Specific detection of Mycobacterium tuberculosis in radiometric cultures by using an immunoassay for antigen 5.
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Bacteriological Techniques↗
Biomedical subjects
M R Jacobs
Publications and source records attributed to M R Jacobs.
Treatment of experimental Salmonella typhimurium infection in mice with fleroxacin.
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Animals↗
Postmortem diagnosis of meningococcemia by detection of capsular polysaccharides.
Detection of specific meningococcal capsular polysaccharide (CPS) in postmortem blood permits rapid diagnosis of meningococcemia and differentiation from pneumococcemia and septicemia caused by Haemophilus influenzae Type b. We present studies validating application of latex agglutination assay for CPS on blood samples collected at autopsy, delineate the circumstances when CPS testing is indicated, and illustrate the usefulness of this procedure by several recent cases. Blood samples from victims dying of injury or disease other than infection were examined to determine whether the postmortem interval, bacterial contamination, anticoagulants, or delay in testing would result in false positive assays. Series 1 samples, collected so as to minimize bacterial contamination, were immediately submitted for assay. Series 2 evaluated the effect of adverse conditions of collection, anticoagulation, and prolonged sample storage. Despite extended postmortem intervals of up to 14 days, heavy bacterial contamination, prolonged storage at 4 degrees C, deep hemolysis, and presence of anticoagulants, false positive assays were seldom observed.
Adult↗
Streptococcus mitis. A cause of serious infection in adults.
Twenty strains of Streptococcus mitis were isolated from blood or body fluids at the Cleveland Veterans Administration Medical Center from Jan 1, 1981, to April 30, 1984. Fifteen (75%) isolates were considered contaminants. Five (25%) were clinically important and associated with a serious infection of the oropharynx or gastrointestinal tract (three of five), endovascular system (one of five), or a prosthetic hip. Four of five patients required surgical intervention for treatment. Two of five died; one death was directly attributable to S mitis infection. Eighteen strains were available for detailed bacteriologic study. Three strains had a minimum inhibitory concentration of greater than 0.1 micrograms/mL of penicillin and six other strains were tolerant to penicillin. This review suggests that S mitis can be an important pathogen in adults and may cause infections other than endocarditis.
Adult↗
Pseudomonas aeruginosa as a primary pathogen in children with bacterial peritonitis.
This prospective study compared the efficacy of sulbactam/ampicillin and clindamycin/gentamicin in the treatment of children with bacterial peritonitis. Of the 29 children enrolled, 17 were evaluable; eight received sulbactam/ampicillin/gentamicin and nine clindamycin/gentamicin. Sixteen patients were previously healthy children with appendicitis. An average of 3.6 bacterial species were recovered from the peritoneal fluid of each patient. E coli and B fragilis were the most common aerobic and anaerobic isolates, recovered from 15 and ten patients, respectively. Pseudomonas aeruginosa was recovered from seven of 17 children; the three children with P aeruginosa infections randomized to the sulbactam/ampicillin group received gentamicin in addition to the investigational agents throughout the treatment course. Although the study groups were small, there was no difference in age, sex, number of pathogens per patient, duration of hospitalization, toxicity, or treatment failures between the two treatment groups or between children infected with P aeruginosa and controls. As a result of the high prevalence of P aeruginosa in the peritoneal exudate of otherwise healthy children with appendicitis, initial antimicrobial therapy in this patient population should include agents effective against this organism.
Adolescent↗
In-vitro activity of erythromycin, roxithromycin and CP 62993 against common paediatric pathogens.
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Anti-Bacterial Agents↗
Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients.
The clinical distinction between bacterial colonization of the tracheobronchial tree and nosocomial pneumonia is difficult, especially in intubated patients. We studied 51 intubated, intensive care unit patients prospectively by serial examinations of tracheal aspirates for elastin fibers, graded Gram's stains, and quantitative bacterial cultures in conjunction with clinical and radiologic observations in an attempt to develop criteria for the early detection of pulmonary infection. Patients with infection had new or progressive pulmonary infiltrates plus 1 of the following: positive blood culture results, radiographic evidence of cavitation, or histologic evidence of pneumonia, or 2 or more of the following: new fever, new leukocytosis, or grossly purulent tracheal aspirates. Twenty-one patients developed infection, 22 remained colonized, and 8 had an uncertain status. Infiltrates developed in 34 patients (21 infected, 8 colonized, 5 uncertain status). Gram-negative bacilli were most commonly isolated and were more frequent in infected patients (81 versus 47%, p less than 0.05); Pseudomonas aeruginosa and Serratia marcescens were most often associated with infection. No differences were observed between infected and colonized patients in demographic features, smoking history, underlying disease, previous antibiotic therapy, days in hospital before intubation, preexisting pneumonia upon intubation, or highest temperature or leukocyte count during course. By univariate analysis, infected patients had a longer duration of intubation (p less than 0.05), higher Gram's stain grading for neutrophils (p less than 0.05) or bacteria (p less than 0.005), higher bacterial colony counts (p less than 0.05), and more frequent detection of elastin fibers in tracheal aspirates (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Comparative activities of the beta-lactamase inhibitors YTR 830, clavulanate and sulbactam combined with extended-spectrum penicillins against ticarcillin-resistant Enterobacteriaceae and pseudomonads.
The in-vitro synergistic activity of YTR 830, a new beta-lactamase inhibitor, combined with four extended-spectrum penicillins (ticarcillin, piperacillin, mezlocillin and apalcillin) against ticarcillin-resistant clinical isolates of Gram-negative enteric bacilli was compared with that of clavulanate and sulbactam. Synergy testing was performed with fixed concentrations of beta-lactamase inhibitors (8 mg/l) combined with doubling dilutions of beta-lactams in microdilution trays. Synergy was defined as a four-fold or greater decrease of beta-lactam MIC in the combination compared with the beta-lactam alone. For 79 ticarcillin-resistant Enterobacteriaceae, ticarcillin-YTR 830 and ticarcillin-clavulanate were synergistic against 90% of strains; for ticarcillin-sulbactam, 70% showed synergy. The synergistic activity of all three inhibitors was similar against strains resistant only to ticarcillin; for strains resistant to all four extended-spectrum penicillins, the activity of ticarcillin with YTR 830 and clavulanate was similar (synergy against 79% of strains) and superior to ticarcillin-sulbactam (synergy against 39% of strains). YTR 830 was more active than clavulanate against Serratia, Citrobacter, Proteus and Providencia spp. Piperacillin, mezlocillin and apalcillin susceptible strains, with MICs of 8-16 mg/l, showed synergy with inhibitors against 37-87% of strains. Amongst pseudomonads, no synergy was demonstrated against Pseudomonas aeruginosa; ticarcillin produced synergy with the inhibitors against Ps. maltophilia, while piperacillin-YTR 830 and apalcillin-YTR 830 were synergistic against Ps. cepacia. YTR 830 appears to have comparable in-vitro activity to that of clavulanate, and further development of this compound is warranted.
Ampicillin↗
Synergy of amoxycillin combined with clavulanate and YTR 830 in experimental infections in mice.
YTR 830, a new beta-lactamase inhibitor, is synergistic with amoxycillin in vitro against a number of beta-lactamase-producing organisms. The combination of amoxycillin-YTR 830 was compared to amoxycillin-clavulanate in the treatment of experimental Staphylococcus aureus, Citrobacter freundii and Proteus mirabilis infections in mice. Both combinations were synergistic with amoxycillin against all three test organisms. The amoxycillin-clavulanate combination was superior against S. aureus and C. freundii while amoxycillin-YTR 830 was more effective against P. mirabilis. The difference in efficacy between the two drug combinations appears to relate to the degree of protection afforded the animals by the beta-lactamase inhibitor alone. YTR 830 is a promising new agent and should undergo further investigation.
Amoxicillin↗
Comparative activities of the beta-lactamase inhibitors YTR 830, clavulanate, and sulbactam combined with ampicillin and broad-spectrum penicillins against defined beta-lactamase-producing aerobic gram-negative bacilli.
The in vitro synergistic activities of the beta-lactamase inhibitors YTR 830, clavulanate, and sulbactam, combined with ampicillin, ticarcillin, mezlocillin, azlocillin, piperacillin, and apalcillin, were determined against 34 strains of members of the Enterobacteriaceae family, Pseudomonas aeruginosa, Aeromonas hydrophila, and Haemophilus influenzae with characterized plasmid or chromosomal beta-lactamases or both. Strains were tested against fixed concentrations of beta-lactamase inhibitors (8 micrograms/ml) combined with doubling dilutions of beta-lactams. Synergy was defined as a fourfold or greater decrease in the MIC of the beta-lactam. Against Enterobacteriaceae producing Richmond and Sykes class III and V plasmid-mediated beta-lactamases, synergy was obtained against most strains with YTR 830- and clavulanate-beta-lactam combinations, with sulbactam being less effective. Against Enterobacteriaceae producing class I chromosomal beta-lactamases, combinations containing YTR 830 or sulbactam were more synergistic than combinations containing clavulanate. Against strains producing class V PSE enzymes, all three inhibitors were synergistic with piperacillin and apalcillin against strains producing PSE-1, -3, and -4 enzymes, while the PSE-2-producing strain was resistant to all inhibitors. YTR 830-beta-lactam combinations were also synergistic against strains producing the novel beta-lactamases OHIO-1, TLE-1, AER-1, and ROB-1. Overall, YTR 830 with piperacillin or apalcillin was the most effective combination.
Ampicillin↗
Comparative activity of beta-lactamase inhibitors YTR 830, clavulanate, and sulbactam combined with beta-lactams against beta-lactamase-producing anaerobes.
The in vitro activities of the beta-lactamase inhibitors YTR 830, clavulanate, and sulbactam combined with six beta-lactams against 88 beta-lactamase-producing anaerobes were determined. When combined with the beta-lactams, the three beta-lactamase inhibitors showed no synergy against the 10 Bacteroides fragilis homology group II strains. When the beta-lactams were combined with the inhibitors, their geometric mean MICs against the remaining 78 strains were reduced from 4.2 to 150.2 micrograms/ml to 0.2 to 12.9 micrograms/ml. The activity of the beta-lactams combined with the beta-lactamase inhibitors was significantly greater than that of the beta-lactams alone against all groups except B. fragilis homology group II, with 76 to 100% of the strains susceptible to ampicillin plus inhibitor and greater than or equal to 90% susceptible to the other combinations.
Anti-Bacterial Agents↗
Accuracy and reproducibility of the IDS rapID STR system for species identification of streptococci.
The RapID STR system (Innovative Diagnostic Systems, Inc., Atlanta, Ga.) was evaluated in the identification of 266 streptococci. Organisms included 60 beta-hemolytic streptococci, 71 group D strains (48 enterococci and 23 nonenterococci), 26 Streptococcus pneumoniae, and 109 viridans group strains. With concomitant optochin testing, as is currently recommended by the manufacturer for all alpha-hemolytic strains, the RapID STR system correctly identified 100% of beta-hemolytic strains, 87.3% of group D strains (93.7% of enterococci, 73.9% of nonenterococci), 88.5% of S. pneumoniae, and 72.5% of viridans strains. Without the use of optochin, the correct identification of S. pneumoniae and the viridans group was 26.9 and 52.3%, respectively. The RapID STR system incorrectly identified 3.0% of strains, including four group D streptococci, three pneumococci, and one viridans isolate. Reproducibility was excellent, with 95% of strains tested in triplicate yielding identical results on each of the three occasions. The RapID STR system represents a worthwhile advance in streptococcal species identification, especially for group D and viridans strains.
Reagent Kits, Diagnostic↗
Preoperative use of povidone-iodine. A prospective, randomized study.
One hundred one adult orthopedic surgical patients were studied in a randomized, prospective clinical trial to compare the effectiveness of the standard povidone-iodine scrub and paint with povidone-iodine painting alone for presurgical skin preparation. No infections occurred in either group. The scrub-plus-paint group showed a 0.601 logarithmic reduction in bacteria counts, compared with 0.622 with painting alone. Further, 36.8% of the patients in the scrub-plus-paint group had skin counts that actually increased after preparation, compared with 13.8% of patients in the paint-only group. The preparation bacterial counts among inpatients, who received preoperative hexachlorophene showers, were significantly lower than that of outpatients, who did not receive preoperative showers. The data support the use of the preoperative hexachlorophene shower and the omission of scrubbing from the surgical skin preparation technique.
Ambulatory Care↗
Evaluation of the Micro-ID, the API 20E and the Rapid 20E for same-day identification of Enterobacteriaceae.
In a comparative study of three methods for same-day identification, the Rapid 20E identified 91.8% of 328 clinically isolated Enterobacteriaceae correctly to species level, 0.3% to genus level, 4.0% as part of a spectrum of identifications, and 4.0% incorrectly. Corresponding data for Micro-ID were 86.6%, 3.7%, 5.8%, 4.0%, and for same-day API 20E values were 72.6%, 7.3%, 13.4%, and 6.7%. Both Rapid 20E and Micro-ID provide accurate identification within four hours; same-day five-hour API 20E was less satisfactory.
Bacteriological Techniques↗
Infection caused by vancomycin-resistant Streptococcus sanguis II.
A patient with bacteremia caused by vancomycin-resistant Streptococcus sanguis II is presented. This rare occurrence suggests that vancomycin may not be a completely reliable antibiotic in the treatment of infections due to viridans species of the genus Streptococcus. Gram-positive isolates from blood and otherwise sterile body fluids should be tested for susceptibility to vancomycin.
Anti-Bacterial Agents↗
Comparative activities of the beta-lactamase inhibitors YTR 830, sodium clavulanate, and sulbactam combined with amoxicillin or ampicillin.
YTR 830, a new beta-lactamase inhibitor, was compared with clavulanic acid and sulbactam against aminopenicillin-resistant clinical isolates. At a concentration of 8 micrograms/ml, YTR 830 was as effective as clavulanate or sulbactam in reducing the aminopenicillin MICs. Combined with amoxicillin, YTR 830 is a potentially useful agent for therapy of many bacterial infections.
Amoxicillin↗
Comparative evaluation of the API 20S system and the automicrobic system gram-positive identification card for species identification of streptococci.
Two commercial methods, the API 20S system (API; Analytab Products, Inc., Plainview, N.Y.) and the Gram-Positive Identification Card (GPI; Vitek Systems, Inc., Hazelwood, Mo.), were evaluated without additional tests for the identification of 241 streptococcus strains. Organisms included 60 beta-hemolytic strains, 36 group D strains, 26 Streptococcus pneumoniae strains, and 119 viridans streptococcus strains. API correctly identified to species 68.3% of beta-hemolytic strains, 86.1% of group D strains, 53.9% of S. pneumoniae strains, and 12.6% of viridans streptococci. This method provided excellent identification of group A and B and S. faecalis strains. Overall, API correctly identified 41.9% of strains to species, with 41.1% good likelihood but low selectivity, 15.8% incorrect, and 1.2% not identified. GPI correctly identified to species 58.3% of beta-hemolytic strains, 97.2% of group D strains, 80.8% of S. pneumoniae strains, and 57.2% of viridans streptococci. Group A, B, and D strains were all accurately identified by this system. Overall, GPI correctly identified to species 66.0% of strains, with 8.7% correct preliminary identification, 20.8% incorrect, and 4.6% not identified. Both methods represent a worthwhile advance in streptococcal identification. Neither system, however, can be recommended for species identification of the viridans group at this time.
Bacteriological Techniques↗
Evaluation of the rapid strep system for species identification of streptococci.
The Rapid Strep system (API System S.A., Montalieu-Vercieu, France) was evaluated, without additional tests, in the identification of 209 streptococci. Organisms included 59 beta-hemolytic, 36 group D, 24 Streptococcus pneumoniae, and 90 viridans group streptococci. The Rapid Strep system correctly identified to species level 69.5% of the beta-hemolytic strains, 100% of the group D strains, none of the S. pneumoniae strains, and 84.5% of the viridans group streptococci. The method provided excellent identification rates of groups A, B, and D but failed to differentiate between groups C and G. The method for preparation of suspensions for the Rapid Strep system, as initially recommended by the manufacturer, was responsible for the failure to identify S. pneumoniae. This method was subsequently modified to yield a heavier inoculum; all 10 pneumococcal strains tested with the revised inoculum method were correctly identified. Good identification rates of commonly encountered viridans strains were found. The Rapid Strep system represents a worthwhile advance in streptococcal species identification, especially for group D and viridans strains.
Bacteriological Techniques↗