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PubMed2006

In vitro activity of tigecycline, a new glycylcycline, tested against 1,326 clinical bacterial strains isolated from Latin America.

UNLABELLED: The in vitro activity of tigecycline (former GAR-936), a new semisynthetic tetracycline, was evaluated in comparison with tetracycline and other antimicrobial agents. MATERIAL AND METHODS: A total of 1,326 contemporary clinical isolates collected from the Latin American region were collected in 2000-2002 period and tested with microdilution broth according to the CLSI guidelines. The bacterial pathogens evaluated included Staphylococcus aureus (505), Streptococcus pneumoniae (269), coagulase-negative staphylococci (CoNS; 227), Haemophilus influenzae (129), Enterococcus spp. (80), Moraxella catarrhalis (54), beta-haemolytic streptococci (28), viridans group streptococci (26), and Neisseria meningitidis (8) RESULTS: Tigecycline demonstrated excellent activity against all Gram-positive cocci, with 90% of penicillin-resistant S. pneumoniae strains being inhibited at 0.12 microg/mL, while the same isolates had an MIC90 of > 16 microg/mL for tetracycline. All Enterococcus spp. were inhibited at 0.25 microg/mL of tigecycline. Tigecycline (MIC50, 0.25 microg/mL) was eight-fold more potent than minocycline (MIC50, 2 microg/mL) against oxacillin-resistant S. aureus (ORSA); all ORSA were inhibited at < 2 microg/mL of tigecycline. Tigecycline demonstrated excellent activity (MIC50, 0.5 microg/mL) against CoNS with reduced susceptibility to teicoplanin (MIC, 16 microg/mL). Tigecycline also showed high potency against respiratory pathogens such as M. catarrhalis (MIC50, 0.12 microg/mL) and H. influenzae (MIC50, 0.5 microg/mL). No tigecycline resistant isolates were detected when the proposed susceptible breakpoints (< 4 microg/mL) was applied. CONCLUSIONS: This results indicate that tigecycline has potent in vitro activity against clinically important pathogenic bacteria, including Gram-positive isolates resistant to both tetracycline and minocycline.

Anti-Bacterial Agents↗
PubMed2005

[Vancomycin-resistant Staphylococcus aureus].

The evolution and molecular mechanisms of vancomycin resistance in Staphylococcus aureus were reviewed. Case reports and research studies on biochemestry, electron microscopy and molecular biology of Staphylococcus aureus were selected from Medline database and summarized in the following review. After almost 40 years of successful treatment of S. aureus with vancomycin, several cases of clinical failures have been reported (since 1997). S. aureus strains have appeared with intermediate susceptibility (MIC 8-16 microg/ml), as well as strains with heterogeneous resistance (global MIC < or =4 microg/ml), but with subpopulations of intermediate susceptibility. In these cases, resistance is mediated by cell wall thickening with reduced cross linking. This traps the antibiotic before it reaches its major target, the murein monomers in the cell membrane. In 2002, a total vancomycin resistant strain (MIC > or =32 microg/ml) was reported with vanA genes from Enterococcus spp. These genes induce the change of D-Ala-D-Ala terminus for D-Ala-D-lactate in the cell wall precursors, leading to loss of affinity for glycopeptides. Vancomycin resistance in S. aureus has appeared; it is mediated by cell wall modifications that trap the antibiotic before it reaches its action site. In strains with total resistance, Enterococcus spp. genes have been acquired that lead to modification of the glycopeptide target.

Anti-Bacterial Agents↗
PubMed2002

Antibiotic susceptibility patterns for environmental streptococci isolated from bovine mastitis in central California dairies.

Environmental streptococci are frequently isolated from bovine mastitis in dairy cows with only limited information available on the antimicrobial susceptibility of these organisms. A total of 362 environmental streptococci isolated from cases of bovine mastitis from the central San Joaquin Valley of California over a 3-yr period were used in the study. Overall, 39.9% of the strains tested were Streptococcus uberis, 42.2% were Streptococcus dysgalactiae, and 11.1% were Enterococcus spp. The antimicrobial susceptibility for these organisms was determined for the following antimicrobial agents: penicillin, ampicillin, cephalothin, ceftiofur, penicillin + novobiocin, erythromycin, pirlimycin, tetracycline, and sulfadimethoxine. Results demonstrate substantial differences in the susceptibility patterns for the various organisms collectively referred to as the environmental streptococci. The MIC90 for penicillin was 0.06 microg/ml for 152 strains of S. dysgalactiae compared with 0.25 microg/ml for 133 strains of S. uberis. However, the Enterococcus spp. were the most resistant organisms tested. These data also indicate that the use of interpretive criteria based on human data may provide misleading results. In conclusion, these data confirm that the environmental streptococci are a diverse group of organisms comprised of several different genera and species and that identification of environmental streptococci to the species level is needed to appropriately modify control methods. Moreover, the use of the agar disk diffusion (Kirby-Bauer) susceptibility test for agents with human-based interpretive criteria is contraindicated, and these tests should only be performed with agents with mastitis specific interpretive criteria.

Animals↗
PubMed2005

[Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents--special references to bacteria isolated between April 2003 and March 2004].

Tendency of isolated bacteria from infections in general surgery during the period from April 2003 to March 2004 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, 455 strains including 14 strains of Candida spp. were isolated from 191(75.2%) of 254 patients with surgical infections. Two hundred and thirty-nine strains were isolated from primary infections, and 216 strains were isolated from postoperative infections. From primary infections, anaerobic Gram-positive bacteria and aerobic Gram-negative bacteria were predominant, while aerobic Gram-positive bacteria were predominant from postoperative infections. The isolation rate of aerobic Gram-positive bacteria, such as Enterococcus spp. and Staphylococcus aureus were higher from both types of infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Klebsiella pneumoniae, Enterobacter cloacae and Pseudomonas aeruginosa in this order, and from postoperative infections, E. coli was the most predominantly isolated, followed by P. aeruginosa, E. cloacae, and K. pneumoniae. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both types of infections. The isolation rate of anaerobic Gram-positive bacteria from primary infections and that of aerobic Gram-positive bacteria from postoperative infections were high in the last several years. In this series, we noticed no vancomycin-resistant Gram-positive cocci, but a few strains of moderately arbekacin-resistant MRSA. Carbapenm-resistant P. aeruginosa was seen in less than 10 per cents. Last year we noticed that there were cefazolin-resistant E. coli producing extended spectrum beta-lactamase, but there was no highly cefazolin-resistant E. coli in this year. In the next series, increase of both anaerobic bacteria and Enterococcus spp. should be carefully followed up.

Anti-Bacterial Agents↗
PubMed1995

Activity of two novel fluoroquinolones (DU-6859a and DV-7751a) tested against glycopeptide-resistant enterococcal isolates.

Two novel fluoroquinolones, DU-6859a and DV-7751a, were compared with three peer compounds (ciprofloxacin, levofloxacin, and ofloxacin) by testing 150 strains of enterococci that were resistant to vancomycin. Standardized methods recommended by the National Committee for Clinical Laboratory Standards were used for all minimum inhibitory concentration tests, and DU-6859a was additionally tested by the standardized disk diffusion procedure (5-mu g disks). The rank order of the fluoroquinolone spectrums against these Enterococcus spp. isolates was DU-6859a (71.3% of strains inhibited at < or = 2 mu g/ml) > DV-7751a (38.7%) > levofloxacin (33.3%) > ofloxacin (32.0%) > ciprofloxacin (3.3%). Using previously proposed break point zone diameters of > or = 16 mm (susceptible) and < or = 12 mm (resistant), the DU-6859a disk diffusion tests for these glycopeptide-resistant organisms were without false-susceptible or false-resistant error (81.3% absolute agreement). These results indicate that among the investigational and currently marketed fluoroquinolones, DU-6859a appears to have the greatest potential value in the therapy of Enterococcus spp. strains that are resistant to the glycopeptides and many other therapeutic agents.

Anti-Bacterial Agents↗
PubMed2003

Effect of various growth media upon survival during storage of freeze-dried Enterococcus faecalis and Enterococcus durans.

AIMS: The effects of three different growth media (MRS, M17 and Lee's) on survival during freeze-drying and subsequent storage of six strains of Enterococcus faecalis and two strains of E. durans were investigated. METHODS AND RESULTS: Distinct Enterococcus spp. strains were grown on M17, MRS and Lee's broth, freeze-dried and stored at 20 degrees C in air under darkness. At regular intervals throughout storage, freeze-dried samples were rehydrated and then plated on M17 agar. CONCLUSIONS: A higher survival rate during storage of dried E. durans was obtained when growth occurred in MRS. The same effect was not observed, however, for the majority of E. faecalis strains, which clearly survived better in the dried state when this organism had been grown in M17 or Lee's medium. SIGNIFICANCE AND IMPACT OF STUDY: The survival of the dried Enterococcus spp. tested during storage was shown to be strain-specific and dependent on the growth medium.

Culture Media↗
PubMed1999

In vitro activity of clinafloxacin against fluoroquinolone resistant Spanish clinical isolates.

The in vitro activity of clinafloxacin against 162 ciprofloxacin-resistant clinical isolates was determined. Isolates were selected when their MIC to ciprofloxacin was 2 mg/l (intermediate) or > 2 mg/l (resistant). The following strains were tested: 61 Escherichia coli, 12 Klebsiella pneumoniae, 7 Proteus mirabilis, 21 Serratia marcescens, 4 Enterobacter cloacae, 21 Pseudomonas aeruginosa, 21 Staphylococcus. aureus (resistant to methicillin) and 15 Enterococcus spp. Clinafloxacin, ciprofloxacin, ofloxacin and norfloxacin activities were evaluated by agar dilution using Müeller-Hinton agar according to NCCLS recommendations. Of the 162 isolates, 16 (9.8%) were intermediate and 146 (90.1%) resistant to ciprofloxacin. 95 of the 162 strains (58.6%) were susceptible, 27 (16.7%) intermediately susceptible, and 40 strains (24.7%) were resistant to clinafloxacin. The percentage susceptible to clinafloxacin was 65.6% for E. coli, 75% for K. pneumoniae, 71.4% for P. mirabilis, 28.6% for S. marcescens, 75% for E. cloacae, 33.3% for P. aeruginosa, 90.5% for S. aureus and 40% for Enterococcus spp. Clinafloxacin was active against 58.6% of the ciprofloxacin-resistant clinical isolates tested. It was particularly active against S. aureus strains resistant to both ciprofloxacin and methicillin.

Anti-Infective Agents↗
PubMed2006

Clinical significance of bacteriuria with low colony counts of Enterococcus species.

The clinical significance of low counts of enterococci in urine cultures remains unclear. The goal of this study was to investigate the clinical significance of enterococci growing in numbers lower than 100,000 colony-forming units per milliliter (cfu/ml) in urine samples. Clinical parameters were collected from patients whose midstream clean-catch urine samples grew Enterococcus spp. in amounts between >or=10,000 and 100,000 cfu/ml and who were not previously treated with antibiotics. Only those patients who had leukocyturia in addition to positive culture were considered to have true urinary tract infection (UTI). Of the 208 patients included in the study, 54% were diagnosed with true UTI. Patients with true UTI were older by 6 years (p=0.03), were more likely to be hospitalized (p=0.016), had higher rates of dysuria (p=0.0001), urgency (p=0.0001), and frequency (p=0.0001), and had more solid tumors (p=0.03). By multivariate analysis, urgency (OR=7.1) and hospitalization (OR=4.4) were identified as independent risk factors for true UTI with enterococci in low counts. Enterococcal counts in patients with true UTI were randomly distributed all along the scale between 10,000 and 100,000 cfu/ml, and no differential cutoff could be determined. In conclusion, more than half of the patients whose urine cultures grow Enterococcus spp. in counts lower than 100,000 cfu/ml may have true UTI, especially if they are hospitalized and have symptoms of dysuria, urgency, or frequency. Microbiology laboratories should perform a complete work-up on samples containing low counts of enterococci, and the final interpretation should be done by physicians, using additional clinical information.

Adult↗
PubMed2003

Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial therapy.

Susceptibility data for all organisms associated with a range of skin and soft tissue infections (SSTI) in hospitalised patients were studied. Data were reported by clinical laboratories in the USA, France, Germany, Italy and Spain during 2001 which participate in The Surveillance Network (TSN). Staphylococcus aureus, Enterococcus spp. and coagulase-negative staphylococci (CNS), Escherichia coli and Pseudomonas aeruginosa were the most prevalent pathogens in all countries. MRSA was detected in 44.4, 34.7, 12.4, 41.8 and 32. 4% of S. aureus in each country, respectively. The majority of MRSA were cross resistant to other compound classes tested except for vancomycin (100% susceptible) trimethoprim-sulphamethoxazole with range 1.7% (France) to 15.9% (Italy) resistant, and gentamicin with range 12.2% (France) to 87.0% (Italy) resistant. More than 99.0% of MSSA tested susceptible to ceftriaxone and >94.9% to trimethoprim-sulphamethoxazole. 87.2% (France) to 94.6% of MSSA (Germany) were ciprofloxacin susceptible; 73.2% (USA) to 86.6% (Spain) were erythromycin susceptible; 85.4% (Italy) to 99.2% (France) were gentamicin susceptible. MSSA were more frequently found and generally more antibiotic susceptible from out patients. Overall, 100% of Streptococcus agalactiae and Streptococcus pyogenes were susceptible to penicillin, ceftriaxone and cefotaxime. Macrolide resistance was common among S. agalactiae (20.7%, Germany to 10%, Italy and Spain), S. pyogenes (19.2%, France to 11.1%, USA) and viridans streptococci (25.7%, France to 14.1%, Germany). Vancomycin-resistant Enterococcus spp. were uncommon outside the USA (17.5%) and Italy (7.4%). For all countries susceptibility of E. coli was 100% to imipenem, >98.7% to amikacin, >96.0% to ceftriaxone and cefotaxime. Susceptibility of E. coli isolates to ciprofloxacin was 77.6% in Spain to 94.3% in Germany. Klebsiella spp., Proteus spp., Citrobacter spp. and Enterobacter spp. displayed varying susceptibilities between countries to drugs tested. Putative extended spectrum beta-lactamase expression in E. coli remained rare comprising 4-5% of isolates in USA, Italy and Spain and in France and Germany <2%. For P. aeruginosa piperacillin-tazobactam, amikacin, imipenem and ceftazidime were the most active compounds tested irrespective of region. Surveillance data should be considered when selecting empirical therapy for treating SSTI.

Anti-Bacterial Agents↗
PubMed2004

Impact of prolonged treatment with trimethoprim-sulfamethoxazole on the human gut flora.

The case of a mentally ill man inadvertently treated with trimethoprim-sulfamethoxazole (TMP-SMX) for 2 y is presented. Quantitative stool cultures revealed a substantially suppressed Gram-negative aerobic flora, while Enterococcus spp. and anaerobes were not affected. Yeasts were moderately increased. TMP-SMX represents an attractive antimicrobial for immunocompromized patients who need the integrity of their intestinal anaerobic flora for colonization resistance.

Adult↗
PubMed2001

The prebiotic effects of biscuits containing partially hydrolysed guar gum and fructo-oligosaccharides--a human volunteer study.

Prebiotics are non-digestible food ingredients that target selected groups of the human colonic microflora, thus having the ability to alter the composition towards a more 'beneficial' community, i.e. selectively increasing populations of bifidobacteria and/or lactobacilli. In the present study the prebiotic potential of partially hydrolysed guar gum (PHGG) and fructo-oligosaccharides (FOS) in a biscuit was assessed in human volunteers. Fluorescent in situ hybridization using oligonucleotide probes targeting Bacteroides spp., Bifidobacterium spp., Clostridium spp. and Lactobacillus-Enterococcus spp. were used for the bacteriology and total bacteria were enumerated using the fluorescent stain 4',6-diamidino-2-phenylindole. Thirty-one volunteers consumed daily either three experimental biscuits (providing a total (g/d) of 6.6 FOS and 3.4 PHGG) or three placebo biscuits for two 21-d crossover periods. Bifidobacteria significantly increased in number on ingestion of the experimental biscuits compared with pre-treatment and placebo population levels. Bifidobacterial numbers returned to pretreatment levels within 7 d of the cessation of intake of experimental biscuits. A correlation was observed between the initial faecal bifidobacterial numbers and the magnitude of bifidogenesis, with volunteers who possessed low initial population levels of bifidobacteria experiencing the greatest increase in bifidogenesis. No changes were observed in the other bacterial groups monitored during the trial. Thus, the prebiotic nature of FOS and PHGG was maintained in a final food product as evidenced from the selective increase in bifidobacterial numbers.

Adult↗
PubMed1997

Susceptibility patterns of bacterial isolates from intensive care and haematology/oncology patients in New Zealand.

AIMS: To determine the current susceptibility pattern of bacterial isolates from intensive care and haematology/oncology patients in New Zealand. METHOD: Over a 6 month period 417 consecutive clinically relevant bacterial isolates from intensive care and haematology/oncology patients from seven New Zealand hospitals had their susceptibility to multiple antimicrobial agents determined by the agar plate dilution method. Methicillin resistant staphylococci were not included. RESULTS: Of the 417 isolates, 224 (54%) were gram negative and 193 were gram positive. Predominant species/groups were: Escherichia coli 63 (15%), Enterobacter spp 26 (6%), other Enterobacteriacae 41 (10%), Pseudomonas aeruginosa 42 (10%), Staphylococcus aureus 111 (27%), coagulase negative staphylococci 30 (7%), Streptococcus spp 31 (7%), and Enterococcus spp 19 (5%). Isolate sources were: respiratory tract, 170 (41%); cutaneous sites, 81 (19%); blood, 64 (15%); and urine 63 (15%). Resistance was uncommon amongst staphylococci, streptococci, enterococci, and H influenzae. No vancomycin resistant or beta-lactamase-positive enterococci were encountered. For different groups of enteric gram negative bacilli: amoxycillin and amoxycillin-clavulanic acid resistance was common, 46-93% and 24-85% respectively; cefpirome was the most active cephalosporin; aminoglycoside resistance was uncommon; and no isolate possessed extended spectrum beta-lactamase. For P aeruginosa: most isolates were susceptible to cefpirome and ceftazidime, and aminoglycoside resistance was uncommon. CONCLUSION: Gram positive bacteria make up a higher proportion of isolates than in a similar European study. At present New Zealand does not have widespread resistance amongst common isolates. Several agents currently available in New Zealand provide adequate cover for commonly encountered pathogens. The choice of which agent to choose therefore rests more with their purchase and administration costs, as well as safety and efficacy data than simply susceptibility data alone.

Anti-Bacterial Agents↗
PubMed2003

Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities.

BACKGROUND: We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients in the US Prospective surveillance for nosocomial bloodstream infections at 49 hospitals during a 6-year period [Surveillance and Control of Pathogens of Epidemiologic Importance (SCOPE)] detected 22 609 bloodstream infections, of which 3432 occurred in patients < or =16 years of age. RESULTS: Gram-positive organisms accounted for 65% of cases, Gram-negative organisms accounted for 24% of cases and 11% were caused by fungi. The overall crude mortality was 14% (475 of 3432) but notably higher for infections caused by Candida spp. and Pseudomonas aeruginosa, 20 and 29%, respectively. The most common organisms were coagulase-negative staphylococci (43%), enterococci, Staphylococcus aureus and Candida spp. (each, 9%). The mean interval between admission and infection averaged 21 days for coagulase-negative staphylococci, 25 days for S. aureus and Candida spp., 32 days for Klebsiella spp. and 34 days for Enterococcus spp. The proportion of methicillin-resistant S. aureus increased from 10% in 1995 to 29% in 2001. Vancomycin-resistance was seen in 1% of Enterococcus faecalis and in 11% of Enterococcus faecium isolates. CONCLUSION: Nosocomial BSI occurred predominantly in very young and/or critically ill children. Gram-positive pathogens predominated across all ages, and increasing antimicrobial resistance was observed in pediatric patients.

Age Distribution↗
PubMed2004

Algorithm for the identification of bacterial pathogens in positive blood cultures by real-time LightCycler polymerase chain reaction (PCR) with sequence-specific probes.

We developed real-time polymerase chain reaction (PCR) assays for rapid detection of the most common and clinically relevant bacteria in positive blood culture bottles, including Staphylococcus spp., S. epidermidis, S. aureus, Enterococcus spp. (including differentiation of E. faecalis and E. faecium), Streptococcus spp., Streptococcus agalactiae, Enterobacteriaceae, E. coli, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter spp., Bacteroides spp., Haemophilus influenzae, and Neisseria meningitidis. A total of 507 positive blood cultures were investigated according to a specific PCR algorithm based on the microscopic result of the blood culture, and the PCR results were compared to the culture results. Apart from-cross reactions between E. coli and Chryseomonas luteola and Enterococcus faecium and E. durans, the PCR assay correctly identified all bacteria in the blood cultures and did not show any false-positive results. Regarding blood cultures positive with a single species of bacteria (n = 474), 98.3% of all bacteria were correctly detected by the PCR algorithm within a few hours. However, in mixed infections, the sensitivity was lower. The PCR algorithm is well suited for rapid identification of the most common bacteria in positive blood cultures.

Algorithms↗
PubMed1990

[Antibacterial activity and beta-lactamase stability of eleven oral cephalosporins].

Oral cephalosporins (cefixime, cefdinir, cefetamet, ceftibuten, cefpodoxime, loracarbef, cefprozil, cefuroxime, cefaclor, cefadroxil and BAY 3522) were compared by their antibacterial profile including stability against new beta-lactamases. Both activity and antibacterial spectrum of compounds structurally related to third generation parenteral cephalosporins (of the oximino class) were superior to established compounds. Activity against staphylococci was found to be highest for cefdinir, cefprozil and BAY 3522. Cefetamet, ceftibuten and cefixime demonstrate no clinically meaningful antistaphylococcal activity while the other compounds investigated demonstrate intermediate activity. The antibacterial spectrum was broadest for cefdinir and cefpodoxime. New oral cephalosporins are equally inactive as established compounds against Enterobacter spp., Morganella, Listeria, Pseudomonas and Acinetobacter spp., methicillin-resistant staphylococci, Enterococcus spp., penicillin-resistant pneumococci and anaerobes. New extended broad-spectrum betalactamases (TEM-3, TEM-5, TEM-6, TEM-7, SHV-2, SHV-3, SHV-4, SHV-5, CMY-1, CMY-2, and CTX-M) are active against the majority of oral cephalosporins. Ceftibuten, cefetamet, cefixime and cefdinir were stable against some of these enzymes even to a higher extent than parenteral cephalosporins. New oral cephalosporins should improve the therapeutic perspectives of oral cephalosporins due to their higher activity against pathogens marginally susceptible to established compounds (higher multiplicity of maximum plasma concentrations over MICs of the pathogens) and furthermore by including in their spectrum organisms resistant to established absorbable cephalosporins (e.g. Proteus spp., Providencia spp., Citrobacter spp., and Serratia spp.).

Administration, Oral↗
PubMed2006

Analysis on antimicrobial resistance of clinical bacteria isolated from county hospitals and a teaching hospital.

The distinction of antimicrobial resistance of clinical bacteria isolated from county hospitals and a teaching hospital was investigated. Disc diffusion test was used to study the antimicrobial resistance of isolates collected from county hospitals and a teaching hospital. The data was analyzed by WHONET5 and SPSS statistic software. A total of 655 strains and 1682 strains were collected from county hospitals and a teaching hospital, respectively, in the year of 2003. The top ten pathogens were Coagulase negative staphylococci (CNS), E. coli, Klebsiella spp., S. areus, P. aeruginosa, Enterococcus spp., Enterobacter spp., otherwise Salmonella spp., Proteus spp., Shigella spp. in county hospitals and Streptococcus spp., Acinetobacter spp., X. maltophilia in the teaching hospital. The prevalence of multi-drug resistant bacteria was 5% (4/86) of methicillin-resistant S. areus (MRSA), 12% (16/133) and 15.8% (9/57) of extended-spectrum beta-lactamases producing strains of E. coli and Klebsiella spp., respectively, in county hospitals. All of the three rates were lower than that in the teaching hospital and the difference was statistically significant (P < 0. 01). However, the incidence of methicillin-resistant CNS (MRCNS) reached to 70% (109/156) in the two classes of hospitals. Generally, the antimicrobial resistant rates in the county hospitals were lower than those in the teaching hospital, except the resistant rates of ciprofloxacin, erythromycin, clindamycin, SMZco which were similar in the two classes of hospitals. There were differences between county hospitals and the teaching hospital in the distribution of clinical isolates and prevalence of antimicrobial resistance. It was the basis of rational use of antimicrobial agents to monitor antimicrobial resistance by each hospital.

Anti-Bacterial Agents↗
PubMed2002

The etiology of urinary tract infection: traditional and emerging pathogens.

The microbial etiology of urinary infections has been regarded as well established and reasonably consistent. Escherichia coli remains the predominant uropathogen (80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10% to 15%). Klebsiella, Enterobacter, and Proteus species, and enterococci infrequently cause uncomplicated cystitis and pyelonephritis. The pathogens traditionally associated with UTI are changing many of their features, particularly because of antimicrobial resistance. The etiology of UTI is also affected by underlying host factors that complicate UTI, such as age, diabetes, spinal cord injury, or catheterization. Consequently, complicated UTI has a more diverse etiology than uncomplicated UTI, and organisms that rarely cause disease in healthy patients can cause significant disease in hosts with anatomic, metabolic, or immunologic underlying disease. The majority of community-acquired symptomatic UTIs in elderly women are caused by E coli. However, gram-positive organisms are common, and polymicrobial infections account for up to 1 in 3 infections in the elderly. In comparison, the most common organisms isolated in children with uncomplicated UTI are Enterobacteriaceae. Etiologic pathogens associated with UTI among patients with diabetes include Klebsiella spp., Group B streptococci, and Enterococcus spp., as well as E coli. Patients with spinal cord injuries commonly have E coli infections. Other common uropathogens include Pseudomonas and Proteus mirabilis.Recent advances in molecular biology may facilitate the identification of new etiologic agents for UTI. The need for accurate and updated population surveillance data is apparent, particularly in light of concerns regarding antimicrobial resistance. This information will directly affect selection of empiric therapy for UTI.

Enterobacteriaceae↗
PubMed2002

Antibiotic prescription practices, consumption and bacterial resistance in a cross section of Swedish intensive care units.

BACKGROUND: The purpose of this work was to study usage of antibiotics, its possible determinants, and patterns of bacterial resistance in Swedish intensive care units (ICUs). METHODS: Prospectively collected data on species and antibiotic resistance of clinical isolates and antibiotic consumption specific to each ICU in 1999 were analyzed together with answers to a questionnaire. Antibiotic usage was measured as defined daily doses per 1000 occupied bed days (DDD1000). RESULTS: Data were obtained for 38 ICUs providing services to a population of approximately 6 million. The median antibiotic consumption was 1257 DDD1000 (range 584-2415) and correlated with the length of stay but not with the illness severity score or the ICU category. Antibiotic consumption was higher in the ICUs lacking bedside devices for hand disinfection (2193 vs. 1214 DDD1000, p=0.05). In the ICUs with a specialist in infectious diseases responsible for antibiotic treatment the consumption pattern was different only for use of glycopeptides (58% lower usage than in other ICUs: 26 vs. 11 DDD1000,P=0.02). Only 21% of the ICUs had a written guideline on the use of antibiotics, 57% received information on antibiotic usage at least every 3 months and 22% received aggregated resistance data annually. Clinically significant antimicrobial resistance was found among Enterbacter spp. to cephalosporins and among Enterococcus spp. to ampicillin. CONCLUSIONS: Availability of hand disinfection equipment at each bed and a specialist in infectious diseases responsible for antibiotic treatment were factors that correlated with lower antibiotic consumption in Swedish ICUs, whereas patient-related factors were not associated with antibiotic usage.

Adult↗