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Ig-binding bacterial proteins also bind proteinase inhibitors.

Protein G is a streptococcal cell wall protein with separate binding sites for IgG and human serum albumin (HSA). In the present work it was demonstrated that alpha 2-macroglobulin (alpha 2M) and kininogen, two proteinase inhibitors of human plasma, bound to protein G, whereas 23 other human proteins showed no affinity. alpha 2M was found to interact with the IgG-binding domains of protein G, and in excess alpha 2M inhibited IgG binding and vice versa. A synthetic peptide, corresponding to one of the homologous IgG-binding domains of protein G, blocked binding of protein G to alpha 2M. Protein G showed affinity for both native and proteinase complexed alpha 2M but did not bind to the reduced form of alpha 2M, or to the C-terminal domain of the protein known to interact with alpha 2M receptors on macrophages. Binding of protein G to alpha 2M and kininogen did not interfere with their inhibitory activity on proteinases, and the interaction between protein G and the two proteinase inhibitors was not due to proteolytic activity of protein G. The finding that protein G has affinity for proteinase inhibitors was generalized to comprise also other Ig binding bacterial proteins. Thus, alpha 2M and kininogen, were shown to bind both protein A of Staphylococcus aureus and protein L of Peptococcus magnus. The results described above suggest that Ig-binding proteins are involved in proteolytic events, which adds a new and perhaps functional aspect to these molecules.

Bacterial Proteins↗

[Comparative study of the antimicrobial effect of various cavity liners used in conservative dentistry].

We have compared the microbiological activity of the following cavity liners: Life, Dycal II, Calcipulpe, Pure calcium hydroxide and Cavitec; against five different bacterial strains: Veillonella parvula, Bacteroides fragilis, Peptococcus s.p., Staphylococcus aureus, and Streptococcus beta hemolytic: The results demonstrate the higher antimicrobial activity of the manufactured cavity liners with calcium hydroxide base in comparison with the pure calcium hydroxide.

Bacteria↗

[Etiology of infectious endocarditis at the Instituto Nacional de Cardiologia Ignacio Chavez from 1976 to 1986].

We studied 85 cases of infectious endocarditis (IE) with an anatomical diagnosis (biopsy or necropsy). Most cases occur between the second and fourth decade of life; male/female ratio was 1/0.8; 45 had IE in a natural valve; 40 had prosthetic IE. Clinical diagnosis was established or at least suspected in 61 cases (72%); the most common misdiagnosis was acute rheumatic fever. Blood cultures were positive in 25 cases of natural valve IE (56%) and in 25 cases of prosthetic IE (63%). Half of those negative culture cases had a history of antimicrobial use before their arrival at the hospital. Those microorganisms which cause natural valve IE were: staphylococci (9), streptococci (8), Gram negatives (5), Candida sp (1), and two non-identified cases; 1 patient had a polymicrobial infection. Prosthetic IE was divided into early and late infections. The former was due to: staphylococci (4), streptococci (1), Candida sp (1); the latter: staphylococci (7), streptococci (4), Gram negatives (4), Candida sp, Mycobacterium fortuitum and Peptococcus (1 each), and in a single case Lactobacillus sp, presumably a contaminant.

Adolescent↗

Ischaemic mouse thigh model for evaluation of pathogenicity of non-clostridial anaerobes.

A mouse thigh model has been devised in which the growing culture of non-clostridial anaerobe in the ischaemic tissue produces inflammatory swelling and death. The swelling of the right thigh served as an index of pathogenicity of the test strain in comparison to the negatively reacting left thigh which received injection of the control strain of Bifidobacterium infantis. Actinomyces naeslundii exceptionally caused death in all animals within 24 h. Mortality and thigh swelling were pronounced (greater than 75%) in case of Fusobacterium gonidiaformans and Propionibacterium acnes but less (less than 50%) in Acidaminococcus fermentans. High (less than 75%) rate of thigh swelling was also encountered in case of Bacteroides oralis, Bacteroides corrodens, Fusobacterium necrophorum, Fusobacterium prausnitzii, Fusobacterium plauti, Peptococcus prevotii, Streptococcus intermedius, Eubacterium lentum and Propionibacterium freudenreichii ss. shermanii.

Animals↗

[In vitro effect of piperacillin, amoxicillin, cefoxitin and metronidazole against obligate anaerobic bacteria].

The minimum inhibitory concentrations (MIC) of piperacillin and three other antibiotics (amoxicillin, cefoxitin, metronidazole) against 165 strains of obligate anaerobes isolated in hospitals in 1985 and 1986 were determined by the Wilkins-Chalgren agar medium dilution method. Among the 67 strains of Bacteroides fragilis, 98.5% were sensitive to piperacillin (MIC less than or equal to 128 mg/l), 100% were sensitive to metronidazole (MIC less than or equal to 4 mg/l), 11.9% were resistant to cefoxitin (MIC greater than 32 mg/l) and 46% were resistant to amoxicillin (MIC greater than 16 mg/l). The MIC50 was about 4 mg/l with piperacillin, 8 mg/l with cefoxitin and 0.5 mg/l with metronidazole. All 32 strains of Clostridium perfringens were sensitive to the 4 antibiotics tested, with an MIC50 of about 0.06 mg/l with piperacillin, 0.125 mg/l with amoxicillin and 0.5 mg/l with cefoxitin and metronidazole. All other strains of Clostridium spp. (33 in all) were sensitive to piperacillin and metronidazole; the MIC's were about 0.06 mg/l with piperacillin, 0.25 mg/l with amoxicillin and metronidazole and 0.5 mg/l with cefoxitin. Seven strains (C. innocuum 5, C. difficile 1, C. ramosum 1) were resistant to cefoxitin. All 33 strains of Peptostreptococcus and Peptococcus were sensitive to the 4 antibiotics tested. Although metronidazole still is the most effective of anti-anaerobes agents, piperacillin has proved to be effective against most anaerobic bacteria, including B. fragilis. It is clearly superior to amoxicillin and relatively superior to cefoxitin, notably against this species.

Amoxicillin↗

In vitro activity of vancomycin and teicoplanin against anaerobic bacteria.

The in vitro activity of vancomycin and teicoplanin, a new glycopeptide antimicrobial, was determined against a total of 286 anaerobic bacteria including Bacteroides fragilis group (100), B. melaninogenicus (21), B. bivius (16), Fusobacterium spp. (15), Peptococcus spp. (20), Peptostreptococcus spp. (21), Clostridium perfringens (23), C. difficile (41) and Propionibacterium acnes (29). Minimum inhibitory concentrations (MIC) were determined using an antimicrobial incorporation technique in Wilkins-Chalgren agar approximately 10(4) colony forming units (cfu) contained in 10 microliters Wilkins-Chalgren broth, which was applied to the surface of the agar plates using a multipoint inoculator. Following inoculation, plates were incubated for 48 h at 37 degrees C in an anaerobic atmosphere. Both vancomycin and teicoplanin were highly active against all the Gram-positive anaerobic bacteria examined, 90% of all isolates being inhibited by 0.5 micrograms/ml of either antimicrobial. Isolates of B. fragilis group and Fusobacterium spp. were resistant to vancomycin (MIC90 64 micrograms/ml) and teicoplanin (MIC90 128 micrograms/ml). Unexpectedly, isolates of B. melaninogenicus and B. bivius which were resistant to vancomycin (MIC90 64 and 128 micrograms/ml respectively) were sensitive to teicoplanin (MIC90 2 and 2 micrograms/ml respectively).

Bacteria, Anaerobic↗

[Our experience with ofloxacin in the treatment of osteoarticular infections].

Twenty patients with osteoarticular infections, fourteen post-arthroplasty and six with osteitis, were treated with ofloxacin, usually in combination. Sixteen staphylococcus strains including eight aureus and eight coagulase negative (modal MIC and MBC: 0.5 micrograms/ml), three Escherichia coli (modal MIC and MBC: 0.06 micrograms/ml) and one Peptococcus (MIC: 0.25, MBC: 0.5) were isolated. Treatment was given at a mean dose of 9.81 +/- 2.46 mg/kg for a mean duration of 100 days. The serum concentration of ofloxacin was measured at 3.73 +/- 2.13 micrograms/ml for a dosage of 8.23 +/- 0.94 mg/kg (25 assays) and 7.42 +/- 4 micrograms/ml for 11.46 +/- 1.3 mg/kg (23 assays). Bacteriological control was carried out nineteen times; in one case of staphylococcal osteitis, a relapse occurred on the 43rd day of treatment when the strain isolated was resistant to ofloxacin. Three patients presented adverse effects: two cases of bone and muscle pain and one cutaneous allergic reaction: treatment was withdrawn after two restarts. The antibacterial action, the good tolerance and the easy administration of ofloxacin make it a useful antibiotic in the treatment of osteoarticular infections, where a dosage of 8 mg/kg appears to be necessary, particularly in infections due to staphylococci.

Adult↗

Anaerobic infections in the head and neck region.

Anaerobic bacteria form the predominant flora of the oral cavity, outnumbering facultative organisms by 10-1,000: 1. The type of anaerobic bacteria and their concentration depend on the anatomical site and the degree of anaerobiosis in the different sites in the mouth. Three groups of anaerobic bacteria inhabit the oral cavity; the strict anaerobes, the moderate anaerobes, and the microaerophilic group of organisms. The majority of anaerobic bacterial infections occurring in the region of the mouth, head and neck are caused by the commensal flora. These infections include dental and periodontal disease where the predominant organisms are Bacteroides species, Veillonella, Bifidobacteria, Peptococcus, Peptostreptococcus and Propionibacterium species. More recently, Bacteroides endontalis has been isolated from a periapical abscess of endodontal origin and B. gingivalis, B. intermedius, Haemophilus actinomycetemcomitans and Wollinella species in chronic periodontal disease. Treponema species and other strict anaerobes are seen in smears of severe periodontal disease and acute necrotising gingivitis, but have not yet been isolated in pure culture. Until such time, their role in disease remains uncertain. Fusobacterium nucleatum is specially associated with severe orofacial infections which may extend into the mediastinum. Other anaerobic infections include chronic otitis media, chronic sinusitis and mastoiditis, and brain abscess. Treatment of these conditions should include the use of beta-lactamase resistant antimicrobials, such as clindamycin or one of the nitroimidazoles with penicillin.

Abscess↗

[Bacterial infection agents in hospitalized patients].

During six months the pattern of microbial isolates has been analysed from 1492 urinary tract infections, from 1445 wound infections, from 451 bronchial secretions, from 3067 blood cultures, from 116 peritoneal swabs and from 39 cerebrospinal fluids. All the specimens investigated were taken from patients of surgical, neurosurgical, internal wards and two intensive care units. In total, the most frequent isolates were grampositive microorganisms like Staphylococus aureus, Straphylococcus epidermidis and Streptococcus sp. of different serotypes. Out of the Enterobacteriaceae Escherichia coli and Klebisella pneumoniae predominated followed by Enterobacter cloacae and indolnegative and -positive Proteus species. The over all isolation rate of Pseudomonas aeruginosa in nosocomial infections was about 10%. In the last time Pseudomonas maltophilia will be isolated more frequently as well as occasional Streptococcus faecium and Corynebacterium JK. Dependent from the site of infection anaerobic bacteria like Bacteroides sp., Peptococcus- and Peptostreptococcus sp. are really important in the infectious diseases. The epidemiological data should be always transmitted to the infection control board. From there preventive measures must be induced.

Bacteria↗

The effect of carbon dioxide on the in vitro activity of erythromycin and RU-28965 against anaerobic bacteria.

The in vitro activity of erythromycin and RU-28965 (a novel macrolide antimicrobial with improved pharmacokinetics) was determined against a variety of anaerobic bacteria in anaerobic atmospheres with and without added carbon dioxide. Minimum inhibitory concentrations (MIC) were determined using an antimicrobial incorporation technique in Wilkins-Chalgren agar (Oxoid, UK) containing saponinlysed horse blood to a final concentration of 10%. The inoculum used was approximately 10(4) colony forming units (cfu) contained in 10 microliters Wilkins-Chalgren broth, which was applied to the surface of the agar plates using a multipoint inoculator. Following inoculation, plates were incubated for 48 h at 37 degrees C in an anaerobic atmosphere containing 10% carbon dioxide or in hydrogen alone. The MIC of each antimicrobial for each organism examined was determined as the lowest concentration of the antimicrobial which completely inhibited growth of the inoculum. The minimum concentrations required to inhibit the growth of 50% (MIC50) and 90% (MIC90) of the bacteria examined were also determined. The MICs of erythromycin and RU-28965 for isolates of the Bacteroides fragilis group, B. bivius and Fusobacterium spp. were generally 10-100 times greater when determined in the presence of carbon dioxide than when determined in hydrogen alone. The MICs of erythromycin and RU-28965 for B. melaninogenicus, Peptococcus spp., Peptostreptococcus spp., Clostridium perfringens, Cl. difficile and Propionibacterium acnes were less affected by the presence of carbon dioxide.

Anaerobiosis↗

Crystal structure of Clostridium acidi-urici ferredoxin at 5-A resolution based on measurements of anomalous X-ray scattering at multiple wavelengths.

The crystal structure of Clostridium acidi-urici ferredoxin has been determined using multiple wavelength anomalous diffraction (MAD) techniques at 5.0-A resolution. The electron density map shows striking similarity to a map of Peptococcus aerogenes ferredoxin computed at the same resolution from the atomic coordinates reported by Adman et al. (Adman, E. T., Sieker, L. C., and Jensen, L. H. (1973) J. Biol. Chem. 248, 3987-3996). Such similarity is expected from the high degree of identity between amino acid sequences of the two proteins. The use of MAD methods has in the relatively recent past become a practical possibility due to instrumental advances enabling the collection of accurate data at several wavelengths at synchrotrons and due to theoretical and computational advances that facilitate the analysis of these data for the determination of phases. These methods hold great promise as an alternative to the multiple isomorphous replacement method in macromolecular structure determination. The present report represents one of the first applications of the MAD techniques to the determination of the structure of a protein which was previously unknown in detail.

Amino Acid Sequence↗

[Aerobic and anaerobic bacterial flora of crural ulcers].

In a group of 600 patients treated in the Metropolitan Dermatological Hospital in Warsaw bacteriological examination were carried out of swabs from the untreated crural ulcers. In 95% of these cultures growth of pathological aerobic organisms was obtained. Coagulase-positive staphylococci (St. aureus) and Gram-negative bacteria (Pseudomonas aeruginosa, Proteus vulgaris, Enterobacter sp and E. coli) prevailed. In 27% of cases the cultured strains were resistant to the generally available antibiotics. In the second group in 70 patients no growth of anaerobes exclusively was noted. Pathological aerobes and anaerobes in the same case were found in 45% of cultures. In the remaining ones pathogenic aerobes were present with a similar frequency as in the preceding group. Of the anaerobes the most frequently cultured species were Gram-negative bacteria such as Bacteroides melaninogenicus, Bacteroides sp, and Bacteroides fragilis. Among pathogenic anerobic cocci Peptostreptococcus and Peptococcus were most frequent. In 2 cases spore-forming anaerobic bacteria (Clostridium perfringens) were obtained. Forty-eight percent of anaerobes were resistant to the commonly used antibiotics.

Bacterial Infections↗

[Nonclostridial obligate anaerobes--the main causative agents of lung abscesses].

The use of the anaerobic technique in bacteriological investigations has made it possible to establish the leading role of asporogenous anaerobes in the etiological structure of the causative agents of pulmonary abscesses. Asporogenous anaerobes have been isolated from 93% of all examined patients, and in 54.4% of such patients these microorganisms have proved to be an independent etiological factor. Among asporogenous anaerobes, the main causative agents of pulmonary abscesses have been found to belong to four genera: Bacteroides, Fusobacterium, Peptococcus and Peptostreptococcus. Pulmonary abscesses of purely aerobic etiology are rather rare (5.3%). The schemes of the antibacterial treatment of patients with pulmonary abscesses, developed with regard to the leading etiological role of asporogenous anaerobes and clinically approved, have permitted achieving a considerable improvement in the results of treatment and an essential economic effect.

Anti-Bacterial Agents↗

[Treatment of post-traumatic and post-neurosurgical bacterial meningitis with ceftriaxone alone or in combination with fosfomycin].

From 1984 to 1986, 13 patients (10 adults, 3 children) with bacterial meningitis following neurosurgery or traumatism were given ceftriaxone alone 6 times at a dose of 40 mg/kg one IV injection per day, or in association 7 times with fosfomycin at a dose of 200 mg/kg/day, 3 IV perfusions every 4 h. The bacteriological diagnosis was confirmed in 9 cases (3 Staphylococcus aureus, 4 Streptococcus pneumoniae, 1 Klebsiella, 1 Peptococcus). In vitro neither synergy nor antagonism were observed between the two antimicrobial agents. The acute infections episode resolved in all patients except on who died with a negative CSF culture. One superinfection meningitis with Achromobacter was seen. CSF concentrations of ceftriaxone were assayed and found to be comparable with those reported by most authors. Tolerance was excellent for all our patients.

Adult↗

[Sensitivity to an amoxicillin-clavulanic acid combination, of deep tonsillar flora isolated in chronic tonsillitis].

Deep tonsillar flora were identified in tonsils removed from 48 patients, children and adults, with chronic tonsillitis and recurrent sore throats or obstructive hypertrophy. Most specimens (38/48) cultured multiple germs (2 to 5 different species) with aerobic and anaerobic Gram+ and Gram-forms, some being beta-lactamase producers. Of the total of 135 strains isolated, 104 were aerobic and 31 anaerobic. The species of aerobic germs most frequently isolated were: Apart from alpha-hemolytic streptococci of undertermined group (38 strains), Haemophilus sp. : 14 (including 3 beta-lactamase + strains), Staphylococcus aureus: 15 (including 11 beta-lactamase + strains), Streptococcus A : 10, Enterobacteriaceae : 6, Neisseria sp. : 8 (including 1 beta-lactamase + strain). And among the anaerobic germs: Peptococcus : 3, Veillonella alc : 10, Fusobacterium nucleatum : 9, Bacteroides melaninogenicus : 6, Other Bacteroides : 2. Of the 127 strains tested, 102 were sensitive to amoxicillin and 121 to amoxicillin and clavulanic acid combination. The presence of a beta-lactamase producing bacterium in 1 of 3 specimens suggests the risk of failure of treatment with penicillin, prescribed classically for this type of affection.

Adolescent↗

[Fundamental and clinical studies of imipenem/cilastatin sodium in the field of obstetrics and gynecology].

Fundamental and clinical studies of a new carbapenem antibiotic, imipenem/cilastatin sodium (MK-0787/MK-0791), were carried out to evaluate the drug in treating infections of the female genital organs. The following results were obtained: In 4 patients undergoing hysterectomy, the penetration of MK-0787 and MK-0791 into female genital organ tissues was studied following a 30-minute intravenous drip infusion of MK-0787/MK-0791 500 mg/500 mg. Plasma levels of MK-0787 and MK-0791 in cubital venous blood following the drip infusion peaked at 0 minute with values of 51.2 micrograms/ml and 61.9 micrograms/ml, respectively, then decreased to 1.9 micrograms/ml and 0.7 microgram/ml, respectively, at 201 minutes. MK-0787 penetrated readily to female genital organ tissues and levels of the drug exceeded 0.5 approximately 1.9 micrograms/g in various organ tissues at 201 minutes following an intravenous drip infusion of 500 mg/500 mg of MK-0787/MK-0791. Clinically, MK-0787/MK-0791 was used for the treatment of obstetrical and gynecological infections at a dosage of 500 mg/500 mg twice daily by intravenous drip infusion. Clinical effects of MK-0787/MK-0791 were analyzed in 22 patients, including 9 patients with intrauterine infections, 7 with intrapelvic infections, 5 with adnexitis, and 1 with an external genital infection. Excellent responses were seen in 5 patients (22.7%), good responses in 15 (68.2%), and poor responses in 2 (9.1%). The efficacy ratio was 90.9%. After the treatment, 15 out of 18 isolates were eradicated for an 83.3% eradication rate. All strains of S. epidermidis (2 strains), Eubacterium lentum (1 strain), Peptococcus sp. (1 strain), beta-Streptococcus (1 strain), Gram-positive rods (2 strains), Enterobacter cloacae (1 strain), Bacteroides bivius (1 strain), Pseudomonas sp. (1 strain), Pseudomonas cepacia (1 strain) and Gram-negative rods (1 strain) were eradicated by the MK-0787/MK-0791 treatment. The safety of the drug was analyzed in 22 patients, effects occurred in 3 (13.6%). Among those 3 patients, diarrhea occurred in 1 patient, rash in another and nausea and vomiting in yet another. One patient had an increased BUN after the MK-0787/MK-0791 treatment. In the other 21 patients, no abnormalities in creatinine, GOT, GPT, or T. Bil. values were observed. It may be concluded that MK-0787/MK-0791 is useful for the treatment of obstetrical and gynecological infections.

Adolescent↗

[Fundamental and clinical studies of imipenem and imipenem/cilastatin sodium in the field of obstetrics and gynecology].

Fundamental and clinical studies of imipenem (MK-0787), a new type of carbapenem antibiotic, and MK-0787 combined with cilastatin sodium (MK-0791), a renal dipeptidase inhibitor, were carried out. The results obtained were as follows: MK-0787 500 mg alone or MK-0787 500 mg with MK-0791 500 mg was administered by intravenous drip infusion over 30 minutes. Plasma levels of the drug were similar either following the administration of 500 mg of MK-0787 alone or 500 mg of MK-0787 with 500 mg of MK-0791. When MK-0787 was administered with MK-0791, MK-0787 and MK-0791 levels at 2 hours after the end of infusion in uterine arterial plasma were 6.8 micrograms/ml and 3.2 micrograms/ml, respectively, and in venous plasma were 8.4 micrograms/ml and 4.7 micrograms/ml, respectively. MK-0787 tissue levels ranged from 0.8 microgram/g to 3.8 micrograms/g at 205 minutes after the end of infusion. Based on these results, the plasma and tissue levels of MK-0787 and MK-0791 with b.i.d. dosage exceeded the MICs of the drug against clinical isolates in the field of obstetrics and gynecology such as E. faecalis, E. coli Klebsiella sp., Peptococcus sp., Peptostreptococcus sp. and B. fragilis immediately after the administration. However, it seemed that the b.i.d. dosage was insufficient to maintain the in vivo concentration of these agents high enough to inhibit the growth of the above bacteria. Eighteen patients with obstetric and gynecologic infection (12 with intrauterine infections, 2 with pelvic dead space inflammation, 2 with pelvic peritonitis, 1 with a vaginal cuff abscess and 1 with a vulvar abscess) and 1 patient with other infection (abdominal wall abscess) were evaluated, but 1 patient with pelvic peritonitis was later excluded from the efficacy evaluation because of a serious illness. MK-0787/MK-0791 was administered twice daily in a 30-minute intravenous drip infusion. Clinical results were excellent in 1 patient, good in 16 and poor in 1, for an efficacy ratio of 94.4%. No side effects were observed. Only abnormal laboratory findings observed were elevation of S-GOT and S-GPT in 1 patient which normalized 2 weeks after the treatment was discontinued. These results suggest that MK-0787/MK-0791 will be useful for the treatment of obstetric and gynecologic infections.

Adult↗

The bacterial flora of the nasal cavity in healthy young men.

The nasal cavity of 97 young healthy men (applicants for the pilot education in the Finnish Air Force) was examined. Bacterial culture demonstrated one or more species of aerobic bacteria in all 194 nasal cavities examined and anaerobic bacteria in 76.5%. In ten per cent of the cultures bacteria were detected after enrichment only. The most common aerobic bacteria were Staphylococcus epidermidis (79%), diphtheroids (41%) and Staphylococcus aureus (34%). Haemophilus influenzae was found in 5% and Streptococcus pneumoniae in 0.5%. Anaerobic culture yielded Propionibacterium acnes in 74.5% and Peptococcus magnus in 3.5%.

Adolescent↗