A national surveillance study was conducted to determine trends in antimicrobial resistance patterns among three common causes of community-acquired respiratory tract infections. Fifteen participating U.S. medical centers submitted clinically significant isolates of Haemophilus influenzae, MoraxeeUa (BranhameUla) isolates, 1 (0.2%) was penicillin resistant, while 3.8% were relatively resistant to penicillin, 4.5% were resistant to trimethoprim-sulfamethoxazole, 2.3% were resistant to tetracycline, 1.2% were resistant to chloramphenicol, and 0.2% were resistant to erythromycin. Overall, the lowest resistance rates for these common bacterial respiratory pathogens were noted with amoxicillin-clavulanate, cefuroxime, and cefaclor.Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella (Branhamella) catarrhalis are bacterial agents responsible for a number of upper and lower respiratory tract infections, including otitis media (3, 4, 6, 12), maxillary sinusitis (3,6,12,22), community-acquired pneumonia (6, 11), and in some cases, exacerbations of chronic bronchitis (6,12,29). These species may harbor resistance mechanisms which affect several antimicrobial agents commonly used to treat such infections (2,3,5,6,14,15,17,23,24,26,31

A total of 2,811 clinical isolates of Haemopbilus influenzae were obtained during 1986 from 30 medical centers and one nationwide private independent laboratory in the United States. Among these, 757 (26.9%) were type b strains. The overall rate of 3-lactamase-mediated ampicillin resistance was 20.0%. Type b strains were approximately twice as likely as non-type b strains to produce (-lactamase Antimicrobial resistance among clinical isolates of Haemophilus influenzae has become an increasingly prevalent problem (G. V. Doern, Antimicrob. Newsl. 5: [28][29][30][31][32][33][34] 1986). In a national collaborative study conducted in 1984, 15.2% of a large number of strains of H. influenzae produced Ilactamase (6). The problem of ampicillin resistance is complicated by recent descriptions of clinical isolates of H. influenzae that are resistant to ampicillin by mechanisms other than the production of a TEM-type P-lactamase (10,11,14). In addition, chloramphenicol resistance has now been reported (2,15), as has resistance to a variety of alternative agents commonly used to treat Haemophilus infections (Doern, Antimicrob. Newsl. 5:28-34). The intent of this investigation was to define systematically the prevalence of antimicrobial resistance among clinical isolates of H. influenzae in the United States. Rates of P-lactamase production and the activities of 12 antimicrobial agents were assessed. These agents included ampicillin, chloramphenicol, cefamandole, cefaclor, cephalothin, cephalexin, tetracycline, rifampin, erythromycin, sulfisoxazole, and the combinations erythromycin-sulfisoxazole and trimethoprim-sulfamethoxazole (TMP-SMX). MATERIALS AND METHODSStudy centers. A total of 30 hospital-based microbiology laboratories and 1 national, private, independent laboratory participated in the study (Table 1) by the laboratories listed in Table 1. All isolates were recovered from different patients and were randomly selected for inclusion in the study. After being characterized in study center laboratories, isolates were subcultured to chocolate agar slants (GIBCO Diagnostics, Madison, Wis.), which were incubated overnight in a CO2 atmosphere and then mailed, with selected patient demographic information, to one of two coordinating study centers for further characterization. The coordinating study centers were the Department of Clinical Microbiology, University of Massachusetts Medical Center, Worcester, and the Department of Pathology, University of Texas Health Science Center, San Antonio. Upon receipt in the coordinating study centers, growth from slants was transferred into 10% sterile skim milk and frozen at -70°C in 1-dram (ca. 3.7-ml) plastic freezer vials.Isolate characterization. Frozen stock suspensions were thawed, and aliquots were subcultured to chocolate agar plates (GIBCO) which were incubated overnight at 35°C in 5 to 7% CO2. Individual isolated colonies were then subcultured to a second chocolate agar plate which was incubated under identical conditions. Growth from the second plate was used for the fol...

Rates of influenza vaccination during pregnancy are low. There is a significant relationship between healthcare provider recommendation for the vaccination and vaccine uptake. Increasing provider recommendation rates has the potential to increase coverage rates of influenza vaccination in pregnant women.

BackgroundPregnant women have an increased risk of influenza complications. Influenza vaccination during pregnancy is safe and effective, however coverage in Australia is less than 40%. Pregnant women who receive a recommendation for influenza vaccination from a health care provider are more likely to receive it, however the perspectives of Australian general practitioners has not previously been reported. The aim of the study was to investigate the knowledge, attitudes, beliefs, and practices of general practitioners practicing in South-Western Sydney, Australia towards influenza vaccination during pregnancy.MethodsA qualitative descriptive study was conducted, with semi-structured interviews completed with seventeen general practitioners in October 2012. A thematic analysis was undertaken by four researchers, and transcripts were analysed using N-Vivo software according to agreed codes.ResultsOne-third of the general practitioners interviewed did not consider influenza during pregnancy to be a serious risk for the mother or the baby. The majority of the general practitioners were aware of the government recommendations for influenza vaccination during pregnancy, but few general practitioners were confident of their knowledge about the vaccine and most felt they needed more information. More than half the general practitioners had significant concerns about the safety of influenza vaccination during pregnancy. Their practices in the provision of the vaccine were related to their perception of risk of influenza during pregnancy and their confidence about the safety of the vaccine. While two-thirds reported that they are recommending influenza vaccination to their pregnant patients, many were adopting principles of patient-informed choice in their approach and encouraged women to decide for themselves whether they would receive the vaccine.ConclusionsGeneral practitioners have varied knowledge, attitudes, and beliefs about influenza vaccination during pregnancy, which influence their practices. Addressing these could have a significant impact on improving vaccine uptake during pregnancy.