Streptococcus suis infection.

A recent outbreak of Streptococcus suis infection associated with the slaughter, preparation or consumption of pigs in Sichuan, China has led to concerns that similar outbreaks could occur in other Asian countries. Although the pig farming industry is flourishing in Taiwan, reports of S. suis infection remain rare. We report 2 cases of S. suis meningitis successfully treated with ceftriaxone and penicillin. Previous reports of S. suis infection from the English literature are reviewed and the clinical data of cases reported in Asian and European countries are summarized. In Europe, there was good correlation between clinical disease and porcine contact, while few cases in Asia reported this association. Meningitis remained the most common presentation of infection in both areas (84.6% and 75.2%, respectively), followed by sepsis (15.4% and 18.6%, respectively), which had a higher mortality rate, particularly for splenectomized patients. Other clinical presentations included enteritis, arthritis, endocarditis, pneumonia, spondylodiscitis, endophthalmitis, uveitis and peritonitis. Deafness was a distinct sequelae (50.5% in Europe and 51.9% in Asia) after recovery from S. suis infection, especially in patients with meningitis. Not all commercial identification systems for streptococci could offer adequate speciation for S. suis. When viridans group streptococci are isolated from patients with meningitis and sepsis, prompt and correct identification of isolates to the species level should be performed, especially in areas with a high prevalence of S. suis diseases.     

Group B streptococcal soft tissue infections in non-pregnant adults

Skin and soft tissue infections are the most common presentations of invasive Streptococcus agalactiae infections. This study reviewed 71 patients in a medical centre in southern Taiwan with S. agalactiae soft tissue infections. The mortality rate was 7%, and 11% of patients lost their extremities following extensive tissue necrosis. Critical illness and the presence of cutaneous ulceration heralded a fatal prognosis. Risk-factors for amputation of limbs included advanced age, cutaneous ulceration and polymicrobial infection. It was concluded that invasive S. agalactiae soft tissue infections, as with infections caused by Streptococcus pyogenes, can also lead to substantial morbidity and mortality in non-pregnant adults.     

GA2LEN skin test study I: GA²LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe

Background:  Skin prick testing is the standard for diagnosing IgE-mediated allergies. However, different allergen extracts and different testing procedures have been applied by European allergy centres. Thus, it has been difficult to compare results from different centres or studies across Europe. It was, therefore, crucial to standardize and harmonize procedures in allergy diagnosis and treatment within Europe.
Aims:  The Global Asthma and Allergy European Network (GA²LEN), with partners and collaborating centres across Europe, was in a unique position to take on this task. The current study is the first approach to implement a standardized procedure for skin prick testing in allergies against inhalant allergens with a standardized pan-European allergen panel.
Methods:  The study population consisted of patients who were referred to one of the 17 participating centres in 14 European countries ( n  = 3034, median age = 33 years). Skin prick testing and evaluation was performed with the same 18 allergens in a standardized procedure across all centres.
Results:  The study clearly shows that many allergens previously regarded as untypical for some regions in Europe have been underestimated. This could partly be related to changes in mobility of patients, vegetation or climate in Europe.
Conclusion:  The results of this large pan-European study demonstrate for the first time sensitization patterns for different inhalant allergens in patients across Europe. The standardized skin prick test with the standardized allergen battery should be recommended for clinical use and research. Further EU-wide monitoring of sensitization patterns is urgently needed.     

Epidemiology of the most frequent diseases in the European a-symptomatic post-menopausal women. Is there any difference between Ireland and the rest of Europe?

Osteoporosis, cardiovascular disease, breast cancer and genitourinary diseases are some of the most frequently diagnosed diseases in a-symptomatic post-menopausal women. There is a marked European geographic distribution of osteoporosis. Rates are higher in Scandinavia than in the Southern European countries. The possible reasons for this higher incidence of osteoporotic fractures in the Northern European countries is associated with the climate, which limits physical activity and exposure to sunlight and increases the risk of falls. During the next two decades, the number of hip fractures for European women over 65 years is expected to nearly double. Despite these figures, osteoporosis prevention has not yet been adopted in many European countries. There is a devastating impact and a huge financial burden on the European economy and health care system. Breast cancer is the most common cancer in females in Europe. The regions of highest incidence are Western and Northern Europe, while Southern and Eastern Europe have lower incidence rates. The causes of differences in breast cancer incidences between Northern and Southern Europe are not known, but the average 5-year survival of women with breast cancer has increased in Europe in the last three decades. Studies have revealed marked differences in cardiovascular diseases across Europe, showing cardiovascular death rates as highest among the Eastern and Central European countries and lowest in the Mediterranean countries. Cardiovascular disease is the major cause of mortality in European women. However, in North European countries, there are more ischaemic heart diseases in women than in Mediterranean countries. In Mediterranean countries, on the other hand, there are more strokes than in Northern Europe. These strokes events occur 10 years later than the ischaemic heart attacks.     

Clinical and microbiologic characteristics of invasive Streptococcus pyogenes infections in north and south India

The lack of epidemiologic data on invasive Streptococcus pyogenes infections in many developing countries is concerning, as S. pyogenes infections are commonly endemic in these areas. Here we present the results of the first prospective surveillance study of invasive Streptococcus pyogenes infections in India. Fifty-four patients with invasive S. pyogenes infections were prospectively enrolled at two study sites, one in the north and one in the south of India. Sterile-site isolates were collected, and clinical information was documented using a standardized questionnaire. Available acute-phase sera were tested for their ability to inhibit superantigens produced by the patient's own isolate using a cell-based neutralizing assay. The most common clinical presentations were bacteremia without focus (30%), pneumonia (28%), and cellulitis (17%). Only two cases of streptococcal toxic shock syndrome and no cases of necrotizing fasciitis were identified. Characterization of the isolates revealed great heterogeneity, with 32 different emm subtypes and 29 different superantigen gene profiles being represented among the 49 sterile-site isolates. Analyses of acute-phase sera showed that only 20% of the cases in the north cohort had superantigen-neutralizing activity in their sera, whereas 50% of the cases from the south site had neutralizing activity. The results demonstrate that there are important differences in both clinical presentation and strain characteristics between invasive S. pyogenes infections in India and invasive S. pyogenes infections in Western countries. The findings underscore the importance of epidemiologic studies on streptococcal infections in India and have direct implications for current vaccine developments.     

Prevalence and burden of dengue infection in Europe: A systematic review and meta‐analysis

Imported dengue cases are thought to be important source for transmission of autochthonous dengue in Europe. We aimed to investigate the prevalence of dengue in Europe, its severity, and factors associated with it. Out of 5287 reports resulting from the search of nine electronic search engines, we included 174 reports. Meta‐analysis was performed by pooling the event rate and 95% confidence interval (CI). Subgroup meta‐analyses were performed to test the effect of the covariates. Among 20 284 reported cases, 130 autochthonous dengue cases were reported in eight countries with the highest number of cases reported in Israel (n = 41). The highest number of imported dengue cases was in Germany (n = 6638) then France (n = 6610). Most cases were imported from Southeast Asia (n = 2533) especially Thailand. Dengue infection cases increased with time, with 4157 cases reported in 2010. Second dengue infection and dengue serotype 2 were positively associated with dengue severity. The proportion of autochthonous dengue infection increased with time to reach 14.8% (95% CI, 7.6‐26.9) in 2015. The pooled proportion of severe dengue was 6.18% (95% CI, 2.7‐13.3). The United Kingdom and France had the highest rate of severe dengue (25%; 95% CI, 6.3‐62.3, and 21.4%; 95% CI, 24.5‐18.7, respectively). This change may be due to the surveillance efforts instead of true biological phenomenon; thus, the lack of surveillance is an obvious limitation. In conclusion, imported and autochthonous dengue has been increasing in Europe. Severe dengue began to increase recently in Europe. European health authorities should pay more attention for the diagnosis and control of dengue infection among returning travelers, especially the travelers with fever of unknown origin.     

Prevalence and Correlates of Overweight and Obesity in 12 European Countries in 2017–2018

IntroductionUsing data from the TackSHS survey, we aim to provide updated estimates on the prevalence and determinants of overweight and obesity in Europe.MethodsA face-to-face survey was conducted in 2017–2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain). Overall, 10,810 participants, representative in each country of the general adult population, provided information on self-reported height and weight.ResultsAlmost half of participants (48.1%; 95% confidence interval, CI: 47.2–49.1) reported to be overweight or obese (54.1% in men and 42.5% in women) and 12.6% (95% CI: 12.0–13.2) obese (11.3% in men and 13.8% in women). Obesity prevalence was lowest in Italy (7.5%) and France (8.8%) and highest in Greece (19.7%) and Romania (21.1%). Multilevel logistic random-effects analyses showed that prevalence of obesity was related with higher age and lower level of education and socioeconomic status. As compared to northern European countries, Western and Southern European ones showed a significantly lower obesity prevalence. When compared to a companion study conducted in 2010, Eastern and Northern European countries showed an increased trend in obesity prevalence. Conversely, countries with the lowest obesity prevalence (less than 10%), such as Italy and France, showed a decreased trend.ConclusionsDespite a large heterogeneity across countries, overweight and obesity prevalence estimates in Europe are alarming, with most of the countries reporting obesity prevalence approaching 20% or more, particularly in Eastern and Northern Europe. Since 2010, obesity prevalence increased in most of these countries.     

A European survey of antibiotic management of methicillin-resistant Staphylococcus aureus infection: current clinical opinion and practice

Although the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) varies across Europe, healthcare-associated MRSA infections are common in many countries. Despite several national guidelines, the approach to treatment of MRSA infections varies across the continent, and there are multiple areas of management uncertainty for which there is little clinical evidence to guide practice. A faculty, convened to explore some of these areas, devised a survey that was used to compare the perspectives of infection specialists from across Europe on the management of MRSA infections with those of the faculty specialists. The survey instrument, a web-based questionnaire, was sent to 3840 registered delegates of the 19th European Congress of Clinical Microbiology and Infectious Diseases, held in April 2009. Of the 501 (13%) respondents to the survey, 84% were infection/microbiology specialists and 80% were from Europe. This article reports the survey results from European respondents, and shows a broad range of opinion and practice on a variety of issues pertaining to the management of minor and serious MRSA infections, such as pneumonia, bacteraemia, and skin and soft tissue infections. The issues include changing epidemiology, when and when not to treat, choice of treatment, and duration and route of treatment. The survey identified areas where practice can be improved and where further research is needed, and also identified areas of pan-European consensus of opinion that could be applied to European guidelines for the management of MRSA infection.     

Hantavirus infections in Europe and their impact on public health

Hantaviruses (genus Hantavirus, family Bunyaviridae) are enveloped tri‐segmented negative‐stranded RNA viruses each carried by a specific rodent or insectivore host species. Several different hantaviruses known to infect humans circulate in Europe. The most common is Puumala (PUUV) carried by the bank vole; another two important, genetically closely related ones are Dobrava–Belgrade (DOBV) and Saaremaa viruses (SAAV) carried by Apodemus mice (species names follow the International Committee on Taxonomy of Viruses nomenclature). Of the two hantaviral diseases, hemorrhagic fever with renal syndrome (HFRS) and hantaviral cardiopulmonary syndrome, the European viruses cause only HFRS: DOBV with often severe symptoms and a high case fatality rate, and PUUV and SAAV more often mild disease. More than 10,000 HFRS cases are diagnosed annually in Europe and in increasing numbers. Whether this is because of increasing recognition by the medical community or due to environmental factors such as climate change, or both, is not known. Nevertheless, in large areas of Europe, the population has a considerable seroprevalence but only relatively few HFRS cases are reported. Moreover, no epidemiological data are available from many countries. We know now that cardiac, pulmonary, ocular and hormonal disorders are, besides renal changes, common during the acute stage of PUUV and DOBV infection. About 5% of hospitalized PUUV and 16%–48% of DOBV patients require dialysis and some prolonged intensive‐care treatment. Although PUUV–HFRS has a low case fatality rate, complications and long‐term hormonal, renal, and cardiovascular consequences commonly occur. No vaccine or specific therapy is in general use in Europe. We conclude that hantaviruses have a significant impact on public health in Europe. Copyright © 2012 John Wiley & Sons, Ltd.     

Perceived Threat, Risk Perception, and Efficacy Beliefs Related to SARS and Other (Emerging) Infectious Diseases: Results of an International Survey

Purpose  To study the levels of perceived threat, perceived severity, perceived vulnerability, response efficacy, and self-efficacy for severe acute respiratory syndrome (SARS) and eight other diseases in five European and three Asian countries. Method  A computer-assisted phone survey was conducted among 3,436 respondents. The questionnaire focused on perceived threat, vulnerability, severity, response efficacy, and self-efficacy related to SARS and eight other diseases. Results  Perceived threat of SARS in case of an outbreak in the country was higher than that of other diseases. Perceived vulnerability of SARS was at an intermediate level and perceived severity was high compared to other diseases. Perceived threat for SARS varied between countries in Europe and Asia with a higher perceived severity of SARS in Europe and a higher perceived vulnerability in Asia. Response efficacy and self-efficacy for SARS were higher in Asia compared to Europe. In multiple linear regression analyses, country was strongly associated with perceived threat. Conclusions  The relatively high perceived threat for SARS indicates that it is seen as a public health risk and offers a basis for communication in case of an outbreak. The strong association between perceived threat and country and different regional patterns require further research.     

European surveillance for enterovirus D68 during the emerging North-American outbreak in 2014

BackgroundIn August and September 2014, unexpected clusters of enterovirus-D68 (EV-D68) infections associated with severe respiratory disease emerged from North-America. In September, the European Centre for Disease Prevention and Control (ECDC) asked European countries to strengthen respiratory sample screening for enterovirus detection and typing in cases with severe respiratory presentations.ObjectivesTo provide a detailed picture of EV-D68 epidemiology in Europe by conducting a retrospective and prospective laboratory analysis of clinical specimens.Study designAn initiative supported by the European Society for Clinical Virology (ESCV) and ECDC was launched to screen for EV-D68 in respiratory specimens between July 1st and December 1st 2014 in Europe and to sequence the VP1 region of detected viruses for phylogenetic analytic purposes.ResultsForty-two institutes, representing 51 laboratories from 17 European countries, analyzed 17,248 specimens yielding 389 EV-D68 positive samples (2.26%) in 14 countries. The proportion of positive samples ranged between 0 and 25% per country. These infections resulted primarily in mild respiratory disease, mainly detected in young children presenting with wheezing and in immuno-compromised adults. The viruses detected in Europe are genetically very similar to those of the North-American epidemic and the majority (83%) could be assigned to clade B. Except for 3 acute flaccid paralysis (AFP) cases, one death and limited ICU admissions, no severe cases were reported.ConclusionsThe European study showed that EV-D68 circulated in Europe during summer and fall of 2014 with a moderate disease burden and different pathogenic profile compared to the North-American epidemic.     

Increase in COVID-19 cases and case-fatality and case-recovery rates in Europe: A cross-temporal meta-analysis

The new coronavirus (COVID-19) infection reported in China in December 2019 has become a pandemic in a few weeks, affecting the entire world. In this respect, it is crucial to determine the case-increase, case-fatality, and case-recovery rates to control COVID-19. In this study, the case-increase, case-fatality, and case-recovery rates of COVID-19 in 36 European countries were analyzed with the meta-analysis method using data released by the health organizations and WHO. The data were obtained from the website of health organizations of 36 European countries and the website of WHO until 11 May 2020. The analyses were carried out on 1 744 704 COVID-19-diagnosed cases in 36 European countries. The case-increase, case-fatality and case-recovery rates of COVID-19 were calculated using 95% confidence intervals (95% CI), single-arm meta-analysis, cross-temporal meta-analysis, and meta-regression random-effects model. The standardized case-increase rate of COVID-19 is 5% (95% CI [0.040, 0.063]) and the average case-increase rate in European countries has started to decline by around 3% (95% CI [0.047, 0.083]) weekly. The countries with the highest rate of case increase are Belgium, Sweden, Russia, the Netherlands and the United Kingdom. Although the case-fatality rate of COVID-19 patients was 4.5% as of May 11 (95% CI [0.037-0.055]), this rate is 6.3% (95% CI [0.047, 0.083]) in standardized time (6th week). The case-recovery rates of patients are 46% (95% CI [0.376-0.547]). This study presents important results regarding the COVID-19 pandemic in Europe. Although the rate of increase in new COVID-19 cases has dropped, there is not much decline in the case-fatality rates and no increase in case-recovery rates. The case-fatality rate of COVID-19 in Europe was estimated to be in the range of 4% to 4.5% and a minimum of 4 weeks (as of 11 May) is expected to have the figure below 1% in a country with an average case-increase rate. Monitoring case fatalities in Belgium, the Netherlands and Sweden, and treatment successes in Germany and Austria play a role of utmost importance.     

Specialist training in medical microbiology across Europe in 2021—an update on the actual training situation based on a survey

BackgroundThe importance of defining and establishing professional standards for Clinical Microbiology (CM) in Europe has long been highlighted, starting with the development of a European curriculum. The first European Curriculum in Medical Microbiology (MM) was adopted by the European Union of Medical Specialists (UEMS) council in 2017.ObjectivesThis paper assesses how training programmes in CM in Europe align with the European curriculum, just under 5 years after its introduction, and reviews what methods of assessment are in use to assess the CM trainees' progress during training programmes.SourcesUsing an internet-based platform, a questionnaire was circulated to the full, associate and observer members of the UEMS MM section. Information collected related to the structure, content and delivery of CM training in the participating countries, as well as methods of assessment used to evaluate training progress.ContentTwenty-one countries responded, from a total of 30 countries invited to participate. All had a structured CM training programme, with a curriculum, dedicated trainers and a record of training activities. Fifteen countries require trainees to pass an exit examination, and over 60% of countries participate in continuous workplace-based assessment. Of the participating countries, 57% meet the European Training Requirements recommendation that duration of specialist training is 60 months. Regarding core competencies, all trainees gain experience in laboratory skills and infection prevention and control, but the emphasis on clinical management and antimicrobial stewardship is more varied across countries.ImplicationsThe UEMS MM curriculum has been largely adopted by 21 countries within less than 5 years of ratification, which speaks optimistically to a future of standardized quality training across Europe. The introduction of a pilot European Examination in Clinical Microbiology in 2021 is the start of a pan-European assessment of the success of the implementation of this curriculum and the first step in quality assurance for CM training in Europe.     

Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study

Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals from 32 European countries, categorised by five geographical regions. A formal IC programme existed in 72% of hospitals, and a multidisciplinary IC committee was operational in 90%. Trained IC nurses (ICNs) were present in 80% of hospitals (ranging from 54% in south-east and central-eastern Europe, to 100% in northern Europe), whereas 74% had one or more trained IC doctors (ICDs) (ranging from 46% in south-east Europe to 84% in western Europe). Median staffing levels were 2.33 ICNs/1,000 beds and 0.94 ICDs/1,000 beds. The intensity of IC programmes scored higher in centres from northern and western Europe than from other European regions. Written guidelines promoted hand hygiene for healthcare workers in 89% of hospitals, education in 85%, and audit in 46%. Guidelines recommended use of alcohol-based solutions (70%) and/or medicated/antiseptic soap (43%) for decontamination of non-soiled hands. Use of alcohol-based solutions varied according to region, from 41% in southern Europe to 100% in northern Europe, compared with use of medicated soap from 77% in southern Europe to 11% in northern Europe (p < 0.01). These findings showed that IC programmes in European hospitals suffer from major deficiencies in human resources and policies. Staffing levels for ICNs were below recommended standards in the majority of hospitals. Education programmes were incomplete and often not supported by audit of performance. Hand hygiene procedures were sub-standard in one-third of centres. Strengthening of IC policies in European hospitals should be a public health priority.     

The incidence,risk factors and characteristics of pressure ulcers in hospitalized patients in China

Pressure ulcers are very common in hospital patients. Though many studies have been reported in many countries, the large-scale benchmarking prevalence of pressure ulcers in China is not available. The aim of this study is to quantify the prevalence of pressure ulcers and the incidence of hospital-acquired pressure ulcers and analyze risk factors in hospitalized patients in China. A multi-central cross-sectional survey was conducted in one university hospital and 11 general hospitals in China. The Minimum Data Set (MDS) recommended by European Pressure Ulcer Advisory Panel (EUPAP) was used to collect information of inpatients. All patients stayed in hospital more than 24 hours and older than 18 years signed consent form and were included. Data from 39952 out of 40415 (98.85%) inpatients were analyzed. Of the 39952 patients, 631 patients (including 1024 locations) had pressure ulcers. The prevalence rate of pressure ulcers in 12 hospitals was 1.58% (0.94-2.97%). The incidence of hospital-acquired pressure ulcers (HAPU) was 0.63% (0.20-1.20%). The most common locations developed pressure ulcers were sacrum, heels, and iliac crests. The common stages of pressure ulcers were stage I and II. Patients in Intensive Care Unit, Geriatric and Neurological Department were easier to develop pressure ulcers. The prevalence and incidence of pressure ulcers in China was lower than that reported in European and other countries. The stages of pressure ulcers in China were different than that reported in European countries. Our study provides with a baseline value for intensive research on pressure ulcer in China.     

慢性肝病患者免疫状态对HBV血清学标志物表达模式的影响

目的探讨慢性肝病患者免疫状态对乙肝病毒血清学标志物（HBVM）表达模式的影响。方法以确诊的慢性肝病患者包括慢性病毒性乙型肝炎轻、中、重度、慢性重型乙型肝炎、肝炎肝硬化和原发性肝细胞癌患者作为研究对象,采用ELISA法对研究对象的乙肝病毒血清学标志物（HBsAg、HBsAb、HBeAg、HBeAb和HBcAb）、IL-2、IL-10进行检测,采用流式细胞仪进行CD4＋、CD8＋T细胞分析,应用两样本均数比较的统计学方法进行统计学分析。结果慢性肝病患者共有3种HBVM表达模式：大三阳（HBsAg、HBeAg和HBcAb阳性）、小三阳（HBsAg、HBeAb和HBcAb阳性）和小二阳（HBsAg和HBcAb阳性）模式。大三阳、小三阳和小二阳表达模式的阳性率分别为31.09%、57.14%和11.77%;小三阳表达模式组的CD8＋细胞显著低于大三阳表达模式组（P〈0.05）,其余各组间的IL-2、IL-10、CD4＋、CD8＋T细胞水平虽有差别但差异无统计学意义（P〉0.05）。结论慢性肝病患者小三阳表达模式多见;患者血中CD8＋细胞水平低可能有助于慢性肝病患者HBVM小三阳模式的表达,反之可能有助于HBVM大三阳模式的表达。     

Serotypes of Streptococcus pyogenes isolated from healthy school children in Kangwon-do.

Seventy-seven Streptococcus pyogenes strains isolated of children of three elementary schools located in Kangwon-do in spring, 1992 were serotyped with M, opacity factor (OF) and T typing antisera. In the M/OF typing results, M-78 (46.8%) and M-28 (22.1%) were most frequently encountered, while M-4 (6.5%), M-12 (5.2%), M-3 (1.3%), M-5 (1.3%) and M-6 (1.3%) were rarely observed. Twelve strains (15.6%) were not typable with M or OF typing system. In the T typing results, T-11 (35.1%) and T-28 (27.3%) were most common. We were able to identify 77.9% of S. pyogenes strains by T typing, 94.8% with T typing and OF typing. With the addition of M typing, 97.4% were typable. Through the serotypings, we could know the basic distribution of serotypes of S. pyogenes of healthy children which could be comparable to those of rheumatic fever, poststreptococcal glomerulonephritis and other severe streptococcal disease.     

Predominant pathogens found in the European prevalence of infection in intensive care study

A one-day point prevalence of infection analysis was undertaken in 1417 intensive care units (ICUs) (10,038 patients) in 17 western European countries. The prevalence of ICU-acquired infection was 20.6% (2064 patients), representing almost half the cases of infection. Pneumonia was the most commonly reported infection (46.9%), followed by infection of the lower respiratory tract (17.8%), urinary tract (17.6%), and blood (13.0%).Staphylococcus aureus was the most frequently isolated organism (30.1 %), followed byPseudomonas aeruginosa (28.7%), coagulase-negative staphylococci (19.1%), yeasts (17.1%), and enterococci (11.7%). As a group, theEnterobacteriaceae were the most commonly isolated organisms (34.4%). The study also revealed that resistance to anti-microbial agents is common amongStaphylococcus aureus, Pseudomonas aeruginosa, and coagulase-negative staphylococci.     

Hyperendemic Streptococcus pyogenes infection despite prophylaxis with penicillin G benzathine

BACKGROUND. In closely confined populations, in which epidemics of Streptococcus pyogenes infection are common, penicillin G benzathine has long been used prophylactically to reduce morbidity from this pathogen. We report on our investigations of the effectiveness of penicillin G benzathine prophylaxis at a military recruit camp. METHODS. We prospectively studied the rates of pharyngeal colonization and infection by S. pyogenes among 736 male U.S. Marine Corps recruits from January through March 1989. Throat swabs for culture, clinical data, and questionnaire data were obtained during six examinations at intervals of two weeks. Serum samples obtained before training, after training, and from acutely ill recruits were analyzed with use of an antistreptolysin O microtitration technique. RESULTS. Although 93 percent of the recruits received prophylaxis with two intramuscular injections of 1.2 million units of penicillin G benzathine each (administered 30 to 39 days apart), 33 percent of the recruits were colonized by S. pyogenes, and 42 percent had infection (as defined by a two-dilution increase in the antistreptolysin O titer). Thirty-seven percent of 265 recruits who reported a sore throat and were infected with S. pyogenes did not seek medical attention. The recruits who were allergic to penicillin (7 percent of the total), who received no prophylaxis, were more likely to be colonized; an increased risk of colonization and infection among the nonallergic recruits was associated with the presence of a higher percentage of allergic recruits in the platoon. After the study was completed, all recruits who were allergic to penicillin were prescribed 250 mg of oral erythromycin twice daily (a total daily dose of 500 mg) for 60 days. Subsequently, the average weekly rate of clinically evident S. pyogenes pharyngitis fell by more than 75 percent. CONCLUSIONS. If the prevention of S. pyogenes infection is to be effective in closely confined populations such as military recruits, prophylactic antibiotics must be administered to all members of the population. Exempting those who are allergic to penicillin may create a bacterial reservoir from which infection can be transmitted to nonallergic members of the population.