Marc Lontie

Imported malaria in the 1990s: a review of 101 patients.

Imported malaria remains a difficult problem in nonendemic areas of the world. We describe the clinical presentation of 101 cases of malaria diagnosed at the Leuven University Hospital between 1 January 1990 and 31 December 1999. Ninety‐three patients (92%) presented initially at the emergency department. Diagnosis was initially not suspected by the referring physician in 48 patients (47%). Plasmodium falciparum was the commonest species, accounting for 67% of the cases. All but three patients had fever as the presenting symptom, but only 10 had a typical tertian fever pattern. Haemolytic anaemia, thrombocytopenia and hyponatraemia represented a typical triad in 20% of the cases. Only 13% of the malaria patients had taken correct chemoprophylaxis according to WHO recommendations. Eighty‐three per cent of the patients were admitted to the hospital with a median duration of hospitalization of 4 days. All complications occurred in cases with P. falciparum. All patients were cured.

Surveillance of antibiotic resistance in non invasive clinical isolates of streptococcus pneumoniae collected in belgium during winters 2003 and 2004.

Abstract A total of 391 and 424 non-invasive isolates of Streptococcus pneumoniae collected by 15 laboratories during the 2003 and 2004 survey were tested for their susceptibility by a microdilution technique following NCCLS recommendations. Insusceptibility rates (IR) in the two surveys (2003/2004) were as follows: penicillin 15.0/14.7 % [8.4/6.4 % Resistance (R)], ampicillin 17.4/14.6 % (R 9.0/7.1 %), amoxicillin ± clavulanic acid 2.6/1.2 % (R 0/0 %), cefaclor 14.3/14.1 % (R 11.5/13.4 %), cefuroxime 13.6/12.7 % (R 10.5/11.8 %), cefuroxime-axetil 10.5/11.8 % (R 10.0/9.2 %) (breakpoints based on 250 mg), cefotaxime 4.9/6.2 % (R 1.3/2.4 %), ceftazidime NotTested (NT)/6.4 (R NT/2.6 %), cefepime NT/6.4 (R NT/2.6 %), imipenem 7.7/8.9 % (R 1.8/1.4 %), ertapenem 0.8/NT % (R 0/NT %), ciprofloxacin 13.8/9.0 % (R 4.3/2.4 %), levofloxacin 3.3/2.8 % (R 1.5/0.2 %), moxifloxacin 0.6/0.2 % (R 0.3/0 %), ofloxacin 13.5/9.0 % (R 4.3/2.4 %), erythromycin 26.1/24.7 % (R 25.3/24.5 %), azithromycin 25.4/24.7 % (R 24.6/24.5 %), telithromycin 0.8/0.2 % (R 0.5/0 %), clindamycin 21.2/18.4 % (R 19.2/17.7 %) and tetracycline 32.3/22.1 % (R 29.2/19.3 %). There were only minor differences in resistance rates according to age, sample site, admission type (i.e. ambulatory, hospitalized or long-term care facility patients), gender and geographic origin. Overall, telithromycin (MIC50, MIC90 in 2003/2004: 0.015 µg/ml, 0.12 µg/ml/ 0.008,0.06 respectively), ertapenem (0.03; 0.25/NT), moxifloxacin (0.06; 0.25/0.06, 0.12), and amoxicillin ± clavulanic acid (0.03; 0.25/0.015, 0.5) were the most active compounds in both surveys. In 2003, the most common resistance phenotype was isolated insusceptibility to tetracycline (10.5 %) followed by combined insusceptibility to erythromycin and tetracycline (9.3 %). Erythromycin-tetracycline resistance (10.4 %) was the most common in 2004. Isolates showing resistance to an antibiotic were significantly more present in 2003 than in 2004 (50.4 % versus 40.8 %). In penicillin-insusceptible isolates, MICs of all beta-lactams were increased but cross-resistance between penicillin and other β-lactams in the penicillin-insusceptible isolates was not complete. In the 2003 survey, most of these isolates remained fully susceptible to ertapenem (94.9 %) and amoxicillin ± clavulanic acid (83.1 %). In the 2004 survey, 91.9 % of the penicillin insusceptible isolates remained susceptible to amoxicillin ± clavulanic acid. In both surveys, the most common serotypes in penicillin insusceptible isolates were 14, 23, 19 and 9 (20.0 %, 20.0 %, 16.4 % and 10.9 % respectively in 2003; 41.6 %, 11.7 %, 15.0 % and 18.3 % respectively in 2004).

In vitro activity of commonly used oral antimicrobial agents against community isolates of respiratory pathogens.

The in vitro activity of ampicillin, amoxicillin/clavulanate, cefadroxil, cefaclor, cefuroxime (axetil), co-trimoxazole, doxycycline, ciprofloxacin, ofloxacin, erythromycin, and roxithromycin was tested against unselected isolates of S. pneumoniae (70), H. influenzae (93), and M. catarrhalis (46), cultured from clinically significant sputum samples of general practice patients. All isolates of S. pneumoniae were highly susceptible to ampicillin; cefadroxil and cefaclor were markedly less active on a weight basis; resistance was only observed with co-trimoxazole (4.3%), doxycycline (5.7%), and erythromycin (2.9%); however, ciprofloxacin and ofloxacin showed median MICs (MIC50), that were only one dilution below breakpoint. Beta-lactamase was detected in 14.0% of H. influenzae isolates; all isolates were susceptible to amoxicillin/clavulanate, cefaclor, and cefuroxime (axetil), although MICs were generally higher for cefaclor; the highest activity was exhibited by ciprofloxacin and ofloxacin; apart from cefadroxil, erythromycin, and roxithromycin, that showed only marginal activity, resistance was observed with co-trimoxazole (4.3%) and doxycycline (1.1%). All (including 71.7% of beta-lactamase producing) isolates of M. catarrhalis were susceptible to amoxicillin/clavulanate, cefaclor and cefuroxime (axetil), although MICs were markedly lower for amoxicillin/clavulanate; ciprofloxacin and ofloxacin showed the lowest MICs; resistance was only observed with cefadroxil (2.2%). In conclusion, the antimicrobial agents showing the most uniformly high in vitro activity against the 3 common community respiratory pathogens tested in the present study, were amoxicillin/clavulanate and, to a lesser extent, cefuroxime (axetil).

10th Survey of antimicrobial resistance in noninvasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winter 2007-2008

OBJECTIVES The aim of the study was to evaluate the antibiotic resistance in noninvasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winter 2008-2007. METHOD Four hundred and forty eight unduplicated isolates collected by 15 laboratories were tested by microdilution following CLSI. RESULTS Insusceptibility rates (I+R) were as follows: penicillin G (PEN) 11.6% (4.0% R), ampicillin 11.4% (4.0% R), amoxicillin+/-clavulanic acid 0, cefaclor 10.3% (9.6% R), cefuroxime 9.2% (8.7% R), cefuroxime-axetil 8.7% (7.8% R), cefotaxime, ceftazidime and cefepime 2.0% (0% R), imipenem 2.5% (0% R), ciprofloxacin and ofloxacin 5.1% (0.4% R), levofloxacin 0.7% (0.4% R), moxifloxacin 0.4% (0.2% R), erythromycin (ERY) 29.7% (29.2% R), azithromycin 29.7% (28.8% R), telithromycin 0%, clindamycin 26.3% (25.4% R) and tetracycline (TET) 21.9% (16.5% R). From 2001 to 2008, a significant decrease in penicillin-insusceptibility (21.0% to 11.6%), penicillin-resistance (9.7% to 4.0%) and ciprofloxacin-insusceptibility (11.2% to 5.1%) was found. Cross-resistance between penicillin and other betalactams in penicillin-insusceptible isolates was incomplete: all these isolates remained fully susceptible to amoxicillin. Erythromycin-insusceptibility was significantly higher in children than in adults (43.9%/27.4%), while penicillin-insusceptibility significantly higher in Brussels than in the Flanders (22.9%/8.1%). The commonest resistance phenotype was ERY-TET (12.7%) followed by ERY (7.4%) and PEN-ERY-TET (5.8%). Capsular types 19 (25%), 14 (19.3%), 23 (15.4%) and 15 (13.5%) were the most important in penicillin-insusceptible. CONCLUSION We noted a decrease in resistance to the majority of the compounds. Insusceptibility rates were higher in children than in adults and the difference between the north and the south of Belgium became less marked.

STUDY OF THE IN VITRO ACTIVITY OF AMOXICILLIN/CLAVULANIC ACID AND OTHER ß-LACTAM ANTIBIOTICS AGAINST ESCHERICHIA COLI ISOLATED FROM URINE SPECIMENS

Abstract A total of 205 serial, unduplicated urinary isolates of Escherichia coli was collected from June through August 1998 in 2 community and 3 hospital laboratories. By using the NCCLS broth microdilution technique, their in vitro susceptibility to ampicillin, amoxicillin/clavulanic acid, cefuroxime, cefuroxime axetil, ticarcillin/clavulanic acid and piperacillin/tazobactam was determined. One hundred and twenty isolates were from hospitalised patients, 85 from ambulatory, 129 community acquired and 76 nosocomial. Half of the nosocomial isolates were obtained from naturally produced and half from alternatively produced urine specimens. In general, the highest susceptibility rates, following NCCLS criteria, were found for piperacillin/tazobactam (93.2%) followed by cefuroxime (92.2%) and amoxicillin/clavulanic acid (82.9%). Ampicillin showed a clear bimodal distribution with a clear peak for the resistant population. The highest degree of ampicillin resistance was found in nosocomial isolates. Overall, ampicillin showed the lowest degree of susceptibility. Most of the ampicillin resistant isolates remained susceptible to piperacillin/tazobactam, cefuroxime and amoxicillin/clavulanic acid. In general, the community acquired isolates had higher susceptibility rates than the nosocomial isolates.

The Antimicrobial Susceptibility of Neisseria Gonorrhoeae Belgium In

SummaryThe in vitro susceptibility of 130 Neisseria gonorrhoeae strains isolated in different Belgian * localities in 1980–1981 was determined for penieilline, tetracycline, spectinomycin and thiamphenicol. Among 70 consecutively isolated strains in Antwerp, 5 were producing penicillinase (PPNG). The non-penicillinase producing strains Were sensitive in vitro to the antimicrobials tested. The antimicrobial susceptibility of Belgian gonococcal strains has not changed significantly since 1974 for spectinomycin. In 1981, more strains had a minimal inhibitory concentration (MIC) of penicillin of 0.5 mg/1 or Ilore. The prevalence of gonococcal strains with a MIC of tetracycline of more than 0.5 mg/1 has decreased.