Persistence of Pseudomonas aeruginosa strains in seven cystic fibrosis patients followed over 20 months.
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Biomedical subjects
Publications and source records attributed to C Godard.
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Strains of Staphylococcus aureus isolated in Belgium and Zaïre from food and from various sources in the meat industry were biotyped, phage typed and tested for staphylococcal enterotoxin (SE) production. Thirty of the 185 strains examined produced one or more SE, and 23 of these belonged to the human biotype. Most SE-positive strains belonged to phage groups III and Mixed, or were not typable. None of the poultry-like biotype strains, which were frequent in nasal carriers among workers in meat plants as well as in minced meat, produced enterotoxins. Avian biotype strains similarly were negative.
To evaluate the usefulness of phenotypic and genotypic analyses for the epidemiologic typing of methicillin-resistant Staphylococcus aureus (MRSA), we characterized 64 epidemic MRSA isolates and 10 sporadic methicillin-susceptible S. aureus isolates from a university hospital and 18 MRSA isolates from hospitals in different geographical areas. Chromosomal DNA macrorestriction analysis with SstII was resolved by pulsed-field gel electrophoresis and compared with antibiotype analysis, phage type analysis, and standard genomic DNA restriction analysis with BglII. Indices of the discriminatory ability of these methods were 0.982, 0.959, 0.947, and 0.959, respectively. Macrorestriction patterns of 94% of MRSA isolates from patients, personnel, and the environment associated with a nosocomial outbreak were closely related (similarity coefficient, 85 to 100%). In contrast, methicillin-susceptible S. aureus isolates showed a marked diversity of macrorestriction patterns (median similarity, 41%). MRSA isolates from other geographical areas showed diverse macrorestriction patterns, with the exception of four isolates displaying identical or closely related patterns; these isolates were associated with concurrent outbreaks in four other Belgian hospitals. A concordance of genomic DNA macrorestriction typing with phenotypic methods was observed for 60 to 65% of MRSA isolates, and a concordance with standard DNA restriction analysis was found for 79 to 98% of these isolates. In conclusion, genomic DNA macrorestriction analysis was a useful complement to phenotypic methods for delineating epidemic isolates of MRSA, for identifying their nosocomial reservoirs, and for tracing their intra- and interhospital spread. The genetic relatedness of MRSA isolates, as estimated by this technique, appeared to correlate with their space-time clustering.
We analysed the implantation pattern and persistence of Pseudomonas aeruginosa in the tracheobronchial tracts of patients with cystic fibrosis, and investigated the relation of this bacterium with the environment and antibiotic therapy. We used four different techniques to ensure the precise and detailed identification of isolates. In particular, chromosomal differences were assessed by pulsed field electrophoresis (pulsotype determination). Sputum samples were collected from 8 patients, from 6 to 22 years-old, over a period of 19 to 24 months. Only a single strain was isolated from samples from each five patients taken at different times, and there was a predominant strain in the samples from two others. Patient 8, aged 14, was free of infection throughout the study. None of the infections was eradicated by antibiotic therapy (an association of two antibiotics for 15 days at one or two months interval). The strains isolated from two patients became resistant to imipenem: 3 out of the 4 resistant strains were the result of mutation in the resident, susceptible strain. Swabs were taken from the environments of infected patients and were tested for P. aeruginosa: this bacteria was found in three sites, and two of these contained an isolate with the same pulsotype as the strain responsible for the infection, whereas no P. aeruginosa was detected in the environment of an uninfected patient. The detailed and accurate identification of the isolates (by pulsotyping) enabled us--to show that each infected patient was infected by a single or predominant strain,--to investigate the relationship of these strains with those in the environment and the effects of antibiotic therapy.
4.2% Pseudomonas aeruginosa strains isolated in our hospital were resistant to ceftazidime. The 174K strain was also resistant to azthreonam but susceptible to imipenem and was studied as representative of these strains. It produced a single beta-lactamase (pI 8.6) which had all the characteristics of the chromosomal beta-lactamase Id and was the only beta-lactamase present. This enzyme hydrolyses slowly ceftazidime and imipenem. It could be a factor of imipenem resistance if the antibiotic influx into the bacteria was decreased or if the beta-lactamase Id was synthesized at a high level.
A large majority (87.4%) of 190 Staphylococcus aureus isolates from fresh beef in Lubumbashi (Zaïre) belonged to the human St. aureus ecovar; 81.2% of the phage-typed human strains were partially or solely lysed by phages of group III. Thirteen of the 52 tested strains (25.0%) were enterotoxin producers; nine of these (69.2%) were positive for staphylococcal enterotoxin A. Sixteen serotypes were identified among the 122 Salmonella isolates and nearly all these strains were susceptible to the 8 different antibiotics tested.
The antimicrobial agents most active against bacteremic isolates of oxacillin-resistant Staphylococcus aureus isolated from 1983 to 1985 were new fluoroquinolones, including PD 117,596 and PD 127,391 (MIC for 90% of isolates [MIC90] in agar, in micrograms per milliliter, 0.1) and temafloxacin, pefloxacin, and ofloxacin (MIC90, 0.4). Other active antimicrobial agents included fusidic acid (MIC90, 0.2) and fosfomycin (MIC90, 12.5). Vancomycin was active against all isolates. Mupirocin was very active (MIC90, 0.4).
Two hospital-made, lactose-free, hypoosmolar formulas were compared for therapy for 61 children aged 10-28 months who had severe malnutrition and protracted diarrhea. The formulas were isocaloric and contained dextrin-maltose, carrots, sunflower oil, minerals, and vitamins. One had chicken meat as the protein source and the other had hydrolyzed lactalbumin (LAD). Initially the formulas were given as a continuous enteral feeding by nasogastric tube and pump. Six patients died from metabolic and infectious complications: four failed to equilibrate and changed diet. The remaining 51 were divided into two groups; group A, chicken formula (n = 26), and group B, LAD formula (n = 25). The mean duration of diarrhea was similar in both groups; number of days with liquid stools = 6.0 +/- 4.1 in group A, 5.5 +/- 2.8 in group B; number of days with greater than 4 stools/day = 3.5 +/- 3.4 in group A, 4.1 +/- 2.1 in group B. The time until beginning nutritional recovery was 13.2 +/- 12.0 days in group A and 13.3 +/- 7.8 days in group B. Intercurrent infections were significantly more frequent in patients receiving chicken formula (12 of 30 patients) than in those receiving LAD formula (4 of 27 patients) (p less than 0.05). We conclude that chicken formula is an efficient substitute to expensive semielemental formulas for continuous enteral feeding of protracted diarrhea in severely malnourished children.
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Routine typing was performed on a total of 7089 Pseudomonas aeruginosa strains isolated in 16 Belgian hospitals in the period from 1977 to 1986. The annual number of strains received ranged from 318 to 1346. The incidence of serotype O:12 was less than 2% until 1981 when it rose to 4%, steadily increasing to become the predominant serotype in 1984 (22%), 1985 (18%) and 1986 (22%). Since 1980 the O:12 isolates have exhibited characteristic patterns on pyocin and phage typing, 89% of O:12 isolates belonging to pyocin types 1, 39, 43, 45 or 105, whereas only 51% of isolates of other serotypes belonged to those pyocin types. Ninety-three per cent of serotype O:12 isolates belonged to phage types 68/119x, 68 or 119x, or were non-typable, whereas only 24.37% of other serotypes isolates exhibited these phage patterns. These distinctive patterns of pyocin and phage types suggest a high degree of homogeneity within the O:12 strains isolated in recent years in Belgium. Multi-centre or country-wide survey of Pseudomonas aeruginosa strains isolated in hospitals using epidemiological markers may be of value in identifying a sudden increase in epidemic strains.
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Haemoglobin (Hb) was measured in 348 full-term one-year-old infants in 7 private paediatric offices. In 36 (10.3%) subjects, the Hb value was less than 110 g/l, and in 7 (2.0%) less than 100 g/l. In 11 of 212 (5.2%) subjects, MCV was less than 70 fl. Twenty-six infants with an Hb below 115 g/l showed an increase of Hb of +10 g/l or more after a therapeutic trial with oral iron. No relationship was found between Hb levels and early introduction of whole cow's milk into the diet. It is concluded that screening for iron deficiency is justified in healthy Swiss infants: Hb and MCV measurements may be the initial step.
Screening for abnormal hemoglobins and G6PD deficiency was conducted in adult and new born Maroccans from Casablanca. The results presented deal with HbS and HbC traits, alpha, gamma, and delta mutations, the presence of detectable amount of Hb Bart's and the G6PD deficiency frequency.
One hundred and twenty eight strains of Staphylococcus from lesions, mostly of the skin, in horses were identified and compared with 29 strains isolated from the healthy skin. The pathogenic species Staphylococcus aureus, S. intermedius and S. hyicus were found almost exclusively in lesions. Other species such as S. xylosus and S. sciuri were more frequently found on the healthy skin than in lesions. The S. aureus strains formed a very heterogeneous collection. Many of these strains were staphylokinase positive and rapidly coagulated bovine plasma. Such strains are rarely found in other animals and man.
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An outbreak of cutaneous staphylococcosis caused high mortality among newborn and very young rabbits. The most typical lesions were exudative dermatitis in the youngest, subcutaneous abscesses in rabbits of all ages and mastitis in lactating does. Generalised staphylococcosis was a frequent secondary manifestation of the disease.
Staphylococcus simulans was found to be the most common staphylococcal species present on the healthy skin and in the nares of cats. S. aureus was the most frequent Staphylococcus species in lesions. Most of the S. aureus strains showed the characteristics of the human ecovar. Other strains isolated formed a heterogenic collection in which not less than 13 species were represented. One of these, S. epidermidis, was almost exclusively associated with lesions. It was concluded that coagulase-positive staphylococci are not endogenous to cats. Staphylococci from other sources, most frequently from man, are often associated with lesions in these animals.