Breast-feeding was strongly protective against severe infection requiring hospital admission and also against minor infection. The protective effect, which lasted even after breast-feeding was discontinued, was independent of family size, overcrowding in the home, family income and education of the parents. Measures to achieve breast-feeding for virtually all infants, particularly in northern communities, should be given high priority.     

Congenital Syphilis in Newborn

In six cases of congenital syphilis in newborn at Los Angeles County-USC Medical Center over a seven-month period the clinical findings fell into two categories related to the time of onset of symptoms. Infants ill in the nursery presented evidence of transplacental infection; infants who became ill later showed the “classic” findings of rash, rhinorrhea and pseudoparalysis.No single clinical symptom was present in all cases but all symptomatic infants had radiographic evidence of bone disease. Respiratory distress was present at the onset of symptoms in three of four infants with neonatal disease, and all three had evidence of interstitial pneumonia in chest radiographs.Serologic testing may be difficult to evaluate in the newborn period, but more recent and specific tests are helpful in diagnosis. Penicillin remains the drug of choice. The only death occurred at five hours of life in a premature infant. Growth and development in surviving infants appeared normal.     

The use of bacterial interference to prevent infection

For decades, bacterial strains of low virulence were occasionally used in man to replace or to block colonization by the more virulent organisms and thereby prevent bacterial infection. This paper reviews the topic and presents recent information on the implantation of strain 215 alpha-hemolytic streptococcus (alpha-strep) in the nasopharynx of neonates in the intensive care unit. A single inoculation of strain 215 can change abnormal colonization of the pharynx to "normal" (alpha-strep predominant) in 48-72 h in most neonates. Following implantation, alpha-strep with strain 215 like characteristics fluctuate among naturally occurring strains of alpha-strep, sometimes persisting in dominance and sometimes decreasing rapidly as new strains appear. Strain 215 can survive in the pharynx during subsequent antibiotic therapy and can be recalled to dominance by such therapy. It seems remarkably stable in vivo. There is no evidence of its nosocomial spread in the nursery. Streptococcus with strain 215 like characteristics occurred naturally in 1-6% of neonates in our intensive care unit. No infection (disease) attributable to strain 215 occurred in implanted infants.     

Attachment and social preferences in cooperatively-reared cotton-top tamarins

In many primate species a close attachment between mother and infant provides a secure base for the infant when the infant is frightened or under stress. In cooperatively breeding primates infant carrying is divided among several individuals in the group, with the mother often doing little more than nursing. In these species it is not clear which individual would best serve as a secure base for the infant. We studied eight infant cotton-top tamarins from birth through 20 weeks of age, noting who carried the infant during the first 100 days, who transferred food with the infants, and, as infants became independent, with whom they associated during social play and affiliative behavior. From week 9 to week 20, when infants were independent of carriers most of the time, we presented families with six trials (once every 2 weeks) with a threatening stimulus (a human dressed in a lab coat and wearing an animal mask). Infants played primarily with their twin or youngest sibling and had affiliative interactions with many family members. However, in fearful situations, infants ran to those who had carried them and transferred food with them the most-their father or oldest brother (never to the mother). Although adults increased rates of mobbing calls in response to the threat, infants significantly reduced their vocalization rate. For these cooperatively breeding monkeys, the attachment object for infants is the family member that invested the most effort in carrying the infant and transferring food with the infant. These results parallel and extend results from bi-parental infant care species in which the father serves as the primary attachment figure.     

Antibiotic resistant N. gonorrhoeae in Trinidad and Tobago.

We tested the susceptibility patterns of 128 N. gonorrhoeae isolates to six antimicrobials; penicillin, tetracycline, spectinomycin, ceftriaxone, ciprofloxacin and azithromycin, and examined whether certain demographic or behavioral factors related to antibiotic use increased the likelihood of infection by a resistant strain. There was a low rate of resistance to penicillin; penicillinase-producing and chromosomal-mediated penicillin resistant gonorrhea were estimated to be 0.8%. A much higher proportion of isolates were resistant to tetracycline (up to 15%). All isolates were sensitive to spectinomycin, ciprofloxacin and ceftriaxone. However, less than 2% of isolates displayed intermediate resistance to both ciprofloxacin and ceftriaxone, and 9% exhibited intermediate resistance to spectinomycin. Patients who had obtained medication before attending the clinic and had taken all of the medication were more likely (p = 0.03) to be infected with a resistant strain of gonococcus. Also, patients who were asked by a clinic doctor to return for a test of cure during an earlier clinic visit, but who did not return were more likely to be infected with a resistant organism (p = 0.006) compared to those who returned at the doctor's request. These findings have important implications for antibiotic use and educational programs in Trinidad and Tobago.     

Rotavirus infection of infant and young adult nonobese diabetic mice involves extraintestinal spread and delays diabetes onset

Rotaviruses have been implicated as a possible viral trigger for exacerbations in islet autoimmunity, suggesting they might modulate type 1 diabetes development. In this study, the ability of rotavirus strain RRV to infect the pancreas and affect insulitis and diabetes was examined in nonobese diabetic (NOD) mice, an experimental model of type 1 diabetes. Mice were inoculated either orally or intraperitoneally as infants or young adults. In infant mice inoculated orally, rotavirus antigen was detected in pancreatic macrophages outside islets and infectious virus was found in blood cells, pancreas, spleen, and liver. Extraintestinal RRV spread and pancreatic presence of infectious virus also occurred in intraperitoneally inoculated infant and adult mice. The initiation of insulitis was unaltered by infection. The onset of diabetes was delayed in infant mice inoculated orally and infant and adult mice inoculated intraperitoneally. In contrast, adult mice inoculated orally showed no evidence of pancreatic RRV, the lowest rate of detectable RRV replication, and no diabetes modulation. Thus, the ability of RRV infection to modulate diabetes development in infant and young adult NOD mice was related to the overall extent of detectable virus replication and the presence of infectious virus extraintestinally, including in the pancreas. These studies show that RRV infection of infant and young adult NOD mice provides significant protection against diabetes. As these findings do not support the hypothesis that rotavirus triggers autoimmunity related to type 1 diabetes, further research is needed to resolve this issue.     

Food sharing in black lion tamarins (Leontopithecus chrysopygus)

Food sharing behavior was investigated by studying 10 captive black lion tamarin (Leontopithecus chrysopygus) infants (six litters) between the ages of four and 26 weeks. The frequency of sharing by parents in response to infant begging increased steadily from the age of five to nine weeks, but then declined gradually, although infants were still receiving food even at 26 weeks. Until the age of 15 weeks, infants received more food items by transfer from other group members than they did from self-feeding. Thereafter, self-feeding predominated. Offering of food by adults without prior infant begging occurred at low frequencies (5.3% of items transferred) and ceased at 20 weeks of age. Begging success (the proportion of infant begs which resulted in food sharing) remained relatively constant, averaging 65%. In common with other lion tamarins, black lion tamarins appear to continue to share food with infants well after weaning, and until at least six months of age.     

分离自母婴肠道的假小链双歧杆菌的耐药性分析

【背景】由于滥用抗生素导致细菌耐药性日益严重。对于双歧杆菌,人们往往注重其益生功能的挖掘而忽视了对其耐药性的研究,存在一定的安全隐患。【目的】检测母婴肠道中假小链双歧杆菌的耐药性,探究婴儿肠道中假小链双歧杆菌耐药性的来源。【方法】利用微量肉汤稀释法测定48株分离自母婴肠道的假小链双歧杆菌对14种抗生素的耐药性,比较分离自不同家庭母婴肠道中假小链双歧杆菌的耐药性。【结果】48株母婴肠道分离株对四环素、氯霉素、新霉素、环丙沙星100%耐药,对其余10种抗生素耐药率依次为：卡那霉素98%、利福平80%、克林霉素78%、甲氧苄啶63%、红霉素59%、庆大霉素43%、链霉素16%、万古霉素14%、氨苄西林6%、利奈唑胺2%。母婴肠道分离株的耐药性无显著差异,分离自同一家庭母婴肠道的菌株具有相似的耐药表型。【结论】分离自母婴肠道的假小链双歧杆菌对多种抗生素具有耐药性,婴儿肠道中假小链双歧杆菌的耐药性可能是由母亲肠道垂直传递而来。     

Six year follow up of infants with bacteriuria on screening.

OBJECTIVE--To determine the value of screening for bacteriuria in infants with special emphasis on the natural course of untreated asymptomatic bacteriuria, renal growth, and renal damage. DESIGN--Prospective six year follow up of infants with bacteriuria on screening in an unselected infant population. SETTING--Paediatric outpatient clinic. PATIENTS--50 Infants (14 girls, 36 boys) with bacteriuria on screening verified by suprapubic aspiration from an unselected population of 3581 infants in a defined area of Gothenburg. INTERVENTIONS--Children with asymptomatic bacteriuria and normal findings on initial urography were untreated, although other infections were treated. MAIN OUTCOME MEASURES--Culture of urine and determination of C reactive protein concentration every six weeks for the first six months after diagnosis, every three months from six months to two years, and every six months between two and three years; thereafter yearly urine culture. Evaluation of renal concentrating capacity with a desmopressin test; radiological examination, including first and follow up urography and micturition cystourethrography without antibiotic cover; and measurement of renal parenchymal thickness and renal surface area. RESULTS--Of the original 50 infants, 37 (12 girls, 25 boys) were followed up for at least six years. Two infants developed pyelonephritis within two weeks after bacteriuria was diagnosed; the others remained free of symptoms. 45 Infants were untreated; the bacteriuria cleared spontaneously in 36 and in response to antibiotics given for infections in the respiratory tract in eight. Recurrences of bacteriuria were observed in 10 of the 50 children, of whom one had pyelonephritis. No child had more than one recurrence. At follow up urography in 36 of the 50 children (9 girls, 27 boys) after a median of 32 months no child had developed renal damage. First samples tested for renal concentrating capacity showed significantly higher values than those from a reference population (mean SD score 0.50, 95% confidence interval 0.21 to 0.79; p less than 0.001), but the last samples showed no significant difference (mean SD score 0.08, -0.24 to 0.40; p greater than 0.05). CONCLUSIONS--Mass screening for bacteriuria in infancy results primarily in detection of innocent bacteriuric episodes and is not recommended.     

Clinical and parasitologic aspects of cryptosporidiosis in nonhuman primates

Eighty-one cases of acute cryptosporidiosis were diagnosed among 157 (52%) infant primates, predominantly Macaca nemestrina, housed in the nursery unit of the Washington Regional Primate Research Center. The mean age at onset of oocyst passage was 38 +/- 25 days. The outbreak was confined to the nursery and no cases were detected among juvenile or adult primates housed in other rooms within the colony. All but one animal manifested symptoms of enteric infection, including severe diarrhea and dehydration. Infected animals excreted oocysts for a mean of 36 days (range 7-78 days). No reinfections occurred. Cryptosporidium was the second most common enteric pathogen detected in the population, after Campylobacter jejuni. The risk of infection was related to the length of time the animal was housed in the nursery and to social interaction with other monkeys. These findings are relevant to the understanding of the epidemiology of cryptosporidiosis among human infants and children in environments with close social interactions and minimal learned personal hygiene practices.     

A methicillin-resistant Staphylococcus aureus outbreak in a new University hospital due to a strain transferred with an infected patient from another city six months previously

Kocaeli University Medical School was established in 1995. The first methicillin resistant Staphylococcus aureus isolate was detected two years later in a patient transferred from a different city. Six months after this, we detected a small MRSA outbreak in the intensive care unit involving four patients, two of whom had bacteremia, and a staff nasal carrier. All isolates, including the first, appeared to be a single outbreak strain, demonstrated by pulsed field gel electrophoresis profiles which different by at most two bands, identical randomly amplified polymorphic DNA profiles, and identical coagulase gene types by PCR. Antibiogram were identical except that one isolate was additionally resistant to cotrimoxazole. These results show that MRSA isolates can spread between hospitals with infected or colonized patients and can apparently persist in the hospital for six months without causing infection. Screening of asymptomatic patients on wards affected by MRSA or transferred from other hospitals may be helpful in controlling these infections.     

Protracted course of lymphocytic choriomeningitis virus WE infection in early life: induction but limited expansion of CD8+ effector T cells and absence of memory CD8+ T cells

Viral infections in human infants frequently follow a protracted course, with higher viral loads and delayed viral clearance compared to viral infections in older children. To identify the mechanisms responsible for this protracted pattern of infection, we developed an infant infection murine model using the well-characterized lymphocytic choriomeningitis virus (LCMV) WE strain in 2-week-old BALB/c mice. In contrast to adult mice, in which viral clearance occurred as expected 8 days after infection, LCMV titers persisted for several weeks after infection of infant mice. LCMV-specific effector CD8(+) T cells were elicited in infant mice and fully functional on day 7 but rapidly waned and could not be recovered from day 12 onwards. We show here that this results from the failure of LCMV-specific CD8(+) T cells to expand and the absence of protective LCMV-specific memory CD8(+) T cells. Under these early life conditions, viral control and clearance are eventually achieved only through LCMV-specific B cells that contribute to protect infant mice from early death or chronic infection.     

Maternal responses to dead and dying infants in wild troops of ring-tailed lemurs at the Berenty Reserve,Madagascar

We describe responses of seven mothers and other troop members to dead and dying infants in several troops of ring-tailed lemurs(Lemur catta) at the Berenty Reserve, Madagascar. In contrast to mothers in simian species, ring-tailed lemur mothers rarely carried their dying, immobile or dead infants. However, they sniffed, licked, and touched them even after they had died. While the dying infants were still peeping, their mothers remained near them, and 15 to 76 min after the infants ceased to peep, they were left by their mothers. Six of the seven mothers returned to their dead infants several times within the first few hours after they had left them. All seven mothers gave repeated calls, such as “mew” and “pyaa,” when they were separated from either their dead infants or other troop members or both. Thus, each mother exhibited some form of maternal behavior toward her dead infant for hours after its death. These results indicate that there may not be a great gap in terms of maternal affection between simian and prosimian mothers. We also discuss visuospatial memory ability in ring-tailed lemurs and the causes of the infants’ deaths.     

Male parenting and response to infant stimuli in the common marmoset (Callithrix jacchus)

Callithrix jacchus infants are raised in complex family environments where most members participate in rearing the young. Many studies examining male parental behavior have focused on the carrying of infants with observations made within the family context. However, interference from family members can make it difficult to assess the father's motivation to care for infants. Our goals were to develop a testing paradigm for determining an individual's response to infant stimuli separate from family influences, compare a male's motivation to respond to an infant stimulus outside the family with his paternal behavior within the family, to compare responses to infant stimuli of parentally experienced versus inexperienced males and finally to develop a reproducible and standardized method of testing male responsiveness to infant stimulus that could serve to evaluate hormonal manipulations. Fifteen experienced common marmoset fathers were evaluated using three different measures of parental behavior: (1) instantaneous scan sampling, (2) continuous focal sampling in the family, and (3) continuous focal sampling of males presented with four infant stimuli: familiar and unfamiliar infants, familiar and unfamiliar infant vocalizations. Six parentally inexperienced males (non-fathers) served as controls. Males that carried the most in the family were typically the same males that responded most to the infant vocalization tests. Experienced fathers did not differ in their latency to enter the stimulus cage for any of the four infant stimuli response tests while inexperienced males took significantly longer to enter the stimulus cage. In addition, fathers expressed a greater frequency of infant-directed behavior than did the inexperienced males during the unfamiliar infant and unfamiliar vocalization tests. These studies show that experienced male marmosets are highly motivated to interact with infant stimuli and that there is interindividual variability in response to infant vocalizations. Testing males outside of the family allows for a clear assessment of male's interest in infant stimuli in both parentally experienced fathers and inexperienced males.     

Prevalence of Campylobacter in infant, juvenile and adult laboratory primates

A cross-sectional study of Campylobacter spp. infection was conducted on 125 infant (Macaca nemestrina and Macaca fascicularis) in an infant primate nursery housing infants from birth to 18 months of age, and 145 M. nemestrina aged from 4 months to 15 years at another facility (Primate Field Station) housing animals from birth to aged adults. The objective was to determine the prevalence of Campylobacter spp. in various age groups and to investigate the correlation with diarrhea. In the Infant Primate Research Laboratory approximately 70% of infants were infected at 18 months-old. Campylobacter coli was isolated from approximately two-thirds of the infected infants. One-third were Campylobacter jejuni and occasional infants were infected with a naladixic acid resistant, hippurate negative (NAR) Campylobacter spp. At the Primate Field Station virtually all animals cultured in 4-6 month-old, 16-20 month-old, and 3-5 year-old age groups were positive. Approximately one-third of middle-aged adults (10-15 years old) were positive with C. coli or NAR Campylobacter spp. Environmental factors such as location and movement of animals may provide an explanation for the prevalence data obtained in the two facilities and different age groups of animals. An etiologic role of Campylobacter spp. in diarrhea of laboratory primates was not established in this study.     

Transmission of experimentally-induced rat virus infection

The duration of transmission of rat virus (RV) infection was determined using Sprague-Dawley rats inoculated oronasally as juveniles (4 weeks old) or as infants (2 days old). Contact transmission from rats inoculated as juveniles was detected for 3 weeks, whereas transmission from rats inoculated as infants occurred for 10 weeks. Transmission continued for at least 7 weeks after seroconversion occurred in rats inoculated as infants. Two of three rats that had ceased to transmit infection harbored infectious virus as detected by explantation of kidney. Intrauterine transmission occurred only after pregnant dams were inoculated with large doses of virus and was more efficient when virus was inoculated intravenously than by the oronasal route. Enzyme immunoassay antibody titers to RV in offspring of previously infected dams decreased steadily during the first 13 weeks of life and 27 of 29 offspring tested by immunofluorescence assay at 12 or 13 weeks of age were seronegative. These results indicate that RV was transmitted by rats inoculated as infants for long periods after seroconversion occurred. They also suggest that the offspring of previously-infected dams were not infected. In utero transmission of RV-Y is unlikely to occur after oronasal inoculation unless rats are exposed to large doses of virus.     

Variations in care for cottontop tamarin, Saguinus oedipus, infants as a function of parental experience and group size

We examined the effects of parental experience and group size on infant care and development. Ten cottontop tamarin families were followed across three consecutive births of offspring to examine differences in survival, quality of care, developmental maturation and physical development for infants in two experimental conditions: (1) in large groups with previous parenting experience and (2) in small groups with little or no parenting experience. Although we found no differences in infant mortality, parents treated infants differently between conditions. However, when we examined the cumulative care provided by parents and sibling helpers together across experimental conditions, there were no differences in the rates of retrieval or rejection of infants. Overall levels of infant transport and food transfers were similar between conditions, with fathers and sibling helpers contributing the bulk of care. Fathers in small groups carried infants and transferred food with infants much more than helpers but, as group size increased, helpers augmented this role. Infant development varied with the experience of the family both between conditions and within a family. The results indicate that infants receive similar levels of care regardless of group size and parenting experience, although the individual contributions of family members change with both factors. Parental experience with previous infants had effects on early infant development, but only for the first sets of infants. Copyright 2002 The Association for the Study of Animal Behaviour. Published by Elsevier Science Ltd. All rights reserved.     

The Social Life of Infants in the Context of Infectious Disease Transmission; Social Contacts and Mixing Patterns of the Very Young

Insight into how humans interact helps further understanding of the transmission of infectious diseases. For diseases such as pertussis, infants are at particular risk for severe outcomes. To understand the contact pattern of infants, especially those too young to be vaccinated, we sent contact diaries to a representative sample of 1000 mothers in the United Kingdom. We received 115 responses with a total of 758 recorded contacts. The average number of daily contacts for an infant was 6.68 overall and 5.7 for those aged ≤10 weeks. Of the latter, 2.1 (37%) contacts were with non-household members and were >15 minutes duration, suggesting that a cocooning programme may miss a substantial proportion of exposures leading to disease transmission. The least contact was between adolescents and infants. Thus the impact of adolescent (pertussis) vaccination on infants would likely be limited, unless it reduces transmission to other age groups whose contact with infants is greater.