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PubMed2005

Methicillin-resistant Staphylococcus aureus (MRSA) isolated from animals and veterinary personnel in Ireland.

Reports of methicillin-resistant Staphylococcus aureus (MRSA) in animals have become more frequent in recent years. This paper documents the recovery of MRSA from animals with respiratory, urinary tract or wound infection and from animals subjected to surgical procedures following treatment in one veterinary hospital and 16 private veterinary clinics in different geographical locations throughout Ireland. MRSA was recovered from 25 animals comprising 14 dogs, eight horses, one cat, one rabbit and a seal, and also from 10 attendant veterinary personnel. Clinical susceptibility testing suggested that the 35 isolates fell into two different groups. One group of isolates (Group 1) was resistant to one or more of the following classes of antimicrobials: macrolides, lincosamines, tetracyclines and/or fluoroquinolones. The second group (Group 2) was resistant to macrolides, aminoglycosides, tetracyclines and trimethoprim/sulphamethoxazole and variably resistant to fluoroquinolones, lincosamines and rifampicin. One isolate in Group 2 was susceptible to trimethoprim. Epidemiological typing by antibiogram-resistogram (AR) typing, biotyping and by chromosomal DNA restriction fragment length polymorphism analysis using SmaI digestion followed by pulsed field gel electrophoresis (PFGE), confirmed these two major clusters. PFGE analysis showed that most isolates from non-equine animals were indistinguishable from each other and from the isolates from personnel caring for these animals. MRSA was isolated from eight horses which attended six different veterinary practices before referral to an equine veterinary hospital. Isolates from the eight horses and from their attendant personnel had PFGE patterns that were indistinguishable and were unlike the patterns obtained from the other isolates. Comparison of PFGE patterns of isolates from veterinary sources with patterns from MRSA recovered in human hospitals showed that the most frequently occurring pattern of MRSA from non-equine animals was indistinguishable from the predominant pattern obtained from the most prevalent MRSA strain in the human population in Ireland. However, the patterns of the isolates from horses were unlike any patterns previously reported in Irish studies of human isolates. This study shows that transmission of two strains of MRSA is occurring in veterinary practices in Ireland and that one strain may have arisen from human hospitals. The source of the second strain remains to be determined.

Animal Technicians↗
PubMed2006

Recurrent recovery of Pseudomonas oryzihabitans strains in a karstified chalk aquifer.

Pseudomonas oryzihabitans is an uncommon pathogen that may cause catheter-associated infections, particularly in immunocompromised patients. Although it has been isolated from environment, the source of human infection is not well documented. In the present study, 14 isolates of P. oryzihabitans were recovered over a 28-month period from a karstified chalk aquifer, allowing to advance that distributed natural water could be a source of contamination. Microbiological analyses showed that the bacterium was mainly associated with suspended particulate matters. To investigate the clonality of P. oryzihabitans environmental isolates, 16S rRNA gene sequencing, antibiogram and randomly amplified polymorphic DNA (RAPD) typings were performed. Results demonstrated (i) the presence of at least three clones within the aquifer and (ii) that the presence of the bacterium in groundwater is not only the result of a biofilm bloom but also of an exogenous contamination.

Aluminum Silicates↗
PubMed1984

Cefmenoxime in surgical infections: treatment and penetration into peritoneal fluid and wound secretions.

Sixty patients (23 men and 37 women) with a median age of 56.7 years (range 20 to 80) and a median weight of 69 kg were treated with cefmenoxime as short-term perioperative prophylaxis. Patients were undergoing surgery for an infected gallbladder, bile duct, or colon or were being treated for local or diffuse peritonitis and soft tissue infections. Overall clinical efficacy including very good and good results could be achieved in 88.3 percent. Moderate clinical efficacy was achieved in six cases, two of which were due to Pseudomonas aeruginosa. In 38 of 60 patients an antibiogram could be performed before and after therapy. Of the isolated 46 strains, 40 pathogens (86.95 percent) were eradicated during cefmenoxime treatment and in two cases a replacement was observed. After one hour, peak concentrations in serum could be reached with over 70 micrograms/ml.

Adult↗
PubMed1984

Cultures of thoracotomy specimens confirm usefulness of sputum cultures in cystic fibrosis.

Bacteriologic cultures of sputum and specimens obtained at thoracotomy from 17 patients with cystic fibrosis were compared. All organisms found in the surgical specimens were found in the sputum. Only two surgical specimens failed to yield any organisms. The most frequently isolated organisms were Pseudomonas aeruginosa (41%) and Pseudomonas cepacia (35%). Serotypes of P. aeruginosa and antibiogram results on both P. aeruginosa and P. cepacia further supported the concordance of the isolates from the two sources. In addition, anaerobic cultures were obtained in specimens from 10 patients with CF and revealed two patients with anaerobic colonization of the lower respiratory tract. These findings also correlated well with the sputum cultures. The correlation of sputum and lung specimen culture results supports the value of sputum culture in the management of lung disease in CF.

Adolescent↗
PubMed2003

[Treatment of acute infection of total or partial hip arthroplasty with debridement and oral chemotherapy].

BACKGROUND AND OBJECTIVE: The suitable antibiotic(s) and duration of treatment for hip prosthesis acute infections (HPAIs) has not been clearly defined. PATIENTS AND METHOD: We studied 32 patients whose HPAI was diagnosed within 2 months after surgery. All patients underwent debridement and samples were taken for culture purposes. Antibiotics were started and adjusted to the antibiogram. Ambulatory follow-up controls were carried out for more than 18 months after treatment had finished. RESULTS: There were 16 cases of staphylococcal infection while it was streptococcal in 2 cases, enterococcal in 6 and due to gram-negative bacillus in 6 patients. In 2 patients, the causal microorganism could not be identified. Patients with an infection due to gram-positive cocci (other than enterococci) were administered an association of antibiotics including rifampicin for a mean 2.7 months period. Outcome was favorable in 100% valuable cases, after a mean follow-up of 20.7 months. Patients with enterococcal infections were treated with a glycopeptide or beta-lactams for a mean of 2.6 months; all them had a unfavorable outcome. Out of 6 infections due to gram-negative bacilli, 2 valuable cases had a favorable evolution. CONCLUSIONS: HPAIs due to Staphylococcus sp. or Streptococcus sp. can be successfully treated by means of surgical debridement plus an antibiotic scheme that includes rifampicin for a maximum period of 3 months. It is necessary to analyze the effectiveness of new antibiotics or antibiotic associations in cases of enterococcal infections.

Administration, Oral↗
PubMed2003

Pulmonary nocardiosis in heart transplant recipients: treatment and outcome.

BACKGROUND: Nocardial infections typically affect patients receiving immunosuppressants, occurring early after surgery in 3% to 40% of heart transplant (HTx) recipients. The emergence of antibiotic resistance and occurrence of disease recurrences in AIDS population has engendered controversy about the treatment for immunodepressed HTx patients. METHODS: We present a retrospective study of the diagnosis, treatment and outcome of 560 HTx recipients between 1984 and 2002. RESULTS: Among the five cases of Nocardia infection (0.9%), three cases developed late after HTx (between 3.1 and 11 years follow-up). All patients had pulmonary disease and one in addition had subcutaneous nodules. Microbiological diagnosis required open lung biopsy in one case. All patients were treated primarily with trimethoprim-sulphamethoxazole, but evidence of resistance to sulfonamides led us to change the antimicrobial combination in two cases. Four patients who received one year of antibiogram-guided therapy showed complete healing without recidivism. Three patients died, all due to non-related causes, at follow-ups between 1 and 5 years. In one case a cutaneous recurrence of disease was attributed to noncompliance. CONCLUSIONS: Nocardiosis in current HTx is less common than previously reported. Its incidence seems to be delayed in time with modern immunosuppressants. Given the high incidence of sulfamide resistance, treatment must be guided by antibiotic sensitivity. We believe that maintenance therapy for a whole year is the appropriate option in order to avoid recidivism in this population.

Anti-Bacterial Agents↗
PubMed1976

Detection of Serratia outbreaks in hospital.

Infections due to Serratia marcescens were studied in 23 different hospitals. A retrospective study was done in 4 hospitals; all isolates were compared by serological typing, antibiograms, bacteriocin production, and bacteriocin sensitivity. 2 of the hospitals were having cross-infection problems due to antibiotic-resistant strains, but the other 2 had little or no cross-infection. Outbreaks were studied in 19 other hospitals. 9 of these outbreaks were classified as "common source" since contaminated "sterile solutions" were incriminated as the cause in each. One hospital had a "pseudo-outbreak," in which Serratia from E.D.T.A. blood-collecting tubes contaminated blood-cultures as they were collected. All 10 of these strains from common-source outbreaks were generally sensitive to antibiotics. Outbreaks in 9 other hospitals resulted from cross-infection and were caused by strains which were very resistant to antibiotics. Guidelines for detecting outbreaks are given and control measures are suggested.

Alabama↗
PubMed2002

Effects on antibiotic resistance of Staphylococcus epidermidis following adhesion to polymethylmethacrylate and to silicone surfaces.

A number of studies appears to give emphasis to the role of prosthetic materials in determining microbial adherence and resistance to host defence and drug therapy. Aim of this study was to explore whether the direct contact with biomaterial substrata of different chemical nature could influence bacterial behaviour, determining possible changes in the bacteria population as far as antibiotic resistance is concerned. To this end, susceptibility to penicillin, erythromycin, clindamycin, cefamandole, imipenem, vancomycin, ciprofloxacin. ampicillin, cefazolin, trimethoprim-sulfamethoxazole, chloramphenicol, amikacin and netilmicin was evaluated in a methicillin-, gentamicin- and tobramycin-resistant Staphylococcus epidermidis strain, after in vitro adhesion to polymethylmethacrylate (PM MA) and to silicone elastomer. The susceptibility to antibiotics of both adherent bacteria and bacteria which, although exposed to the materials, had not undergone adhesion was measured as bacterial growth inhibition area onto a plate antibiogram. according to Kirby-Bauer and using an image analyser system. The results obtained suggest that the two test materials considered in this study were capable to condition bacterial behaviour. In particular. the adhesion onto PMMA surfaces induced a marked and significant decrease in susceptibility to the following beta-lactam antibiotics: cefamandole (32%), cefazolin (23%), imipenem (27%), ampicillin (31%). Moreover, PMMA caused a lower but significant reduction in resistance to vancomycin (15%), chloramphenicol (16%), amikacin (13%). netilmicin (13%), erythromycin (11%) trimethoprim-sulfamethoxazole (13%). In contrast, the adhesion onto silicone elastomer appeared to influence bacterial changes to a lesser extent and elicited a significant decrease in susceptibility only to cefazolin (10%) and amikacin (11). Further studies are required to thoroughly investigate the mechanisms of these variations, even though, also according to other authors, one of the best conceivable conclusions is that some material substrata can lead to selection of variant adhesive bacteria with increased antibiotic resistance.

Biocompatible Materials↗
PubMed2003

Comparison of phenotypic and genotypic characteristics of Salmonella bredeney associated with a poultry-related outbreak of gastroenteritis in Northern Ireland.

OBJECTIVES: To employ a combination of phenotypic and genotypic subspecies typing methods to aid in an epidemiological investigation of an outbreak of Salmonella bredeney involving ten persons. METHODS: Isolates were characterised by employing antibiogram typing, in addition to two genotyping techniques, including pulsed field gel electrophoresis (PFGE), random amplification of polymorphic DNA (RAPD) with two oligonucleotide primers. RESULTS: An outbreak of gastroenteritis associated with S. bredeney (serovar O:4 H:Lv 1,7) occurred in Belfast, Northern Ireland in November 1997. In total, ten cases were confirmed, of which eight had consumed chicken cooked at local butchers and retailed through one of two local bakeries. One of the remaining cases was secondarily infected within her home and the final case had eaten a product other than cooked chicken from one of the bakeries. Food preparation practices were inadequate in one of the bakeries in question and record keeping and possibly cooking procedures were inadequate in the butchers. S. bredeney was isolated from an uncooked chicken supplied to the butchers confirming that improperly cooked chicken was most likely the source of the outbreak. All outbreak clinical isolates were indistinguishable from each other and were similar to the isolate obtained from the uncooked poultry demonstrating that these DNA-based methods were valuable in the molecular characterization of S. bredeney. CONCLUSIONS: This report emphasises the importance and maintenance of an effective hazard analysis critical control point (HACCP) approach to the processing and retailing of foodstuffs containing chicken in order to help eliminate hazards to public health.

Adult↗
PubMed1987

Secondary cases of invasive disease caused by spread of Haemophilus influenzae type b.

Three 6-year-old girls were admitted to hospital within a period of 9 days because of invasive disease caused by Haemophilus influenzae type b (Hib). Two days after the index case contracted bacterial meningitis, her twin sister developed septicemia. Nine days after onset of illness in the index case, a day-care contact developed a febrile illness. The antibiograms of the bacterial strains isolated from cerebrospinal fluid or blood in the first two cases were identical; in the third case, blood cultures were negative but Hib antigen could be detected in serum and in urine. These cases illustrate the contagiousness of Hib disease. All household contacts of a case should be informed about the risk and their protection with rifampicin considered.

Child↗
PubMed1998

The use of pulsed-field gel electrophoresis for subdivision of Salmonella typhimurium in an outbreak situation.

An institutional outbreak of gastroenteritis provided an opportunity to investigate further the isolates of Salmonella typhimurium by pulsed-field gel electrophoresis (PFGE). Three phage types were identified. Antibiograms identified two types and two distinct patterns were found on PFGE. If phage typing alone is used for epidemiological study of strains, it is possible that an association between strains may be missed.

Adolescent↗
PubMed2005

[Senegalese experience of orbital cellulitis].

AIM: To show the etiological, clinical, and epidemiological aspects of orbital cellulitis at the ophthalmological clinic of A. le Dantec hospital. PATIENTS AND METHOD: This is a retrospective study conducted from January 1994 to October 2003. Sixty-eight patient records were used. We noted patients' civil status, past medical history, clinical and paraclinical examinations, treatment received before and at admission to the clinic, and progression. RESULTS: The incidence of orbital cellulitis was 8.9 cases per year. The average age of patients was 18 years and the sex ratio 2.78 in favor of males. Patients were hospitalized for a mean of 11 days. The fever was often stopped at admission. All patients had violent retrobulbar pain, associated with inflammatory exophthalmos in 77.8% of cases, and ophthalmoplegia in 67.2%. Two cases of diplopia were noted; 57.5% had sinusitis. Streptococcus was the bacterium found most frequently. In hospital, all patients received three antibiotics (ampicillin, aminoglycoside, metronidazole) and prednisone. In 51.5% of the cases, surgical treatment was necessary. Progression was favorable in 55.88% of the cases. Three patients died and 18 cases of blindness were noted. CONCLUSION: Orbital cellulitis is a young people's disorder with serious complications. This medical emergency requires a combination of effective antibiotics and a corticosteroid. Treating the source of infections is essential to avoid recurrence. In our practice, these three drugs in association in first intention was beneficial without an antibiogram.

Adolescent↗
PubMed2003

Clustering of enterococcal infections in a general intensive care unit.

This is a retrospective study comparing patients' characteristics, antibiotic consumption and environmental contamination before the impact of a new regimen of intensified infection control measures in a general intensive care unit (ICU) at a university-affiliated tertiary-care teaching hospital. The new regimen consisted of (1) reorganization of patient rooms (2) improved hygienic measures including strict hygiene barrier nursing (3) more isolated patient care and (4) more restrictive use of antibiotics. The regimen was introduced after a cluster of enterococcal infections. All patients admitted to the ICU from 1 March 1995 to 28 february 1997 were included. A study period of 12 months after reorganization of the ward was compared with the 12 months immediately before it. The antibiotic consumption, the individual patient's severity of disease (APACHE score), and the extent of therapeutic interventions (TISS score) were recorded. Enterococci were typed biochemically, antibiograms were established and the relation between the isolates was investigated with pulsed-field gel electrophoresis. The bacteriological results and the patient data suggested a hospital-acquired spread as the cause of the ICU enterococcal outbreak. After implementation of the new regimen, we observed a reduction in the rate of enterococcal bloodstream infections from 3.1 to 1.8%. The consumption of antibiotics fell from 6.11 to 4.24 defined daily doses per patient. The introduction of strict hygiene and barrier nursing, more restrictive use of antibiotics, isolation of infected patients, thorough cleaning and disinfection of the unit was followed by an absence of enterococcal infection clustering and reduction in incidence of enterococcal bacteraemia. We were not able to determine whether the reduction in antibiotic consumption was due to the intervention programme.

Adult↗
PubMed1995

The origin of coagulase-negative staphylococci isolated from blood cultures.

The source of coagulase-negative staphylococci (CNS) isolated from blood cultures and thought to be contaminants was investigated over a two month period. Isolates recovered from swabs taken from patients, doctors and laboratory staff were compared with the blood culture patient isolate in an attempt to identify the source of contamination. Six hundred and ninety-six blood culture sets were received of which 28 were contaminated with CNS. Nineteen of these blood cultures had sufficient data to be included in this study. Six were matched to isolates from the patient's skin and none to the medical or laboratory staff. Major differences in the antibiograms were seen between the patients, medical and laboratory staff. Organisms from patients and medical staff were more likely to have multiple antibiotic resistances. It appears that the most important source of CNS contamination of blood cultures processed in a semi-automated manner is the patient's own skin flora.

Bacterial Typing Techniques↗
PubMed1996

When should healthcare workers be screened for methicillin-resistant Staphylococcus aureus?

The role of screening of healthcare workers (HCWs) in the control of methicillin-resistant Staphylococcus aureus (MRSA) is controversial. It is recommended in guidelines by expert groups in both North America and the United Kingdom, although the role of MRSA carriage by HCWs in outbreaks is not clearly defined. The present report describes the spread of a distinct strain of MRSA to patients by a single HCW on three separate occasions over 27 months. The isolates from this HCW and patient contacts were shown to be indistinguishable by antibiogram and repetitive extragenic palindromic polymerase chain reaction (REP/PCR); none were typeable by lytic phage-typing. Throat carriage of the MRSA probably recurred in this HCW, despite attempts to eradicate it on three occasions. Over the same period, nine other small clusters were seen in the Oxford Hospital Group, involving 66 patients and 22 HCWs colonized, or occasionally infected, with a variety of MRSA strains. In none of these instances could HCWs be implicated in the initiation of an outbreak. The advantages of a screening policy include the determination of the full extent of MRSA-colonization and work exclusion; the disadvantages include detection of transient nasal carriage, disruption of staff routine and stigmatization. Screening of HCWs can be a valuable tool in the control of MRSA outbreaks but it should be used selectively. This strategy remains an important part of a control programme.

Cost-Benefit Analysis↗
PubMed1996

Coagulase-negative Staphylococci in Danish blood cultures: species distribution and antibiotic susceptibility.

The distribution and antibiotic susceptibility of coagulase-negative staphylococci (CoNS) isolated from blood cultures was examined in samples from hospitals covering most of Denmark. A total of 499 CoNS isolates were detected in 477 blood cultures from 340 patients and speciated as Staphylococcus epidermidis, 285; Staphylococcus hominis, 61; Staphylococcus haemolyticus, 43; Staphylococcus warneri, 12; Staphylococcus cohnii, 7; Staphylococcus saprophyticus, 4; Staphylococcus capitis, 2 and Staphylococcus lugdunensis, 1. Seventy-eight isolates could not be identified to species level and six were Micrococcus spp. In 108 (22.6%) blood culture sets, more than one CoNS strain were found, as detected by species identification, antibiogram and biotyping. Significantly more blood cultures from patients in university hospitals were drawn from central venous catheters. Comparing university and non-university hospitals, the overall antibiotic susceptibility among CoNS was only slightly different, except for methicillin and amikacin. The prevalence of methicillin-resistant strains was 35.1% in the university hospital strains vs. 25.3% in the non-university hospital strains. The overall prevalence of methicillin resistance was 32%. Great geographic variation in both species distribution and antibiotic resistance was observed. The high prevalence of S. epidermidis makes subtyping of this species important.

Blood↗
PubMed1997

Outbreak of septicaemia in neonates caused by Acinetobacter junii investigated by amplified ribosomal DNA restriction analysis (ARDRA) and four typing methods.

Septicaemia caused by Acinetobacter occurred in six infants in the neonatal unit. A total of 18 acinetobacters were isolated from blood cultures, cultures of intravascular catheters, and surveillance cultures. Twelve isolates from the six affected infants were identified as Acinetobacter junii by the use of a novel method, amplified ribosomal DNA restriction analysis (ARDRA). Typing of the organisms using the biochemical profiles of the API 20NE system, antibiogram typing, cell envelope protein electrophoresis, and PCR fingerprinting with two primer sets, ERIC1/ERIC2 and ERIC2/ 1026, showed that these 12 isolates were indistinguishable, whereas the remaining six isolates were different. The six infants recovered after therapy with ciprofloxacin alone in five cases and with a combination of ciprofloxacin and gentamicin in one case. This study showed that A. junii is capable of causing a serious, though non-fatal infection in neonates. The combined use of genotypic and phenotypic methods allowed the rapid separation of epidemic from non-epidemic isolates. It is concluded that for a better understanding of the role of the various Acinetobacter genomic species in human pathology, identification of acinetobacters according to the recent taxonomy is imperative.

Acinetobacter↗