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PubMed2005

Polyclonal emergence and importation of community-acquired methicillin-resistant Staphylococcus aureus strains harbouring Panton-Valentine leucocidin genes in Belgium.

OBJECTIVES: Worldwide spread of a limited number of Panton-Valentine leucocidin (PVL) -producing methicillin-resistant Staphylococcus aureus (MRSA) clones has been reported in various communities. The objective of this study was to describe the molecular characteristics of the first PVL-positive MRSA strains isolated in Belgium. METHODS: Clinical MRSA isolates (n = 41) collected from 2002 to 2004 from Belgian patients were investigated for the PVL gene by PCR. PVL-positive isolates were genotyped by PFGE, staphylococcal cassette chromosome mec (SCCmec) typing, spa sequence typing, accessory gene regulator (agr) polymorphism and multi-locus sequence typing (MLST). Susceptibility to 14 antimicrobials was determined by the disc diffusion method. Genes encoding resistance to tetracyclines, aminoglycosides and macrolide-lincosamide-streptogramin were determined by PCR. RESULTS: Sixteen isolates carried lukS-lukF genes that encode the PVL toxin. All but one isolate were community-acquired. Three patients reported recent travel to North Africa and South America. They were associated with skin or soft tissue infections, bacteraemia and peritonitis. By molecular typing, they belonged to five genotypes: ST80-SCCmec IV, ST8-SCCmec IV, ST30-SCCmec IV, ST153-SCCmec IV and ST88-SCCmec IV. They belonged to the agr type 3 except for ST8 strains, which showed agr type 1. All isolates were susceptible to fluoroquinolones. Approximately, half of them were resistant to tetracycline, fusidic acid and kanamycin. Tetracycline-resistant strains harboured the tet(K) gene and resistance to kanamycin was associated with the aph3'-IIIa gene. The single erythromycin-resistant isolate harboured msr(A/B) genes conferring the M resistance phenotype. CONCLUSIONS: These results indicate the recent emergence and sporadic importation into Belgium of PVL-positive community-associated MRSA strains belonging to five distinct clones.

Adolescent↗
PubMed2006

Linezolid for the treatment of patients with endocarditis: a systematic review of the published evidence.

BACKGROUND: Linezolid is a bacteriostatic oxazolidinone antibiotic that has been proven to be effective for the treatment of patients with pneumonia, skin and soft tissue infections, and possibly bacteraemia, due to Gram-positive cocci. However, the drug is sometimes used for the treatment of patients with endocarditis due to Gram-positive cocci resistant to other antibiotics. METHODS: We carried out a review of the available literature to evaluate whether linezolid is also effective for the treatment of patients with infective endocarditis. RESULTS: We identified 23 case reports and 3 case series reporting the experience with 56 patients with endocarditis treated with linezolid. Evaluable data for 33 patients who received linezolid and for whom individual patient data were reported were further analysed. Prosthetic valve infective endocarditis accounted for 25% of the reviewed cases. Methicillin-resistant Staphylococcus aureus and vancomycin-intermediate S. aureus were the most commonly isolated cocci (24.2% and 30.3% of cases, respectively). Linezolid alone was administered to 66.7% of patients while the rest received the antibiotic in combination with rifampicin, gentamicin, fusidic acid or amikacin. A total of 63.6% (21/33) of patients with endocarditis were cured after linezolid administration. The overall and endocarditis-related mortality was 33.3% (11/33) and 12.1% (4/33), respectively. Thrombocytopenia developed in 30.8% (8/26) of patients for whom relevant data were available. CONCLUSIONS: The limited available evidence suggests that linezolid may be considered as a therapeutic option for the treatment of patients with endocarditis due to multidrug-resistant Gram-positive cocci. However, further published experience is needed to answer the question of whether a bacteriostatic antibiotic could be proven beneficial for patients with an infection for which bactericidal antibiotics have been traditionally used.

Acetamides↗
PubMed1991

Alpha-sarcin cleavage of ribosomal RNA is inhibited by the binding of elongation factor G or thiostrepton to the ribosome.

The translocation reaction catalyzed by elongation factor G (EF-G) is inhibited either by alpha-sarcin cleavage of 23S rRNA or by the binding of thiostrepton to the E. coli ribosome. Here we show that the transitory binding of EF-G and GDP to the ribosome inhibited the rate of alpha-sarcin cleavage and that stabilization of this binding with fusidic acid completely prevented alpha-sarcin cleavage. A similar pattern of inhibition was seen upon the binding of elongation factor 2 to the S. cerevisiae ribosome. The irreversible binding of the antibiotic thiostrepton to the E. coli ribosome, on the other hand, decreased the rate of cleavage by alpha-sarcin approximately 2-fold. These results suggest that the alpha-sarcin site is located within the ribosomal domain for EF-G binding and that the conformation of this site is affected by the binding of thiostrepton.

Aspergillus↗
PubMed1978

Properties of membrane adenosine triphosphatase of the obligately anaerobic bacterium Veillonella alcalescens.

Some properties of membrane ATPase activity in Veillonella alcalescens were examined. Mg2+ is required for the activity of the enzyme, and Ca2+ also activates the enzyme to some degree. Of the nucleotide triphosphates, GTP and ITP were hydrolyzed to a lesser extent than ATP. The apparent Km for ATP hydrolysis was 0.25 to 0.63 mM. ADP inhibited the enzyme and the kinetic data of its inhibition showed that the presence of ADP resulted in positive cooperativity. The enzyme activity was strongly inhibited by DCCD, azide, fusidic acid and the antibody to purified soluble ATPase from the thermophilic bacterium PS3. Oligomycin, dinitrophenol, and ouabain showed no significant effect.

Adenosine Triphosphatases↗
PubMed1988

A simple high-performance liquid chromatography method for measuring serum cloxacillin in eight Asian patients.

A simple reversed-phase high-performance liquid chromatography method using probenecid as internal standard was used for the quantitation of serum cloxacillin in eight Asian patients. The method does not require the extraction of the antibiotic from serum and the percentage recovery of cloxacillin was 96-103%. The presence of ampicillin, fusidic acid, benzylpenicillin, and gentamicin in serum appeared not to interfere with the method. The day-to-day coefficient of variation of the method over 6 months for 4-120 micrograms/ml ranged between 6.2 and 11.5%. In the eight patients in whom cloxacillin was administered intravenously or orally, there was great interindividual and intra-individual variation in the serum concentrations attained. The highest concentration of 85 micrograms/ml was obtained in a sample taken 1.5 h after an intravenous dose of 1 g. The lowest concentration of less than 1 microgram/ml was from a sample taken 6 h after an oral dose of 500 mg.

Chromatography, High Pressure Liquid↗
PubMed2002

Natural antibiotic susceptibility and biochemical profiles of Yersinia enterocolitica-like strains: Y. bercovieri, Y. mollaretii, Y. aldovae and 'Y. ruckeri'.

The natural susceptibility of 54 Yersinia enterocolitica-like strains of Y. bercovieri (formerly Y. enterocolitica biovar 3B, n = 17), Y. mollaretii (formerly Y enterocolitica biovar 3A, n = 12), Y. aldovae (formerly Y. enterocolitica-like group chi2, n = 10) and 'Y ruckeri' (n = 15) was tested to 69 antibiotics. MIC values were determined with a microdilution procedure in IsoSensitest broth for all strains and in cation-adjusted Mueller Hinton broth for some strains. All yersiniae tested showed uniform MIC distributions to most antibiotics and were naturally sensitive or intermediate to aminoglycosides, several cephalosporins, and penicillins, carbapenems, aztreonam, quinolones, tetracyclines, antifolates, chloramphenicol and nitrofurantoin, and naturally resistant to benzylpenicillin, oxacillin, all macrolides except azithromycin, lincosamides, streptogramins, glycopeptides, rifampicin and fusidic acid. Significant differences in susceptibility affecting clinical assessment criteria were seen with aminopenicillins (in the presence and absence of beta-lactamase inhibitors), some cephalosporins (e.g., cefoxitin) and fosfomycin. Whereas strains of Y. aldovae and 'Y. ruckeri' were naturally sensitive or intermediate to amoxicillin and amoxicillin/clavulanate, strains of Y. bercovieri and Y. mollaretii were naturally resistant or naturally resistant or intermediate, respectively. Strains of the two latter species were also highly susceptible to fosfomycin. These data can be valuable for the validation of routine susceptibility test results. beta-Lactam MICs suggest that Y bercovieri and Y. mollaretii strains express chromosomally encoded AmpC beta-lactamases and that most Y. aldovae and 'Y. ruckeri' strains express no, or only small amounts, of enzyme. An evaluation of 30 biochemical tests that determined phenotypic identification to the Yersinia species level is presented.

Anti-Bacterial Agents↗
PubMed1979

Variations in surface protein composition associated with virulence properties in opacity types of Neisseria gonorrhoeae.

The biological properties of a series of opacity variants of Neisseria gonorrhoeae P9 have been examined. A novel protein, designated protein IId* (mol. wt 28 850), was identified within the set of heat-modifiable surface proteins previously reported. All variants producing extra outer membrane proteins were less sensitive to the bactericidal action of serum than the prototype transparent strain, with protein IIa* (mol. wt 28 500) being associated with increased resistance. The production of a different protein, protein II* (mol. wt 29 000), was correlated with resistance to low molecular weight antimicrobial agents (penicillin, fusidic acid, Cu2+, Zn2+). Increased adhesion to human buccal epithelial cells was demonstrated in all variants that produced extra surface proteins. These variants did not show increased binding to hexyl- and phenyl-substituted Sepharose gels suggesting that hydrophobic interaction was not responsible for their cohesive properties. The prototype strain lacking additional proteins demonstrated the greatest binding to erythrocytes, indicating that adhesion to buccal cells and red blood cells is mediated by different mechanisms. One variant producing protein IIa* showed increased association with leukocytes, whereas another producing protein IIb* showed decreased association with leukocytes. These results show that the heat-modifiable surface proteins are important virulence attributes of the gonococcus: this must be considered in the selection of strains for vaccine trials.

Anti-Bacterial Agents↗
PubMed1997

The effects of adherence to silicone surfaces on antibiotic susceptibility in Staphylococcus aureus.

Sensitivity of Staphylococcus aureus to the antibiotics tetracycline, benzylpenicillin and vancomycin was found to decrease by 2-10 fold when cells were grown adherent to silicone catheter surfaces. Sensitivity to rifampicin and fusidic acid was not significantly altered in adherent cells. Susceptibility further decreased with increased adherence time prior to antibiotic challenge. The resistance observed was not genotypic, or due to the presence of a specialized subpopulation of bacteria, as it disappeared when the bacteria were removed from the catheter, subcultured and retested. Also, adherent bacteria were found to grow more slowly than bacteria growing planktonically. It is concluded that the decrease in antibiotic susceptibility of adherent bacteria is a function of the physiological status of the individual cells rather than a function of biofilm formation or slime production. The decrease in growth rate of the adherent bacteria is a result of the adherence process rather than a result of nutrient depletion. The decrease in growth rate is implicated, but is not the sole factor, in the decreased antibiotic susceptibility of adherent bacteria.

Anti-Bacterial Agents↗
PubMed1983

Correlation of penicillinase production with phage type and susceptibility to antibiotics and heavy metals in Staphylococcus aureus.

One hundred and thirty-nine bacteraemia strains of Staphylococcus aureus, representing different combinations of phage type and susceptibility to antibiotics and to cadmium (Cd), arsenate (As) and mercury (Hg), were investigated for penicillinase production. The determination of enzyme activity in induced and uninduced conditions was performed by iodometric titration. The amount of penicillinase produced could be correlated with phage pattern. Epidemically occurring strains of the 94,96 and the 83A complexes produced the largest amount of penicillinase, whereas strains of the 52,52A,80,81 complex were weaker producers. Group-II and group-III strains produced the smallest amount. Susceptibility to antibiotics and to Cd, As and Hg could not be correlated with enzyme activity, but strains resistant to penicillin plus tetracyclines and strains resistant only to Cd did produce less enzyme than strains with other resistance patterns. The percentage mean values than strains with other resistance patterns. The percentage mean values of extracellularity of the enzyme was highest amongst strains of the 94,96 complex and of type 95. Four strains had constitutive production, one being macro-constitutive and three micro-constitutive. All four strains represented rare combinations of the above properties but were susceptible to fusidic acid. The importance of penicillinase production by epidemically occurring strains is discussed.

Acetates↗
PubMed1996

Comparison of the E test and a proportion dilution method for susceptibility testing of Mycobacterium avium complex.

The newly developed E test was compared with an extended 1% proportion dilution method for determining the susceptibility of Mycobacterium avium complex (MAC) strains to amikacin, streptomycin, fusidic acid, rifampicin, clarithromycin, ciprofloxacin, ofloxacin and fleroxacin. For all antibiotics tested except clarithromycin and ciprofloxacin, no more than one strain gave a different susceptibility result with the two methods. The discrepant results occurred near the chosen breakpoint concentration of clarithromycin and outside the concentration range of the E test for ciprofloxacin. For the minimum inhibitory concentration (MIC) values obtained within the range of antibiotic concentrations tested, there was good correlation between the two methods; the MICs differed by more than one two-fold dilution in no more than two strains per antibiotic. It is concluded that the E test is suitable for susceptibility testing of MAC.

Diffusion↗
PubMed2005

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea.

Antibiotic-associated diarrhoea (AAD) represents a clinical entity leading to prolonged hospital stays and diagnostic and therapeutic procedures, and results in additional costs. The aim of the present study was to assess the prevalence and characteristics of different bacteria in stools of patients with AAD. The reliability of diagnostic procedures under routine conditions was evaluated. Host factors were also analysed. From June 2002 to April 2003 89 cases of diarrhoea were reported at a hospital unit for internal medicine. Clostridium difficile and Clostridium perfringens toxin enzyme-immunoassays (EIAs), and culture for C. difficile, C. perfringens and Staphylococcus aureus were performed on stool samples from all patients. Toxin production was determined in isolated S. aureus strains. In vitro susceptibility of S. aureus for oxacillin and of C. difficile for vancomycin, metronidazole, linezolid, fusidic acid and tetracycline was tested. Host factors, such as age, comorbidities, antibiotic exposure and contact with other patients, were evaluated. Twenty-six stools were positive for C. difficile toxins by an EIA technique, while C. difficile was cultured from 39. C. difficile was isolated from 21 stools that were EIA negative. Additionally, from 28 stools S. aureus and/or C. perfringens could be isolated. Nine samples contained only S. aureus and/or C. perfringens. Thirty-one stools were negative in all tests. All C. difficile isolates were susceptible to vancomycin and metronidazole. Age >60 years, and diseases of the vascular system, the heart, the kidneys and the lungs were identified as risk factors for acquiring C. difficile in this setting (P values < 0.05). Stool culture for C. difficile was shown to be more sensitive than toxin EIA in this study. Risk factors for the acquisition of C. difficile in outbreak situations seem to differ from risk factors in the normal hospital setting. The role of toxin-producing S. aureus in cases of AAD needs further investigation.

Anti-Bacterial Agents↗
PubMed1994

Sensitivity of Staphylococcus aureus and Streptococcus pyogenes isolated from skin infections in 1992 to antimicrobial agents.

We studied the efficacy of antimicrobial agents against Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes) isolated from skin infections in 1992. For S. aureus, we measured the minimum inhibitory concentrations (MICs) of the following 10 drugs: methicillin (DMPPC), cefaclor (CCL), gentamicin (GM), erythromycin (EM), clindamycin (CLDM), minocycline (MINO), vancomycin (VAN), fusidic acid (FA), ofloxacin (OFLX) and nadifloxacin (NDFX); for S. pyogenes, we determined the MICs of the following 9 drugs: ampicillin (ABPC), amoxicillin (AMPC), cefpodoxime proxetil (CPDX-PR), erythromycin (EM), clindamycin (CLDM), minocycline (MINO), norfloxacin (NFLX), of loxacin (OFLX) and nadifloxacin (NDFX). These drugs are frequently used to treat skin infections, either systemically or topically. NDFX is a new synthetic fluoroquinolone, recently developed for use as a topical acne medication in Japan. It is used NDFX for acne, but not for skin infections. There were no strains of S. aureus resistant to NDFX, VAN or FA. The resistance (> or = 12.5 micrograms/ml) of S. aureus was highest to GM and lowest to OFLX. Four strains of methicillin-resistant (> or = 12.5 micrograms/ml) S. aureus (MRSA) were found. In contrast, no resistant strains of S. pyogenes were found except to MINO. Only two strains of S. pyogenes were susceptible to MINO. The sensitivity of S. pyogenes to ABPC, AMPC, CPDX-PR, EM and CLDM was very good. All the strains were susceptible at a MIC below > or = 0.05 microgram/ml. However, the S. pyogenes strains were not very sensitive to the new quinolones, especially NFLX. We concluded that penicillins, cephalosporins and macrolides are still effective against streptococcal infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1982

Antimicrobial susceptibility of Clostridium difficile from different sources.

A total of 79 Clostridium difficile strains from healthy young and elderly adults, elderly patients without gastrointestinal disease, elderly patients receiving antibiotics without gastrointestinal complications, and elderly patients with antibiotic-associated diarrhea or pseudomembranous colitis were tested for their susceptibilities to 24 antimicrobial agents. All of the 79 strains were inhibited by low concentrations of rifampicin, metronidazole, fusidic acid, vancomycin, ampicillin, and penicillin G. Strains were highly resistant to aminoglycosides, trimethoprim, sulfamethoxazole, nalidixic acid, and cycloserine and often resistant to neomycin, cefoxitin, and cefalexin. Wide variations in the susceptibility of C. difficile strains to erythromycin, clindamycin, lincomycin, chloramphenicol, and tetracycline were found. Strains resistant to erythromycin, clindamycin, and lincomycin were more frequently found among strains isolated from elderly adults than those isolated from young adults, with particularly high frequency among strains isolated from elderly patients receiving antibiotics. None of the 23 strains isolated from healthy young adults was resistant to chloramphenicol. All of the 14 strains resistant to erythromycin, clindamycin, lincomycin, and chloramphenicol were sensitive to tetracycline and all of the 15 strains resistant to erythromycin, clindamycin, lincomycin, and tetracycline were sensitive to chloramphenicol. Only one out of 19 tetracycline, resistant strains was highly toxigenic, whereas 42 (70%) of the 60 sensitive strains were highly toxigenic.

Adult↗
PubMed2006

Impetigo: incidence and treatment in Dutch general practice in 1987 and 2001--results from two national surveys.

BACKGROUND: Impetigo is a common skin infection in children. The epidemiology is relatively unknown, and the choice of treatment is subject to debate. OBJECTIVE: The objective of our study was to determine the incidence and treatment of impetigo in Dutch general practice, and to assess trends between 1987 and 2001. METHODS: We used data from the first (1987) and second (2001) Dutch national surveys of general practice. All diagnoses, prescriptions and referrals were registered by the participating general practitioners (GPs), 161 and 195, respectively. RESULTS: The incidence rate of impetigo increased from 16.5 (1987) to 20.6 (2001) per 1000 person years under 18 years old (P < 0.01). In both years, the incidence was significantly higher in summer, in rural areas and in the southern region of the Netherlands, compared with winter, urban areas and northern region, respectively. Socioeconomic status was not associated with the incidence rate. From 1987 to 2001, there was a trend towards treatment with a topical antibiotic (from 43% to 64%), especially fusidic acid cream and mupirocin cream. Treatment with oral antibiotics (from 31% to 14%) and antiseptics (from 11% to 3%) was prescribed less often. CONCLUSIONS: We have shown an increased incidence of impetigo in the past decade, which may be the result of an increased tendency to seek help, or increased antibiotic resistance and virulence of Staphylococcus aureus. Further microbiological research on the marked regional difference in incidence may contribute to understanding the factors that determine the spread of impetigo. Trends in prescribing for impetigo generally follow evidence-based knowledge on the effectiveness of different therapies, rather than the national practice guideline.

Adolescent↗
PubMed1986

Estimation of gram-negative bacteria in milk: a comparison of inhibitor systems for preventing gram-positive bacterial growth.

A number of inhibitor systems which have been reported to allow selection of Gram-negative bacteria were tested against Gram-positive and Gram-negative isolates of dairy origin. No one system worked perfectly. A mixture of crystal violet-penicillin-nisin or monensin had least inhibitory effect on Gram-negative isolates whereas Selectocult (a commercially available mixture of Benzalkon A 50% and crystal violet) and sodium deoxycholate were the most effective inhibitors of Gram-positive bacteria. Cetrimide-fucidin-cephaloridine solutions, which have been reported as allowing selective growth of pseudomonads, were not so specific when applied to milk systems.

Animals↗
PubMed1992

Outer membranes of gram-negative bacteria are permeable to steroid probes.

The permeability of bacterial outer membranes was assayed by coupling the influx of highly hydrophobic probes, 3-oxosteroids, with their subsequent oxidation catalysed by 3-oxosteroid delta 1-dehydrogenase, expressed from a gene cloned from Pseudomonas testosteroni. In Salmonella typhimurium producing wild-type lipopolysaccharide, the permeability coefficients for uncharged steroids were 0.45 to 1 x 10(-5) cm s-1, and the diffusion appeared to occur mainly through the lipid bilayer domains of the outer membrane. These rates are one or two magnitudes lower than that expected for their diffusion through the usual biological membranes. The permeation rates were markedly increased (up to 100 times) when the lipopolysaccharide leaflet was perturbed either by adding deacylpolymyxin or by introducing mutations leading to the production of deep rough lipopolysaccharides. An amphiphilic, negatively charged probe, testosterone hemisuccinate, penetrated much more slowly than the uncharged steroids. Study of various Gram-negative species revealed that P. testosteroni, Pseudomonas acidovorans, and Acinetobacter calcoaceticus showed higher outer membrane permeability to steroid probes and higher susceptibility to hydrophobic agents such as fusidic acid, novobiocin and crystal violet relative to S. typhimurium and Escherichia coli.

Bacterial Outer Membrane Proteins↗
PubMed2005

Virulence, phenotype and genotype characteristics of endodontic Enterococcus spp.

BACKGROUND/AIMS: Enterococci have been implicated in persistent root canal infections but their role in the infection process remains unclear. This study investigated the virulence, phenotype and genotype of 33 endodontic enterococcal isolates. METHODS: Phenotypic tests were conducted for antibiotic resistance, clumping response to pheromone, and production of gelatinase, hemolysin and bacteriocin. Genotype analysis involved polymerase chain reaction amplification of virulence determinants encoding aggregation substances asa and asa373, cytolysin activator cylA, gelatinase gelE, gelatinase-negative phenotype ef1841/fsrC, adherence factors esp and ace, and endocarditis antigen efaA. Physical DNA characterization involved pulsed-field gel electrophoresis of genomic DNA, and plasmid analysis. RESULTS: Potential virulence traits expressed included production of gelatinase by Enterococcus faecalis (n=23), and response to pheromones in E. faecalis culture filtrate (n=16). Fourteen strains produced bacteriocin. Five strains were resistant to tetracycline and one to gentamicin, whereas all were susceptible to ampicillin, benzylpenicillin, chloramphenicol, erythromycin, fusidic acid, kanamycin, rifampin, streptomycin and vancomycin. Polymerase chain reaction products encoding efaA, ace, and asa were detected in all isolates; esp was detected in 20 isolates, cylA in six isolates, but asa373 was never detected. The gelatinase gene (gelE) was detected in all isolates of E. faecalis (n=31) but not in Enterococcus faecium (n=2); a 23.9 kb deletion sequence corresponding to the gelatinase-negative phenotype was detected in six of the eight E. faecalis isolates that did not produce gelatinase. Pulsed-field gel electrophoresis and plasmid analyses revealed genetic polymorphism with clonal types evident. Plasmid DNA was detected in 25 strains, with up to four plasmids per strain and a similar (5.1 kb) plasmid occurring in 16 isolates. CONCLUSIONS: Phenotypic and genotypic evidence of potential virulence factors were identified in endodontic Enterococcus spp., specifically production of gelatinase and response to pheromones.

Adult↗
PubMed2004

Antimicrobial susceptibility of skin-colonizing S. aureus strains in children with atopic dermatitis.

Children with atopic dermatitis (AD) are prone to recurrent cutaneous and occasional systemic infections caused by Staphylococcus aureus. Antibiotic therapy represents an important component of the overall management of AD, especially during exacerbations of disease. Erythromycin is still widely used as a first-line antibiotic for this indication. We studied 115 consecutive children (mean age: 2.7 yr, range: 0.2-15) with moderate to severe AD (mean SCORAD: 43.2, range: 16-77) presenting to our outpatient department. Staphylococcus aureus was isolated from 100 of 115 (87%). Antimicrobial susceptibility testing revealed resistance against erythromycin in 18 and against roxithromycin in 19%, respectively. Six percentage of the strains were resistant or only intermediately susceptible to fusidic acid, 13% to amoxicillin and 1% to clindamycin. All strains isolated were susceptible to oxacillin, amoxicillin/clavulanic acid, cefadroxil and cefuroxim. The high rate of primary resistance to macrolides should be born in mind when starting antibiotic therapy in children with AD. Since Gram-positive cocci represent the only relevant microbial agents in AD, first generation cephalosporins such as cefadroxil, whose antimicrobial spectrum is basically restricted to Gram-positive bacteria, would appear to be the ideal first-line antibiotics for the treatment of bacterial superinfections.

Adolescent↗