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PubMed2003

Identification of lactic acid bacteria from spoilage associations of cooked and brined shrimps stored under modified atmosphere between 0 degrees C and 25 degrees C.

AIMS: To evaluate spoilage and identify lactic acid bacteria (LAB) from spoilage associations of cooked and brined shrimps stored under modified atmosphere packaging (MAP) at 0, 5, 8, 15 and 25 degrees C. METHODS AND RESULTS: Bacterial isolates (102) from spoilage associations of cooked and brined MAP shrimps were characterized by phenotypic tests and identified as lactic acid bacteria (78 isolates), other Gram-positive bacteria (13 isolates) and Gram-negative bacteria (11 isolates). A selection of 48 LAB isolates were further characterized and identified by phenotypic tests and SDS-PAGE electrophoresis of whole cell proteins. Selected clusters of LAB isolates were analysed by plasmid profiling, pulsed field gel electrophoresis and 16S rRNA gene sequencing. Enterococcus faecalis was identified in spoilage associations at 15 degrees C and 25 degrees C, and its metabolic activity corresponded to chemical changes in spoiled products. Carnobacterium divergens, a non-motile Carnobacterium sp. nov. and Lactobacillus curvatus were the LAB species observed in spoilage associations of products stored at 0 degrees C, 5 degrees C and 8 degrees C. CONCLUSIONS: Enterococcus spp. and Carnobacterium spp. were the dominant parts of spoilage associations of cooked and brined MAP shrimps stored at high and low temperatures, respectively. SIGNIFICANCE AND IMPACT OF THE STUDY: The SDS-PAGE technique and simple biochemical keys allowed the majority of LAB isolates from spoilage associations of cooked and brined MAP shrimps to be identified at the species level.

Animals↗
PubMed1999

[Bacteriological and clinical break points: evaluation of the usefulness of cefozopran based on MIC].

Drug sensitivity of clinically isolated bacteria to cefozopran (CZOP), which is a new cephem antibiotic, was investigated, and the usefulness of the drug was evaluated from the viewpoint of bacteriological and clinical (pneumonia) break points. The following results were obtained. 1. According to bacteriological break points, methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus spp. showed low sensitivity to cefozopran (CZOP). However, the sensitivity of methicillin-sensitive Staphylococcus aureus (MSSA), E. coli, and Klebsiella spp., which are often isolated as pathogens of common infections, was 100%, that of Enterobacter spp., Serratia sp., and Citrobacter sp. was 90% or higher, and that of Pseudomonas aeruginosa was 80% or higher; the values were comparable to or better than those for ceftazidime (CAZ). These results suggest a expanded antibacterial spectrum and enhanced antibacterial potency of CZOP. 2. The estimated response rate of pneumonia to CZOP was 87.5% in outpatients and 51.9% in inpatients. Therefore, CZOP is considered to be one of the first choices especially in outpatient empiric therapy.

Cephalosporins↗
PubMed2000

[Evaluation of the activity and effects of combinations of various antibacterial agents against methicillin-resistant Staphylococcus aureus in vitro].

MICs of various antibacterial agents against methicillin-resistant Staphylococcus aureus (MRSA) were measured. Furthermore, we evaluated the effects of combinations of antibacterial agents against MRSA in vitro. In 24 cases out of 37, in which MRSA was isolated from inpatients, other microorganisms, such as Candida spp., Entrococcus spp., and Pseudomonas aeruginosa, were simultaneously isolated. From the results of minimum inhibitory concentrations (MICs), obtained from micro broth-dilution method, of various antibacterial agents against MRSA, range of MICs of arbekacin (ABK), vancomycin (VCM) and teicoplanin (TEIC) were < or = 0.25-4.0, 0.5-1.0 and 0.25-4.0 micrograms/ml respectively, and no strains of MRSA showed resistance to ABK, VCM and TEIC, so that we concluded that these three antibacterial agents were effective for MRSA infection. On the in vitro study of combination-effect of antibacterial agents, significant synergistic effects were achieved in the combination of VCM and flomoxef (FMOX) (Synergism rate was 97.3%) or VCM and imipenem (IPM) (Synergism rate was 97.2%). From the results that the fractional inhibitory concentration index in the combination of VCM with IPM was smaller than that with FMOX and that P. aeruginosa or Enterococcus spp. were simultaneously isolated in high frequency in the MRSA-isolated cases, we thought that the combination of VCM with IPM is more useful, because IPM is effective against P. aeruginosa but FMOX is not.

Aminoglycosides↗
PubMed1996

The effect of positive semen bacterial and Ureaplasma cultures on in-vitro fertilization success.

A total of 342 couples planning to undergo in-vitro fertilization (IVF) were examined for the presence of bacteria in semen prior to and during the procedure. Pregnancy rates were analysed retrospectively to ascertain any adverse affects if > 10000 colony forming units (CFU)/ml bacteria were detected in the semen sample. The most common bacteria isolated from semen were Enterococcus spp. (73%). The presence of these bacteria did not affect the pregnancy rate of the patients with positive cultures prior to (32%) or during (37%) the IVF procedure compared with those patients in whom no bacteria were detected (32%). Those patients with semen cultures positive for Escherichia coli prior to the IVF procedure, but which cleared after treatment had a higher pregnancy rate (60%) compared with those patients who were positive for E.coli at the time of the attempt. The group of patients with Staphylococcus aureus in the semen at the time of IVF also demonstrated a low pregnancy rate (17%). Of the patients. 36 (11%) had positive Ureaplasma cultures from the screening test carried out on the semen and 22% became pregnant after successful treatment. None of the three patients with persistently positive cultures became pregnant. In conclusion, the presence of Enterococcus in semen does not affect pregnancy rates following IVF. E.coli, S.aureus and Ureaplasma urealyticum may have a negative effect and should be treated.

Abortion, Spontaneous↗
PubMed1992

Bacteriology of anal fistulae.

Anal fistulae are said to arise from cryptoglandular infection of the anal glands, which lie within the intersphincteric space. The type and virulence of the micro-organism responsible may determine whether an anal fistula develops. The microbiology of chronic anal fistulae has not been reported previously. Twenty-five consecutive anal fistulae were studied prospectively (eight intersphincteric fistulae, 12 trans-sphincteric fistulae, two suprasphincteric fistulae, one extrasphincteric fistula, one superficial fistula, one anovaginal fistula). There were 18 men and seven women, with a median age of 42 (range 22-71) years. Patients with Crohn's disease or acute anorectal suppuration were excluded. In 18 patients, 0.1 ml granulation tissue from the track of the fistula was obtained and processed within 4 h using standard microbiological techniques. Sixty-nine isolates representing at least 17 species were obtained. The predominant organisms were Escherichia coli (22 per cent), Enterococcus spp. (16 per cent) and Bacteroides fragilis (20 per cent). The majority of the growths were obtained only from enrichment. Bacteria from only one patient grew at a dilution of 10(3). Granulation tissue from 25 patients was processed for mycobacterial culture, and Mycobacterium tuberculosis was grown from one patient. No other mycobacterium was isolated. The chronic inflammation in anal fistulae does not seem to be maintained by either excessive numbers of organisms or organisms of an unusual type.

Adult↗
PubMed1997

Natural milk cultures for the production of Argentinian cheeses.

Samples (32) of natural milk cultures used in the Santa Fe, Argentina, area for soft and semihard cheese production were examined. The microbial composition (including lactic acid microflora characterization) and technological parameters (acidifying and proteolytic activities) were evaluated. The cultures contained mainly thermophilic lactic acid bacteria, identified as Streptococcus salivarius subsp. thermophilus (96.8% of the total strains) and Enterococcus spp. The strains showed a low proteolytic activity. The isolates of S. salivarius subsp. thermophilus exhibited a widespread phage resistance. The nonlactic microflora comprised coliforms, yeasts, spore-forming bacteria and lactate fermentative bacteria. The samples showed an acidity level from 0.38 to 0.69% lactic acid (pH from 4.25 to 5.75). The acidifying activity was optimal at 45 degrees C. The advantages and disadvantages of the employment of natural milk starters are discussed.

Animals↗
PubMed2002

Skin and soft tissue infections in Latin American medical centers: four-year assessment of the pathogen frequency and antimicrobial susceptibility patterns.

We report the results of pathogen frequency and antimicrobial susceptibility of isolates collected from skin and soft tissue infections (SSTIs) in Latin American medical centers during the first 4 years (1997-2000) of the SENTRY Antimicrobial Surveillance Program. Ten laboratories participated each year distributed among nine cities in six countries. A total of 1,789 bacterial isolates were susceptibility tested by reference broth microdilution at the coordinating central laboratory. Results from isolates collected during the year 2000 were compared with those from isolates collected during the prior three years. Selected carbapenem-resistant Pseudomonas aeruginosa were genotyped by automated ribotyping to evaluate the occurrence of clonal, epidemic dissemination. The five most frequently isolated species were (n/%): Staphylococcus aureus (584/32.8%), Escherichia coli (233/13.1%), P. aeruginosa (211/11.9%), Enterococcus spp. (137/7.7%), and Klebsiella spp. (127/5.8%). The most problematic antimicrobial resistances were related to the high prevalence of multi-drug resistant (MDR) Gram-negative bacilli. Carbapenem resistance among non-fermentative Gram-negative bacilli was much higher than that reported in other regions evaluated in the SENTRY Program. Only 74.9% of P. aeruginosa and 84.9% of Acinetobacter spp. were considered susceptible to imipenem. The antimicrobial susceptibility rates of P. aeruginosa decreased during the study period for most antimicrobial agents evaluated. More than 40% of K. pneumoniae and nearly 10% of E. coli showed an extended spectrum beta-lactamase phenotype. Only 73.4% of E. coli and 76.0% of Enterobacter spp. were susceptible to ciprofloxacin. The molecular typing of carbapenem-resistant P. aeruginosa demonstrated clonal dissemination in two institutions. These reported results indicate that rates of resistance among isolates causing SSTI continue to raise in Latin America, with specific concerns for the high prevalence of MDR Gram-negative bacilli. National and international surveillance programs as a guide to focusing intervention strategies should assist in the control of escalating antimicrobial resistance in this geographic area.

Anti-Bacterial Agents↗
PubMed2001

In vitro activity of linezolid and 11 other antimicrobials against 566 clinical isolates and comparison between NCCLS microdilution and Etest methods.

The in vitro activity of linezolid and 11 other antimicrobials was determined for 566 clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus spp., Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, some of them resistant to several antibiotics, using a broth microdilution method and the Etest method. All Gram-positive organisms tested were inhibited by a concentration of <or=4 mg/L of linezolid, including methicillin-resistant staphylococci, vancomycin- and ampicillin-resistant enterococci, and penicillin-intermediate and -resistant pneumococci. MICs of linezolid by the Etest method were usually one to two dilution values lower than those obtained by microdilution.

Acetamides↗
PubMed2002

Comparative antimicrobial spectrum and activity of BMS284756 (T-3811; a desfluoroquinolone) tested against an international collection of staphylococci and enterococci, including in vitro test development and intermethod comparisons.

The study was initiated to determine the in vitro activity and MIC/disk test comparisons of BMS284756, a new des-fluoro(6)-quinolone, against isolates of staphylococci and enterococci from the SENTRY Antimicrobial Surveillance Program, 2000. Isolates were tested by reference broth microdilution and standardized disk diffusion methods. Against 3,789 strains of gram-positive cocci from the SENTRY Program (2000), the BMS284756 MIC90 and percentage susceptible at < or = 2 and < or = 4 microg/ml were: Staphylococcus aureus (4 microg/ml; 89.3 and 97.1%), coagulase-negative staphylococci (CoNS; 4 microg/ml; 86.1 and 96.0%) and enterococci (> 4 microg/ml; 62.0 and 76.2%). Also tested were selected staphylococci (300 strains) and enterococci (102 strains) by two standardized methods. The activity of BMS284756 was highly correlated with oxacillin resistance among staphylococci. Oxacillin-susceptible staphylococci were all inhibited by BMS284756 at < or = 0.5 microg/ml, whereas oxacillin-resistant strains required inhibitory concentrations of > or = 1 microg/ml. Excellent correlation was observed between the MIC and 5-microg disk zone diameter for staphylococci and enterococci (r=0.91 to 0.93). Among vancomycin-susceptible enterococci, 67% of Enterococcus faecalis, 25% of E. faecium, and 76% of other Enterococcus spp. isolates were inhibited by BMS284756 at < or = 2 microg/ml. All vancomycin-resistant enterococci (VRE; 11 E. faecalis and 15 E. faecium) were inhibited by > or = 2 microg/ml of BMS284756. Among the non-VRE, non-faecium enterococcal isolates (n=64), 62% were inhibited by < or = 0.5 microg/ml. BMS284756 showed excellent activity against oxacillin-susceptible staphylococci and moderate activity against enterococci other than VRE and E. faecium. Acceptable correlations were observed between MIC and disk test results for both tested genus groups.

Anti-Infective Agents↗
PubMed2001

Ertapenem: a new carbapenem.

Ertapenem is a new 1-beta-methyl carbapenem, stable to dehydropeptidase, which binds preferable to penicillin-binding proteins (PBP) 2 and 3. Ertapenem has a broad antibacterial spectrum with MIC90 values < 0.5 mg/l for penicillin-susceptible Streptococcus pneumoniae, Streptococcus pyogenes, methicillin-sensitive Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli, Citrobacter spp., Klebsiella spp., Serratia spp., Proteus spp., Clostridium perfringens, Fusobacterium spp. Peptostreptococcus spp. and anaerobic Streptococcus spp. Ertapenem exhibits a bactericidal mode of action as shown by time-killing curves and exhibits a short PAE of 1.4 - 2.6 h against the Gram-positive strains but no PAE against Gram-negative strains. In an infection model in mice, it has been shown that ertapenem and imipenem were highly efficacious at a level of 2 mg/kg in bacterial clearance in comparison to ceftriaxone, cefepime, ceftazidime, cefazolin, cefonicid, cefotaxime and meropenem. In comparison to other available carbapenems, ertapenem has a long half-life of 4.5 h and is developed as a single daily dose carbapenem. The protein binding is dose-dependent and is estimated to 94% at concentrations under 100 mg/l and approximately 85% at 300 mg/l. Cmax after a dose of 1 g in healthy volunteers has been estimated to 190 mg/l. Given the pharmacokinetic/pharmacodynamic data, it may be predicted that ertapenem will have an effect on most Gram-positive and Gram-negative bacteria with the exception of Pseudomonas aeruginosa, Enterococcus spp. and Acinetobacter spp. For pathogens with a MIC of 0.5 mg/l, the estimated T > MIC will be 50% (of 24 h) and for pathogens with a MIC of 1 mg/l 31%. For anaerobic bacteria with MIC values between 1-2 mg/l, the T > MIC may not be sufficient for bacterial eradication. However, clinical trials have to confirm this hypothesis.

Animals↗
PubMed2005

[Incidence of vancomycin-resistant Enterococcus at a university hospital in Brazil].

OBJECTIVE: Vancomycin-resistant Enterococcus (VRE) is today one of the principal microorganisms implicated in nosocomial infections. Thus, a study was carried out with the objective of evaluating its epidemiology at a tertiary-level teaching hospital. METHODS: This was a three-year retrospective epidemiological study conducted from 2000 to 2002. Samples of VRE-positive clinical cultures at a 660-bed university hospital were analyzed. The incidence of VRE and the main anatomical sites and hospital units from which it was isolated were defined. Differences between the variables over the three years of the study were verified, and these were considered significant when p<0.05. RESULTS: There was a progressive increase in the vancomycin resistance in the clinical cultures that were positive for Enterococcus spp., over the three years of the study. In 2000, 9.5% of the samples were vancomycin-resistant, and this increased to 14.7% in 2001 and 15.8% in 2002. The hospital units with the largest numbers of isolates were, respectively, the emergency ward (19.5%) and the general intensive care unit (15%). The anatomical sites with the highest amounts of isolates included: urine (36%) and blood (20%). CONCLUSIONS: With the progressive increase in the incidence of vancomycin resistance and the VRE rate, it is concluded that more effective control measures are needed for deterring the dissemination of VRE.

Brazil↗
PubMed2002

Antimicrobial susceptibility pattern of Enterococcus species from urinary tract infections.

OBJECTIVE: To determine the extent of drug-resistance among Enterococcus species in, in vitro experiments. Test strains were isolated from cases with urinary tract infection. Antimicrobial sensitivity was determined with particular reference to the beta-lactams, glycopeptide and aminoglycoside groups of antibiotics. METHODS: Studies were carried out on pure cultures of enterococci isolated from urine specimens of 147 patients. Freshly voided, aseptically collected, midstream specimens of urine were cultured by using standard techniques. The identification and speciation of the strains of enterococci were performed by employing a battery of tests. In vitro drug-susceptibility tests of enterococci were performed against the following antibiotics: penicillin, ampicillin, ampi-sulbactum, co-amoxi-clavulanate, ciprofloxacin, vancomycin, teicoplanin, gentamicin and streptomycin, by employing the disk diffusion method. MIC values for penicillin, ampicillin, vancomycin and teicoplanin against enterococci were determined by the agar dilution technique. MIC determinations were further carried out by the E-test method, for the glycopeptide antibiotics. Prevalence of high level resistance to aminoglycoside antibiotics was determined by the agar dilution method. RESULTS: The most common species isolated was E. faecalis (87.07%), followed by E. faecium (10.88%) and E. durans (2.05%). The magnitude of resistance to both penicillin and ampicillin among the Enterococcus spp. was 23.13%, and that to ciprofloxacin was 55.78%. The three antibiotics: nitrofurantoin, co-amoxi-clavulanate, and ampi-sulbactum, showed resistance of 0.78%, 8.16% and 2.72%, respectively. High-level aminoglycoside resistance among strains of enterococci for streptomycin and gentamicin was found to be 33.84% and 36.92%, respectively. All the strains were susceptible to the glycopeptide antibiotics tested. CONCLUSION: The emergence of enterococci with alarming rates of resistance concomitantly to penicillins and aminoglycosides highlights the need for a more rational and restricted use of antimicrobials, in order to minimize the selection and spread of such strains. An early detection of these problem pathogens is also important for preventing any treatment failures.

Anti-Bacterial Agents↗
PubMed2002

Gram-positive bacterial resistance. A challenge for the next millennium.

Penicillin G was first used in 1941. Since then, the trend in bacterial infections has changed. New antibiotics have been developed and bacterial resistance has spread as a consequence. The spread of Gram positive resistant bacteria is related to an inappropriate use of antibiotics. Antibacterial agents are abused or overused in various fields: medicine itself, veterinary science and zootechnics. Now, at the beginning of the third millennium we have been forced to limit our therapeutic options in order to combat these insidious enemies. Selective antibiotic pressure on the microbial population, notably on enterococci and staphylococci, made these two pathogens recalcitrant to traditional chemotherapy. It is a matter of concern that today, vancomycin-resistant Enterococcus spp. (VRE) and vancomycin-intermediate and resistant Staphylococcus aureus (VISA and VRSA) are now being observed worldwide among emerging pathogens. Most pharmaceutical companies are today developing antimicrobial drugs that are active against Gram-positive bacteria. Quinupristin/dalfopristin and linezolid are the most promising drugs and are available only for serious infections; future agents being developed for multi-resistant Gram-positive infections include daptomycin and the glycyclines, although these are still in the development phase. Nevertheless, our group has had the opportunity to treat some serious infections with these drugs and the good results achieved are reported in this review.

Acetamides↗
PubMed1997

[Efficacy and safety of sulbactam/cefoperazone for hepato-biliary infections].

We studied efficacy and safety of sulbactam/cefoperazone (SBT/CPT) in the treatment of biliary tract infections in hospitalized patients at 26 hospitals from February 1993 to March 1995. Secondary to dropout, 273 out of 338 patients entered in the study were evaluated, 127 patients with cholecystitis, 132 patients with cholangitis, and 14 patients with liver abscesses. Of these, 93 patients (34.1% had malignancy as an underlying disease. SBT/CPZ had an efficacy of 79.9% (218 patients; excellent: 52, good: 166), with the efficacy in patients with cholecystitis, cholangitis and liver abscess at 89.0% (113 patients), 77.3% (102 patients and 21.4% (3 patients), respectively. A significant difference (p < 0.05) was observed in the efficacy rates of patients with (59 patients [63.4%]) and without malignancy (159 patients [88.3%]). A total of 84 strains were isolated from bile specimens of 53 patients, and the major isolates were Escherichia coli, Pseudomonas aeruginosa and Enterococcus spp. Two or more bacterial strains were isolated simultaneously in 20 patients. Mild or moderate side effect (allergic reaction including rash etc.) were noted in 4 patients (1.18%), and laboratory abnormalities (increased GOT, etc.) were in 16 patients (4.71%) out of the total 338 patients. This study clearly demonstrated that SBT/CPZ retains its excellent clinical efficacy and safety profile, throughout its use over the past decade.

Adolescent↗
PubMed1993

[Antimicrobial activities of aspoxicillin of fresh clinical isolates].

The Antimicrobial activity of aspoxicillin (ASPC) in terms of minimum inhibitory concentration (MICs) was compared with those of other penicillin antibiotics (PCs) against clinical isolates sent to us from medical institutions throughout Japan in 1988, 1990 and 1992 and strains isolated and identified from samples collected from patients with various infections. 1. The MIC80's of ASPC against Staphylococcus aureus, Enterococcus spp., Escherichia coli, Bacteroides fragilis group were almost the same as those against these isolates in 1985 to 1986. 2. A trend for increasing susceptibility to PCs including ASPC was observed in the isolates of S. aureus and Haemophilus influenzae. This trend in S. aureus was attributed to the appearance of non beta-lactamase producing strains associated with the development of highly resistant strains among the methicillin-resistant S. aureus (MRSA) as well as to a tendency toward yearly decreasing frequency of MRSA. The trend for the increased susceptibility in H. influenzae was related to the decrease in the number of beta-lactamase production strains. 3. The frequency of the strains highly resistant to PCs including ASPC increased. 4. No PCs-resistant strains were observed among the so-called beta-streptococci, while among alpha-streptococci and Streptococcus pneumoniae there was a trend for decreasing frequency of strains with lower susceptibility to PCs or those with resistant to PCs. These strains may be variants which were also resistant to cephems and had penicillin-binding proteins (PBPs). Meanwhile, a high frequency of highly PCs-resistant strains were noted among Enterococcus faecium. In view of the fact that the PCs-resistance of E. faecium is known to be related to PBPs, the pattern of the susceptibility of the recent clinical isolates to beta-lactams is considered to be multimodal.

Amoxicillin↗
PubMed2004

Underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis: 51 cases (1990-2001).

OBJECTIVE: To determine the underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis and identify differences between cats that survived following treatment and cats that did not survive despite treatment. DESIGN: Retrospective study. ANIMALS: 51 cats with septic peritonitis. PROCEDURE: Medical records were reviewed for clinical findings; results of clinicopathologic testing, microbial culture, and radiography; diagnosis; treatment; and outcome. RESULTS: Signs of pain during palpation of the abdomen were reported for only 29 of 47 (62%) cats. Eight (16%) cats had relative bradycardia (heart rate < 140 beats/min). The most commonly isolated organisms included Escherichia coli, Enterococcus spp, and Clostridium spp. The most common cause of peritonitis was gastrointestinal tract leakage (24 cats). No definitive source could be identified in 7 cats. Treatment, including exploratory surgery, was pursued in 23 cats, of which 16 (70%) survived and were discharged. There were no significant differences between survivors and nonsurvivors in regard to heart rate, age, rectal temperature, serum lactate concentration, WBC count, PCV, blood glucose concentration, or serum albumin concentration. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that clinicopathologic abnormalities and outcome in cats with septic peritonitis are similar to those reported for dogs. However, certain features may be unique, including an absence of signs of pain during abdominal palpation, relative bradycardia, and apparent spontaneous peritonitis in some cats.

Abdominal Pain↗
PubMed1993

Aorto-femoral graft infections: a clinical and microbiological analysis.

A 5-year experience of 19 aortic graft infections is reviewed. Of these, 13 (68%) had a late onset (more than 4 months after graft implantation) and usually presented with anastomotic pseudo-aneurysm or thrombosis. The remaining six infections (32%) had an early onset and presented more often with surgical wound infection. Aorto-enteric fistulae and inguinal sinus tracts were observed in both early and late onset infections. Coagulase-negative staphylococci (all slime negative, oxacillin susceptible strains) were the prevalent pathogens in both groups of infections and were isolated in six (32%) patients. Next most commonly seen were Pseudomonas aeruginosa in four (21%) patients, Enterococcus spp. in three (16%) patients, Staphylococcus aureus in three (16%) patients, other bacteria in six (32%) patients. No organisms were isolated in three (16%) patients. Mortality and major amputation rates were 47.3% and 31.6%, respectively. The therapeutic procedures included total graft removal (15 patients), partial graft excision (two patients), partial graft excision followed by total graft removal (one patient) and local treatment without graft removal (one patient). Six patients recovered, including two who underwent total graft removal associated with a non-conventional 'in situ' graft replacement and one patient treated conservatively with local treatment and antibiotics. The three patients undergoing partial graft excision showed signs of active infection of the residual graft.

Adult↗
PubMed1996

An economic approach to the MIC.

The determination of the Inhibitory Concentration in Diffusion (ICD) is proposed as an alternative to the agar dilution Minimal Inhibitory Concentration (MIC) that is time-consuming and cumbersome for routine use. Based on the technique of the disk diffusion test, it consists in calculating a continuous variable, the ICD, corresponding to the antibiotic concentration in the agar at the edge of the inhibition zone. Six antibiotics were tested (ampicillin, cefotaxime, erythromycin, gentamicin, nalidixic acid and rifampicin) each against 17 to 51 strains of enterobacteria, Staphylococcus aureus and Enterococcus spp. and six other antibiotics (cefsulodin, ceftazidime, imipenem, piperacillin, ticarcillin and tobramycin), against 13 to 25 strains of Pseudomonas aeruginosa. A total of 284 antibiotic-strain combinations were tested. Three different antibiotic charges were obtained for each antibiotic by cutting commercial disks in two and four equal pieces. The ICD was calculated for each strain from the size of inhibition zones around a full disk, a half and a quarter of a disk. Concurrently, the MIC was performed, using a conventional agar dilution method. There was a good correlation between the two methods and reproducibility for the ICD proved to be correct. This reliable technique is very efficient both in terms of laboratory time and cost of materials and could be proposed for widespread use in clinical laboratories.

Ampicillin↗