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PubMed1996

Preoperative treatment of children with chronic suppurative otitis media.

259 patients with chronic suppurative otitis media were bacteriologically assessed. 12 bacterial strains were isolated in 196 of the cases. The most common species present was Staphylococcus - 77 (39%) cases, followed by Proteus vulgaris isolated in 36 (18%) cases, and Pseudomonas aeruginosa in 33 (17%) cases. The flora in 25 cases (18%) yielded two bacterial strains with identical oxygen demands, and a mixture of Staphylococcus and Streptococcus in 32%. In 60.6% of cases the flora was sensitive to ototoxic antibiotics (gentamycin, kanamycin and neomycin), especially to gentamycin - 29.9%. The highest sensitivity of the flora to non-ototoxic antibiotics was to chlorocid (in 25.5% of the cases). Topical and systemic treatment were administered based on antibiogram and the inflammation and the otorrhea were controlled in 91.4% of the cases. No or little effect was found in the patients with cholesteatoma (8.6%). A conclusion was made that the monoflora was the commonest in the ear effusion (87%), comprising facultative anaerobes, present in 63.8%, anaerobes in 18.8%, and aerobes, mainly Pseudomonas aeruginosa, in 17.4%. The combined (topical and systemic) treatment based on antibiogram is effective in the preoperative management of the inflammation.

Adolescent↗

PubMed1996

Aerobic bacteria isolated from blood cultures of patients and their antibiotic susceptibilities in Harare, Zimbabwe.

OBJECTIVE: To assess the extent of involvement of different types of gram positive and gram negative bacteria and incidence of monomicrobial and polymicrobial cases in patients with bacteremia but without a record of the underlying clinical conditions of the patients. Antibiotic susceptibility patterns of isolates were also determined to guide clinicians in the management of such bacteremic cases especially where routine sensitivity testing is not performed. DESIGN: Case series. SETTING: The study comprised patients attending different clinics in Parirenyatwa Hospital, Harare. SUBJECTS: A total of 817 blood cultures from patients, comprising 469 and 348 males and females respectively. There were no records of the underlying clinical conditions of the patients. MAIN OUTCOME MEASURES: Prevalence rates of organisms and their antibiograms using standard techniques and Kirby-Bauer disc diffusion method. RESULTS: Results obtained revealed that only 303(37.1%) of the 817 total samples screened were positive for either monomicrobial or polymicrobial bacteremia. Two hundred and eighteen (71.9%) and 85 of positive cultures were Gram positive and Gram negative bacteria respectively. Coagulase negative staphylococci (CNS) strains were the predominant organisms isolated (42.9%). Other organisms isolated were Staphylococcus aureus (11.6%), Escherichia coli (6.9%), Salmonella spp. (8.3%), Klebsiella spp. (5.3%), whereas Pseudomonas aeruginosa, Haemophilus influenzae, Enterobacter and Micrococcus species each accounted for less than 4%. Antibiogram patterns showed multiple resistance of S. aureus and CNS to Penicillin, Erythromycin and Methicillin. All isolates of S. pyogenes (10), S. pneumoniae (18) and Micrococcus spp (10). were susceptible to penicillin. Ciprofloxacin, Clindamycin, Fusidic acid and Gentamycin were highly active against gram positive organisms except that Gentamycin was inactive against S. pneumoniae. Ceforoxime, Erythromycin and Ceftriazone also showed good activities against Gram positive organisms. All (10) isolates of P. aeruginosa were susceptible to Polymyxin B, Carbenicillin and Ciprofloxacin. Ciprofloxacin, Norfloxacin and Gentamycin were highly active against all Gram negative bacteria. CONCLUSION: For infections due to both Gram positive and Gram negative bacteria, Ciprofloxacin and Gentamycin would be appropriate for therapy whereas Fusidic acid and Clindamycin may, in addition, be recommended for Gram positive organisms. It is also concluded that a prevalence rate of 37.1% of bacteremic cases existed in the sampled population and that monomicrobial cases were more predominant.

Bacteremia↗

PubMed1996

[Evaluation of external laboratory test results for the correct identification and determination of chemotherapeutic sensitivity of staphylococci in bacteriologic provincial laboratories of sanitary-epidemiologic stations in 1995].

In the tests bacteriological laboratories participated in 45 sanitary-epidemiological stations. Each station was given two strains of staphylococci: S. epidermidis and S. aureus homogeneously resistant to methicillin (MRSA) or S. aureus sensitive to methicillin (MSSA), and S. aureus coagulase-negative and clumping-factor-positive strain. The analysis was carried out of the results of control identifications of strains of the determinations of the sensitivity of the identified strains to antibiotics. Among the studied strains the greatest difficulty in identification were caused by the coagulase-negative strain of S. aureus. In the determination of the sensitivity of the control strains to chemotherapeutic agents abnormalities were found in the technique of antibiogram performing and incorrect selection of discs for antibiograms as well as erroneous interpretation of the results.

Methicillin↗

PubMed1976

[Studies of enterotoxin production by strains of Staphylococcus aureus of different origins (author's transl)].

376 Staphylococcus aureus strains of clinical and epidemiological origin were tested for their ability to produce the enterotoxins, A, B and C1. For these investigations, microagargel precipitation against specific antisera has been used. Additionally these strains were studied by phagetyping, biochemical typing and for their antibiogram. The strains tested came from human pathological processes, mouth throat swabs of healthy people, persons working in hospitals, outbreaks of food poisoning from cows suffering from mastritis and some from milk samples. Most of the strains isolated from food poisonings were associated with enterotoxin-A-production. Among the group of strains from autopsy material, the enterotoxin-B-producing strains were predominant. The strains from human pathological processes which were found to be enterotoxin producing, were mostly belonging to phage group III. With regard to the antibiogram, the enterotoxin-producing strains were somewhat more resistent than the enterotoxin-negative strains. Correlations between the production of enterotoxin B and methicillin resistance did not become evident in our material. The strains were differentiated, too, as to their classification as var. hominis or var. bovis. With one exception, all enterotoxin-producing strains which could be classified in this way, were belonging to var. hominis. From five enterotoxin-producing strains isolated from cattle, only one strain belonged to var. bovis, the other to var. hominis. Obviously the ability to produce the enterotoxins, A, B and C1 is very rare in the group of var. bovis strains.

Animals↗

PubMed1997

Epidemiological survey of Neisseria meningitidis susceptibility to penicillin G in France.

The susceptibility of 82 strains of Neisseria meningitidis to penicillin G and amoxicillin was evaluated with two media "gonococci-meningococci" medium (G medium) derived from Mueller Hinton and chocolate agar. Among these 82 strains 52 were isolated from CSF and/or blood and 30 from miscellaneous isolates. G medium was compared with chocolate agar using the correlation between diameters and MIC and the E-test. Routinely standardised antibiogram is still used but the authors added the following techniques 1) MIC of penicillin G is tested (0.06; 0.125; 0.250; 0.50 mg/l); 2) use of oxacillin disc charged with 5 micrograms. Penicillinase producing meningococci were not found. Standardised antibiogram on 4192 strains resulted in a modal distribution of diameters between 18 to 40 mm. Moderate meningococci susceptible strains to penicillin G are increasing in France: 1994: 4%; 1995: 11%; 1996: 18%.

Amoxicillin↗

PubMed1995

[Coagulase type and antimicrobial susceptibility of Staphylococcus aureus isolated from various areas in Taiwan].

A total of 129 strains of Staphylococcus aureus, isolated from clinical specimens in Taiwan between February 1992 and December 1993, were subjected to coagulase typing and susceptibility testing to 21 kinds of antimicrobial agents using Pasco MIC Gram-positive panels. In the determination of minimum inhibition concentration (MIC), there were 94 strains (72.9%) resistant to penicillin and ampicillin, 54 strains (41.9%) resistant to tetracycline and erythromycin, and 21 strains (16.3%) resistant to oxacillin (oxacillin-resistant S. aureus; ORSA), but none of them was resistant to vancomycin or nitrofurantoin. As the susceptibility of the isolates from four different geographic districts was compared, no statistical difference was found except that the resistance rate to penicillin and ampicillin was higher in southern Taiwan, and resistance rate to rifampin and gentamicin was higher in central Taiwan. The ORSA strains were all resistant to penicillin, ampicillin, tetracycline; 95.2% of the strains were resistant to gentamicin, tobramycin and erythromycin. The resistance rates to drugs tested for ORSA strains were statistically higher than those for OSSA strains except vancomycin, nitrofurantoin, trimethoprim/sulfamethoxazole and ampicillin/sulbactam. In the coagulase typing of 127 strains, Type IV, III and VII were most frequently encountered. Among the coagulase types, Type IV was mostly encountered in the North, the South and the East of Taiwan; Type III was mostly encountered in central Taiwan. Among the ORSA strains, coagulase Type III was most predominant (85%). In conclusion, analysis of an antibiogram is easy to perform and the results can provide clinicians not only with correct guides for patient treatment but also with a useful tool for epidemiological studies. However, if antibiogram and coagulase typing are carried out simultaneously, results will be more reliable in epidemiological studies, including nosocomial infection survey.

Coagulase↗

PubMed2003

Comité de l'Antibiogramme de la Société Française de Microbiologie report 2003.

Following the recommendations of the WHO Expert Committee for Biological Standardization (Technical reports No. 610, 1977), the French Society for Microbiology created an Antibiogram Committee (CA-SFM), with the aim of proposing the standards which define the clinical categories of antibiotic susceptibility (formerly therapeutic categories). The MIC and zone diameter interpretive standards, as well as the specific recommendations for certain species or certain antibiotic groups, are published in a yearly report.

Anti-Bacterial Agents↗

PubMed1996

Stenotrophomonas maltophilia ocular infections.

OBJECTIVES: To determine if the number of ocular infections associated with Stenotrophomonas maltophilia is increasing, to identify predisposing factors, and to evaluate antimicrobial susceptibility. METHODS: Retrospective review of ocular microbiology laboratory records from January 1, 1972, through December 31, 1995. RESULTS: Stenotrophomonas maltophilia was recovered from 15 cases of ocular infection, at a rate of one in every 1339 ocular specimens in the 1970s, one in 413 in the 1980s, and one in 363 in the 1990s through 1995. The organism was the predominant isolate in five cases and was part of a polybacterial infection in the remaining 10 cases. Eight of the 15 cases had bacterial keratitis, including one with infectious crystalline keratopathy. Of the remaining seven infections, S maltophilia was recovered from two cases of acute conjunctivitis, two infected scleral buckles (one with orbital cellulitis), two cases of infantile dacryocystitis, and one case of preseptal cellulitis. Ocular isolates of S maltophilia were resistant to the aminoglycosides and most beta-lactams, and showed variable susceptibility to the fluoroquinolones. CONCLUSIONS: Stenotrophomonas maltophilia is emerging as an important opportunistic ocular pathogen. Most infections by this organism occur in patients with ocular compromise, and the characteristically resistant antibiogram of S maltophilia limits the therapeutic options.

Adult↗

PubMed1977

Meningitis due to two serotypes of Escherichia coli. An infant who recovered.

A newborn infant with hyaline membrane disease and aspiration pneumonia developed purulent meningitis on day 19, three days after discontinuation of ampicillin sodium and gentamicin sulfate therapy. Therapy with gentamicin, both systemically and intrathecally, for two weeks was ineffective. During this time each of four specimens of cerebrospinal fluid contained two serotypes of Escherichia coli, namely, O83:H4 and O75:H5. The antibiograms of the two strains were identical, both being susceptible to gentamicin and ampicillin. Treatment with ampicillin resulted in prompt disappearance of the infecting microorganisms and recovery from the infection. One of the strains (O75:H5) produced an antigen cross-reacting with the capsular antigen of Haemophilus influenzae type B; the other did not. The patient developed O antibodies in substantial titers against E coli O83 but not against E coli O75.

Ampicillin↗

PubMed1981

Transmission of group B streptococci. Traced by use of multiple epidemiologic markers.

During a three-week period, septicemia caused by group B Streptococcus, serotype III, developed in four infants born at a community hospital. The first infant had early-onset disease; late-onset disease that appeared, from epidemiologic data, to be nosocomial developed in the other three infants. Bacteriophage typing and antimicrobial susceptibility testing confirmed the relatedness of the isolates. A prospective study designed to differentiate between vertical and nosocomial transmission of group B Streptococcus showed that of 82 infants, 21 (26%) were culture-positive during their hospitalization, and nine of these infants (43%) had been culture-negative at birth. Although serotype III strains were recovered from four of nine infants with apparently nosocomial acquisition, none of the isolates displayed an antibiogram or bacteriophage type similar to that of the isolates involved in the recent cluster. Bacteriophage typing and antimicrobial susceptibility testing in addition to the use of serotyping may be helpful in epidemiologic studies of group B Streptococcus.

Bacteriological Techniques↗

PubMed1989

Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit.

Between October 1985 and August 1986, 49 isolates of methicillin-resistant Staphylococcus aureus (MRSA) were obtained from 26 neonates in the neonatal intensive care unit (NICU) at the Medical University Hospital, Charleston, SC. Sites of MRSA isolation were the respiratory tract (33%); nasopharynx (12%); gastrointestinal tract (12%); eye (8%); blood (6%); and catheter tips, wounds, or umbilicus (29%). Very low birth weight was a significant risk factor for MRSA acquisition. All isolates had the same phage type (47/54/75/83A), antibiogram, and whole-cell protein profile. Agarose gel electrophoresis of all 49 isolates disclosed a plasmid level of approximately 45 X 106 daltons (45 megadaltons) in ten different isolates and no plasmid DNA in 39 isolates. Cultures of NICU personnel failed to disclose MRSA carriers and environmental cultures for MRSA were negative. Ten selected isolates showed lower minimal bactericidal concentrations for hexachlorophene than for chlorhexidine. Standard infection-control measures such as contact isolation, hand washing with chlorhexidine, and cohorting (when possible) failed to contain the epidemic. Ultimately, eradication of MRSA from the NICU was associated with the institution of hexachlorophene hand washing.

Cross Infection↗

PubMed1989

Emergence of isolates resistant to ampicillin.

Clinical isolates of Streptococcus faecium demonstrating ampicillin resistance were recovered from eight pediatric patients. Sites of isolation included blood, surgical wound, bile drainage, urine, burns, and peritoneal fluid. Seven patients had prolonged hospitalization, and all had been treated with broad-spectrum antibiotics prior to isolation of the resistant enterococcus. One isolate was from an ill, bacteremic patient; the others were in mixed culture and were not considered causes of disease. The isolates were not epidemiologically related. Minimal inhibitory concentrations for various antibiotics included ampicillin (16 to 32 mg/L), penicillin (128 mg/L), gentamicin (16 mg/L), and vancomycin (2 mg/L). Three isolates demonstrated high-level resistance (greater than 2000 mg/L) to streptomycin; none did so to gentamicin. In vitro synergy testing performed on seven available isolates for ampicillin and gentamicin demonstrated no synergy to this combination. None produced beta-lactamase. Combined antibiogram and plasmid data showed at least five distinct patterns. These strains present a new clinical problem in their high level of resistance to ampicillin and to the combination of ampicillin and gentamicin.

Ampicillin Resistance↗

PubMed1996

Prognosis and treatment of peritonitis. Do we need new scoring systems?

OBJECTIVE: To assess the clinical significance of present scoring systems for prognosis and treatment in patients with secondary bacterial peritonitis and to define risk factors for patient survival and outcome not included in the scores. A secondary objective was to review our therapeutic regimens and the need for reoperation with regard to outcome. DESIGN: Prospective observational study. SETTING: University hospital, secondary referral center. PATIENTS: From 1992 to 1995, 92 patients with secondary peritonitis were examined at the University Surgical Clinic, Vienna, Austria. the populations as a whole consisted of 56 men and 36 women with an average age of 56 +/- 19 years. Forty-four percent of patients had postoperative peritonitis. OUTCOME MEASURES: Mortality, multiple organ system failure (MOSF), relaparotomy. RESULTS: The mortality rate in patients with an APACHE II (Adult Physiology and Chronic Health Evaluation) score of less than 15 was 4.8%, while mortality rose to 46.7% in those with a score of 15 or higher (P = .001). The average total mortality rate was 18.5%. The prognosis for patients without organ failure or with failure of one organ system was excellent (mortality rate, 0%); quadruple organ failure, however, had a mortality rate of 90%. Initial thrombocytopenia ( < 60 x 10(9)/L), four-quadrant peritonitis, and diabetes mellitus were associated with significantly higher mortality. Leukopenia (white blood cells, < 6 x 10(9)/L) and inappropriate antibiotic therapy as determined by the antibiogram were mildly significant for higher mortality. The need for relaparotomy resulted in substantially higher mortality (P < .001). The impossibility of definitive operative resolution of the intra-abdominal pathologic findings at initial operation had no significant effect on mortality, possibly because planned reoperations were always carried out in those cases. For patients with definitive resolution at initial operation, it was possible to reduce the traditionally high mortality rate associated with relaparotomy on demand by making the decision for reexploration promptly, within the first 48 hours. Nevertheless, the 52.4% mortality rate observed in those cases was still much higher than the 33% found in patients who were not free of disease after the initial operation. CONCLUSION: The prognosis in peritonitis is decisively influenced by the health status of the patient at the beginning of treatment and by any concomitant risk factors. As a result, a fairly accurate prediction of the outcome of the disease can initially be made on the basis of the APACHE II score and the MOSF score according to Goris. However, the certainty that severely ill patients with high scores often die has little clinical relevance, since it does not provide any therapeutic alternatives to the attending physician. The decision to perform a relaparotomy must be made as soon as possible, at least before MOSF emerges. Already existing MOSF will lead to the "point of no return."

APACHE↗

PubMed1998

Bacterial decontamination of blood stem cell apheresis products.

High-dose chemotherapy using autologous bone marrow or mobilized blood as the source of stem cells for haematologic rescue, is being widely used for a variety of haematological malignancies and solid tumours. To collect sufficient numbers of haematopoietic stem cells for successful engraftment, standard apheresis procedures are performed. Newer techniques and refinements of the procedure allow using only 1 to 2 apheresis products (AP) for autografting. Bacterial contamination of the AP, although very rare, sometimes occurs and may lead to generalized infection in the recipient. The apheresis must be repeated, sometimes even including time-consuming and costly mobilization. At our institution, the patients' blood stem cells are usually mobilized with chemotherapy followed by daily s.c. haematopoietic growth factor injections or with growth factor alone. An apheresis machine is used for collection through a central venous line and the AP is routinely checked for bacterial contamination. Results are only available after the product has been processed and cryopreserved. In the last 5 years, we observed bacterial contamination in four of our AP. Therefore, we investigated the possibility of in vitro antibiotic decontamination. Using standard antibiograms, we determined the sensitivities of the contaminating bacteria. By incubating the products with the specific antibiotics at bactericidal concentrations, we were able to sterilize the probes from the contaminating bacteria. In the concurrently performed controls without the active substance, bacteria were still detectable. We conclude that in selected cases, in vitro decontamination using pretested antibiotics, may be a feasible, cost-effective, and easy alternative to performing additional apheresis procedures.

Anti-Bacterial Agents↗

PubMed1989

Treatment of alpha chain disease. Results of a prospective study in 21 Tunisian patients by the Tunisian-French intestinal Lymphoma Study Group.

Between 1981 and 1985, the authors studied 21 Tunisian patients with alpha chain disease. Twenty of 21 underwent laparotomy. According to Galian et al. six patients were classified Stage A, two Stage B, and 13 Stage C. The therapeutic regimen included the following: (1) Antibiotics: In the case of intestinal bacterial overgrowth (IBO), antibiotics selected by their antibiograms were delivered; in absence of IBO, metronidazole plus ampicillin were first given. The antibiotic treatment was changed in case of therapeutic failure. (2) Chemotherapy: From 1981 to 1983 a cyclophosphamide, Adriamycin (doxorubicin), teniposide (VM-26), prednisone (CHVP) protocol (Adriamycin 35 mg/m2, teniposide 50 mg/m2 day 2, cyclophosphamide 300 mg/m2 days 2 through 4, prednisone 40 mg/m2 days 1 through 10) was used. After 1983 bleomycin 15 mg, Adriamycin 30 mg, vinblastine 10 mg were given on day 15. Serum immunoelectrophoresis and immunohistochemical study of duodenojejunal specimens were made on a 3-month and 6-month basis, respectively. Survival curve analysis was made according to Kaplan and Meier. Results were as follows: (1) Stage A: Six patients were first treated by antibiotics alone; two complete responses (CR) persisting 42 and 55 months later were observed, respectively. The four antibiotic failures were submitted to further chemotherapy with four subsequent failures and two deaths. (2) Stage B-C: Chemotherapy led to nine CR with one precocious relapse, a salvage chemotherapy allowing to one more CR. (3) All stages mixed, percentage of survival reached 90 +/- 12% at 2 years and 67 +/- 25% at 3 years, all patients alive beyond 3.5 years being disease-free.

Actuarial Analysis↗

PubMed1994

Established antimicrobial susceptibility testing methods with a new twist--points to consider and a glimpse of the future.

The developments seen in these systems allow speculation about future trends in antimicrobial susceptibility testing methods. Microbiology system manufacturers seem to be heeding the call of all industry, for greater automation, enhanced data management capabilities and increased flexibility (see Table 2 below). [table: see text] Cost seems to be less of an issue. This may be due to the decrease in the availability of medical technologists and the need to find systems with better throughput and increased productivity. Increased automation, data management capabilities, and walkaway technology may justify the additional cost of some of these systems. The computer software package provided with these systems is becoming increasingly important with the focus on quality assurance and utilization. Computer generated data analysis gives the microbiologist the tools to educate physicians through the use of selective reporting functions, antibiograms, cost analysis and drug effectiveness comparisons. Each of the four systems is unique and will probably find a niche among the various markets that exist in the United States, European and other specialized markets. The lack of automation in the ALAMAR system may be its selling point in those areas where automation is not affordable, but new ways are being sought for ease of interpretation of results. BIOMIC and CATHRA systems may be more beneficial to those microbiologists who do not want to stop doing traditional Bauer-Kirby or agar dilution methods, but require computer enhancements. ALADIN, may fill a niche to which other walkaway systems have not adapted, but because of its expense, will face more demands than the other three systems covered in this review.

Clinical Laboratory Information Systems↗

PubMed1987

Cluster analysis of antibiotic susceptibility patterns of clinical isolates as a tool in nosocomial infection surveillance.

Hospital infections represent a major epidemiological problem. The first step in the detection of nosocomial infections consists in assessing the probability that two or more isolates from different patients are similar or different. Many methods are available for typing purposes. Among these, antibiotic susceptibility patterns do not need extra cost or extra work and are available "on line" every moment they are needed. A mathematical technique of elaboration is proposed for disk zone sizes, in order to assess the probability of two or more clinical isolates to be the same strain. Antibiograms performed according to Kirby-Bauer are evaluated detecting zone sizes by a computer controlled device and then submitted to cluster analysis. Similarity of strains is reported in a dendrogram, in which strains are successively fused. Strains that share a common susceptibility pattern are considered a "cluster". At last, epidemiological maps are constructed for each group of strains, in which all the isolates are reported, ordered for patients, plotted on the day the specimen was collected, drawn in a different shape according to the source of specimen, and shadowed by the pattern of its cluster. This method of reporting data directly allows to detect cross infections among patients and can be used as a first typing step before other more expensive procedures.

Anti-Bacterial Agents↗

PubMed1984

Gentamicin resistance among salmonellae. A ten-year study, 1973-1982.

A total of 8579 Salmonella strains received during 1973-1982 were tested for their antibiogram patterns against nine routinely used antibiotics including gentamicin. Of these, 380 strains (4.4%) showed resistance to gentamicin at levels of 10 micrograms/ml and above. A high degree of resistance to gentamicin was recorded in 1979 (18.7%) and 1980 (9.4%). M.I.C. levels of strains received during 1982 were determined and it was found that some strains had levels as high as 160 micrograms/ml. The comparative results of gentamicin resistance from 1973 to 1982 are presented and the public health significance of the alarming increase in two years (1979-1980) is discussed.

Animals↗