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Reinhard Berner

Publications and source records attributed to Reinhard Berner.

At least 19 recordsLinked to original sources
PubMed2006

Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in a southwestern region of Germany.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) has developed into an important human pathogen and is increasingly being found to be the cause of skin and soft tissue infections or invasive infections in many communities. We have determined the prevalence of MRSA among S. aureus isolates from pediatric in- and outpatients of the University Children's Hospital of Freiburg, from children attending primary care pediatricians and from healthy children entering school in a prospective study carried out in a southwestern region of Germany. Of the healthy children tested, all between 5 and 7 years of age, 25.8% were intra-nasally colonized with S. aureus. A total of 1455 S. aureus isolates were tested for antibiotic susceptibility. Apart from penicillin resistance (82.1%), an overall high susceptibility of S. aureus to antibiotics, including clindamycin, was common, while resistance among the S. aureus isolates to erythromycin and clindamycin had even significantly decreased from 2002 to 2004. Methicillin-resistance was exceedingly rare (0.3%). CONCLUSION: In the southwestern region of Germany, about one quarter of the healthy children tested at school entry were found to be colonized with S. aureus. The prevalence of MRSA among healthy as well as hospitalized children colonized with S. aureus is still extremely rare in this region.

Child↗
PubMed2006

SIRS and group-B streptococcal sepsis in newborns: pathogenesis and perspectives in adjunctive therapy.

Clinical signs of systemic inflammation and suspected systemic infection are common in neonatal medicine. Yet, causative infectious organisms can only infrequently be isolated. In previously healthy infants at low risk of sepsis, group B streptococcus (GBS) is the most common isolate. In vitro and in vivo data suggest that immune cells from newborn infants have impaired antimicrobial properties against GBS. In contrast large amounts of inflammatory mediators are formed upon GBS challenge and Toll-like receptors (TLR) are critical host molecules in this context. Thus, the immune balance tilts towards inflammation, SIRS and sepsis. Adjunctive therapy of neonatal sepsis needs to adjust the inflammatory response without further impairing bacterial clearance. This article summarises the pathophysiological events leading to sepsis and suggests molecular targets for adjunctive therapy.

Animals↗
PubMed2006

Incidence and clinical presentation of invasive neonatal group B streptococcal infections in Germany.

OBJECTIVE: Streptococcus agalactiae (group B Streptococcus) is an important cause of morbidity and mortality in newborn infants. So far, there have been no published data on the incidence, morbidity, and mortality of invasive neonatal group B Streptococcus infections in Germany. METHODS: A prospective active surveillance study involving all of the pediatric hospitals, which reported their cases to the German Pediatric Surveillance Unit, and all of the microbiological laboratories serving pediatric hospitals, which reported their cases to the Laboratory Sentinel Group at Robert Koch Institute Berlin, was conducted between 2001 and 2003. Capture-recapture analysis was used to evaluate the completeness of reported neonatal invasive group B Streptococcus infections. RESULTS: We collected and analyzed data from 347 and 360 infants with invasive group B Streptococcus infection during the first 3 months of life, as reported by pediatricians to the German Pediatric Surveillance Unit and microbiologists to the Robert Koch Institute Berlin, respectively. Using capture-recapture analysis, we calculated an incidence of 0.47 per 1000 live births. Nearly 60% of the infants suffered from early-onset disease, and 16% of these presented with meningitis. In contrast, 61.8% of infants with late-onset disease presented with meningitis. Prematurity was present in 22.4% of early-onset disease and 39.7% of late-onset disease cases, respectively. A high proportion of infants suffered from sequelae because of group B Streptococcus infection at the time of discharge from the hospital. Most common sequelae were hydrocephalus and cerebral seizure. Case fatality rate was 4.3%. CONCLUSIONS: This study, which is the first to provide information on the current national incidence and morbidity of invasive group B Streptococcus infection in Germany, demonstrates remarkable country-specific variation in comparison with other European countries, which gather data in a similar fashion. Therefore, the importance of country-specific prevention guidelines has to be stressed.

Germany↗
PubMed2006

Streptococcus agalactiae Cbeta protein gene (bac) sequence types, based on the repeated region of the cell-wall-spanning domain: relationship to virulence and a proposed standardized nomenclature.

The Cbeta protein (Bac) of Streptococcus agalactiae (group B streptococcus; GBS) is an IgA binding protein encoded by bac, of which at least 39 sequence types have been described, based on polymorphisms in the repeated region of the cell-wall-spanning domain ('bac sequence types'). Cbeta is usually found in serotype Ib, less commonly in serotype II, and rarely in other serotypes. The aim of this study was to examine the prevalence, variety and distribution, among GBS serotypes and between invasive and superficial isolates, of bac sequence types. A total of 1101 GBS isolates were tested, from 10 countries, with a bac-specific PCR, and amplicons from all 255 (23 %) with positive results were sequenced. Ninety-seven percent (184/190) of serotype Ib and 37 % of serotype II isolates were bac positive. The Calpha protein gene (bca) was present in 98 % (251/255), and insertion sequences IS1381 and IS861 in 94 % (239/255), of bac-positive isolates. The authors identified 59 bac sequence types belonging to 19 groups, based on length, from 496 to 946 bp, with up to six sequence variants (a-f) in each group. The median bac sequence length of invasive isolates was significantly shorter than that of superficial isolates overall (640 versus 586 bp; P < 0.001) and specifically for serotype Ib (541 versus 676 bp; P < 0.001), and invasive isolates were significantly (P < 0.001) more likely to have one or more 18 bp deletions relative to the original published bac sequence (X59771). bac sequence typing is a useful addition to the previously described genotyping system, and will help to predict relative virulence among S. agalactiae serotype Ib strains.

Antigens, Bacterial↗
PubMed2005

Antibiotic resistance patterns among respiratory pathogens at a German university children's hospital over a period of 10 years.

UNLABELLED: Growing antimicrobial resistance among Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis is raising major concern worldwide. Strains of S. pneumoniae, H. influenzae and M. catarrhalis isolated from children with respiratory tract as well as invasive infection in a South-Western region of Germany between 1993 and 2002 were tested for susceptibility to common antibiotics including penicillins, cephalosporins and macrolides. A total of 2,362 S. pneumoniae, 2,501 H. influenzae, and 1,982 M. catarrhalis isolates were tested. Only two S. pneumoniae strains were found to be highly resistant to penicillin. The overall rate of intermediate resistance to penicillin was 3.5%. There was a significant increase in erythromycin resistance from 5% in 1993 to 12.2% in 2002 (P=0.001). No increase in ampicillin resistance was observed for H. influenzae over time. The rate of cefaclor resistance, however, increased from 4.5% to 11.8% (P<0.0001). Furthermore, a massive increase in erythromycin resistance from 26% to 40% was observed (P<0.0001). The vast majority of M. catarrhalis isolates were beta-lactamase positive, the minimal inhibitory concentration to ampicillin, however, exceeded only in 3% of all strains the cut-off of 1.5 mg/l. The erythromycin resistance rate of M. catarrhalis was 0.3%. CONCLUSION: There is still a low rate of penicillin/ampicillin resistance in S. pneumoniae, and H. influenzae, but an alarming increase in resistance to erythromycin, and in H. influenzae a significant increase in cefaclor resistance was observed over the 10-year period in South-Western Germany.

Child↗
PubMed2005

Role of lipoteichoic acid in the phagocyte response to group B streptococcus.

Group B Streptococcus (GBS) cell walls potently activate phagocytes by a largely TLR2-independent mechanism. In contrast, the cell wall component lipoteichoic acid (LTA) from diverse Gram-positive bacterial species has been shown to engage TLR2. In this study we examined the role of LTA from GBS in phagocyte activation and the requirements for TLR-LTA interaction. Using cells from knockout mice and genetic complementation in epithelial cells we found that highly pure LTA from both GBS and Staphylococcus aureus interact with TLR2 and TLR6, but not TLR1, in contrast to previous reports. Furthermore, NF-kappaB activation by LTA required the integrity of two putative PI3K binding domains within TLR2 and was inhibited by wortmannin, indicating an essential role for PI3K in cellular activation by LTA. However, LTA from GBS proved to be a relatively weak stimulus of phagocytes containing approximately 20% of the activity observed with LTA from Staphylococcus aureus. Structural analysis by nuclear magnetic resonance spectrometry revealed important differences between LTA from GBS and S. aureus, specifically differences in glycosyl linkage, in the glycolipid anchor and a lack of N-acetylglucosamine substituents of the glycerophosphate backbone. Furthermore, GBS expressing LTA devoid of d-alanine residues, that are essential within immune activation by LTA, exhibited similar inflammatory potency as GBS with alanylated LTA. In conclusion, LTA from GBS is a TLR2/TLR6 ligand that might contribute to secreted GBS activity, but does not contribute significantly to GBS cell wall mediated macrophage activation.

Alanine↗
PubMed2005

Serotype distribution of invasive group B streptococcal isolates in infants: results from a nationwide active laboratory surveillance study over 2 years in Germany.

We report the serotype distribution of invasive group B streptococci (GBS) isolated from 296 infants in Germany. Serotype distribution was as follows: serotype Ia, 15%; Ib, 5%; II, 5%; III, 65%; IV, 1%; and V, 8%. Analysis of serotype according to the source of isolation highlighted the considerable role of serotype III in meningitis in early-onset infection (82%) and late-onset infection (84%). Use of a trivalent GBS vaccine in Germany could theoretically provide protection against 84% and 94% of invasive early-onset and late-onset infections, respectively.

Germany↗
PubMed2005

Hospital admission with neonatal sepsis and development of atopic disease: Is there a link?

The role of suspected or confirmed neonatal sepsis in modifying the risk of atopic disease during childhood was assessed. Children with early-onset neonatal sepsis were identified from a cohort of neonates, hospitalized between 1990 and 1995. Of 196 individuals, 140 were recruited (71.4%). Pre- and postnatal history was ascertained from neonatal medical records. Based on clinical symptoms and a positive blood culture or at least three of initially defined laboratory or bacteriological criteria, they were stratified in either confirmed neonatal sepsis (CS) or suspected sepsis (SS) group. A control group (C) comprised children who were never hospitalized during infancy (n = 696). Primary end-point was the development of atopic dermatitis, bronchial asthma or allergic rhinitis during childhood (mean age 8.4 yr, range 5.7-12.4). CS and SS children had a higher prevalence of atopic dermatitis (CS 15.7%, SS 21.4%) compared with controls (C 5.2%, p < 0.001). Similarly, children with SS (7.1%), but not with CS (4.3%) had significantly more often a doctor's diagnosis of bronchial asthma compared to controls (1.9%, p = 0.02). No difference in the prevalence of allergic rhinitis was observed (CS 4.3%, SS 10%, C 8.3%). After adjusting for parental history of atopic disease and demographic factors, no significant difference for the risk to develop atopic dermatitis, asthma or allergic rhinitis among the groups was calculated in children with normal birth weight (>2500 g). Our data failed to show a possible link between hospital admission with SS and development of atopic disease.

Adolescent↗
PubMed2005

Association between resistance to erythromycin and the presence of the fibronectin binding protein F1 gene, prtF1, in Streptococcus pyogenes isolates from German pediatric patients.

A total of 301 German pediatric group A streptococcus isolates were screened for the presence of macrolide resistance and the fibronectin binding protein F1 gene (prtF1) encoding an adhesin and cell invasiveness protein. The prtF1 gene was present significantly more often among macrolide-resistant isolates. The majority of these were not clonally related.

Adhesins, Bacterial↗
PubMed2005

Heterogeneity of genotype-phenotype correlation among macrolide-resistant Streptococcus agalactiae isolates.

Seventy-four erythromycin-resistant group B Streptococcus isolates were analyzed regarding their phenotype-genotype and phenotype-serotype correlation. Four different phenotypes were assessed, one of them for the first time. ermB and ermTR were the most frequent genotypes (80%). The most prevalent serotype III showed great phenotypic variability while serotype V was strongly associated only with two different phenotypes.

Anti-Bacterial Agents↗
PubMed2004

Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy.

Empirical antibiotic treatment in urinary tract infection (UTI) in children must rely on surveillance data on the epidemiology and resistance patterns of common uropathogens. A retrospective analysis of bacteria isolated from children with UTI irrespective of underlying disease or pre-treatment was performed at the University Hospital of Freiburg, Germany, in 1997, and from 1999 to 2001. In the first study period, 261 positive urine samples and in the second period 684 positive samples were analyzed. Escherichia coli (57.2%) was the leading uropathogen followed by Enterococcus spp. (13.7%), Pseudomonas aeruginosa (7.0%), Proteus spp. (5.9%), Klebsiella spp. (4.7%), and Enterobacter/Citrobacter spp. (4.3%). Almost 50% of the E. coli isolates were resistant to ampicillin, but effectively no resistance against cephalosporins, aminogylcosides, ciprofloxacin, nitrofurantoin, and imipenem was observed. In Enterococcus spp. the resistance to ampicillin was about 15% and 40% to netilmicin, while none of the latter showed high-level aminoglycoside resistance. In P. aeruginosa, there was no resistance to aminoglycosides. No difference in resistance patterns between the two study periods was observed. We conclude that an empirical combination treatment of ampicillin and gentamicin, netilmicin, or tobramycin is appropriate in children with UTI independent of pre-treatment or underlying disease. This therapy should be clinically efficacious, well tolerated, and cost effective, and should prevent unnecessary development of antimicrobial resistance.

Bacteria↗
PubMed2004

Prospective population-based study of viral lower respiratory tract infections in children under 3 years of age (the PRI.DE study).

UNLABELLED: Population-based incidence data from Europe on the disease burden of lower respiratory tract infections (LRTI) due to respiratory syncytial viruses (RSV), parainfluenza viruses (PIV) and influenzaviruses (IV) are lacking, especially with respect to the disease burden. In a 2-year prospective multicentre study of children aged <3 years in Germany, we registered population-based cases as outpatients (n=2386), inpatients (n=2924), and nosocomially-acquired (n=141). Nasopharyngeal secretions were tested for viral RNA. The annual incidence for physician visits per 100 children for all LRTI was 28.7, RSV 7.7, PIV 3.8 and IV 1.1. Annual hospitalisation rates per 10(5) children were for all LRTI 2941, RSV 1117, PIV 261 and IV 123. Annual nosocomial cases per 10(5) hospital days were for all LRTI 79, RSV 29, PIV 9 and IV 1.5. All five children (0.27%) who died had an underlying disease and four were nosocomially acquired. CONCLUSION: Hospitalisation rates due to lower respiratory tract infections in healthy children were similar to those reported elsewhere; the rates for outpatient visits were approximately ten times higher.

Child, Preschool↗
PubMed2004

Association study suggests opposite effects of polymorphisms within IL8 on bronchial asthma and respiratory syncytial virus bronchiolitis.

BACKGROUND: IL-8 is a strong inductor of inflammation. Accordingly, it plays a pivotal role in acute inflammatory responses during respiratory syncytial virus (RSV) infections and in chronic inflammatory diseases such as bronchial asthma and juvenile idiopathic arthritis. Recently, 2 studies have found association of the polymorphism -251A of IL8 with RSV bronchiolitis. Furthermore, epidemiologic studies have demonstrated an increased risk for the development of asthma after RSV bronchiolitis, and a common genetic background for the 2 diseases is currently being discussed. OBJECTIVE: This study investigated whether IL-8 is in association with asthma and/or arthritis and whether the results can confirm a common genetic background of RSV bronchiolitis and asthma. METHODS: The polymorphisms -A251T, C781T, C1633T, and A2767T within IL8 were genotyped in the following 4 populations: children with asthma, atopic children, children with juvenile idiopathic arthritis, and control subjects. Statistical analysis made use of the Armitage trend test and the software program Arlequine. RESULTS: Association of all polymorphisms was found with asthma ( P =.008 to P =.03). Surprisingly -251T was associated with asthma, which is the opposite allele as described in association with RSV bronchiolitis. Furthermore, all polymorphisms were significantly more common in children with arthritis than in asthmatic children ( P =.006 to P =.02). No association was seen with the diagnosis of arthritis per se or with atopy. CONCLUSION: This is the first study to describe association of IL-8 with asthma and a significant inverse distribution of the polymorphisms in juvenile idiopathic arthritis. In addition, the results of this study might suggest that RSV bronchiolitis and bronchial asthma have at least some different genetic factors.

Adolescent↗
PubMed2004

Two siblings with lethal pneumococcal meningitis in a family with a mutation in Interleukin-1 receptor-associated kinase 4.

We describe two siblings with one confirmed and one inferred homozygous base pair deletion in the gene for interleukin-1-related kinase 4 (IRAK-4) who died of pneumococcal meningitis at 2 and 14 months, respectively. Interleukin-1-related kinase 4 deficiency is a potentially lethal immunodeficiency characterized by a poor inflammatory response to pyogenic infections.

Fatal Outcome↗
PubMed2004

Antibiotic susceptibility in neonatal invasive isolates of Streptococcus agalactiae in a 2-year nationwide surveillance study in Germany.

The antimicrobial susceptibility of 296 invasive neonatal group B streptococcus isolates from a nationwide 2-year surveillance study in Germany was investigated. All isolates were susceptible to beta-lactams, linezolid, quinupristin-dalfopristin, and vancomycin. Erythromycin and clindamycin resistance was found in 10.1 and 5.7%, respectively. The ermB, ermTR, or mefA gene was detected in all but one of the erythromycin-resistant isolates.

Anti-Bacterial Agents↗