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PubMed1997

Epidemiologically related and unrelated strains of Pseudomonas aeruginosa serotype O12 cannot be distinguished by phenotypic and genotypic typing.

A clonal origin for European isolates of antibiotic multi-resistant Pseudomonas aeruginosa serotype O12 has been suggested. This study was designed to assess the value and limitations of several typing methods for the investigation of outbreaks due to this serotype. In Hôpital de Rodez, France, this organism is endemic, and a prospective clinical epidemiological study was undertaken over a 15 month period, encompassing all patients at the hospital from whom P. aeruginosa O12 was isolated. All isolates were examined by auxanogram, antibiogram, phage-typing, electrophoresis of esterases and pulsed-field gel electrophoresis of DNA. The results suggest that (1) the methods used did not clearly differentiate between clinically-related and epidemiologically-unrelated European isolates, (2) in Hôpital de Rodez, while some isolates were likely to have been transmitted from patient-to-patient, most infections or colonizations with this organism were sporadic and their origin is unknown. The limits of typing methods for the investigation of outbreaks of nosocomial infection with multi-resistant P. aeruginosa O12 are emphasized.

Aged↗
PubMed1997

Epidemiological study of variations in beta-lactam antibiotic susceptibility of Pseudomonas aeruginosa in two intensive care units.

A six-month prospective study was carried out in the medical and surgical intensive care units (ICUs) at Besançon University Hospital to assess the frequency and risk factors for beta-lactam-resistant isolates of Pseudomonas aeruginosa. Clinical samples were screened for P. aeruginosa, and four antibiograms were distinguished using imipenem and ceftazidime, namely: fully susceptible (SS), imipenem-resistant (RS), ceftazidime-resistant (SR), and resistant to both (RR). DraI restriction fragment length polymorphism of isolates from different patients or with different resistance patterns but the same serotype was assessed by pulsed-field gel electrophoresis. One hundred and twenty-one isolates were obtained from 50 of 281 patients, 60.3% were fully susceptible. 19.8% imipenem-resistant, 13.2% ceftazidime-resistant, and 6.6% resistant to both. Antibiotic-resistance was independent of serotype. Twenty-two of 32 imipenem-resistant isolates from six patients were of the same DNA type, and six other isolates from four patients were of a second DNA type. On only one occasion did a clonally defined strain develop imipenem resistance. By contrast ceftazidime-resistant strains had differing DNA types, but had been originally ceftazidime-susceptible in seven of 12 patients. Reversion of imipenem resistant strains to susceptibility occurred in one patient, and of ceftazidime-resistant strains in five patients. Case-control studies identified prior antibiotic therapy as a risk factor in colonization with resistant strains. Resistance to imipenem followed imipenem therapy, and resistance to ceftazidime followed use of weakly anti-pseudomonal beta-lactam antibiotics. The major route of spread of imipenem-resistant strains was cross-colonization. Thus, assuming appropriate isolation, a carbapenem should be preferred to an extended-spectrum cephalosporin to treat pseudomonas infections in ICU patients.

Adult↗
PubMed1999

Keeping MRSA out of a district general hospital.

This study describes a three-year audit of methicillin-resistant Staphylococcus aureus (NIRSA) in a district general hospital and surrounding community. Despite a continuing increase in new cases of MRSA both nationally and locally, and the transfer of patients with MRSA from outside, the hospital remains free from endemic MRSA, albeit with occasional sporadic cases. This is attributed to the presence of a Control of Infection team who have introduced and implemented various policies to control MRSA. These include prompt screening of hospital transfers, an effective topical regimen, attention to environmental cleaning, treatment for established infection, tailored protocol for colonized urinary catheters and an educational programme for staff. Some of these policies have been extended into the community. This report also presents data from 172 cases of MRSA, including carriage rate, infection site, antibiogram, phage-typing, treatment and/or clearance outcome and preliminary evaluation of pathogenicity. A questionnaire has been formulated to assess colonization vs infection. Future strategies will be required if the status quo is to be maintained.

Adolescent↗
PubMed1999

Incidence of Clostridium difficile infection: a prospective study in an Indian hospital.

Clostridium difficile is the commonest cause of hospital-acquired diarrhoea. A prospective study comprising of 156 patients and 54 healthy controls was undertaken to assess C. difficile associated diarrhoea (CDAD) incidence in an Indian hospital. Methods used included C. difficile culture and enzyme linked immunosorbent assay (ELISA) for Toxin A. Attempts were made to type isolates by antibiogram and SDS-PAGE. Of the 210 stool samples tested, 12 gave positive results in at least one assay. Of these, 11 were positive by the ELISA method, eight by culture, and seven by both methods. Neither the organisms nor the toxin was found in healthy controls or neonates. The average disease incidence of CDAD estimated by using both methods was 15%. Two antibiotypes of the isolates were obtained and of the isolates characterized by SDS-PAGE, two had identical patterns. This study shows that CDAD is an emerging problem in Indian hospitals. Monitoring should enable the development and implementation of policies and procedures that minimize the risk of this nosocomial pathogen.

Adolescent↗
PubMed2001

[Pulmonary disease caused by Mycobacterium kansasii. Analysis of 39 cases].

OBJECTIVE: To study the epidemiological, clinical, radiological, and microbiological characteristics as well as clinical course and response to treatment of patients with lung disease due to Mycobacterium kansasii. METHODS: All cases of lung disease caused by M. kansasii diagnosed between 1993 and 1998 in Santa Marina Hospital in Bilbao (Spain) were reviewed. RESULTS: The nurse identified 39 cases of lung disease caused by M. kansasii. The incidence in our practice is growing. Most patients were men (97.4%). Mean patient age was 55.9 years. Relevant features of patients' case histories were lung tuberculosis (38.4%), chronic airflow limitation (28.2%) and smoking (87%). Most patients lived in urban settings (94.8%). The most frequent symptoms were cough (87%) and general malaise (72%). Hemoptysis occurred in 31%. Chest images showed mainly a localized alveolar pattern (69%). Cavitation was present in 76.9%. Bacilli were observed in 76.9%. Antibiograms (for 30 cases) showed resistance to the following drugs: rifampicin 3.3%, isoniazid (1 microgram/ml 10%, isoniazid (0.2 microgram/ml 100%, ethambutol 6.6%, streptomycin 90%, pyrazinamide 90%. Eight patients (22% of 36) died; all had severe associated disease. In 33% of the 21 patients with cavitation, closure was not achieved according to follow-up images. Follow-up microbiological tests revealed one case (2.7% of 36 patients) of treatment failure and four cases (15.3% of 26 patients) of relapse. CONCLUSIONS: The number of patients with lung disease due to M. kansasii has increased significantly in recent years in our hospital. The mortality rate in these patients was high, but we believe it is explained by the severity of associated disease. The 15.3% rate of relapse calls for long-term follow-up of such patients.

Adult↗
PubMed2001

Microbiologic aspects of predominant bacteria isolated from the burn patients in Korea.

The risk of infection in burns is well-known. In recent decades, the antimicrobial resistance of bacteria isolated from burn patients has increased. For this reason, we have carried out a study of the predominant bacterial profiles and antimicrobial resistance patterns of isolates from a burn center in Korea. A retrospective study was undertaken at Hallym University, Hangang Sacred Heart Hospital to examine the bacterial isolates from the burn patients and to compare the antibiograms of the predominant bacteria isolated from these patients with those of the other wards over a period of 3 years. Pseudomonas aeruginosa was the most common (n=2997, 45.7%) isolate from the burn patients followed by Staphylococcus aureus (n=21261, 19.2%) and Acinetobacter baumannii (n=878, 13.4%). These bacteria, isolated from the burn patients, were almost all higher in antimicrobial resistance rate than those in the non-burn patients (P<0.05). Because these bacteria showed very high resistant rates, they must be avoided in order to control a hospital-acquired infection. Our results seem helpful in providing useful guidelines for choosing effective empiric antimicrobial therapy against bacteria isolated from the burn patients in Korea.

Adolescent↗
PubMed1998

Bacteriology of burns.

A retrospective study was undertaken at University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, to examine the bacterial isolates from the Burns unit and to determine the antibiograms of the isolates to commonly used antimicrobial agents. A total of 600 pus samples from as many patients received, over a period of 5 years (June 1993-June 1997) yielded 920) isolates. Pseudomonas spp. was the most common (36%) followed by Staphylococcus aureus (19%), Klebsiella spp. (15.54%), Proteus spp. (11.19%), Enterococcus faecalis (8.5%), Escherichia coli (5.10%), Acinetobacter spp. (1.1%), Salmonella senftenberg (0.8%) and other (3%). Pseudomonas spp. was the most susceptible to ceftazidime (83% susceptible) and cefoperazone (82% susceptible), whereas the drugs most effective in other Gram-negative organisms were amikacin, netilmicin and ciproflox. Vancomycin was effective in 100% of Gram-positive organisms. The infection of burn wounds with multiple organisms, with the superadded problem of drug resistance, necessitate the institution of a drug policy by the hospitals for burn patients.

Anti-Bacterial Agents↗
PubMed1998

A profile of methicillin resistant Staphylococcus aureus infection in the burn center of the Sultanate of Oman.

A retrospective study of patterns of infection in 168 patients admitted during 1995 and 1996 in the burns-unit of Khoula hospital at Muscat, Oman was performed. Out of 819 isolates positive for pathogenic bacterial culture, there were 326 (39.8%) isolates positive for methicillin resistant Staphylococcus aureus (MRSA) infection. Incidence of MRSA infection was marginally more than that of Pseudomonas aeroginosa. The proportion of patients developing MRSA infection sometime or the other during their burns-unit stay ranging from 1 to 112 days rose from 48% in 1995 to 52.7% in 1996. No sophisticated tests were done to identify the MRSA strain but study of the antibiograms of each MRSA positive isolate showed very similar patterns of sensitivity to different antibiotics. This suggests the source of infection to be common and in all probability 'noscomial', since all patients acquired MRSA infection in the hospital. The susceptibility of MRSA to ciprofloxacin, cotrimoxazole and fucidin was 76, 51 and 37% of isolates in 1995, and 59, 44 and 26% in 1996 were susceptible to these drugs. Vancomycin was the antibiotic to which most MRSA cultures were susceptible, but partial resistance was reported due to very low susceptibility observed in 1.4% of the isolates in 1995 and 1.1% of the isolates in 1996. The control measures being practiced in the burns-unit of Khoula Hospital, especially mechanical cleaning and chemical disinfection of all surfaces, are discussed in detail. This paper emphasizes the need for preventive measures against MRSA infection in the burns-unit.

Adult↗
PubMed2003

[Acute pyelonephritis: bacteriological data and general course of germ resistance].

Recent bacteriological data concerning pyelonephritis mainly focus on sensitivity to antibiotics and virulence factors. Epidemiologically, and regardless of age and sex of the patients, E. coli remains the most often isolated pathogen. Only 55% of E. coli strains (43% if isolated during a nosocomial infection) are sensitive to amoxicillin. Resistance to parenterally administered third generation cephalosporins remain exceptional. Fluoroquinolones remain very active, particularly in community-acquired infections (>95% sensitive strains). P. aeruginosa, S. aureus and enterococci are mainly isolated during nosocomial infections or in patients with a history of previous hospital admissions. Adhesion factors to urothelial cells are of uppermost importance in the pathogenesis of urinary infection. Adhesins G borne by fimbriae P are mainly concerned. Also, hemolysin is very often present in strains responsible for pyelonephritis. As to the search for these factors in the diagnosis of pyelonephritis, particularly in children, further studies are needed. The choice of antibiotherapy not only rests upon antibiogram data, but also upon pharmacological characteristics of the antibiotic.

Acute Disease↗
PubMed2000

Augmentation of antibiotic resistance in Salmonella typhimurium DT104 following exposure to penicillin derivatives.

Antibiotic resistance in pathogenic bacteria has been a problem in both developed and developing countries. This problem is especially evident in Salmonella typhimurium, one of the most prevalent foodborne pathogens. While performing in vitro gentamicin protection-based invasion assays, we found that certain isolates of multiresistant S. typhimurium can be 'induced' to exhibit new resistance profiles. That is, bacteria become resistant to a wider range of antibiotics and they also exhibit quantitative increases in MIC values for antibiotics that were part of their pre-induction antibiograms. This 'induction' process involves growing the bacteria to stationary phase in the presence of antibiotics such as ampicillin, amoxicillin or ticarcillin. Since the isolates studied exhibited resistance to ampicillin, amoxicillin and ticarcillin prior to exposing the bacteria to these antibiotics, the observed phenomenon suggests that resistant Salmonella not only have a selective advantage over non-resistant Salmonella but their resistance phenotypes can be accentuated when an inappropriate antibiotic is used therapeutically.

Ampicillin Resistance↗
PubMed2002

Pulsed field gel electrophoresis for animal Salmonella enterica serovar Typhimurium isolates in Taiwan.

Salmonella enterica subspecies enterica serovar Typhimurium is a common pathogen for humans and animals. In order to trace the clonal relationship and to find the circulating strains between human and animal isolates, chromosomal DNAs from 87 serovar Typhimurium strains isolated from animals (pigs were the majority) were subjected to XbaI and SpeI digestion and pulsed field gel electrophoresis (PFGE). For the 87 animal isolates, 38 PFGE pattern combinations were obtained. As the subtyping results from animal isolates were compared with those from the 45 human isolates, it was found that 14 of the animal isolates and 13 of the human isolates shared a common PFGE pattern combination, i.e., pattern XgSf (or called X5S4). When these human and animal isolates were subjected to antibiotic susceptibility test using 11 antibiotics, it was found that strains of pattern XgSf (X5S4) belong to a common antibiogram pattern which is tetracycline, gentamicin, ampicillin, streptomycin and chloramphenicol resistant. Since most of the animal and human strains in pattern XgSf were originally isolated from various areas over different years, strains of this PFGE pattern may be the most epidemic strains which circulating between human and animal sources.

Animals↗
PubMed1997

In-vitro antimicrobial susceptibility of Clostridium perfringens from commercial turkey and broiler chicken origin.

The minimum inhibitory concentrations (MIC) of eight antibiotics and two anticoccidial agents were determined for Clostridium perfringens strains isolated from 26 commercial broiler farms and 22 commercial turkey farms. Isolates were obtained from the intestines of birds on the farm or as the processing plant using standard culture and identification techniques. The microbroth dilution test was used to determine the MIC for each compound. Most isolates from chickens had MICs in the range of 2-16 mg/L for tilmicosin, tylosin and virginiamycin, whereas the MICs for avilamycin, avoparcin, monensin, narasin and penicillin were < or = 1 mg/L. Most strains from chickens had high MICs (> or = 64 mg/L) and appeared to be resistant to bacitracin and lincomycin. Most turkey isolates had MICs in the range of 2-16 mg/L for bacitracin, tilmicosin, tylosin and virginiamycin, with strains exhibiting MICs < or = 1 mg/L for avilamycin, avoparcin, monensin, narasin and penicillin. Several turkey isolates had MICs > or = 64 mg/L to lincomycin. No attempt was made to associate farm usage of a particular antibiotic to the antibiograms.

Animals↗
PubMed2000

Characterization of oxytetracycline-resistant heterotrophic bacteria originating from hospital and freshwater fishfarm environments in England and Ireland.

This ecotaxonomic study compared the antibiotic tolerance among culturable oxytetracyline-resistant (Ot(r)) heterotrophic strains isolated from two aquatic environments representing human activities in health care and aquaculture, namely hospital effluents and freshwater fishfarms. Using a standardized methodology, samples taken in England and Ireland were analyzed to determine the antibiotic tolerance profiles of two groups of culturable Ot(r) bacterial isolates at the intergeneric and intrageneric level comprising heterotrophs (189 strains) and mesophilic Aeromonas spp. (153 strains), respectively. Antibiogram data of heterotrophic isolates revealed that Irish hospital strains comprised higher frequencies of multi-tolerance than those originating from fishfarm environments whereas a reverse correlation was found among the English heterotrophs. Polyphasic identification of the isolates using fatty acid analysis and API 20E profiling showed that this difference arose from the unique taxonomic diversity within each heterotrophic strain set. Acinetobacter (27%) and Brevundimonas (22%) were predominant among the Irish Ot(r) fishfarm isolates, whereas isolates originating from the English aquaculture site almost entirely consisted of Stenotrophomonas maltophilia (86%) exhibiting high frequencies of tolerance to ampicillin and streptomycin. Within both the English and the Irish Ot(r) Aeromonas strain sets, on the other hand, the hospital strain sets displayed higher numbers of multi-tolerant isolates than to fishfarm isolates although country-specific differences were observed for individual antimicrobial agents. The typical occurrence of kanamycin-tolerant aeromonads in the Irish hospital site could to some extent be linked to the typical presence of A. hydrophila DNA hybridization group (HG) 3 strains as determined by fatty acid analysis and fluorescent amplified fragment length polymorphism (FAFLP) fingerprinting. Essentially, these data indicate that tolerance profiles in a specific environment of one country do not necessarily reflect the corresponding tolerance profiles of the same type of environment in another country, and this mainly as a result of the unique taxonomic composition of each site. Ot(r) representatives of Acinetobacter, S. maltophilia, and A. veronii biovar sobria HG8 were common to most if not all of the four sites under study, indicating that these three taxa may serve as potential indicator organisms for monitoring antibiotic tolerance among indigenous bacterial populations in various aquatic environments.

Aeromonas↗
PubMed2002

Gatifloxacin used for therapy of outpatient community-acquired pneumonia caused by Streptococcus pneumoniae.

Gatifloxacin is an advanced-generation fluoroquinolone with demonstrated efficacy and safety as therapy for community-acquired pneumonia (CAP). As part of a phase IV postmarketing surveillance program (TeqCES), 136 outpatients with CAP whose sputum was culture-positive for Streptococcus pneumoniae were enrolled in an open-label trial of oral gatifloxacin 400 mg daily for 7 to 14 days. An antibiogram of isolates showed 100% susceptibility to gatifloxacin (MIC(90) 0.5 micro g/mL) and respective susceptibilities of 67%, 70%, and 80% to penicillin, erythromycin, and tetracycline. Clinical cure was achieved in 95.3% of evaluable patients, including seven patients infected with penicillin-resistant S. pneumoniae (MIC > or =2 micro g/mL). The bacteriologic eradication rate for S. pneumoniae was 94.5%. Diarrhea, nausea, and dizziness, the most common adverse events in CAP patients (<3%), were generally mild to moderate; no serious adverse events were recorded. These results support recommendations to treat CAP, particularly due to S. pneumoniae including multidrug-resistant strains, with the newer 8-methoxy-fluoroquinolone, gatifloxacin.

Administration, Oral↗
PubMed2003

One predominant type of genetically closely related Shigella sonnei prevalent in four sequential outbreaks in school children.

Seventy-six Shigella sonnei isolates from four sequential outbreaks in school children were analyzed to determine their relatedness. Outbreak strains exhibited two major antibiograms, 9 plasmid profiles, 10 enterobacterial repetitive intergenic consensus sequence (ERIC)-PCR patterns, and 17 pulsed-field gel electrophoresis (PFGE) patterns. Of typing methods, ERIC-PCR types generally coincided with the PFGE types within these outbreak strains. However, ERIC-PCR analysis could not discriminate an epidemiologically unrelated strain from some outbreak strains. Further computer-assisted analysis for similarity of the PFGE patterns revealed that the main culprits of these four sequential outbreaks were strains of pulsotype C (88.2% of total outbreak isolates). The results indicate that PFGE can provide more explicit relatedness of outbreak strains than the other typing methods examined. In conclusion, based on PFGE analysis, one predominant pulsotype of multiple genetically related strains of S. sonnei was prevalent in these four sequential outbreaks.

Anti-Bacterial Agents↗
PubMed2003

Detection of antimicrobial resistance by small rural hospital microbiology laboratories: comparison of survey responses with current NCCLS laboratory standards.

Microbiology laboratory personnel from 77 rural hospitals in Idaho, Nevada, Utah, and eastern Washington were surveyed in July 2000 regarding their routine practices for detecting antimicrobial resistance. Their self-reported responses were compared to recommended laboratory practices. Most hospitals reported performing onsite bacterial identification and susceptibility testing. Many reported detecting targeted antimicrobial resistant organisms. While only 5/61 hospitals (8%) described using screening tests capable of detecting all 8 targeted types of resistance, most (57/61, 93%) were capable of accurately screening for at least 6 types. Conversely, most hospitals (58/61, 95%) reported confirmatory testing capable of identifying only 3 or fewer resistance types with high-level penicillin resistance among pneumococci, methicillin and vancomycin resistance among staphylococci and enterococci, and extended spectrum beta-lactamase production by Gram-negative bacilli presenting the greatest difficulties. Furthermore, only 50% of hospitals compiled annual antibiogram reports to help physicians choose initial therapy for suspected infectious illnesses. This survey suggests that the antimicrobial susceptibility testing in many rural hospitals may be unreliable.

Anti-Bacterial Agents↗
PubMedDate not supplied

Clonal distribution of multiple-drug-resistant Shigella sonnei strains: identification by means of plasmid pattern analysis.

The spread of particular clones of S. sonnei throughout the territory of the German Democratic Republic within one year was evaluated by means of plasmid pattern analysis of the bacterial isolates. Such epidemic clones are described by their "clone formulae" comprising the phage type, biotype, colicinogenotype, antibiogram and the plasmid pattern type. They were not observed before 1982, but potential progenitor strains could be identified as having occurred sporadically in the years before. The additional application of plasmid pattern analysis revealed a better discrimination of the epidemic distribution of distinct bacterial clones than the use of conventional methods such as phage-typing, biotyping and colicinogenotyping only.

Bacteriological Techniques↗
PubMed1997

ERIC-PCR typing profiles of Enterobacter cloacae are stable after development of advanced cephalosporin resistance.

Enterobacterial repetitive intergenic consensus (ERIC) sequence polymerase chain reaction genotype profiles of Enterobacter cloacae were prepared for paired isolates which were obtained before and after the high level expression of the chromosomal cephalosporinase. These profiles were homologous within strain pairs which suggests that the acquired resistance does not lead to major chromosomal alterations. ERIC genotypes are therefore reliable markers in epidemiological investigations where antibiogram modifications may arise as a consequence of antibiotic exposure and beta-lactamase over-production..

Bacterial Typing Techniques↗