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PubMed1996

Characterization of Escherichia coli isolated from foals.

Serotype, biotype, antibiogram, hemolysin production, fimbrial hemagglutinins, select toxin genes (STb, STaP, LT, slt1 and slt2) and the attaching effacing (eae) gene were determined for 99 foal strains of E. coli. E. coli from diarrheic and normal foals could not be distinguished by serotype, biotype, or antibiogram. Differences (P < or = 0.05) were observed in hemolysin production (11.5% vs 0%) and the expression of mannose-resistant hemagglutinins (23% vs 13%) among E. coli from diarrheic and healthy foals, respectively. Three of the E. coli strains from diarrheic foals were positive with probes for slt genes and one was positive for STb and LT genes. One strain from a healthy foal possessed the STb gene. As determined by the polymerase chain reaction, 8 strains possessed the eae gene. Seven of the 8 strains were from diarrheic foals and one eae-positive strain was from a healthy foal. The slt-positive strains did not possess eae genes and the eae-positive strains did not possess slt genes. These results indicate that enterotoxigenic strains of E. coli are not implicated in any substantial degree in sporadic foal diarrhea. However, the identification of slt-positive and eae-positive strains in foal feces indicate the presence of potentially virulent strains among foals.

Animals↗
PubMed1987

Mixed morphotype susceptibility testing of Pseudomonas aeruginosa from patients with cystic fibrosis.

Disk diffusion antibiograms were determined for mixtures of Pseudomonas aeruginosa morphotypes isolated from the sputum of patients with cystic fibrosis (CF). The results were compared with the predicted susceptibility patterns derived from the antibiograms of individual morphotypes within the mixture. Fifty separate cultures, each yielding two, three, or four distinct morphotypes of Pseudomonas aeruginosa were evaluated. Overall, the correlation between observed and predicted results was 92.2% with only 2.9% of all observations leading to major disagreements in susceptibility. These data suggest that mixed morphotype susceptibility is potentially a useful method to monitor the collective resistance of colonizing strains of Pseudomonas aeruginosa from the respiratory tract of patients with CF.

Anti-Bacterial Agents↗
PubMedDate not supplied

Epidemiologic typing of Enterobacter sakazakii in two neonatal nosocomial outbreaks.

Two unrelated hospital outbreaks of Enterobacter sakazakii, involving meningitis, bacteremia, and colonization of neonates, were investigated. In each of these outbreaks, E. sakazakii was isolated from both patients and dried infant formula. In previous outbreaks, the source and mode of transmission of E. sakazakii in neonatal infections was not determined. In this study, we used a combination of typing methods (plasmid analysis, antibiograms, chromosomal restriction endonuclease analysis, ribotyping, and multilocus enzyme electrophoresis) to evaluate the isolates from each outbreak as to their relatedness. The typing results differed among outbreaks, but in each one, patient and formula isolates shared the same typing pattern. The only exceptions were disk antibiograms, which often varied among colonies selected from each of the isolates. Plasmid analysis, chromosomal restriction endonuclease analysis, ribotyping, and multilocus enzyme electrophoresis all were effective as epidemiological typing methods for E. sakazakii, especially when used in combination. By using this typing scheme, we have confirmed that E. sakazakii from intrinsically contaminated dried infant formula was the source of neonatal infection.

Anti-Bacterial Agents↗
PubMed1993

Epidemiologic typing of multiply drug-resistant Pseudomonas aeruginosa isolated from an outbreak in an intensive care unit.

From June to August 1991, there was an outbreak of Pseudomonas aeruginosa infections in an intensive care unit in a general hospital in Sao Paulo, Brazil. We obtained 14 isolates from 14 patients, 11 from tracheal aspirate, and 3 from surgical wound exudates. These strains were typed by serotyping, pyocin typing, and pulsed-field electrophoresis (CHEF) of chromosomal DNA (chrDNA), and the different typing methods were analyzed. These three methods demonstrated seven identical strains. We also performed an extensive antibiogram (33 drugs) in all 14 isolates. The incidence of resistance to aminoglycosides, extended-spectrum beta-lactams, and quinolones was very high among the seven identical isolates; however, the antibiogram profile differed significantly among the isolates. Our results suggest that a unique strain caused several cross-transmitted infections during this period of time, and the emergence of antimicrobial resistance has been occurring before and after the establishment of the epidemic strain by selective drug use. The chrDNA fingerprinting proved to be versatile and precise for epidemiologic investigations of P. aeruginosa infections.

Brazil↗
PubMed2005

Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical, epidemiologic, and laboratory perspective.

BACKGROUND: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including beta-lactams and aminoglycosides. METHODS: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (beta-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. RESULTS: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. CONCLUSION: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.

Anti-Bacterial Agents↗
PubMed2005

Emergence of community-associated methicillin-resistant Staphylococcus aureus USA 300 clone as a cause of health care-associated infections among patients with prosthetic joint infections.

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an important cause of staphylococcal infections, but there have been little data on whether CA-MRSA causes health care-associated infections. METHODS: A case-control study was performed to identify risk factors for prosthetic joint infections (PJI). Antibiograms of isolates associated with PJI were reviewed. Molecular typing of available MRSA isolates was done using pulsed field gel electrophoresis (PFGE). Nares cultures of health care workers who provided care to those orthopedic patients were obtained. RESULTS: Over a 13-month period (January 2003-January 2004), 9.5% of patients with prosthetic hip (THA) or knee (TKA) joint surgery developed PJI (7 TKA and 2 THA). The mean time to development of PJI was 20 days. Five infections were caused by CA-MRSA and 3 by methicillin-susceptible S aureus; one was culture negative. All CA-MRSA isolates had identical antibiograms (resistant to beta-lactams and erythromycin; susceptible to clindamycin, trimethoprim-sulfamethoxazole, rifampin, gentamicin, levofloxacin, and vancomycin). Molecular typing of 2 available CA-MRSA isolates revealed that these were the USA300 clone; these isolates were PVL+ and carried SCCmec IV. CA-MRSA was not recovered from nares cultures from 31 health care workers. In multivariate analysis, TKA (OR, 8.1; 95% CI: 1.3-48.1) and surgery time >180 minutes (OR, 7.4; 95% CI: 1.4-39.6) were associated with PJI. CONCLUSION: We have demonstrated that the CA-MRSA USA300 clone is no longer just a cause of community-acquired infections but has also emerged as a cause of health care-associated infections, causing PJI at our institution.

Adult↗
PubMed2005

Effect of systematic empiric treatment with imipenem on the bacterial ecology in a burns unit.

This study took place over 18 months and was divided into three 6 month periods. During the first and third periods, the bacterial ecology of the unit was reviewed, including the observation of bacteria which were isolated and led us to prescribe general antimicrobial therapy, and record the subsequent antibiograms that became available. During the second 6 month period, any patient developing an infection due (or possibly due) to a "Gram negative" strain received imipenem (as beta lactam antimicrobial agent), usually combined with tobramycin. The comparison between bacteria and antibiograms isolated during the first and the third periods did not show any increase in multiple resistant bacteria or imipenem resistant strains, including methicillin resistant Staphylococcus aureus (MRSA). During the third period, in comparison with the first, the number of Pseudomonas aeruginosa and Acinetobacter strains was lower; however, the number of Enterobacter and Klebsiella had increased. There was an increase of overall resistance to ticarcillin, but there was no increase in resistance to the other antimicrobials concerned in the study. Therefore, we concluded that wide use of imipenem did not impair the bacterial ecology of the unit, if used with precautions such as high dose regimen, de-escalation, and both pharmacokinetics and ecology monitoring.

Anti-Bacterial Agents↗
PubMed2004

Evaluation of an impedance method for subtyping of Pseudomonas aeruginosa.

Eight isolates (no. 1 to 8) of Pseudomonas aeruginosa isolated from 8 burn patients were typed by pulsed-field gel electrophoresis (PFGE), arbitrarily primed polymerase chain reaction (PCR) (AP-PCR), biotyping, antimicrobial susceptibility testing, and a newly developed technique-impedance method. By both PFGE and AP-PCR, isolates 1 and 2 were designated type A, while isolates 3 to 8 were designated type B. However, isolates 3 to 8 could be further divided into three distinct subtypes (B, C, and D) by the impedance method. Four antibiograms were obtained by testing the 8 isolates against six antimicrobial agents and designation of antibiogram to each of the 8 isolates was in accordance with those obtained by the impedance method. The results of biotyping did not agree with any of the above typing methods. In conclusion, the impedance technique had a high discriminatory ability to differentiate genetically related clones into subtypes. The method is simple, reproducible, and has a high typeability.

Bacterial Typing Techniques↗
PubMed2005

Evolution and dissemination of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: epidemiology and molecular report from the SENTRY Antimicrobial Surveillance Program (1997-2003).

During 2001, occurrences of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae isolates were detected in a single medical center (Hospital A) from the SENTRY Antimicrobial Surveillance Program that became endemic in long-term acute care areas and in the intensive care unit in 2002-2003. Between 2001 and 2003, 123 patients were infected or colonized with ESBL-positive K. pneumoniae. Resistance profiles were determined by reference broth microdilution methods, and automated ribotyping and pulsed-field gel electrophoresis (PFGE) were performed. The ESBL-positive K. pneumoniae isolates were resistant to aztreonam, ceftazidime, aminoglycosides, and trimethoprim/sulfamethoxazole and susceptible to ciprofloxacin and tetracycline. In 1997, 1998, and 2000, 9 ESBL-producing K. pneumoniae strains from 2 New York City hospitals shared the same antibiograms and ribotype (204.2) as the strains from Hospital A. PFGE patterns divided Hospital A isolates into 2 subtypes (A and A1) and 3 New York City strains were similar to the Hospital A isolates (A2, A3, and A4). Isoelectric focusing studies of 1 New York City isolate (A4) revealed pIs at 5.4, 7.7, and 8.2. PCR and sequencing results from 1 strain of each Hospital A and 1 New York PFGE pattern determined that TEM-1 and SHV-5 (ESBL) were present in all strains. In addition, 2 New York isolates from 1998 (A3 and A4) also had an OXA-2 enzyme. ESBL-producing K. pneumoniae isolates with ribotype 204.2 from SENTRY Program sites have been recognized in New York only since 1997 and in Hospital A beginning in 2001. The similarities of the antibiogram and epidemiological patterns suggest that these isolates have persisted over time and may have evolved into different but genetically related endemic ESBL-positive K. pneumoniae clones that have the ability to cause sustained epidemic outbreaks in US medical centers.

Adolescent↗
PubMed2006

Phenotypic and molecular typing of Vibrio cholerae O1 and O139 isolates from India.

OBJECTIVES: To determine whether Vibrio cholerae strains with similar phage types are also genetically homogeneous or heterogeneous by molecular typing methods like PFGE and RAPD-PCR employed in this study. METHODS: A total of 26 V. cholerae O1 and O139 strains received from different parts of India were analyzed by using conventional phage typing method, antibiogram and molecular typing methods such as PFGE and RAPD-PCR. RESULTS: Both O1 and O139 strains were resistant against two antibiotics (Ampicillin and Furazolidone) were detected. All of these strains were clustered in a single phage type, i.e., Type 27 for V. cholerae O1 and Type 1 for V. cholerae O139. Extensive molecular characterization by RAPD and PFGE showed that six sets of O1 and O139 strains, each comprising two strains, had identical PFGE and RAPD profiles. Only one O139 strain (PL-4) had unique RAPD and PFGE profile among all the 26 V. cholerae strains used in this study. CONCLUSION: Apart from serology, the strains of V. cholerae can be discriminated by this conventional phage typing system that offers the basic information on identification, biotyping and discrimination of strains. But, a high level of heterogeneity was observed in RAPD and PFGE profiles indicating the clonal diversity of V. cholerae O1 and O139 strains. It was concluded that these strains were phenotypically identical through phage typing system and antibiogram but genetically dissimilar, as shown in molecular typing systems.

Anti-Bacterial Agents↗
PubMedDate not supplied

Nasal carriage and antibiotic resistance of Staphylococcus aureus isolates from hospital and non-hospital personnel in Abha, Saudi Arabia.

The prevalence of nasal carriage of Staphylococcus aureus, antibiograms and prevalence of methicillin-resistant S. aureus (MRSA) were studied in 1999 among healthy hospital and non-hospital personnel in Abha, Saudi Arabia. S. aureus was isolated from 26.1% of 299 adults in the community and 25.4% of 279 hospital personnel. No isolate was resistant to vancomycin. Antibiotic resistance rates, for all other antibiotics tested except cephalothin, were significantly higher for strains from hospital personnel (P values < 0.001-0.04) compared to non-hospital adults. The antibiograms were also compared with those of 140 clinical isolates. The rates of resistance of the inpatient strains to all the antibiotics tested were significantly higher than those of hospital nasal carrier strains (P < 0.001-0.05). MRSA was isolated, respectively, from 5.1% and 18.3% of non-hospital and hospital carriers; MRSA carriage rates were 1.3% and 4.7%, respectively, for non-hospital and hospital carriers, and 61% of S. aureus isolates from infected patients were MRSA. Only 8% of non-hospital but 44% of hospital carrier strains were multiply resistant (P < 0.001). Multiple resistance among inpatient strains (89%) was significantly higher than that among hospital nasal strains (44%) (P < 0.001). Such rates of multiple resistance and endemic MRSA prevalence among healthy carriers (11%) at a much higher rate than those reported in the literature should raise concern in a region with unrestricted availability of antibiotics.

Adult↗
PubMed1999

Computer-assisted evaluation of antibiotic regimen coverage and cost.

Evaluation of the cost-effectiveness of antibiotic regimens has become an essential part of drug selection for pharmacists and physicians. However, these evaluations can be complicated, time-consuming, and, if the data used are not based on local conditions, misleading. The computer program Dare to Compare 98 was developed to provide an analysis of empiric antibiotic regimens. The Infectious Disease Challenge portion of the program lists the commonly identified pathogens in specific infectious diseases. The Antibiogram Susceptibility Reports section generates susceptibility reports based on local antibiogram data or data from institutions nationwide that have similar demographic profiles. Susceptibility information is combined with cost data in the Quality/Cost Index section. Comparison of the quality and cost index values allows the user to determine which regimens provide the optimal microbiologic activity and cost values for treatment of a particular infectious disease based on local data. Thus Dare to Compare 98 can help pharmacists and physicians evaluate antibiotic regimens and their suitability for inclusion in formularies and disease-management algorithms.

Anti-Bacterial Agents↗
PubMed1999

Microbiology of sinusitis in patients undergoing bone marrow transplantation.

As a result of increasing use of bone marrow transplantation and new cytotoxic chemotherapy, more patients have become susceptible to sinus disease caused by unusual organisms. Sinusitis caused by fungi and gram-negative bacteria can be difficult to treat, may lead to severe complications, and should be managed promptly in the bone marrow transplant patient. Here we present the results of 41 cultures of the paranasal sinuses obtained from 18 bone marrow transplant patients in whom sinusitis developed. The most common agents were gram-negative bacteria (56.7%), followed by gram-positive bacteria (26.7%) and fungi (16.6%). In 13 samples the cultures were negative. Nasal cultures were performed ipsilateral to the sinus drained in 28 cases. Concordance was obtained in only 5 (17.8%) samples. The antibiogram of the isolated agents from the maxillary sinuses in this series revealed that the most efficient antibiotics were those that covered gram-negative bacteria. Treatment was usually prolonged in these patients, and different antibiotics were necessary to clear infections from the sinuses. In conclusion, treating sinusitis in bone marrow transplant patients may be challenging. Considerations about the microbiology and antibiogram susceptibilities of this specific population should be kept in mind when dealing with such cases.

Anti-Bacterial Agents↗
PubMed1999

Improved recognition of MRSA case clusters by the application of molecular subtyping using pulsed-field gel electrophoresis.

Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly common in hospital and community populations, making the recognition of true nosocomial outbreaks more difficult. We have used pulsed-field gel electrophoresis (PFGE) with Sma I digestion to analyse retrospectively two perceived outbreaks of epidemic methicillin-resistant Staphylococcus aureus 15 (EMRSA 15) colonization. The first cluster of cases in patients and staff on a general ward (ward D) revealed three different antibiograms based on differences in ciprofloxacin and rifampicin sensitivities. All isolates typed using PFGE, which was more discriminatory than phage-typing. One PFGE banding profile labelled type 5 was predominant, but 12 isolates proved to be subtypes of type 5 and two were PFGE type 11. Four staff members carried a strain not found in patients, three carried strains found in patients and transient carriage was highlighted as a problem when screening staff. PFGE enhanced the epidemiological data and proved that the cases on this ward did not comprise one large outbreak but numerous sporadic cases and smaller clusters. In contrast, isolates from a second cluster of cases which occurred on ward F were indistinguishable using antibiograms, phage-typing and PFGE, confirming this was more likely to be a true outbreak of colonization. We conclude that PFGE usefully augments epidemiological information and allows more logical infection control decisions to be made, with better utilization of scarce resources.

Bacterial Typing Techniques↗
PubMed1986

Plasmid analysis of simultaneous nosocomial outbreaks of methicillin-resistant Staphylococcus aureus.

A large outbreak of infections caused by methicillin and aminoglycoside resistant Staphylococcus aureus provided the opportunity to evaluate mechanisms of resistance and compare the usefulness of typing systems. Between January 1979 and December 1980, 63 patients developed infections with S aureus resistant to multiple antibiotics, including methicillin and tobramycin. All isolates had an identical antibiogram and were phage type 47/54/75/77/83A. Beginning in January 1981, a superimposed outbreak caused by S aureus of the same phage type but with a resistance pattern now including gentamicin occurred. The two strains contained different aminoglycoside inactivating enzymes. The initial strain contained a single plasmid of 21.5 mDa molecular weight, whereas the subsequent strain which had acquired gentamicin resistance contained this plasmid plus a heavier one of 33 mDa. Plasmid analysis complements the analysis of antibiograms and phage types and aids in defining epidemiologic patterns of transmission.

Bacteriophage Typing↗
PubMed1992

A longitudinal study of Staphylococcus hyicus colonization of vagina of gilts and transmission to piglets.

High Staphylococcus hyicus colonization rates were found in vaginal samples of healthy breeding sows and in skin samples of their offspring. Twenty-two different phage types were identified among the 720 isolates of S. hyicus examined. Two to 13 different phage types were isolated per herd. Phage typing, as well as characterization of about 10% of the isolates by plasmid profiles and antibiogram patterns, showed that, several different clones of S. hyicus could be present simultaneously in vagina of gilts and also on skin of piglets. Generally isolates from the vagina of one animal were identical as regards to phage types, plasmid profiles, and antibiogram patterns during the entire investigation period. Isolates from the skin of piglets were of the same type as their mothers, indicating that vertical transmission had taken place. S. hyicus strains isolated from the skin of piglets within 24 h after birth were identical to strains isolated 3 weeks after birth from the same litter, indicating that the vaginal strains became part of a stable skin flora.

Animals↗
PubMed1988

A comparison of DNA and immunoblot fingerprinting of the SII biotype of coagulase negative staphylococci.

Thirty-eight isolates of the SII biotype of coagulase negative staphylococci were examined by phase typing, antibiograms, DNA and immunoblot fingerprinting. Multiple isolates were available from 5 patients with clinically proven infections and from 12 further patients who were epidemiologically distinct. Only 3 of the isolates were phage typable and antibiograms produced only 9 types. All isolates were typable by both DNA and immunoblot fingerprinting and reproducibility was excellent provided the conditions were standardized. Discrimination was better with immunoblot fingerprinting (17 types) than DNA fingerprinting (11 types). Both techniques were successful in assessing the significance of multiple isolates from a single patient.

Bacterial Typing Techniques↗
PubMed2001

Molecular epidemiologic analysis of Vibrio cholerae O1 isolated during the 1997-8 cholera epidemic in southern Thailand.

An unusually high incidence of Vibrio cholerae O1 infection was observed in southern Thailand between late December 1997 and March 1998. Fifty-seven V. cholerae O1 strains were isolated in five provinces during this epidemic and were examined. They were El Tor Ogawa strains exhibiting similar antibiograms. All strains were resistant to tetracycline, which had not been reported in Thailand since 1993. The ribotypes. hybridization patterns with ctx and zot gene probes, arbitrarily primed PCR profiles, and pulsed-field gel electrophoresis profiles of the representative strains were compared with the clinical strains isolated from patients in India and Bangladesh in 1997 and 1998 and from international travellers originating from various Asian countries during the 1992-8 period. All southern Thailand strains and the 1998 international traveller strain of Thai origin showed indistinguishable genetic fingerprinting patterns that were distinct from those of other test strains. The results suggest that a tetracycline-resistant clone newly emerged in late December 1997 caused the large epidemic in southern Thailand and that the variants with a slightly different antibiogram appeared during the course of the spreading epidemic.

Cholera↗