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PubMed1996

Antibiograms and plasmids of Staphylococcus aureus and coagulase negative staphylococci isolated from different clinical sources.

OBJECTIVES: To ascertain the antibiotic resistance patterns and plasmids of Staphyl coccus aureus and coagulae negative staphylococci isolated from different clinical specimens in Lagos, Nigeria. DESIGN: Prospective study involving the screening of specimens of blood, urine, skin and soft tissue infections, vagina, urethra, eye, ear, nose, pleural fluid and seminal fluid obtained from patients attending the Lagos University Teaching Hospital (LUTH) and Providence Hospital Diagnostic Laboratories, Lagos, Nigeria. SETTING: A laboratory based study conducted in the Microbiology Unit, University of Lagos and the National Institute for Medical Research (NIMR) Lagos, Nigeria. The patients were from different communities in Lagos. SUBJECTS: A total of 200 patients that were positive for the presence of S. aureus and coagulase negative staphylococci (CONS) were employed in the study. MAIN OUTCOME MEASURES: Frequency of isolation of S. aureus and coagulase negative staphylococci (CONS) from the different clinical specimens determination of their resistance profile using standard techniques for the isolation of both organisms and the Kirby-Bauer disc diffusion method for antibiotic testing. RESULTS: All the S. aureus and CONS isolates were sensitive to novobiocin and ofloxacin. Ninety eight (80 pc) of S. aureus isolates were resistant to tetracycline (Tet), 73 (60 pc) to Streptomycin (Str), and 49 (40 pc) to Chloramphenicol (Chl). All the S. aureus isolates were resistant to Penicillin (P) and only two (2 pc) and four (three pc) were resistant to Cefuroxime (Cxm) and Ceftriasone (Cro) in that order. Twenty six (21 pc) of S. aureus isolates were resistant to Methicillin. For CONS, 92 pc were resistant to Penicillin, 47 (60 pc) to streptomycin and 40 (51 pc) to tetracycline. Nineteen (24 pc) were resistant to Methicillin. Further antibiotic sensitivity results revealed the following patterns: 87 (71 pc) and 29 (36 pc) of S. aureus and CONS respectively showed P RTet"R, pattern of resistance. The resistance pattern PREryRGmRCazRCxmR was shown by only one (17 pc) of S. aureus and none (Opc) of CONS. Only 59% and four pc of S. aureus and CONS isolates showed resistance pattern ChlREryR, CazR respectively. Results of plasmid profiles showed that 48 (96 pc) of 50 S. aureus and 26 (87 pc) of 30 CONS isolates harboured one or more plasmids of molecular sizes ranging from 1.0 Kb to 19.5 Kb. Nine (19 pc) of 48 S. aureus and three (12 pc) of CONS isolates showed plasmid identity. CONCLUSION: We assert that although isolates of S. aureus and CONS showed multiple antibiotic resistance which could be plasmid mediated, only about five pc of both organisms showed resistance pattern ChlREryRCazRTetRCxmRSxtRGmR and EryRGmRCazRCxmR and this is of chemotherapeutic importance. Both organisms, were highly sensitive to Ceftriazone, Ceforoxime and Gentamicin. The high levels of resistance of many antibiotics may be attributable to indiscriminate use or antibiotic abuse in the community.

Coagulase↗
PubMed1996

Antibiogram study over bacterial isolates from cases of bacteraemias.

During January, 1994 to December, 1994, 703 of the 1778 blood specimen were positive for blood culture and 59.9% of the isolates were of staphylococci. Thirty two percent of the staphylococci were methicillin resistant. Netilmycin showed the lowest in vitro resistance among Gram positive cocci & Klebsiella species. Netilmycin, amikacin, ciprafloxacin and the third generation cephalosporins in general showed greater in vitro sensitivity among gram negative bacilli. The netilmycin had the lowest incidence of drug resistance based on the pooled data over the blood culture.

Anti-Bacterial Agents↗
PubMedDate not supplied

[The comparative results of the antibiograms for Mycobacterium tuberculosis performed in 2 different laboratories].

The aim of this study was to appreciate the accuracy of the technique for sensitivity test for M. tuberculosis. We have tested the same bacterial strains (101) using the same drugs concentrations, by absolute concentration method, and we have compared the results obtained in two different laboratories. The concordance of the obtained results (94.05% for SM, 97.03% for INH, 99.01% for RMP, 100% for EMB) is in the limits of reproducibility obtained by other authors. The obtained results show a good technique for sensitivity test in the two laboratories.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Reliabilty of the antibiogram and plasmid profile in detection of epidemic strains of Shigella sonnei].

The aim of the study was to investigate and compare the type of resistance to antibiotics and plasmid profile of Shigellae sonnei isolated at epidemics of bacillary dysentery to determine which method was most reliable in the identification of epidemic strains of that bacteria. It was investigated 130 isolates of Sh. sonnei isolated from the stools of patients in 14 epidemics of bacillary dysentery in Yugoslav Army and citizens in period from 1987 to 1993 year. On the basis of identity of studied features of all isolates originated from one epidemic, epidemic strains of Sh. sonnei could be identified in 10 (71.4%) of 14 studied epidemics by means of plasmid profile, and in 8 (57.1%) epidemics by means of determination of resistance type to antibiotics. According to that, the method of plasmid profile analysis is more reliable in identification of Sh. sonnei epidemic strains compared to the method of determination of resistance type to antibiotics.

Disease Outbreaks↗
PubMed1991

Nosocomial Staphylococcus epidermidis septicaemia among very low birth weight neonates in an intensive care unit.

A cluster of cases of septicaemia caused by coagulase-negative staphylococci was observed among the infants at the Neonatal Intensive Care Unit (NICU) of the Karolinska Hospital in May 1987. The presence of a unique antibiogram among the blood culture isolates prompted an investigation to determine whether an epidemic strain existed or not, using antibiogram, biotyping and plasmid profiles as epidemiological markers. All 14 isolates with a unique antibiogram were investigated, and 22 isolates without the unique antibiogram served as controls. Of the 14 isolates, 11 were Staphylococcus epidermidis and had similar plasmid patterns. Of the 22 control isolates, 15 were S. epidermidis, and none had the special plasmid pattern nor any other recurring plasmid patterns. The use of plasmid profile analysis together with antibiograms thus identified a possible epidemic strain of S. epidermidis which may have been responsible for the upsurge of septicaemia cases at the NICU. The presence of an epidemic strain implies that hospital cross infection control could be important in preventing neonatal septicaemia caused by S. epidermidis.

Coagulase↗
PubMed2004

Are United States hospitals following national guidelines for the analysis and presentation of cumulative antimicrobial susceptibility data?

The National Committee for Clinical Laboratory Standards recently published guidelines for analysis and presentation of cumulative antimicrobial susceptibility test data (antibiograms). We sought to determine how well US hospitals already adhere to standards for antibiogram compilation, and to examine the relationship between hospital characteristics and guideline adherence. We surveyed laboratory directors at 670 hospitals and examined 3 guideline criteria: compilation of an antibiogram, annual updating, and distribution to infection control staff and medical staff yearly; 494 surveys were returned (74%). Almost all of the hospitals surveyed publish an antibiogram (95%, n = 481); however, only 60% (n = 296) met all three criteria. Hospital laboratories meeting criteria were more likely to serve as referral laboratories (OR = 1.82; 95% CI = 1.26-2.63), perform susceptibility testing on site (OR = 4.47; 95% CI = 1.84-10.84), use confirmatory tests to detect extended-spectrum beta-lactamases (OR = 1.8; 95% CI = 1.2-2.6), and have more laboratory personnel per bed (3.0 vs. 2.0 FTEs/bed, p = 0.0031). Adherence to guidelines for preparation and dissemination of antibiograms could be improved. Institutional commitment to high quality, on-site microbiology laboratory services will improve adherence to these guidelines.

Anti-Bacterial Agents↗
PubMed1996

Multiresistant Staphylococcus epidermidis in a neonatal care unit.

OBJECTIVE: To study the presence and diversity of types of Staphylococcus epidermidis in the neonatal intensive care unit of a university hospital. METHODS: During a period of 6 weeks, samples were taken from nose, external auditory canal, axilla, groin and umbilicus from consecutively admitted patients. Patients were sampled two times a week for up to 2 weeks. Isolates of S. epidermidis were characterized by antibiogram, plasmid pattern and biotype. RESULTS: Fifteen patients were included. Each patient was sampled in one to four successive surveys, depending on the admission period. A total of 128 isolates of S. epidermidis were obtained and allocated to seven antibiogram types, 36 plasmid types and 14 biotypes. One plasmid type found in 58 isolates (six patients) corresponded with one multiresistant antibiogram type. The number of isolates with these characteristics increased per neonate from the first survey to the fourth. Nineteen isolates from four patients were allocated to a second plasmid type and were of a common antibiogram type. The remaining 34 plasmid types were sporadic. No clear correspondence of biotypes with antibiogram or plasmid types was found. CONCLUSIONS: The present study revealed the increase in colonization of a multiresistant type of S. epidermidis in the compromised patients during admission to the ward. Further studies have to assess whether this type remains persistent in the ward.

Journal Article↗
PubMed2001

[Staphylococcus aureus: new detection of intrinsic resistance using the diffusion method].

Because of an heterogeneously-expressed resistance among methicillin-resistant Staphylococcus aureus strains the conditions for antibiogram determination had rapidly to be modified so as to improve their detection. The newly recommended conditions (incubation at +30 degrees C or on hypersalted agar medium) remain widely used at the moment, although they appear to be more and more often badly adapted, particularly because of the recently-observed renewed outbreak of wild strains with a weak in vitro phenotypic expression. It is the reason why we searched for a new and more reliable phenotypic method although still accessible for any laboratory. Sixty-five strains of Staphylococcus aureus entered the study. The absence or presence of mecA gene was previously investigated by gene amplification. These strains were of various origins and had often caused difficulties for the detection of intrinsic resistance to methicillin on the antibiogram. Our results confirm the failures of the classical methods (false negative results at +30 degrees C, false negative or positive results on hypersalted agar medium incubated at +37 degrees C). They also allow to propose a new method which relies on the determination of the susceptibility to cefoxitin using the usual conditions for antibiogram determination. In our series of strains, this new method proved to widely improve both the sensitivity and the susceptibility for the detection of methicillin-resistance by diffusion on the antibiogram.

Agar↗
PubMed1996

Performance improvement with a hybrid FOCUS-PDCA methodology.

BACKGROUND: In 1995 a team of three members of the quality improvement (QI) department at Hardin Memorial Hospital, Elizabethtown, Kentucky, constructed a unified, simple system of tools and activities drawing on the foundation of FOCUS-PDCA and integrating it with the Joint Commission Improving Organizational Performance (IOP) function and language. METHOD: The team developed documentation tools and educational activities to support each part of the cycle for improving performance: plan--a planning workshop; design--a hybrid FOCUS-PDCA model; measure and assess--a three-part indicator workshop; and measure, assess, and improve--a redesigned QI report form. To document the entire cycle, the team developed an IOP Notebook and a workshop introducing it. Requirements for process design were established based on the standards. Next, the C phase, traditionally interpreted to clarify the current process by flowcharting, was broadened to include internal and external clarification of the process. APPENDIX-USING THE FOCUS--PDCA HYBRID TO REDESIGN AN ANTIBIOGRAM: The hybrid model's hallmark is its flexibility in supporting projects where the need for redesign over improvement is not clear at the outset. In a year-long study in 1995, a "Critter Ridder" Team at Hardin Memorial Hospital used the model to design an innovative antibiogram. In the C phase, customer input was gathered from physicians and a literature search was conducted to identify other antibiogram formats. The team constructed the antibiogram to meet key quality characteristics-accessibility, information, accuracy, timelines, and layout. Documentation on the IOP Notebook templates demonstrates the team's implementation of the performance improvement standards in its design.

Data Collection↗
PubMed2000

Performance of phenotypic and genotypic methods to determine the clinical relevance of serial blood isolates of staphylococcus epidermidis in patients with septicemia.

Five typing methods, including biotyping (API ID32; BioMérieux, Marcy l'Etoile, France), quantitative antibiogram typing based on actual zone sizes, plasmid typing, randomly amplified polymorphic DNA (RAPD) analysis (with primer M13 and primer set ERIC-2-1026), and pulsed-field gel electrophoresis (PFGE), were compared with a previously performed method of DNA fingerprinting by AFLP (amplified fragment length polymorphism analysis) for their performance in the typing of blood isolates of Staphylococcus epidermidis. Sixteen epidemiologically unrelated strains and 11 sets of four blood culture isolates from 11 patients with septicemia were used. The stabilities and reproducibilities of the patterns, the discriminatory capacities of the methods, and the ability to apply the methods to blood culture isolates were used as performance criteria. All strains tested were typeable by each method, and the patterns were stable and reproducible. The numbers of different types within the collection of 16 epidemiologically different isolates were 5 by biotyping, 14 by antibiogram typing, 4 by plasmid typing, 9 by the RAPD assay (combination of results with primer M13 and primer set ERIC-2-1026), and 16 by PFGE. Within the 11 sets of four blood culture isolates the types found by quantitative antibiogram typing, plasmid typing, and PFGE were unique for each set, whereas by biotyping and RAPD analysis some types were observed in more than one set. The results of biotyping did not correspond with the results of the other methods or the results of AFLP. For 6 of the 11 sets, the results of all methods except those of biotyping corresponded completely. Quantitative antibiogram typing, PFGE, and AFLP proved to be the most accurate of the six typing methods tested.

Bacteremia↗
PubMedDate not supplied

Tracking drug-resistant Streptococcus pneumoniae in Oregon: an alternative surveillance method.

With the emergence of drug-resistant Streptococcus pneumoniae, community-specific antimicrobial susceptibility patterns have become valuable determinants of empiric therapy for S. pneumoniae infections. Traditionally, these patterns are tracked by active surveillance for invasive disease, collection of isolates, and centralized susceptibility testing. We investigated whether a simpler and less expensive method aggregating existing hospital antibiograms--could provide community-specific antimicrobial susceptibility data. We compared 1996 active surveillance data with antibiogram data from hospital laboratories in Portland, Oregon. Of the 178 S. pneumoniae active surveillance isolates, 153 (86% [95% confidence interval (CI) = 80% to 91%]) were susceptible to penicillin. Of the 1,092 aggregated isolates used by hospitals to generate antibiograms, 921 (84% [95% CI = 82%-87%]) were susceptible to penicillin. With the exception of one hospital's erythromycin susceptibility results, hospital-specific S. pneumoniae susceptibilities to penicillin, cefotaxime, trimethoprim-sulfamethoxazole, and erythromycin from the two methods were statistically comparable. Although yielding fewer data than active surveillance, antibiograms provided accurate, community-specific drug-resistant S. pneumoniae data in Oregon.

Community-Acquired Infections↗
PubMed2001

Outbreaks of nosocomial bloodstream infections associated with multiresistant Klebsiella pneumoniae in a pediatric intensive care unit.

BACKGROUND: Between June and October 1997, and during April 1998, a cluster of nosocomial bloodstream infections (BSIs) associated with Klebsiella pneumoniae was observed in 8 premature neonates from 1 pediatric intensive care unit (TPICU) in a 4000-bed medical center in northern Taiwan. An investigation was conducted to identify the possible reservoirs and mode of transmission. METHODS: Epidemiologic surveillance and infection control interventions were executed. The environment was checked by submitting several swab samples for microbiological studies. The antibiograms and results from 2 molecular typing methods (pulsed-field gel electrophoresis and infrequent-restriction site polymerase chain reaction) of all bacteremic and environmental isolates of K. pneumoniae were compared. RESULTS: Totally 39 K. pneumoniae isolates, including 9 from bacteremia, 26 from the environment, and 4 controls, were analyzed. One major pattern was found in 21 isolates, which included 8 bacteremic isolates with identical antibiograms, a single isolate from rectal swab screening, 2 of 8 isolates from hand cultures of medical staff, and 10 of 17 isolates from swabs of sinks in the TPICU. All 21 isolates illustrated identical antibiograms, while the other 18 isolates shared 4 antibiograms and 15 unique patterns. CONCLUSIONS: The nosocomial BSIs appeared to be an outbreak induced by 1 multiresistant K. pneumoniae strain. The sinks may have acted as reservoirs for this outbreak strain. During washing, splattered water droplets containing the bacterial particles may have contaminated the hands of medical personnel and were then further transmitted to patients.

Bacteremia↗
PubMed2003

[Low urinary tract infection and cystoscopic findings in Urogynecology Service in the Instituto Nacional de Perinatología].

INTRODUCTION: The pathogenesis of urinary tract infection and related to the host and pathogens. There are three associated factors: incontinence, cystocele and residual urine. OBJECTIVES: To know the prevalence of urinary tract infections and uropathogens in urogyneacologic patients of the Instituto Nacional de Perinatología describe the cystoscopic findings in patients with positive urocultures and antibiogram. METHODS: This is a retrospective study involving urogyneacologic patients with positive urine cultures from 1998 to 2001. Positive culture was a growth of only one microorganism more than 100,000 colonies. The antibiogram and patients files were reviewed in order to know: Symptoms, indications, diagnostic and cystoscopic findings; their distribution and differences were analyzed. RESULTS: From 3,433 urine cultures, 540 were positive (16% prevalence). Uropathogens distribution was: E. coli 70%, Klebsiella pneumoniae 6.3%, Pseudomonas aeruginosa 4.3%. The antibiogram showed resistance to beta-lactamics and third generation cephalosporin (96.59% and 85.17%). The most frequent indications were: incontinence, irritative symptoms, urethral hypermovility and pelvic organ prolapse. Urethrothrigonitis was the most frequent cystoscopic finding. Mixed urinary incontinence and urethral hypermotility were the only findings to have a important difference. CONCLUSIONS: There is a change in the uropathogens prevalence and in their antibiotic resistance. This must be considering in the treatment of urogyneacologic patients with urinary tract infections. To ensure the best outcome we must ask for a urine culture with antibiogram. The additional use of anti-inflammatory agents is convenient in the presence of urethrothrigonitis in urogyneacologic patients with urinary tract infections.

Cystoscopy↗
PubMed2005

Analysis of three phenotyping methods and pulsed-field gel electrophoresis for differentiation of methicillin resistant Staphylococcus aureus isolated from two hospitals in Thailand.

Methicillin resistant Staphylococcus aureus (MRSA) is an important hospital and community-acquired pathogen. Rapid and reliable epidemiologic typing is necessary for controlling the spread of MRSA outbreak. The objective of this study was to compare the phenotyping with the genotyping method to differentiate MRSA isolates obtained from the two hospitals in Thailand (central and northeastern). Seventy-four MRSA isolates were randomly collected and confirmed by the presence of mecA gene. Antibiogram, phage typing and enterotoxin production were used for the phenotyping analysis. Pulsed-field gel electrophoresis (PFGE) with Smal digestion of chromosomal DNA was used for the genotyping analysis. We found 17 distinct profiles by the 3 phenotypic typing methods and 18 PFGE types designated as 5 major types (A-E) and 13 subtypes. The most frequent PFGE types and their related subtypes found in both hospitals were A and C, comprising 54 and 27%, respectively. The antibiogram could differentiate 6 different types. All isolates were resistant to the majority of antimicrobial agents tested, but were susceptible to vancomycin and fosfomycin. Ten (13.5%) MRSA isolates produced enterotoxin A. Nontypable phage and phage type 77 were found predominantly in MRSA isolated from the northeast and central hospital, respectively. A significant correlation was found between the phenotyping and the genotyping methods and there was a good correlation between antibiogram and PFGE. Antibiogram typing alone can be used as a useful epidemiological marker for practical purposes. PFGE types A and C were the common endemic MRSA clones in both hospitals in Thailand.

Electrophoresis, Gel, Pulsed-Field↗
PubMed1988

Plasmid profiles and klebocin types in epidemiologic studies of infections by Klebsiella pneumoniae.

The epidemiological methods of klebocin typing, antibiogram and plasmid DNA profile were evaluated using organisms isolated from a suspected epidemic of gentamicin-resistant Klebsiella pneumoniae and unrelated strains from different geographical areas as controls. The electrophoretic analysis of plasmid DNAs from Klebsiella pneumoniae showed the presence of at least one and up to as many as seven plasmids in each strain. The molecular weight of plasmid DNAs ranged from 1 to greater than 70 mega daltons. While none of the control Klebsiella pneumoniae strains showed identical plasmid profiles, 63% of the epidemic-related Klebsiella pneumoniae strains did. Klebocin typing and plasmid DNA profile gave different results for the same strains. Plasmid DNA profile was found to be a more valuable method than klebocin typing alone or klebocin typing in combination with antibiogram for differentiating epidemiologically related from unrelated isolates. Both plasmid DNA profile and klebocin typing methods were superior to antibiogram.

Anti-Bacterial Agents↗
PubMed1984

Characterization of endemic Providencia stuartii isolates from patients with urinary devices.

Providencia stuartii has emerged as a significant nosocomial urinary tract pathogen. An increase in the number of Providencia isolates from urine cultures prompted an investigation into the possibility of an outbreak due to this organism. A high proportion of patients studied had urinary devices. Four wards were screened at two time periods to ascertain the prevalence of Providencia stuartii in urine cultures. Biotype, serotype, antibiogram and plasmid content were determined for each Providencia isolate. Of 129 patients initially sampled 22.5% were found to harbor Providencia stuartii. Biotyping, serotyping and antibiograms indicated an epidemic strain was not present. Similar results were obtained when the wards were screened a second time, with 25.4% of urine cultures found to contain Providencia stuartii. By plasmid analysis the isolates could be grouped into one of ten profiles. A correlation could be made between urease activity and the presence of a large plasmid. No association however could be made between a particular plasmid profile and antibiogram. The data indicate that an epidemic strain of Providencia stuartii was not present. The source(s) of the endemic Providencia stuartii strains remain unknown.

Bacteriuria↗
PubMed1992

Identification of an epidemic strain of Acinetobacter baumannii using electrophoretic typing methods.

Nosocomial infections due to Acinetobacter baumannii dramatically increased in a Lebanese medical center following an outbreak of hostilities in Lebanon in 1984. The incidence of infection caused by this organism has remained high in this institution, thus requiring the implementation of a strain typing system to aid in infection control. Three methods were investigated for their utility in differentiating among a representative group of 36 nosocomial Acinetobacter baumannii isolates obtained over a 10 month period from specimens of hospitalized patients. Isolates were typed by antibiogram analyses, plasmid fingerprinting, and total cell protein profiles. Only three distinct total cell protein profiles were detected, with one pattern accounting for 26 (72.2%) of the isolates. However, eight different plasmid profiles were observed, with 20 (55.5%) isolates having the same profile. Eleven distinct antibiograms were seen with the most prevalent pattern occurring in 21 isolates. Twenty of the 21 (95%) isolates with the common antibiogram also had the same plasmid profile and total protein profile (44.4% of total isolates). The combination of these three typing methods was useful in tracing the spread of these organisms in the medical center. The data obtained suggest the distribution of a common strain among at least six wards of this hospital.

Acinetobacter↗