Linezolid audit: similarities and contrasts with published experience.
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Biomedical subjects
Publications and source records attributed to G Corbett-Feeney.
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We have observed a high incidence of isolated nalidixic acid resistance in Salmonella enterica serovar Enteritidis isolates in Ireland, particularly isolates of phage type 1 (PT1). A group of nalidixic acid-resistant (n = 22) and nalidixic acid-susceptible (n = 28) isolates of serovar Enteritidis from multiple sites in Ireland were selected. Isolates were typed by pulsed-field gel electrophoresis (PFGE) with XbaI, and the MICs for nalidixic acid and ciprofloxacin were determined. Mutations associated with nalidixic acid resistance in clinical isolates and laboratory mutants of serovar Enteritidis and 32 nalidixic acid-resistant isolates of 15 other salmonella serovars were identified. PFGE had limited discriminatory power. A specific point mutation (G246T) associated with amino acid substitution Asp87Tyr in the quinolone resistance determining region of the gyrA gene accounted for 95% of all mutations in serovar Enteritidis and for all mutations in PT1 isolates. Greater diversity of mutations was observed among all non-Enteritidis salmonella serovars studied. Rates of nalidixic acid resistance in serovar Enteritidis may predominantly reflect clonal expansion after infrequent mutation or selection events.
Between 1998 and 2003, 5,161 isolates (3,182 human) of Salmonella enterica were received by the National Salmonella Reference Laboratory of Ireland. Serotyping, antimicrobial susceptibility testing and phage typing were performed by standard methods. The number of isolates of S. enterica serovar Typhimurium decreased from 579 (80%) in 1998 to 208 (19%) in 2003, while S. enterica serovar Enteritidis increased from 59 (8%) in 1998 to 219 (20%) in 2003. Definitive (DT) phage types 104 and DT104b accounted for a declining proportion of all Salmonella Typhimurium isolates (from n = 523 [90%] in 1998 to 126 [60%] in 2003). Numbers of Salmonella Enteritidis phage type 4 declined from 50 (85%) in 1998 to 59 (27%) in 2003. Twenty-eight isolates of typhoidal Salmonella were received with a history of recent travel in 17 cases. Resistance to multiple (four or more) antimicrobial agents was related to serotype and, where applicable, phage type, and was common in Salmonella Typhimurium. Salmonella Typhimurium predominated among isolates from cattle and pigs (n = 213 [58%]), while Salmonella Livingstone (n = 327) and S. Kentucky (n = 227) were predominant in isolates from poultry (total n = 554 [43%]). This paper discusses trends, and their implications, in Irish salmonella isolates since the establishment of the Reference Laboratory.
Shigella sonnei is a significant cause of gastroenteritis in both developing and industrialized countries. Definition of the diversity and antimicrobial susceptibility of S. sonnei isolates may be helpful in the management of individual cases and outbreaks. Antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE) were performed with 67 isolates of S. sonnei predominantly (n = 59) from three counties in the west of Ireland. Phage typing (n = 17), plasmid profiling (n = 28), and integron analysis (n = 24) were performed with subsets of strains. PFGE typing permitted recognition of two major clusters: PFGE type A (n = 53) and PFGE type B (n = 14). PFGE type A was associated with resistance to ampicillin, streptomycin, and sulfonamides (51 of 53 isolates), and those that were phage typed (n = 6) were phage type 3. PFGE type B was associated with resistance to streptomycin, sulfonamides, tetracycline, and trimethoprim (11 of 14 isolates) and phage type 6 (9 of 11 isolates). Fifteen different plasmid profiles were identified among the 28 isolates analyzed. A class 2 integron was present in all 14 PFGE type B isolates. One of these isolates also contained a class 1 integron and showed a unique variant of the PFGE type B pattern. Sequence analysis of the gene cassette structures contained within these integrons identified distinct open reading frames that encoded determinants of resistance to trimethoprim, streptomycin, and streptothricin. Our data demonstrate two predominant PFGE types among S. sonnei isolates circulating in this region. The limited diversity of the S. sonnei isolates in this region means that detection of isolates indistinguishable by PFGE and according to their antibiograms in two or more patients is not persuasive evidence of a common-source food- or waterborne outbreak. Indistinguishable plasmid profiles in addition to indistinguishable PFGE and antibiogram types may be more suggestive of an epidemiologically relevant link between cases.
We describe a case of primary cutaneous mucormycosis (zygomycosis) in a patient with idiopathic aplastic anemia which responded to surgical debridement and therapy with liposomal amphotericin B. The tissue removed at surgery showed dense infiltration with fungal hyphae on histopathological examination. Primary cultures of tissue on solid media were negative, but Absidia corymbifera was isolated from unprocessed tissue placed in brain heart infusion broth.
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Clostridium difficile is the principal pathogen associated with hospital-acquired acute diarrheal disease. We have evaluated the performances of six approaches for diagnosis of C. difficile-associated diarrhea (CDAD). Consecutive stool specimens (n = 200) from 133 patients were examined by cytotoxin assay, by culture of C. difficile on cycloserine-cefoxitin-fructose agar, and by toxin detection using four rapid immunoassay systems (Oxoid Toxin A test, ImmunoCard Toxin A test, TechLab Tox A/B II test, and Premier Toxins A&B test). A diagnosis of CDAD was established for 35 (27%) patients (representing 29% of specimens). The adjusted sensitivity and specificity of the methods were, respectively, 98 and 99% for the cytotoxin assay, 54 and 99% for ImmunoCard, 50 and 98% for Oxoid, 79 and 98% for TechLab, 80 and 98% for Premier, and 57 and 100% for culture. The TechLab and Premier assays are acceptable tests for diagnosis of CDAD but are not equivalent to the cytotoxin assay.
We have compared the BACTEC 460 system with the BACTEC MGIT 960 system for culture of mycobacteria from 1800 routine clinical specimens. Rate of isolation of M. tuberculosis and time to detection of positive culture was comparable for both systems (BACTEC 460, 35 isolates, BACTEC MGIT 960, 34 isolates). Contamination of cultures was more common with the BACTEC MGIT 960 system. With intensification of the decontamination process an acceptable contamination rate was achieved in the BACTEC MGIT 960 system but time to detection of positive culture was increased by 1 to 2 days.
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Data from 8,717 fecal specimens indicate that primary inoculation of xylose lysine deoxycholate (XLD) agar may enhance the speed, but not the sensitivity, of isolation of Salmonella enterica over that achieved with Selenite enrichment only. Plating of Selenite broth onto both brilliant green and XLD agar offers no advantage over plating onto XLD alone.
An institutional outbreak of gastroenteritis provided an opportunity to investigate further the isolates of Salmonella typhimurium by pulsed-field gel electrophoresis (PFGE). Three phage types were identified. Antibiograms identified two types and two distinct patterns were found on PFGE. If phage typing alone is used for epidemiological study of strains, it is possible that an association between strains may be missed.
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During the period from August 1989 to October 1990, 93 patients living in the West of Ireland were screened for Hepatitis C antibodies (Anti HVC) using a commercially available assay. The tests were performed because of abnormal liver function tests (LFTs) or clinical suspicion of Hepatitis C. Nine positive results were obtained (10.3%) seven of whom had a history of transfusion of blood or a blood product. The study revealed that the prevalence of anti HCV was low in patients with chronic liver diseases, in comparison to reported prevalence rates in other parts of the world and that blood transfusion was the commonest predisposing factor to acquisition of anti HCV in this area.
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Admission of patients to University College Hospital, Galway over a five month period commencing December 1989 indicates an increase in the incidence of Neisseria Meningitidis Serogroup C. Seven cases of Group CN. Meningitidis have been identified, five of them occurring over a four week period. A review of Meningococcal isolates occurring at this hospital over eleven years since 1979 shows, serogroup B as the predominant serogroup. Thirty-six isolates identified by serogrouping shows the distribution of serogroups as follows: Serogroup B 69.4%, Serogroup C 19.4%, Serogroup A 8.3%, Serogroup Z 2.7%. Serogrouping, and when available, further serotyping of meningococcal isolates is very important in order to follow epidemiological trends in the disease and to monitor the serogroups that cause outbreaks. This information can influence measures that can be taken in the prevention of spread of the disease as for example the use of vaccination as appropriate.
During a period of 12 months beginning on 18 February 1985, 1246 specimens of faeces from 935 children aged 3 weeks to 12 years with acute diarrhoea of varying severity were examined for the presence of cryptosporidium oocysts. Twenty-six patients required admission to hospital; four of them needed intravenous rehydration. Predominant clinical features were diarrhoea, often watery, and vomiting. Diarrhoea varied in duration between 7-15 days. Cryptosporidium oocysts were found in specimens from 41 patients, an incidence of 4.3%. In four patients an additional enteropathogen was identified (Campylobacter species in two and enteropathogenic Escherichia coli in two - serotypes 0126: K71 (B16) and 018C: K77 (B12]. None of the patients had recently travelled abroad. Of the children 23 were from a farming or rural background. Eight of the farms had recently had significant outbreaks of diarrhoea among calves. There was a marked seasonal variation with 27 of the cases arising between 18 February and 18 June, an incidence during this period of 8%.
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