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See detailEarly onset neonatal sepsis and meningitis in Belgium: a decade review
MELIN, Pierrette ULg; Maquet, Julie; Ducoffre, Geneviève et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 43rd Intersciences Conference on Antimicrobial Agents and Chemotherapy (2003, September)

Background: In the late 1990s, Belgium has reached the era of “group B streptococcal (GBS) prevention” and after 1996, some institutions, but not the majority, had implemented intrapartum ... [more ▼]

Background: In the late 1990s, Belgium has reached the era of “group B streptococcal (GBS) prevention” and after 1996, some institutions, but not the majority, had implemented intrapartum antibioprophylaxis for GBS prevention. Concern exists that one unintended consequence of GBS prevention efforts through chemoprophylaxis may be an increase in the rate of serious neonatal infections due to Gram negative bacteria (GNB). To monitor trends, continued surveillance of neonatal sepsis is needed. Methods: On a weekly basis, laboratories of the Belgian sentinel network notified each case of neonatal bacteremia or meningitis occurring within 28 days after birth. We reviewed on a year-base data collected from 1991-2001 for early–onset diseases (EOD; < 5 days). Results: A yearly mean of 47 cases (24-90) were notified by 28 (16-35) laboratories. Overall GBS remained the leading cause and represented annually 37.9% (25-54.7%) of EOD and did not show significant change. It was followed by E.coli 11.4%, coagulase negative staphylococci (CNS) 11.9%, S.aureus 9.9%, Listeria sp 3.9%, S.pyogenes (GAS) 2.5%, S.pneumoniae 2.7%, H.influenzae 2.7% and others. During the decade, whereas a significant reduction in the rate of E.coli and other GNB EOD occurred (p <0.01), significant increases in the rate of EOD due to GAS (p <0.001), S.aureus (p <0.001), and CNS (p <0.01), were found. For CNS, we did not have data to distinguish definite or possible infections from contaminations. Conclusions: 1) During the last decade, GBS has remained the leading cause of neonatal EOD. 2) A decline in the rate of E.coli and other GNB infections occurred. 3) In the late 1990s, S.aureus and CNS were more frequently reported. 4) An increase in GAS occurrence was found 5) Potential change in pathogens overtime requires confirmation by ongoing surveillance. [less ▲]

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See detailAntimicrobial Susceptibilities of recent clinical isolates of group B streptococci agalactiae from Belgium
MELIN, Pierrette ULg; Maquet, Julie; Rodriguez Cuns, Grisel et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 43rd Intersciences Conference on Antimicrobial Agents and Chemotherapy (2003, September)

Background: : GBS cause severe infections in neonates, pregnant women and other adults. Empiric therapy is usually started before susceptibility results are available. Early neonatal diseases can be ... [more ▼]

Background: : GBS cause severe infections in neonates, pregnant women and other adults. Empiric therapy is usually started before susceptibility results are available. Early neonatal diseases can be prevented with intrapartum antibiotic prophylaxis based on accurate susceptibility surveillance data. A previous Belgian study showed an increase of 3 to 10 % R to erythromycin (EM) through the 1990s. Methods: 187 GBS isolates consecutively received at the reference laboratory between 2001 to March 2003 were from 73 neonates (52 early-onset and 21 late-onset diseases), 52 adults and 62 from pregnant women’s vagina. MICs of penicillin (PG), EM, clindamycin (CM) and gentamicin (GM) were determined with Etest. PG MBCs were also determined by inactivating the drug in MIC plates using betalactamase. EM resistant (R) isolates were tested by the CM + EM double disk to determine macrolide R phenotypes. Results: All strains were susceptible (S) to PG and no tolerance was observed with MBCs falling within 2 dilutions of MICs. 19.2% of isolates were R to EM, with significantly more R isolates from adults (30.8%; p <0.01) and serotype V (46.8%; p <0,001). 80% had the MLSB phenotype (R to EM and CM), 16 were constitutive and 12 inducible. The M phenotype (R to EM and S to CM) was seen in 7 (20%) of isolates. Less than 10% of isolates were inhibited by GM MIC of <=64 mg/L, 83.6% by 128-256 mg/L and 2.9% by >/=512 mg/L. Non typable strains were more R to GM (p <0.01). Conclusions: 1) PG remained active against all isolates and no tolerance was seen. 2) Prevalence of R to macrolides had increased since 1999, particularly in adult isolates and serotype V. 3) Intermediate to high level R to GM was seen and potential synergy of PG + GM should be investigated. 4) R surveillance is mandatory to guide prophylaxis and treatment of serious GBS infections. [less ▲]

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