Biomedical subjects
Publications and source records attributed to Christiane Gaudreau.
Streptococcus strains from animal and human sources identified biochemically as Streptococcus porcinus were investigated by 16S rRNA gene sequencing. The nine human strains isolated between 1997 and 2005 formed a single cluster with more than 2.1% dissimilarity with S. porcinus strains from animal sources. A novel species, Streptococcus pseudoporcinus sp. nov., is proposed.
Campylobacter fetus causes gastrointestinal and systemic infections in humans. Although relapse is common despite antibiotic treatment, the mechanisms are not well understood. The surface-layer proteins (SLPs) of C. fetus, which are critical in virulence, undergo high-frequency phenotypic switching due to recombination of sap homologues, resulting in antigenic variation. To investigate the mechanisms involved in relapsing C. fetus infections, we compared SLP variation in 4 pairs of C. fetus strains that infect humans; initial and follow-up isolations were performed 20 days to 34 months apart. Of the 4 pairs of strains, 2 had antigenic variation, and another provided evidence for selection for SLP-positive populations. Southern hybridization indicated recombination underlying the SLP variation and up-regulation. The fourth pair had the same SLP antigenic profile and sap homologue hybridization pattern, which is consistent with latency of the original strain in a privileged locus. In total, these findings indicate that relapse may reflect at least 3 differing pathogenetic pathways.
From December 1999 to November 2001, a cluster of multidrug-resistant Campylobacter jejuni subsp. jejuni enterocolitis was suspected within the male population of Montreal. Nine men, aged 26-40 years, presented with an erythromycin- and ciprofloxacin-resistant, tetracycline-susceptible C. jejuni enterocolitis. In March 1998 and February 2000, 2 additional men, aged 23 and 27 years, were infected with an erythromycin-resistant, ciprofloxacin and tetracycline-susceptible C. jejuni. All isolates were identical according to pulsed-field gel electrophoresis and flagellin typing. Epidemiological data suggested a sexually transmitted enteric infection; all patients infected with the locally acquired epidemic strain were men, the 8 patients for whom sexual orientation data were available identified themselves as men who have sex with men (MSM), and 3 of the patients had had a sexually transmitted Shigella sonnei infection during a proven outbreak among MSM. Eight patients, 6 of whom were identified as MSM, resided in a predominantly homosexual district of Montreal or its surrounding neighborhoods. The emergence of multidrug-resistant C. jejuni justifies routine susceptibility-testing of these bacteria. MSM should be educated about the prevention of sexually transmitted enteric pathogens.
Transmission of bacterial infections from donor to recipient may occur with donor bacteremia. We describe a novel mechanism for transmission of Pseudomonas to multiple recipients through direct contamination of a donor innominate artery graft. Patient data were collected by chart review from the donor and the kidney, kidney-pancreas, heart, lung, and liver recipients. The donor was not bacteremic but had P. aeruginosa isolated from routine tracheal cultures. Spillage of tracheal contents onto the innominate artery and subsequent contamination of intra-abdominal organs likely occurred. Vascular anastomotic infections with graft loss caused by Pseudomonas occurred in three patients (liver, kidney, and kidney-pancreas), and the lung patient developed severe pneumonia. All Pseudomonas isolates were identical by molecular typing. Donors may transmit bacterial infections to multiple recipients by mechanisms other than donor bacteremia. Although donor tracheal cultures are commonly positive, in certain settings antimicrobial treatment of recipients may be needed.
The rates of resistance of 51 to 72 human strains of Campylobacter jejuni subsp. jejuni isolated annually from 1998 to 2001 in Montréal, Québec, Canada, varied from 1 to 12% for erythromycin, 43 to 68% for tetracycline, and 10 to 47% for ciprofloxacin. In the last years of the study, there was a significant increase in the rate of resistance to ciprofloxacin (P = 0.00003) but not in the rate of resistance to erythromycin (P = 0.056) or tetracycline (P = 0.095) compared to the rate obtained in the first years. All 51 C. jejuni strains isolated in 2001 were susceptible to gentamicin, amoxicillin-clavulanic acid, imipenem, and meropenem. From 1999 to 2001, 74 strains of C. jejuni acquired abroad were significantly more resistant to ciprofloxacin than 109 strains of C. jejuni acquired locally (66 versus 9%, P < 0.00001) but were not significantly more resistant to erythromycin (1 versus 6%, P = 0.15) or to tetracycline (55 versus 58%, P = 0.87).
The epidemiology and antimicrobial susceptibilities of 111 Campylobacter fetus subsp. fetus strains isolated from 103 patients from 1983 to 2000 in Québec, Canada, were determined. The median number of patients infected annually with this bacteria was seven, with an incidence of 0.1 per 100,000 population. The male-to-female ratio was 1.1 to 1.0. The patients originated from 13 of the 18 Québec socioeconomic regions. The age range of the patients was 6 months to 90 years old, 53% being > or = 70 years old and 2% being <20 years old. The isolation site was blood for 69% of the patients, stools for 20%, and other body fluids for 11% of them. Three patients suffered a relapse, with the same strain being isolated from the same site at different times as confirmed by pulse-field gel electrophoresis. All isolates were susceptible to ampicillin, gentamicin, meropenem, and imipenem, with 90% minimal inhibitory concentrations of 4, 1, 0.12, and < or = 0.06 microg/ml, respectively. Three percent and two percent of the strains were, respectively, resistant and intermediate to ciprofloxacin. Thirty-four percent of the strains were resistant to tetracycline. There was a nonsignificant increase in resistance to ciprofloxacin (P = 0.27) and to tetracycline (P = 0.65) in recent years. The percentages of intermediate and resistant MICs were, respectively, 12 and 1% for cefotaxime and 71 and 0% for erythromycin. All strains were beta-lactamase negative.
Pulsed-field gel electrophoresis (PFGE) was used to analyse 147 isolates collected in two regions of Quebec province (Estrie and Montreal) between March 1998 and Feb. 1999, to determine the utility of molecular strain typing for a population-based collection of Campylobacter jejuni and to compare directly the discriminatory power of SmaI and KpnI restriction digests. With a combination of epidemiological criteria including space and time plus molecular strain typing, 49% of isolates from Estrie and 39% of isolates from Montreal were identified as belonging to a putative cluster. For 41% of the cases, sources were either missing or explicitly unknown; the remaining sources were subject to recall bias. Thus, the evaluation of sporadic cases of campylobacter enteritis by descriptive clinical investigation alone is neither sensitive nor reliable for identifying sources of infection. In the PFGE analysis, KpnI digests provided appreciably greater discriminatory power than SmaI digests. When combining the PFGE analyses with basic epidemiological criteria, 30% of the putative SmaI clusters were inconsistent with the epidemiological criteria compared with 17% of the KpnI clusters. Among the 98 isolates assigned to clusters by SmaI, only 65% gave concordant results with KpnI. In contrast, among the 81 isolates assigned to clusters by KpnI, 92% gave concordant results with SmaI. Finally, clusters that were epidemiologically related to ingestion of raw milk and specific water sources correlated better with the typing results based on KpnI than SmaI. Thus, KpnI is the enzyme of choice for molecular epidemiology studies of C. jejuni. The combination of continuous epidemiological surveillance and molecular strain typing may be useful for identifying new sources and mechanisms of transmission for community-acquired C. jejuni infection andultimately for developing new approaches to prevention.
OBJECTIVE: To determine the frequency with which Clostridium difficile was detected in stool specimens from outpatients and patients hospitalized for less than 4 days to assess the usefulness of routine laboratory screening for detecting this enteric pathogen. METHODS: Seven hundred and forty-one specimens from 398 patients were cultured over a 6-month period for Salmonella, Shigella, Yersinia, Escherichia coli O157:H7, Campylobacter and Clostridium difficile. Clostridium difficile culture-positive samples were further tested for cytotoxin production. RESULTS: Campylobacter, Salmonella, Shigella and E. coli O157:H7 were isolated in 50 (6.7%) specimens from 35 (8.8%) patients. Clostridium difficile was cultured from 88 (11.9%) specimens from 35 (8.8%) patients and its cytotoxin detected in 35 (4.7%) specimens of 12 (3%) patients. Clostridium difficile was the second most frequent enteric pathogen after Campylobacter. Of 178 (24%) specimens submitted with a specific request for Clostridium difficile testing, 13 (7.3%) were cytotoxin positive (three patients); of 563 specimens for which Clostridium difficile was not requested, 22 (3.9%) were cytotoxin positive (nine patients). CONCLUSIONS: Nine of 12 patients with cytotoxin-positive specimens would have gone undiagnosed in the laboratory had all stool samples submitted not been tested. These results suggest that Clostridium difficile disease is under-recognized and that testing all stool samples for Clostridium difficile may be warranted in our community of patients.