Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Fosfomycin”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 847 records · Page 47Linked to original sources

Enzyme control of small-molecule coordination in FosA as revealed by 31P pulsed ENDOR and ESE-EPR.

FosA is a manganese metalloglutathione transferase that confers resistance to the broad-spectrum antibiotic fosfomycin, which contains a phosphonate group. The active site of this enzyme consists of a high-spin Mn(2+) ion coordinated by endogenous ligands (a glutamate and two histidine residues) and by exogenous ligands, such as substrate fosfomycin. To study the Mn(2+) coordination environment of FosA in the presence of substrate and the inhibitors phosphonoformate and phosphate, we have used (31)P pulsed electron-nuclear double resonance (ENDOR) at 35 GHz to obtain metrical information from (31)P-Mn(2+) interactions. We have found that continuous wave (CW) (31)P ENDOR is not successful in the study of phosphates and phosphonates coordinated to Mn(2+). Parallel studies of phosph(on)ate binding to the Mn(2+) of FosA and to aqueous Mn(2+) ion disclose how the enzyme modifies the coordination of these molecules to the active site Mn(2+). Through analysis of (31)P hyperfine parameters derived from simulations of the ENDOR spectra we have determined the binding modes of the phosph(on)ates in each sample and discerned details of the geometric and electronic structure of the metal center. The (31)P ENDOR studies of the protein samples agree with, or improve on, the Mn-P distances determined from crystal structures and provide Mn-phosph(on)ate bonding information not available from these studies. Electron spin echo electron paramagnetic resonance (ESE-EPR) spectra have also been recorded. Simulation of these spectra yield the axial and rhombic components of the Mn(2+) (S = (5)/(2)) zero-field splitting (zfs) tensor. Comparison of structural inferences based on these zfs parameters both with the known enzyme structures and the (31)P ENDOR results establishes that the time-honored procedure of analyzing Mn(2+) zfs parameters to describe the coordination environment of the metal ion is not valid or productive.

Bacterial Proteins↗

Effect of early oral fluoroquinolones in hemorrhagic colitis due to Escherichia coli O157:H7.

During the Sakai outbreak of Escherichia coli O157:H7 infection, which was linked to contaminated cafeteria school lunches, there were several treatment modalities with regard to antimicrobial drugs. Patient outcomes among three hospitals with different modalities were compared retrospectively. Hemolytic uremic syndrome did not develop in any of the 15 patients treated with oral fluoroquinolone therapy; however, HUS did develop in three of 15 patients treated with intravenous (i.v.) fosfomycin and in two of 12 patients treated with i.v. cefotaxime and oral fosfomycin. The results indicate that oral fluoroquinolone therapy administered within 3 days of illness is effective in preventing the development of HUS; however, prospective randomized double-blind studies on early antimicrobial therapy of O157 hemorrhagic colitis are necessary. Several antibiotics, including fluoroquinolones, were reported to induce the production or release of Shiga-like toxins (STX) from E. coli O157:H7 in vitro. Although patients were examined for fecal STX, no STX were detected in the stools of patients treated with oral fluoroquinolones. In fact, treatment with fluoroquinolones for 5 days eradicated E. coli O157 in all patients.

Administration, Oral↗

Natural antibiotic susceptibility of Listeria species: L. grayi, L. innocua, L. ivanovii, L. monocytogenes, L. seeligeri and L. welshimeri strains.

OBJECTIVE: To investigate the natural susceptibility to 71 antimicrobial agents of 103 Listeria strains belonging to all known Listeria species (L. monocytogenes (N = 21), L. innocua (N = 21), L. seeligeri (N = 21), L. ivanovii (N = 19), L. welshimeri (N = 11), and L. grayi (N = 10)). METHODS: MICs were determined using a microdilution procedure in H-Medium. RESULTS: All listeriae were naturally sensitive or intermediate to tetracyclines, aminoglycosides, penicillins (except oxacillin), loracarbef, cefazoline, cefaclor, cefotiam, cefoperazone, carbapenems, macrolides, lincosamides, glycopeptides, dalfopristin/quinupristin, chloramphenicol and rifampicin (probably except L. grayi). Listeria spp. were naturally resistant or intermediate to most 'modern' cephalosporins (cefetamet, cefixime, ceftibuten, ceftazidime, cefdinir, cefpodoxime, cefotaxime, ceftriaxone, cefuroxime), aztreonam, pipemidic acid, dalfopristin quinupristin and sulfamethoxazole. Significant differences in natural susceptibility among the species were seen with the quinolones, trimethoprim, co-trimoxazole, rifampicin, fosfomycin and fusidic acid. It seems likely that L. grayi is naturally resistant to all antifolates; the species was least susceptible to rifampicin and most susceptible to quinolones, whereas L. ivanovii was naturally resistant to most quinolones. L. ivanovii was naturally sensitive to fosfomycin, whereas L. innocua and L. monocytogenes were naturally resistant. L. ivanovii was also the most susceptible species to fusidic acid. CONCLUSIONS: The present study describes a database on the natural susceptibility of Listeria spp. to a wide range of antibiotics, which can be used to validate susceptibility testing results of these microorganisms.

Anti-Bacterial Agents↗

Natural antibiotic susceptibility of Enterobacter amnigenus, Enterobacter cancerogenus, Enterobacter gergoviae and Enterobacter sakazakii strains.

OBJECTIVE: To investigate the natural susceptibility to 69 antimicrobial agents of 107 Enterobacter strains comprising E. amnigenus (n = 18), E. cancerogenus (n = 26), E. gergoviae (n = 28) and E. sakazakii (n = 35). METHODS: Minimal inhibitory concentrations (MICs) were determined with a microdilution procedure in Isosensitest broth and cation-adjusted Mueller-Hinton broth. RESULTS: All the species were naturally sensitive or intermediate to tetracyclines, amino-glycosides, numerous beta-lactams (acylureidopenicillins, ticarcillin, ampicillin/sulbactam, several cephalosporins, carbapenems, aztreonam), quinolones, antifolates, chloramphenicol and nitrofurantoin. Natural resistance was found to penicillin G, oxacillin, several macrolides, lincosamides, streptogramins, glycopeptides, rifampicin and fusidic acid. Species-related differences in natural susceptibility were found to some beta-lactams, azithromycin and fosfomycin. Whereas E. gergoviae was the most susceptible species to azithromycin, E. cancerogenus was most susceptible to fosfomycin and was the only species showing natural resistance to amoxicillin, amoxicillin/clavulanic acid, cefaclor, cefazoline, loracarbef and cefoxitin. There were only minor medium-dependent differences in susceptibility to most antibiotics. CONCLUSIONS: The present study establishes a database concerning the natural susceptibility of recently established Enterobacter species to a wide range of antibiotics, which can be applied for the validation of routine susceptibility test results. beta-Lactam susceptibility patterns indicate the expression of species-specific beta-lactamases expressed at high or low levels in all the species except E. sakazakii.

Anti-Bacterial Agents↗

Experimental studies on the nephrotoxicity of amphotericin B in rats.

The renal effects of amphotericin B alone and in combination with cyclosporin A, tobramycin, fosfomycin, D-glucaro-1,5-lactam and verapamil were studied in rats. The parameters for nephrotoxicity were urinary loss of tubular cells and malate dehydrogenase, as well as creatinine clearance. Repeated intraperitoneal injections of amphotericin B led to an increase of urinary tubular cell elimination and malate-dehydrogenase. After co-administration of amphotericin B and cyclosporin A, the urinary loss of tubular cells increased and creatinine clearance was reduced. A combination of amphotericin B and tobramycin reduced tubular cell elimination but the creatinine clearance improved. When verapamil was combined with amphotericin B, endogenous creatinine clearance increased, though the loss of tubular cells was elevated. Furthermore, fosfomycin reduced the loss of tubular cells and improved renal functional parameters in combination with amphotericin B. In addition, D-glucaro-1,5-lactam was found to reduce the urinary loss of tubular cells induced by amphotericin B.

Amphotericin B↗

In vitro activity of the aerosolized agents colistin and tobramycin and five intravenous agents against Pseudomonas aeruginosa isolated from cystic fibrosis patients in southwestern Germany.

Three hundred and eighty-five mucoid and non-mucoid strains of Pseudomonas aeruginosa isolated from 192 sputa from 57 adult cystic fibrosis patients were studied. Susceptibility testing using an agar dilution technique was performed for ceftazidime, ciprofloxacin, fosfomycin, meropenem and piperacillin, and the aerosolized agents colistin and tobramycin. Meropenem, ceftazidime and piperacillin were the most potent agents (susceptibility 86.2%, 84.2% and 84%, respectively). Tobramycin and colistin susceptibility rates were lower, but in light of higher intrabronchial concentrations of these drugs a greater percentage of strains might still be clinically susceptible. Only 46.2% and 41.8% of isolates were susceptible to ciprofloxacin and fosfomycin, respectively.

Aerosols↗

Natural antimicrobial susceptibilities of strains of 'unusual' Serratia species: S. ficaria, S. fonticola, S. odorifera, S. plymuthica and S. rubidaea.

The natural susceptibility to 71 antibiotics of 104 Serratia strains of Serratia ficaria (n = 15), Serratia fonticola (n = 18), Serratia odorifera (n = 16), Serratia plymuthica (n = 32) and Serratia rubidaea (n = 23) was examined. MICs were determined using a microdilution procedure in IsoSensitest broth for all the strains and in cation-adjusted Mueller-Hinton broth for some strains. With few exceptions, all species tested were uniformly naturally resistant to penicillin G, oxacillin, cefazolin, cefuroxime, all tested macrolides, lincosamides, streptogramins, glycopeptides, fusidic acid and rifampicin, and naturally sensitive to several aminoglycosides, piperacillin, piperacillin/tazobactam, carbapenems, some cephalosporins, fluoroquinolones and folate-pathway inhibitors. Major species-related differences in natural susceptibility affecting clinical assessment criteria were seen with tetracyclines, some aminoglycosides, aminopenicillins, ticarcillin, cefaclor, loracarbef, cefoxitin, pipemidic acid, chloramphenicol, nitrofurantoin and fosfomycin. Differences in susceptibility dependent on the medium were seen with macrolides, tetracycline, fosfomycin and some beta-lactams. The natural antibiotic susceptibility patterns suggest novel species-specific mechanisms of antibiotic resistance. Uncharacterized species-specific aminoglycoside-modifying enzymes and multidrug efflux systems affecting tetracyclines, quinolones and chloramphenicol are probably responsible for some of the phenotypes observed. The natural amoxicillin sensitivity of several strains of some species combined with natural resistance to some narrow-spectrum cephalosporins indicate the expression of naturally occurring beta-lactamases with unique substrate profiles. beta-Lactamases of representative strains of each species were characterized phenotypically and genotypically. It was shown that all species expressed naturally occurring AmpC beta-lactamases and, with respect to S. fonticola, also a species-specific class A beta-lactamase. Inducibility of these enzymes was shown in all species with the exception of S. rubidaea and four of five strains of S. plymuthica.

Anti-Infective Agents↗

Impact of plasma protein binding on antimicrobial activity using time-killing curves.

OBJECTIVES: Plasma protein binding (PPB) is known to impair the antimicrobial activity of beta-lactams, but its impact on the activity of other classes of antimicrobials such as fluoroquinolones is controversial. This study was undertaken to investigate the effect of PPB on bacterial killing by selected antibiotics and moxifloxacin, which served as a model compound for the class of fluoroquinolones. METHODS: Bacterial time-killing curves were employed in the absence and presence of physiological albumin concentrations (40 g/L). Moxifloxacin, ampicillin and oxacillin were investigated. Fosfomycin, a non-protein bound antibiotic was used for comparison. Simulations were carried out by employing concentrations of antibiotics of one-fourth of the minimal inhibitory concentration (MIC), equal to the MIC and four-fold the MIC of one select bacterial strain (Staphylococcus aureus ATCC 29213). To correlate bacterial killing to the extent of PPB, bacterial time-killing curves were plotted using the calculated free and the total drug concentration. RESULTS: Bacterial killing by fosfomycin was not affected by the addition of albumin. The antimicrobial activity of oxacillin and ampicillin was reduced in the presence of albumin as expected by the calculation of the free fraction of these antibiotics. Adding albumin to moxifloxacin resulted in a significant decrease in bacterial killing of more than 1 log10 cfu/mL after a period of 8 h when the moxifloxacin concentration was equal to the respective MIC. CONCLUSIONS: Our data confirm the view that albumin substantially impairs the antimicrobial activity of antibiotics including moxifloxacin, a member of the class of fluoroquinolones.

Anti-Bacterial Agents↗

Antibiotic prescribing for acute and recurrent cystitis in primary care: a 4 year descriptive study.

OBJECTIVES: To explore the antibiotic prescribing pattern for cystitis and the patient-related variables associated with prescription during a 4 year period among Italian general practitioners (GPs). METHODS: We obtained information from the 'Health Search Database' (HSD), an Italian general practice research database. From a total sample of 457 672 eligible patients aged >16 years registered up to December 2002, we included those whose diagnoses could be classified as acute (uncomplicated and complicated) and recurrent cystitis. Patients' features and prevalence of antibiotic users were assessed. RESULTS: Of 35 129 cases diagnosed during the period 1999-2002, 96.0% of them were acute cystitis (39.2% recorded as uncomplicated). The prevalence of cases with acute complicated and uncomplicated cystitis slightly increased during the 4 year period, whereas it remained stable for recurrent cystitis. Most of the cystitis cases reported no diagnostic tests. More than 70% of patients were prescribed with at least one antibiotic, with a 4-fold increased risk of antibiotic use for acute cystitis throughout the study period. The prevalence of antibiotic users reached 86.2% for both acute uncomplicated and complicated cystitis in 2002, and 81.5% for recurrent cystitis. Fluoroquinolones represented the most common antibiotics being prescribed although they markedly decreased during these years. Fosfomycin trometamol use increased dramatically, becoming the first choice for any type of cystitis. CONCLUSIONS: Data indicate an evident rise in antibiotic use mostly related to fosfomycin trometamol. They also indicate that such a prescriptive trend finds confirmation from the available evidence for acute uncomplicated cystitis, although the management of recurrent cystitis could be further improved.

Acute Disease↗

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↗

Natural antimicrobial susceptibility patterns and biochemical profiles of Leclercia adecarboxylata strains.

Leclercia adecarboxylata is an opportunistic human pathogen that phenotypically resembles Escherichia coli. The natural susceptibilities of 101 Leclercia strains to 70 antimicrobial agents were investigated. MICs were determined with a microdilution procedure in cation-adjusted Mueller-Hinton broth (all strains) and IsoSensitest broth (some strains). Natural susceptibility patterns were assessed using German (DIN) standards (when applicable). In addition, biochemical properties recommended for the phenotypic identification of L. adecarboxylata were evaluated, applying two commercially available identification systems for Enterobacteriaceae and seven conventional tests. L. adecarboxylata strains were naturally sensitive to tetracyclines, aminoglycosides, all but two beta-lactams, quinolones, folate pathway inhibitors, chloramphenicol, nitrofurantoin and azithromycin. They were naturally resistant to penicillin G, oxacillin, erythromycin, roxithromycin, clarithromycin, ketolides, lincosamides, streptogramins, linezolid, glycopeptides, rifampicin, fusidic acid and fosfomycin. There were only minor medium-dependent differences in susceptibility to most antibiotics. Lysine decarboxylase, malonate assimilation and acid production from arabitol and cellobiose, but not from adonitol and sorbitol, allowed definitive separation of L. adecarboxylata from E. coli. The results of this study form a database that can be applied to validate forthcoming antibiotic susceptibility tests of L. adecarboxylata, and might contribute to its reliable identification. Susceptibility patterns did not indicate obvious therapeutic difficulties for treatment of Leclercia infections. Special attention should be paid to biochemically aberrant leclerciae. Apart from biochemical features, fosfomycin susceptibility might be useful to differentiate between L. adecarboxylata and E. coli.

Anti-Bacterial Agents↗

Antibiotic resistance of Escherichia coli from community-acquired urinary tract infections in relation to demographic and clinical data.

This prospective study determined the antibiotic susceptibility of 164 isolates of Escherichia coli from the urine of 164 patients (112 female, 52 male; mean age of 54.12 years) with community-acquired urinary tract infection (UTI). Half of the isolates were from uncomplicated UTI and half from complicated UTI (52 males and 34 females). Overall, 57.3% of isolates were resistant to ampicillin, 25% to co-trimoxazole, 20.1% to nalidixic acid, 14% to norfloxacin and ciprofloxacin, and 0% to fosfomycin and nitrofurantoin. Of the 82 isolates from complicated UTI, 16 (19.5%) were resistant to norfloxacin and ciprofloxacin, compared with seven (8.5%) from uncomplicated UTI (p 0.043). Isolates from patients aged >50 years were significantly more resistant than those from patients aged <50 years for nalidixic acid (p 0.007) and the fluoroquinolones tested (p 0.015). Resistance to fluoroquinolones was 25% (13/52) in males and 9% (10/112) in females (p 0.006). For patients with and without previous antimicrobial therapy, there was a significant difference only for resistance to nalidixic acid (p < 0.001) and the fluoroquinolones (p 0.011). There were adequate susceptibility rates to fosfomycin, nitrofurantoin and the fluoroquinolones for empirical use in the treatment of acute uncomplicated UTI. In order to interpret cumulative susceptibility data from the primary healthcare setting, it is necessary to take into account the type of UTI (uncomplicated vs. complicated), previous antimicrobial therapy, and the sex and age of each patient.

Adolescent↗

[Study of diarrhea-inducing strains of Escherichia coli mainly isolated in Kanto area between June and September 1996].

A total of 21,609 faecal specimens obtained from patients with diarrhea mainly in Kanto area between June and September 1996 were investigated to identify the causative pathogens for diarrhea. One-hundred fifty-seven strains of Escherichia coli of 29 different O-serotypes were isolated as the causative pathogens, which were previously recognized to induce severe abdominal cramps and diarrhea. Of these, 114 strains, in which the possibility of enterohemorrhagic E. coli due to their O-serotypes was predicted, were examined for the producibility of Vero toxins. Twenty-six (76.5%) of the 34 strains of E. coli O157 produced the Vero toxins, and other 8 strains were the non-producers. Twenty of the 26 producers produced both VT1 and VT2, whereas the other 6 strains produced VT2 only. Furthermore, 4 strains of E. coli O26, and 1 strain each of E. coli O125 and O126 produced Vero toxins. Thirty-two of the 114 strains, isolated from the patients with diarrhea and selected as the enterohemorrhagic E. coli according to the specific O-serotypes, were actually confirmed produce Vero toxins. Thirty-four strains of E. coli O157 tested were susceptible to all antibiotics such as ampicillin, doxycylin, levofloxacin, fosfomycin, chloramphenicol and polymyxin B, and no strains resistant to levofloxacin, polymyxin B and fosfomycin were found.

Bacterial Toxins↗

In vitro killing activities of antibiotics at clinically achievable concentrations in cerebrospinal fluid against penicillin-resistant Streptococcus pneumoniae isolated from children with meningitis.

We evaluated the in vitro killing activities of ceftriaxone, imipenem, vancomycin, gentamicin, fosfomycin, and rifampin, alone and in combination, against 26 Streptococcus pneumoniae strains (penicillin G MICs, > 0.125 to 2 micrograms/ml) isolated from the cerebrospinal fluid of children with meningitis. The antibiotics were tested at clinically achievable concentrations in cerebrospinal fluid. After 5 h of incubation, imipenem was the most effective drug. None of the combinations had synergistic activity. Killing by beta-lactam antibiotics or vancomycin was enhanced by the addition of gentamicin, reduced by the addition of rifampin, and unaffected by the addition of fosfomycin.

Anti-Bacterial Agents↗

Microbial epoxidation of cis-propenylphosphonic to (-)-cis-1,2-epoxypropylphosphonic acid.

Eighteen species of Penicillium, one of Oidium and one of Paecilomyces were found to effect a stereospecific conversion of cis-propenylphosphonate to fosfomycin which was identified by paper chromatography and gas-liquid chromatography (GLC) of the trimethylsilyl esters. Penicillium spinulosum carried out the epoxidation only after the glucose substrate had been utilized. Glucose controlled the epoxidation since its residual concentrations in the broth severely depresses the reaction. At optimum levels of glucose, an epoxidation efficiency approaching 90% of olefin charged (0.2 g/liter) was obtained after 10 days of incubation. The olefin concentration could be increased to 0.5 g/liter when glucose was replaced by glycerol, whereby a 90% conversion to fosfomycin was attainable in 6 days. The high conversion efficiency, a good agreement between the GLC assay and bioactivity, are indicative of the levorotatory nature of the product.

Alkenes↗

A second transport system for sn-glycerol-3-phosphate in Escherichia coli.

Strains containing phage Mucts inserted into glpT were isolated as fosfomycin-resistant clones. These mutants did not transport sn-glycerol-3-phosphate, and they lacked GLPT, a protein previously shown to be a product of the glpT operon. By plating these mutants on sn-glycerol-3-phosphate at 43 degrees C, we isolated revertants that regained the capacity to grow on G3P. Most of these revertants did not map in glpT and did not regain GLPT. These revertants exhibited a highly efficient uptake system for sn-glycerol-3-phosphate within an apparent Km of 5 micron. In addition, three new proteins (GP 1, 2, and 3) appeared in the periplasm of these revertants. None of these proteins were antigentically related to GLPT. However, like GLPT, GP1 exhibits abnormal behavior on sodium dodecyl sulfate-polyacrylamide gels. GP 2 is an efficient binding protein. The new uptake system showed different characteristics than the system that is coded for by the glpT operon. It was inhibited neither by phosphate nor fosfomycin. So far, none of the systems that transport organic acids in Escherichia coli could be implicated in the new sn-glycerol-3-phosphate uptake activity. The mutation ugp+, which was responsible for the appearance of the new transport system and the appearance of GP 1, 2, and 3 in the periplasm was cotransducible with araD by phage P1 transduction and was recessive in merodiploids.

Bacterial Proteins↗

Phenotypic characteristics of 31 strains of Corynebacterium striatum isolated from clinical samples.

During a 34-month period (January 1991 to October 1993), 31 Corynebacterium striatum stains recovered from clinical samples from 24 patients were characterized. Twenty (64%) strains were isolated from wound exudates, 5 (16%) were isolated from bronchial aspirates, 2 (7%) were isolated from urine, 2 (7%) were isolated from endotracheal tubes, 1 (3%) was isolated from a catheter, and 1 (3%) was isolated from empyema. The organisms were identified by conventional culture and phenotypic characterization, the API CORYNE system, and cellular fatty acid composition analyses. The colonies of C. striatum could be confused with those of coagulase-negative staphylococci upon primary isolation from clinical material. A consistent phenotypic pattern was observed: all strains reduced nitrate, hydrolyzed tyrosine, and produced acid from glucose, fructose, and sucrose but not from maltose. API CORYNE profile numbers were 3100105 (28 strains) and 3000105 (3 strains). Susceptibility testing of C. striatum was performed by disk diffusion. All strains were susceptible to both imipenem and vancomycin and resistant to fosfomycin; most strains were susceptible to ampicillin and cephalosporins and resistant to clindamycin, erythromycin, and tetracycline. Performing a Gram stain of fosfomycin-resistant "Staphylococcus-like" colonies was critical in order to identify C. striatum.

Anti-Bacterial Agents↗

[Etiology and antimicrobial susceptibility among uropathogens causing community-acquired lower urinary tract infections: a nationwide surveillance study].

INTRODUCTION: Knowledge of antimicrobial susceptibility patterns is required to prescribe empirical therapy and formulate guidelines for the treatment of community-acquired urinary tract infections. This multicenter study assesses the etiology and antimicrobial susceptibility of the main community-acquired uropathogens in Spain. METHODS: Between March and July 2002, a prospective, multicenter study was conducted in 15 microbiology laboratories located in nine autonomous regions. Each laboratory used its standard methods for sample processing and culture, bacterial identification and susceptibility testing. RESULTS: A total of 2724 isolates were recovered from outpatients with lower urinary tract infections. The most frequent pathogen found was Escherichia coli (73%), followed by Proteus spp. (7.4%), Klebsiella spp. (6.6%) and Enterococcus spp. (4.8%). The susceptibility rates of E. coli were 97.9% for fosfomycin, 95.8% for cefixime, 94.3% for nitrofurantoin, 90.8% for amoxicillin-clavulanic acid and 77.2% for ciprofloxacin. E. coli resistance to fluoroquinolones was significantly higher in men (28.9% vs. 19% in women; P < 0.001), elderly patients (33.7% in 80 years or older vs. 7.1% in 40 years or younger; P < 0.001), complicated infections (24.8% vs. 13.7% in non-complicated; P < 0.001) and some regions (> 32% in Andalusia, Aragon and Castilla-Leon vs. 9.2% in Galicia). CONCLUSIONS: E. coli was the main uropathogen in outpatients. Almost all E. coli isolates were susceptible to fosfomycin, cefixime and nitrofurantoin. Overall fluoroquinolone resistance was near 23%, but this rate varied significantly according to sex, age, type of urinary infection, and geographic region. This information should be considered when empirical therapy is recommended or prescribed in Spain.

Adolescent↗