Archive for February 19, 2016

Caracterización de enterococos multirresistentes aislados de infecciones del pie diabético

Enf Infecc y Microb Clínica Febrero 2016 V.34 N.02

Teresa Semedo-Lemsaddek a, , Carla Mottola a, Cynthia Alves-Barroco a, Patrícia Cavaco-Silva bc, Luís Tavares a, Manuela Oliveira a

a Centro de Investigação Interdisciplinar em Sanidade Animal, Faculdade de Medicina Veterinária, Universidade de Lisboa, Avenida da Universidade Técnica, Lisboa, Portugal

b TechnoPhage, S.A., Lisboa, Portugal

c Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal



La diabetes mellitus es una enfermedad crónica progresiva de alta prevalencia cuyas complicaciones incluyen úlceras del pie.


Se han identificado enterococos aislados de infecciones del pie diabético, evaluados mediante análisis de macrorrestricción y búsqueda de marcadores de virulencia y de resistencia antimicrobiana.


Todos los aislados analizados fueron considerados multirresistentes, productores de citolisina y gelatinasa, y la mayoría fueron capaces de formar biofilms.


Estos resultados permiten conjeturar sobre la importancia de los enterococos en el desarrollo y la persistencia de la infección del pie diabético, fundamentalmente debido a la capacidad de formación de biofilm y de resistencia a antibióticos de relevancia clínica.



February 19, 2016 at 3:33 pm

Update: Interim Guidelines for Health Care Providers Caring for Infants and Children with Possible Zika Virus Infection  US, February 2016

MMWR Morb Mortal Wkly Rep FEBRUARY 19, 2016 V.65 (Early Release) P.1–6

Katherine E. Fleming-Dutra, MD; Jennifer M. Nelson, MD; Marc Fischer, MD; et al.

CDC has updated its interim guidelines for U.S. health care providers caring for infants born to mothers who traveled to or resided in areas with Zika virus transmission during pregnancy and expanded guidelines to include infants and children with possible acute Zika virus disease.

This update contains a new recommendation for routine care for infants born to mothers who traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, when the infant has a normal head circumference, normal prenatal and postnatal ultrasounds (if performed), and normal physical examination.


February 19, 2016 at 3:29 pm

Antibiotic susceptibility of Listeria monocytogenes in Argentina

Enf Infecc y Microb Clínica Febrero 2016 V.34 N.02

Mónica Prieto a, Claudia Martínez a, Lorena Aguerre a, María Florencia Rocca a, Lucía Cipolla a, Raquel Callejo a

a Servicio Bacteriología Especial, Departamento Bacteriología, Instituto Nacional de Enfermedades Infecciosas (INEI) – Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos G. Malbrán”, Ciudad Autónoma de Buenos Aires, Argentina


Listeria monocytogenes is the causative agent of listeriosis, a food-borne disease that mainly affects pregnant women, the elderly, and immunocompromised patients. The primary treatment of choice of listeriosis is the combination of ampicillin or penicillin G, with an aminoglycoside, classically gentamicin. The second-choice therapy for patients allergic to β-lactams is the combination of trimethoprim with a sulfonamide (such as co-trimoxazole). The aim of this study was to analyze the antimicrobial susceptibility profile of strains isolated from human infections and food during the last two decades in Argentina.


The minimal inhibitory concentration (MIC) of 8 antimicrobial agents was determined for a set of 250 strains of L. monocytogenes isolated in Argentina during the period 1992–2012. Food-borne and human isolates were included in this study. The antibiotics tested were ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, erythromycin, gentamicin, penicillin G, tetracycline and rifampicin. Breakpoints for penicillin G, ampicillin and trimethoprim-sulfamethoxazole were those given in the CLSI for L. monocytogenes. CLSI criteria for staphylococci were applied to the other antimicrobial agents tested. Strains were serotyped by PCR, and confirmed by an agglutination method.


Strains recovered from human listeriosis patients showed a prevalence of serotype 4b (71%), with the remaining 29% corresponding to serotype 1/2b. Serotypes among food isolates were distributed as 62% serotype 1/2b and 38% serotype 4b. All antimicrobial agents showed good activity.


The strains of L. monocytogenes isolated in Argentina over a period of 20 years remain susceptible to antimicrobial agents, and that susceptibility pattern has not changed during this period.



February 19, 2016 at 12:35 pm

Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data.

PLoS Med. 2016 Jan 26;13(1):e1001944.

Tosas Auguet O1,2, Betley JR3, Stabler RA4, Patel A1, Ioannou A3, Marbach H1, Hearn P1, Aryee A1, Goldenberg SD1, Otter JA1, Desai N5, Karadag T6, Grundy C7, Gaunt MW4, Cooper BS2,8, Edgeworth JD1, Kypraios T9.

Author information

1Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom.

2Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.

3Illumina, Cambridge Limited, Chesterford Research Park, Little Chesterford, Essex, United Kingdom.

4Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

5Department of Medical Microbiology, King’s Hospital NHS Foundation Trust, London, United Kingdom.

6Department of Microbiology, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, United Kingdom.

7Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.

8Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.

9School of Mathematical Sciences, University Park, University of Nottingham, Nottingham, United Kingdom.



Identifying and tackling the social determinants of infectious diseases has become a public health priority following the recognition that individuals with lower socioeconomic status are disproportionately affected by infectious diseases. In many parts of the world, epidemiologically and genotypically defined community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged to become frequent causes of hospital infection. The aim of this study was to use spatial models with adjustment for area-level hospital attendance to determine the transmission niche of genotypically defined CA- and health-care-associated (HA)-MRSA strains across a diverse region of South East London and to explore a potential link between MRSA carriage and markers of social and material deprivation.


This study involved spatial analysis of cross-sectional data linked with all MRSA isolates identified by three National Health Service (NHS) microbiology laboratories between 1 November 2011 and 29 February 2012. The cohort of hospital-based NHS microbiology diagnostic services serves 867,254 usual residents in the Lambeth, Southwark, and Lewisham boroughs in South East London, United Kingdom (UK). Isolates were classified as HA- or CA-MRSA based on whole genome sequencing. All MRSA cases identified over 4 mo within the three-borough catchment area (n = 471) were mapped to small geographies and linked to area-level aggregated socioeconomic and demographic data. Disease mapping and ecological regression models were used to infer the most likely transmission niches for each MRSA genetic classification and to describe the spatial epidemiology of MRSA in relation to social determinants. Specifically, we aimed to identify demographic and socioeconomic population traits that explain cross-area extra variation in HA- and CA-MRSA relative risks following adjustment for hospital attendance data. We explored the potential for associations with the English Indices of Deprivation 2010 (including the Index of Multiple Deprivation and several deprivation domains and subdomains) and the 2011 England and Wales census demographic and socioeconomic indicators (including numbers of households by deprivation dimension) and indicators of population health. Both CA-and HA-MRSA were associated with household deprivation (CA-MRSA relative risk [RR]: 1.72 [1.03-2.94]; HA-MRSA RR: 1.57 [1.06-2.33]), which was correlated with hospital attendance (Pearson correlation coefficient [PCC] = 0.76). HA-MRSA was also associated with poor health (RR: 1.10 [1.01-1.19]) and residence in communal care homes (RR: 1.24 [1.12-1.37]), whereas CA-MRSA was linked with household overcrowding (RR: 1.58 [1.04-2.41]) and wider barriers, which represent a combined score for household overcrowding, low income, and homelessness (RR: 1.76 [1.16-2.70]). CA-MRSA was also associated with recent immigration to the UK (RR: 1.77 [1.19-2.66]). For the area-level variation in RR for CA-MRSA, 28.67% was attributable to the spatial arrangement of target geographies, compared with only 0.09% for HA-MRSA. An advantage to our study is that it provided a representative sample of usual residents receiving care in the catchment areas. A limitation is that relationships apparent in aggregated data analyses cannot be assumed to operate at the individual level.


There was no evidence of community transmission of HA-MRSA strains, implying that HA-MRSA cases identified in the community originate from the hospital reservoir and are maintained by frequent attendance at health care facilities. In contrast, there was a high risk of CA-MRSA in deprived areas linked with overcrowding, homelessness, low income, and recent immigration to the UK, which was not explainable by health care exposure. Furthermore, areas adjacent to these deprived areas were themselves at greater risk of CA-MRSA, indicating community transmission of CA-MRSA. This ongoing community transmission could lead to CA-MRSA becoming the dominant strain types carried by patients admitted to hospital, particularly if successful hospital-based MRSA infection control programmes are maintained. These results suggest that community infection control programmes targeting transmission of CA-MRSA will be required to control MRSA in both the community and hospital. These epidemiological changes will also have implications for effectiveness of risk-factor-based hospital admission MRSA screening programmes.


February 19, 2016 at 9:23 am

Modeling the transmission of community-associated methicillin-resistant Staphylococcus aureus: a dynamic agent-based simulation.

J Transl Med. 2014 May 12;12:124.

Macal CM1, North MJ, Collier N, Dukic VM, Wegener DT, David MZ, Daum RS, Schumm P, Evans JA, Wilder JR, Miller LG, Eells SJ, Lauderdale DS.

Author information

1Decision and Information Sciences Division, Argonne National Laboratory, 9700 S, Cass Ave,, Bldg 221, Argonne, IL 60439, USA.



Methicillin-resistant Staphylococcus aureus (MRSA) has been a deadly pathogen in healthcare settings since the 1960s, but MRSA epidemiology changed since 1990 with new genetically distinct strain types circulating among previously healthy people outside healthcare settings. Community-associated (CA) MRSA strains primarily cause skin and soft tissue infections, but may also cause life-threatening invasive infections. First seen in Australia and the U.S., it is a growing problem around the world. The U.S. has had the most widespread CA-MRSA epidemic, with strain type USA300 causing the great majority of infections. Individuals with either asymptomatic colonization or infection may transmit CA-MRSA to others, largely by skin-to-skin contact. Control measures have focused on hospital transmission. Limited public health education has focused on care for skin infections.


We developed a fine-grained agent-based model for Chicago to identify where to target interventions to reduce CA-MRSA transmission. An agent-based model allows us to represent heterogeneity in population behavior, locations and contact patterns that are highly relevant for CA-MRSA transmission and control. Drawing on nationally representative survey data, the model represents variation in sociodemographics, locations, behaviors, and physical contact patterns. Transmission probabilities are based on a comprehensive literature review.


Over multiple 10-year runs with one-hour ticks, our model generates temporal and geographic trends in CA-MRSA incidence similar to Chicago from 2001 to 2010. On average, a majority of transmission events occurred in households, and colonized rather than infected agents were the source of the great majority (over 95%) of transmission events. The key findings are that infected people are not the primary source of spread. Rather, the far greater number of colonized individuals must be targeted to reduce transmission.


Our findings suggest that current paradigms in MRSA control in the United States cannot be very effective in reducing the incidence of CA-MRSA infections. Furthermore, the control measures that have focused on hospitals are unlikely to have much population-wide impact on CA-MRSA rates. New strategies need to be developed, as the incidence of CA-MRSA is likely to continue to grow around the world.


February 19, 2016 at 9:02 am


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