The cervical-vaginal colonization in pregnant women favors the early-onset of neonatal infection wath may cause septicemia, meningitis and pneumonia in newborns.This study has as its objective to verify the detection rates of Streptococcus agalactiae in adult patients who were seen at Hospital Universitário de Santa Maria (HUSM), Rio Grande do Sul, in the period of 2007 to 2010. It was also carried out a data survey concerning the guides, Centers for Disease Control and Prevention, published in the years 1996, 2002 and 2010, to future prevent the neonatal disease caused by the Group B Streptococcus . It was evaluated the prevalence of vaginal and rectal S. agalactiae colonization in pregnant women at the HUSM Obstetric Center from June to December 2009. The Streptococcus agalactiae positive urine cultures from patients seen at the HUSM in the period of 2007 to 2010 were evaluated as well. This study found a prevalence of 11,11% in vaginal and rectal S. agalactiae colonization in pregnant women and, among all positive cultures (6,190/34,988), the GBS was isolated in 1,52% (94/6,190) of the samples. An equal proportion was found among pregnant and non-pregnant ones. 40,4% of these women presented a score of ≥105 Colony Forming Units per milliliter of urine (CFU/mL), 53,57% , between 104 -105 CFU/mL and 6% had a score smaller than 104 CFU/mL. All GBS which were submitted to analysis were sensitive to penicillin and ampicillin. / A colonização cérvico-vaginal pelo Streptococcus agalactiae em gestantes favorece a infecção neonatal de início precoce, podendo causar septicemia, meningite e pneumonia no neonato. O objetivo deste estudo foi verificar os índices de ocorrência da detecção do Streptococcus agalactiae em pacientes adultos atendidos no Hospital Universitário de Santa Maria (HUSM), Rio Grande do Sul, Brasil, no período de 2007 a 2010. Também foi realizado um apanhado histórico dos guias Centers for Disease Control and Prevention, publicados nos anos de 1996, 2002 e 2010, para a prevenção da doença neonatal causada por Estreptococo do grupo B. Igualmente foi avaliada a prevalência da colonização vaginal e retal pelo S. agalactiae em gestantes atendidas no Centro Obstétrico do HUSM de junho a dezembro de 2009. As uroculturas positivas para Streptococcus agalactiae dos pacientes atendidos no HUSM no período de 2007 a 2010 também foram avaliadas. Esta pesquisa encontrou uma prevalência de 11,11% da colonização vaginal-retal pelo Streptococcus agalactiae em gestantes e, entre todas as uroculturas positivas (6.190/34.898), o EGB foi isolado em 1,52% das amostras (94/6.190). Uma proporção igual foi encontrada entre as grávidas e não grávidas. 40,4% das mulheres, a contagem foi ≥105 Unidades Formadoras de Colônias/mL, 53,57%, no intervalo de 104 - 105 UFC/mL e 6% com contagem menor que 104UFC/mL. Todos os EGB, submetidos à análise, foram sensíveis à penicilina e ampicilina.

Cronobacter sakazakii is a gram-negative opportunistic pathogen known to survive in dry environments and food matrices, such as infant formula. This foodborne bacterium can cause fatal human infections of the blood, central nervous system, and gastrointestinal tract; it is also problematic in wounds and urinary tract infections. Preterm infants and immunocompromised individuals are in higher risk categories related to necrotizing enterocolitis, neonatal sepsis, and meningitis due to this organism. Therefore, there is a need for increased understanding of how this bacterium is able to persist in thermally treated low-moisture products that do not support growth. The objective of this research is to identify genes and mechanisms in C. sakazakii that contribute to its resistance to desiccation and survival in low-moisture food matrices, including powdered infant formula. C. sakazakii sequence type 4 (ST4) is of particular interest as it is often the cause of neonatal infections originating from contaminated feedings of powder infant formula. The method chosen to explore these genetic patterns is massively parallel transposon insertion sequencing (Tn-seq). The E. coli strain MFDpir was used to facilitate transposon insertional mutagenesis to create a library of mutated C. sakazakii. Three different C. sakazakii ST4 isolates of different origins (clinical, environmental, and infant formula-derived) were selected for this study. Once transposon mutagenesis occurred with the aid of E. coli MFDpir, the three mutant libraries were subjected to desiccation stress in a closed system equilibrated to 11.3% relative humidity. The surviving mutant genomes were analyzed with Tn-seq. The sequencing data revealed that, while transposition events did occur successfully within the genomes of each of the selected C. sakazakii isolates, these events were not dense enough to draw biological conclusions nor statistical inferences concerning which genes contribute to this organism’s uncanny desiccation tolerance. However, we concluded that the Tn-seq method is a promising tool with this organism of interest, despite incomplete results in this first round of experimentation.

No description available.

Tyrimo tikslas – nustatyti nėščių moterų B grupės β hemolizinio streptokoko (BGS) ir Escherichia coli (E.coli) nešiojimo bei naujagimių kolonizacijos dažnumą ir įvertinti šių mikroorganizmų įtaką naujagimių ankstyvai infekcijai atsirasti. Metodika. Perspektyvinis momentinis stebėjimo tyrimas vykdytas Kauno medicinos universiteto Akušerijos ir ginekologijos bei Neonatologijos klinikose. Moterims du atskiri pasėliai iš makšties apatinio trečdalio ir išangės buvo paimti 35-37 nėštumo savaitę arba gimdymo metu, o naujagimiams - iš ausies išorinės landos bei nosiaryklės per 5 – 15 min. po gimimo. Išskirtų BGS serotipavimas atliktas naudojant 9 specifinius antiserumus, o jautrumas antibiotikams nustatytas diskų difuzijos metodu pagal klinikinių laboratorijų standartus nustatančio komiteto (NCCLS) rekomendacijas. Rezultatai. Šimtas keturiasdešimt aštuonioms moterims iš 970 (15,3 proc.) buvo nustatytas BGS nešiojimas, o 193 moterims (19,9 proc.) - E.coli nešiojimas. Naujagimių BGS ir E.coli kolonizacijos dažnumas buvo 6,4 proc. ir 14,4 proc., o vertikalaus pernešimo – atitinkamai 28,4 ir 24,4 procentai. Moterims ir naujagimiams dažniausiai identifikuotas III ir Ia serotipo BGS. Bendras naujagimių įgimtos infekcijos dažnumas buvo 37,5 atvejai iš 1000 naujagimių, o BGS sukeltos infekcijos dažnumas - 3,6 atvejai iš 1000 naujagimių. Nebuvo nė vieno E.coli sukeltos ankstyvos naujagimių infekcijos atvejo. Klinikinis sepsis diagnozuotas 5 kartus dažniau nei mikrobiologiniais tyrimais... [toliau žr. visą tekstą] / Objective - to examine the prevalence of maternal and neonatal colonization of group B streptococcus (GBS) and Escherichia coli (E.coli) in our area, and to evaluate the colonization impact on early onset neonatal infections as a whole. Methods. A prospective cross-sectional study carried out at the Department of Obstetrics and Gynaecology and the Department of Neonatology of Kaunas University Hospital. Samples were collected from the lower vagina and the anorectum of pregnant women at 35-37 weeks of gestation or at delivery and the ear canal as well as throat of the neonates within 5 – 15 min of their lives. The distribution of serotypes of the GBS identified was determined using specific antisera and antimicrobial susceptibility was investigated by disc-diffusion method as described by National Committee for Clinical Laboratory Standards (NCCLS). Results. GBS carriage was detected in 148 (15.3%) of 970 women screened whereas E.coli colonisation was found in 193 (19.9%) of the women studied. The overall GBS and E.coli neonatal colonization rates were 6.4% and 14.4%; vertical transmission rates - 28.4% and 24.4%, respectively. The most common GBS serotypes were III and Ia. The overall incidence of early onset neonatal infection was estimated to be 37.5 per 1000 live birth and the incidence of early onset GBS disease in newborns – 3.6 per 1000 live birth. There was no case of early neonatal E. coli infection. The incidence of clinical sepsis in neonates was 5 fold higher that... [to full text]

La population néonatale est la population pédiatrique la plus vulnérable car immature et celle ayant probablement les besoins en médicaments les plus importants, compte tenu de la spécificité des pathologies néonatales. Pour autant, un grand nombre de médicaments sont prescrits en dehors des conditions de leur AMM, ne permettant pas leur utilisation optimale. Cela est lié notamment aux difficultés de la recherche clinique chez le nouveau-né. L’objectif de cette thèse est d’analyser les différentes étapes de l’évaluation des médicaments chez le nouveau-né et de discuter les méthodes permettant de les optimiser, en centrant la réflexion sur la classe des médicaments anti-infectieux. En effet, ces médicaments sont parmi les plus prescrits hors AMM chez le nouveau-né, prématuré et à terme, bien qu’ils soient commercialisés depuis de nombreuses années. Nos travaux ont porté sur les différentes étapes de leur évaluation, illustrées chacune par un exemple. 1) Analyse des spécificités de la population néonatale et des pratiques d’utilisation des médicaments, illustrées par l’enquête Européenne sur l’utilisation de la ciprofloxacine et du fluconazole dans les unités de soins intensifs néonatales. Cette enquête a mis en évidence la grande variabilité des pratiques entre les pays mais aussi entre les centres d’un même pays, 2) Recueil et analyse des données disponibles, illustrés par la revue exhaustive de la littérature sur l’utilisation de la ciprofloxacine pour le traitement d’infections néonatales à germes Gram négatif, 3) Détermination de la posologie adéquate. L’implémentation d’outils de modélisation et de simulation de données est particulièrement préconisée chez le nouveau-né. La validation de ces modèles est importante, illustrée ici par une étude d’évaluation externe des modèles pharmacocinétiques de population de la vancomycine chez le nouveau-né. 4) Conception et réalisation des essais cliniques illustrées par l’exemple du développement clinique de la ciprofloxacine en néonatologie. La revue de la littérature sur les essais contrôlés randomisés évaluant les antibiotiques chez le nouveau-né a montré que la qualité des résultats de ces essais était globalement faible. L’analyse des obstacles à leur réalisation a permis de discuter les alternatives méthodologiques afin de contourner les difficultés pratiques, cliniques et éthiques sous-jacentes. / Neonates represent the most vulnerable paediatric population and probably the one with the greatest needs in medicines with regard to the specificities of neonatal diseases. Nevertheless, the off-label prescribing of drugs with no marketing authorisation, consequentlywithout information for their proper use, is widespread in neonatology. This situation is related to the difficulties of clinical research encountered in this population. The objective of this thesis is to analyse the different steps of drug development in neonates and to discuss the possible methods to optimize drug evaluation. To illustrate this development, we expose examples from the evaluation of anti-infective agents in neonatology. These drugs are very often concerned by a use outside their product licence in term and preterm neonates, despite the fact that they have been marketed for many years. This thesis includes studies concerning the different steps of their development illustrated by examples. 1) Evaluation of the specificities of the neonatal population and of drug prescribing. This was demonstrated by the results of a European survey on the use of ciprofloxacin and fluconazole in neonatal intensive care units. The surveys’ results underline the considerable variability in drug prescribing observed between different countries but also between units in the same country. 2) Analysis of available data, illustrated by the systematic review of the literature on ciprofloxacin use for the treatment of Gram negative neonatal infections, 3) Definition of optimal dosing. Use of modelling and data simulation approaches should be particularly favoured in neonatal drug research. Correct validation of models should be performed as illustrated by the external validation of vancomycin population pharmacokinetic models. 4) Design and implementation of clinical trials. This step has been illustrated by the clinical development of ciprofloxacin in neonatology. The review of all randomised controlled trials evaluating the therapeutic and prophylactic use of antibiotics in neonates showed that these trials are poorly designed, conducted and reported. Different methods of evaluation should be considered and further developed to circumvent the difficulties in drug evaluation and ensure the efficient and safe use of antibiotics.