Between 1971 and 1975, methicillin-resistant Staphylococcus aureus (MRSA) caused sporadic infection in eight Dublin hospitals although a case of bacteraemia was not recorded until 1976. From then on gentamicin-resistant MRSA rapidly became endemic in Dublin hospitals. The frequency of MRSA bacteraemia reached a peak in 1979-82 but MRSA infection remains an important problem. The most effective antimicrobial agent in treatment of invasive infection was vancomycin; little drug toxicity was seen. Where appropriate, concomitant surgical treatment such as debridement and drainage was usually necessary. Infection control measures directed at eliminating carriage proved effective in reducing spread. Molecular analysis showed two distinct MRSA phenotypes with similar phage-typing patterns. Gentamicin resistance was chromosomally encoded.

Gentamicins↗

PubMed1985

Faecal carriage of methicillin-resistant staphylococci.

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Carrier State↗

PubMed1985

Susceptibility to antimicrobial agents and analysis of plasmids in gentamicin- and methicillin-resistant Staphylococcus aureus from Dublin hospitals.

Methicillin- and gentamicin-resistant Staphylococcus aureus (MGRSA) strains isolated from Dublin Hospitals were classified into two groups (phenotypes). Phenotype-I strains expressed high level resistance to gentamicin and were susceptible to fusidic acid; strains resistant to tetracycline harboured a 3 X 10(6)-mol. wt plasmid. Strains in phenotype II usually expressed low level resistance to gentamicin, were resistant to fusidic acid and often harboured a (22-24) X 10(6)-mol. wt plasmid that specified resistance to ethidium bromide, tetracycline, kanamycin, neomycin and trimethoprim, or to combinations of these markers. A few phenotype-II strains expressed higher levels of resistance to gentamicin and other aminoglycosides. All MGRSA strains carried a 21 X 10(6)-mol. wt plasmid conferring resistance to penicillin, ethidium bromide, cadmium and mercury. Gentamicin resistance was invariably chromosomal and all strains carried chromosomal resistance to methicillin, erythromycin, streptomycin and spectinomycin. Several methicillin-resistant S. aureus (MRSA) strains isolated before the emergence of gentamicin resistance harboured a 21 X 10(6)-mol. wt penicillinase plasmid with the same restriction endonuclease profile as that from some MGRSA strains. Some MRSA strains carried other plasmids related to those found in MGRSA strains.

Anti-Bacterial Agents↗

PubMed1985

Antimicrobial chemotherapy of septicemia due to methicillin-resistant Staphylococcus aureus.

The outcome of treatment of 48 episodes of septicemia due to methicillin-resistant Staphylococcus aureus (MRSA) in 44 patients was assessed. Twenty-six of the patients died; nineteen of them died of infection, and infection was a major contributing factor to the deaths of the remaining seven patients. Fourteen of fifteen patients treated with inadequate antibiotic therapy died, and the other patient developed a mycotic aneurysm of the femoral artery, for which amputation was necessary. Eight of eleven patients treated with amikacin (alone or combined with another antimicrobial) died, and three recovered slowly; only one recovered fully without sequelae. In an additional two patients who failed to respond to amikacin, treatment was changed to vancomycin. Vancomycin was used to treat 18 episodes of MRSA septicemia in 17 patients. In 14 of these episodes the patients recovered fully. One patient died of uncontrolled infection, and in three, infection was a contributing factor but not the major cause of death. Vancomycin was confirmed as antibiotic of choice in treating MRSA septicemia.

Adult↗

PubMed1984

Clinical experience with aztreonam in urinary and respiratory tract infections.

Twenty patients with severe infection, 10 of the urinary tract and the other 10 of the respiratory tract, were enrolled in a clinical trial of aztreonam, a new monobactam antimicrobial agent. For the urinary tract infections, the mean duration of treatment was 7 days, with doses ranging from 0.25 to 1.0 g aztreonam intravenously twice daily. Sustained clinical and microbiological cure was achieved in 9 of the 10 patients. In the group with respiratory infections, the mean duration of treatment was 9.3 days, patients receiving 1 g aztreonam intravenously 3-times daily. Initial clinical cure was achieved in 9 of the patients, the tenth showing an incomplete response. However, bacteriological recurrence, related to the persistent nature of the underlying disease, occurred in 6 of the 10 patients during the 1-month follow-up period. The only side-effects were mild, transient biochemical abnormalities which did not require drug withdrawal in any patient.

Adult↗

PubMed1983

Gentamicin and methicillin resistant Staphylococcus aureus in Dublin hospitals: clinical and laboratory studies.

Strains of Staphylococcus aureus resistant to gentamicin and methicillin first appeared in Dublin hospitals in 1976, and rapidly became widely disseminated. The number of patients infected or colonised increased throughout the period of study, especially in 1979 and 1980. Most isolates were from burns, surgical wounds and traumatic skin lesions. During the 12 months after first isolation of these multiply antibiotic resistant strains, colonisation or minor infection was the usual event. Invasive infection such as bacteraemia, deep wound sepsis and osteomyelitis was rarely seen. Subsequently, as the number of patients from whom these organisms were isolated increased, bacteraemia and other severe infection became more common. The predominant phage type of S. aureus changed with the progression of the outbreak. Isolates of different phage type were sometimes found in a single lesion, or in different sites in one patient. By the second half of 1980, most isolates were untypable or typed only with an experimental phage.

Bacteriophage Typing↗

PubMed1983

Tuberculosis.

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Humans↗

PubMed1982

Q fever endocarditis.

Despite a worldwide distribution of Coxiella burnetii, only single cases of Q fever endocarditis have been reported outside Great Britain and Australia. We present 10 patients; five were female, only four had a history of environmental exposure, and the mitral valve was involved as commonly as the aortic stenosis, and three patients had a prosthetic valve. We confirm the importance of hepatic involvement, thrombocytopenia and hypergammaglobulinemia as diagnostic features. Diagnosis was established by finding and elevated complement-fixing antibody to Phase I C. burnetii antigen. Tetracycline, with or without lincomycin or cotrimoxazole, was used in nine patients, and one patient received cotrimoxazole as as the sole antibiotic agent. Optimal duration of therapy is unknown. In one patient, relapse followed when treatment was stopped after 18 months. Valve replacement was necessary in five patients, because of hemodynamic problems. Five patients died, and the means survival is 36 months with a range of five to 66 months. We suggest that Q fever endocarditis is frequently missed, and we recommend clinicians to consider the diagnosis in all cases of culture-negative endocarditis.

Adult↗

PubMed1982