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Li G, Standing JF, Bielicki J, Hope W, van den Anker J, Heath PT, Sharland M. The Potential Role of Fosfomycin in Neonatal Sepsis Caused by Multidrug-Resistant Bacteria. Drugs 2017; 77:941-950. [PMID: 28456943 DOI: 10.1007/s40265-017-0745-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The broad-spectrum activity of fosfomycin, including against multidrug-resistant (MDR) strains, has led to renewed interest in its use in recent years. Neonatal sepsis remains a substantial cause of morbidity and mortality at a global level, with evidence that MDR bacteria play an increasing role. The evidence for use of fosfomycin in neonatal subjects is limited. We summarise current knowledge of the pharmacokinetics and clinical outcomes for the use of fosfomycin in neonatal sepsis and issues specific to neonatal physiology. While fosfomycin has a broad range of coverage, we evaluate the extent to which it may be effective against MDR bacteria in a neonatal setting, in light of recent evidence suggesting it to be most effective when administered in combination with other antibiotics. Given the urgency of clinical demand for treatment of MDR bacterial sepsis, we outline directions for further work, including the need for future clinical trials in this at-risk population.
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Affiliation(s)
- Grace Li
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Joseph F Standing
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.,UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Julia Bielicki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.,Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), Spitalstrasse 33, Postfach, 4031, Basel, Switzerland
| | - William Hope
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Liverpool, L69 3GE, UK
| | - John van den Anker
- Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), Spitalstrasse 33, Postfach, 4031, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
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Giménez M, Sanfeliu I, Sierra M, Dopico E, Juncosa T, Andreu A, Lite J, Guardià C, Sánchez F, Bosch J. [Group B streptococcal early-onset neonatal sepsis in the area of Barcelona (2004-2010). Analysis of missed opportunities for prevention]. Enferm Infecc Microbiol Clin 2014; 33:446-50. [PMID: 25541009 DOI: 10.1016/j.eimc.2014.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/28/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To study the evolution of the incidence of early-onset neonatal sepsis (EOS) by Streptococcus agalactiae in the area of Barcelona and to analyze failure of compliance with the prevention protocol. METHODS A retrospective review was carried out on EOS cases in 8 Health-Care Centers in the Barcelona area between 2004 and 2010. RESULTS Forty-nine newborns from 48 mothers were diagnosed with EOS. The incidence was 0.29‰ living newborns (0.18-0.47‰), with no significant differences in the fluctuations along the 7 years. The mortality rate was 8.16%. In 68.5% cases the maternal colonization studies were negative, and in 21% these studies were not performed. No risk factors were detected in 58.3% of pregnant women, and 22.9% of births were premature. In 58% of cases intra-partum antibiotic prophylaxis was not administered because it was not indicated, and in 42% due to failure to follow the protocol (3 strains were resistant to erythromycin). Resistance to clindamycin was 33.3%. The Streptococcus agalactiae serotypes more frequently isolated were iii, v, and ia. CONCLUSIONS No significant changes were detected in the incidence of Streptococcus agalactiae EOS in the 7 years of the study. The increased sensitivity of screening methods with the use of molecular techniques, the performance of susceptibility testing of strains isolated from pregnant women, and the improvement of communication between Health-Care Centers, can contribute to a better implementation of the protocol, as well as to reduce the incidence of EOS.
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Affiliation(s)
- Montserrat Giménez
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Isabel Sanfeliu
- Servicio de Microbiología, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | | | - Eva Dopico
- Laboratori Clínic de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España
| | - Teresa Juncosa
- Servicio de Microbiología, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Antonia Andreu
- Servicio de Microbiología, Hospital Vall d'Hebron, Barcelona, España
| | - Josep Lite
- Laboratorio de Mirobiología, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - Cèlia Guardià
- Laboratori Barcelonès Nord i Vallès Oriental, Institut Català de la Salut, Badalona, Barcelona, España
| | - Ferran Sánchez
- Servicio de Microbiología, Hospital de Sant Pau, Barcelona, España
| | - Jordi Bosch
- Servicio de Microbiología, Hospital Clínic, Barcelona, España
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Oviedo P, Pegels E, Laczeski M, Quiroga M, Vergara M. Phenotypic and genotypic characterization of Streptococcus agalactiae in pregnant women. First study in a province of Argentina. Braz J Microbiol 2013; 44:253-8. [PMID: 24159312 PMCID: PMC3804206 DOI: 10.1590/s1517-83822013005000030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 07/02/2012] [Indexed: 11/22/2022] Open
Abstract
Group B Streptococcus (GBS) is the leading cause of neonatal infections. Our purpose was to characterize GBS colonization in pregnant women, current serotypes, resistance phenotypes and genes associated with virulence. In Misiones, Argentina, there are no previous data on this topic. Vaginal-rectal swabs from 3125 pregnant women were studied between 2004 and 2010. GBS strains were identified by conventional and serological methods (Phadebact Strep B Test, ETC International, Bactus AB, Sweden). Serotypes were detected using Strep-B Latex (Statens Serum Institut, Denmark). Resistance phenotypes were determined by the double-disk test. Genes were studied by PCR. Maternal colonization was 9.38%. Resistance to erythromycin was 11.6%, and the constitutive phenotype was the predominant one. Serotype Ia was the most frequent, whereas serotypes IV, VI, VII and VIII were not detected. The lmb, bca and hylB genes were detected in more than 79% of the strains. In this study, the colonization rate with GBS and the serotype distribution were compared with studies reported in other areas of the country. The high resistance to erythromycin in Misiones justifies performing antibiotic susceptibility testing. The serotype distribution, the genes encoding putative virulence factors, and the patterns of resistance phenotypes of GBS may vary in different areas. They thus need to be evaluated in each place to devise strategies for prevention.
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Affiliation(s)
- P Oviedo
- Facultad de Ciencias Exactas, Químicas y Naturales, Universidad Nacional de Misiones, Posadas, Misiones, Argentina
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Alós Cortés JI, Andreu Domingo A, Arribas Mir L, Cabero Roura L, de Cueto López M, López Sastre J, Melchor Marcos JC, Puertas Prieto A, de la Rosa Fraile M, Salcedo Abizanda S, Sánchez Luna M, Sanchez Pérez MJ, Torrejon Cardoso R. [Prevention of Neonatal Group B Sreptococcal Infection. Spanish Recommendations. Update 2012. SEIMC/SEGO/SEN/SEQ/SEMFYC Consensus Document]. Enferm Infecc Microbiol Clin 2012; 31:159-72. [PMID: 22658283 DOI: 10.1016/j.eimc.2012.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 03/23/2012] [Indexed: 12/18/2022]
Abstract
Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including criteria for the diagnosis of UTI and asymptomatic bacteriuria in pregnancy are clarified; IAP in preterm labour and premature rupture of membranes, and the management of the newborn in relation to GBS carrier status of the mother are also revised. These recommendations are only addressed to the prevention of GBS early neonatal infection, are not effective against late neonatal infection.
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Martins ER, Andreu A, Correia P, Juncosa T, Bosch J, Ramirez M, Melo-Cristino J. Group B streptococci causing neonatal infections in barcelona are a stable clonal population: 18-year surveillance. J Clin Microbiol 2011; 49:2911-8. [PMID: 21697333 PMCID: PMC3147731 DOI: 10.1128/jcm.00271-11] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 06/04/2011] [Indexed: 11/20/2022] Open
Abstract
We analyzed 212 group B streptococci (GBS) from newborns with invasive infections in the area of Barcelona, Spain, between 1992 and 2009, with the aim of documenting changes in the prevalences of serotypes, antimicrobial resistance, and genetic lineages and evaluating their associations with either early-onset disease (EOD) or late-onset disease (LOD). Serotypes III (n = 118) and Ia (n = 47) together accounted for nearly 78% of the isolates. All isolates carried an alpha or alpha-like protein gene, and specific associations between genes and serotypes, such as serotype Ib and bca, serotype II and bca, serotype III and rib, and serotype V and alp3, reflected the presence of particular genetic lineages. Macrolide resistance (14.2%) was significantly associated with serotype V. Pulsed-field gel electrophoresis (PFGE) clustering was an excellent predictor of serotype and antibiotic resistance. The combination of PFGE and multilocus sequence typing revealed a large number of genetically distinct lineages. Still, specific lineages were dominant in our collection, particularly the serotype III/ST17/rib lineage, which had enhanced potential to cause LOD. Serotype Ia was concentrated in a single PFGE cluster composed of two genetic lineages: ST23/eps and ST24/bca. The ST24/bca sublineage of serotype Ia, which is found infrequently elsewhere, may be emerging as an important cause of neonatal invasive infections in the Mediterranean region. In spite of the introduction of prophylaxis, resulting in a pronounced decline in the frequency of EOD, the study revealed a remarkably stable clonal structure of GBS causing neonatal infections in Barcelona over a period of 18 years.
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Affiliation(s)
- E. R. Martins
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - A. Andreu
- Servei de Microbiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona
| | - P. Correia
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - T. Juncosa
- Servei de Microbiología, Hospital Sant Joan de Deu, Esplugues de Llobregat
| | - J. Bosch
- Servei de Microbiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - M. Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - J. Melo-Cristino
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Merino Díaz L, Torres Sánchez MJ, Aznar Martín J. Prevalence and mechanisms of erythromycin and clindamycin resistance in clinical isolates of beta-haemolytic streptococci of Lancefield groups A, B, C and G in Seville, Spain. Clin Microbiol Infect 2007; 14:85-7. [PMID: 18034859 DOI: 10.1111/j.1469-0691.2007.01881.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Susceptibility to erythromycin and clindamycin was determined in 860 consecutive clinical isolates of beta-haemolytic streptococci belonging to groups A (GAS, n = 134), B (GBS, n = 689), C (GCS, n = 19) and G (GGS, n = 18). Erythromycin resistance was 26.1% in GAS, 15.7% in GBS, 5.3% in GCS and 33.3% in GGS. The highest rate of clindamycin resistance (33.3%) was in GGS, followed by GBS (15.8%), GCS (15.8%) and GAS (5.2%). The M phenotype was predominant in GAS (80%), the constitutive MLS(B) phenotype was predominant in GBS (75%), and all GGS isolates showed the inducible MLS(B) phenotype. The uncommon erythromycin-susceptible and clindamycin-resistant phenotype was found in four GBS and two GCS isolates.
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Affiliation(s)
- L Merino Díaz
- Servicio de Microbiología, Hospitales Universitarios, Virgen del Rocío, Sevilla, Spain
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Dela Cruz WP, Richardson JY, Broestler JM, Thornton JA, Danaher PJ. Rapid determination of macrolide and lincosamide resistance in group B streptococcus isolated from vaginal-rectal swabs. Infect Dis Obstet Gynecol 2007; 2007:46581. [PMID: 17710240 PMCID: PMC1939917 DOI: 10.1155/2007/46581] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 04/16/2007] [Indexed: 12/03/2022] Open
Abstract
Objective. Our objective was to assess the ability of real-time PCR to predict in vitro resistance in isolates of
group B streptococcus (GBS). Methods. The first real-time PCR assays for the genes known to confer resistance to erythromycin and clindamycin in GBS were developed. Three hundred and forty clinical GBS isolates were assessed with these assays and compared with conventional disk diffusion. Results. The presence of an erythromycin ribosome methylation gene (ermB or ermTR variant A) predicted in vitro constitutive or inducible resistance to clindamycin with a sensitivity of 93% (95% CI 86%–97%), specificity of 90% (95% CI 85%–93%), positive predictive value of 76% (95% CI 67%–84%), and negative predictive
value of 97% (95% CI 94%–99%).
Conclusion. This rapid and simple assay can predict in vitro susceptibility to clindamycin within two hours of isolation as
opposed to 18–24 hours via disk diffusion. The assay might also be used to screen large numbers of batched isolates to establish the prevalence of resistance in a given area.
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Affiliation(s)
- Wilfred P. Dela Cruz
- Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, CA 94535, USA
| | - Joann Y. Richardson
- Department of Pediatrics, F. Edward Hébert School of Medicine, The Uniformed Services University of the Health Sciences,
Bethesda, MD 20814-4799, USA
| | - Judith M. Broestler
- Medical Laboratory Flight/Microbiology Department, David Grant USAF Medical Center, Travis Air Force Base, CA 94535, USA
| | - Jennifer A. Thornton
- Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, CA 94535, USA
| | - Patrick J. Danaher
- Department of Infectious Diseases, Eglin USAF Regional Hospital, Eglin Air Force Base, FL 32542-1282, USA
- *Patrick J. Danaher:
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Alsina-Manrique L, Iriondo M, Muñoz-Almagro C, Borrás M, Pou J, Juncosa T, Jiménez R. Evaluación de la aplicación del cribado de estreptococo del grupo B para la prevención de la infección perinatal en un hospital de tercer nivel. Enferm Infecc Microbiol Clin 2006; 24:505-8. [PMID: 16987468 DOI: 10.1157/13092467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Protocols for the prevention of group B streptococcal disease are being widely used with proven efficacy. The aim of this study was to assess compliance with a culture-based approach recommending universal culture screening at 35-37 weeks' gestation, established in our hospital. A retrospective cohort study was undertaken from January 2003 to January 2004. Compliance with the culture-based approach was considered to be good (92.1%) and only partially amenable to improvements. Effectively, there are inherent limitations to the protocol that can be resolved with the use of other strategies, such as tests for quick identification of genital carrier status.
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Affiliation(s)
- Laia Alsina-Manrique
- Servicios de Pediatría, Hospital Sant Joan de Déu, Universidad de Barcelona, España.
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Gonzalez JJ, Andreu A. Multicenter study of the mechanisms of resistance and clonal relationships of Streptococcus agalactiae isolates resistant to macrolides, lincosamides, and ketolides in Spain. Antimicrob Agents Chemother 2005; 49:2525-7. [PMID: 15917563 PMCID: PMC1140544 DOI: 10.1128/aac.49.6.2525-2527.2005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Macrolide, lincosamide, and ketolide mechanisms of resistance and clonal relationships were characterized in a collection of 79 resistant group B streptococcus isolates obtained from neonates or pregnant women. The erm(B), erm(TR), and mef(A) genes were present in 62%, 30.4%, and 3.8% of the isolates, respectively. There was considerable clonal diversity among them.
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Affiliation(s)
- J J Gonzalez
- Servicio de Microbiología, Hospital Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Campo-Esquisabel AB, Ugalde-Zárraga E, Portillo A, Martínez-Martínez L. Streptococcus agalactiae: sensibilidad antimicrobiana y genotipos de resistencia a macrólidos en muestras genitales de gestantes en Cantabria. Enferm Infecc Microbiol Clin 2005; 23:389-90. [PMID: 15970178 DOI: 10.1157/13076186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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